11.01.09
Surgery #2
As my regular readers know I developed necrosis two weeks after the October 2nd breast augmentation and lift surgery in 2007. After several weeks of Hell I was scheduled for a second surgery on November 2. This surgery was for the purposes of removing the implants and the remaining necrotic tissue. We showed up in the afternoon at the surgical center – which we had to pay the fee for – I was prepped and before I knew it, part two of my nightmare had begun.
When I was able I looked at what had been done. It seemed, in retrospect, Frankenstinian. The line of vertical sutures looked like someone had whip stitched the skin together. I also found out that, on the left side, there had been a half inch spot left open.
I also found out that over 300 ccs of serous fluid had built up in each pocket. The implants were both intact. That explained the pressure and the bubble under my flesh. Fortunately this time the HiQ put in what passed for really crappy drains. He had inserted open-ended surgical tubing. The outer ends were covered in gauze to absorb the leaking serous fluid that my body produced. Compared to the closed-system drains I had after my reconstruction, these things were positively primitive.
I was also an A cup now down from a DD cup and before that a C cup. This wasn’t nesecarilly a bad thing. I finally had the ski slope breast shape I had been after from the beginning. By ski slope I mean the breasts that are heavy and rounded on the bottom and on the top the breast gently slopes down to be capped by a pert, rosy nipple.
I was just missing the nipple.
The HiQ assured me that after i had healed, we could do reconstruction. At this point I was already starting to have my doubts. But I’ll talk more about that later.
For those of you joining me from NaNoBloMo and reading my blog for the first time, please go read the first post for more information about what BoobCast is all about.
07.29.09
Under-Do??
I found this old draft and thought I would revisit some of the more pertinent issues I dealt with during my process. This post was originally started on 4/27/09, 11 days after my latissimus flap breast reconstruction surgery.
It seems as though practically over night, the color of the drainage has gone from Ruby Grapefruit to Apple Juice. I’m taking that as an encouraging sign. Although when I wake up, my back still feels like there are rocks under my skin.
Moving definitely helps. Though I’m not sure how much is too much. I don’t want to over do and hurt myself that way. But it seems that under-doing is just as bad and has the potential for lengthening my recovery. So I’m doing something I hate to do. I’ve told Ken that when he sees fit, if I’m not in pain, he’s to take me for a walk.
Poor Ken has to do so much. Not only is he taking care of me but he’s also keeping up with the household needs and the business. I’ve been so out of it, I’ve actually had to ask him on numerous occasions WHEN I need to take my meds.
The pain meds are really helpful but they’re draining me of the ability to think. It takes me about 30 minutes to write one of these daily entries. Granted, I am a lightweight when it comes to intoxication of any sort. But it’s still frustrating. I feel disjointed and I have no memory.
Eleven days after surgery I’m guessing that’s to be expected. It’s just really frustrating not being able to remember things that are really important. Like how long ago I took meds that could REALLY mess me up if I forget and take a double dosage. If I wait TOO long though, then there’s real trouble with the pain. Once the meds start wearing off, my options are 1) Take more or 2) Sit very, very still until I CAN take more.
The bad part is that if I wait, the it takes longer for the meds to kick in and they’re not as effective because they have more pain to battle. So I’m walking a very fine line here. And this is a line that my dear Hubby is in charge of because my brain is about as useful as cottage cheese.
07.09.09
M M M My Seroma
I posted about my check up yesterday. This morning the troubled spot will be left to heal. No more wet to dry dressings. YAY! It’s closing up nicely finally so that’s not an issue any more.
Now since I can’t seem to do anything half-ass-ed, while Dr. Guy was poking around on my back (and I mean that literally…poke…poke…poke) she discovered that the right side had a pretty massive seroma.
A seroma is a pocket of clear serous fluid that sometimes develops in the body after surgery. When small blood vessels are ruptured, blood plasma can seep out; inflammation caused by dying injured cells also contributes to the fluid.
This isn’t a threatening or serious condition, though it could potentially cause complications down the line. The fluid is that yellowish slightly sticky stuff that bubbles up when you scrape your knee before the scab forms. A good idea of what a seroma looks like is here: http://tinyurl.com/n8ne2
It is evident the bruising is the skin is also distended and there is a large, softball sized lump where the fluid has collected. I was unable to find a photo of a seroma on the back. With a Latissimus Flap breast reconstruction, seromas are VERY common. From what Dr. Guy said, basically the pocket it causes makes the skin separate from the muscle. Until the fluid is drained or reabsorbed back into the body, the skin cannot reattach itself to the muscle. Basically the right side of my back from below the shoulder blade to my waist and in towards my spine was one gigantic seroma.
After giving me a local anesthetic, Dr. Guy excised the fluid by sucking it out with a needle the size of a harpoon. At least that’s what it seemed like. Ken says it was only an inch or two long and pretty small in diameter.
The Doc removed 455ccs of fluid. That is very nearly half a liter of fluid. She showed Ken how to tell if it builds up again. Basically he has to poke my back. If it ripples like a waterbed, there’s a buildup of fluid.
I have another check up in two weeks. I’m really hoping there will be no more fluid build up. As usual I’ll keep you all posted.
06.23.09
9 1/2 Weeks
From the title of the post, it’s pretty obvious what today’s topic is.
Medical updates.
The spot on my back is still troublesome. It’s not really getting any better. I’m still not too worried about it though as no one else at Dr. Elliott’s office is overly concerned. Last night Ken said he thinks I should “be seen” by Dr. Elliott’s contemporary down here, Dr. Roxanne Guy. I have an appointment for Thursday.
Honestly, I am SICK of “being seen”. I am SO over all of this medical crap. I just want to get ON with my life. I think that’s part of the reason I’ve started doing Ta Ta Tuesday. Even though I may not be completely done with all of this, I want to start enjoying the completion of the major stage.
The nurse at Dr. Elliott’s office had suggested that I wait another month to take the tape off the suture line. I got tired of waiting so I went ahead and took the tapes off four days early. Really I could have taken the tapes off at 6 weeks but I tend to be overly cautious as far as suture lines go.
I haven’t taken any acetaminophen for pain in a few days. I’m happy about that. It’s definitely a few steps ahead of where I was. My endurance, however, is another matter all together. I used to be able to be at Disney for anywhere from 12 to 14 hours. Now I can’t walk around for more than a couple hours without getting worn out. It’s possible that the heat could be exacerbating the issue, but I just don’t think so.
Mobility is another issue. I can raise my left arm all the way up next to my head. The skin in my armpit is still a little tight. My right arm is another matter. I can only raise it at a 55 or 60 degree angle without tightness and pain. It HAS improved since surgery. It’s just improving more slowly.
Emotionally I’m doing better, as the idea of TaTa Tuesday shows. I’m still trying to decide if I want to take a chance on nipple reconstruction. Some articles say that in experienced hands the failure rate is less than 2%. On other websites I’ve read women’s stories of how their nipples flattened out between six months to 2 years. There was also a fairly high incident of infection.
I have emailed Dr. Elliott and asked him to suggest someone who makes custom silicone nipples and write a letter of request. Every prosthetics maker I have found that does really good hand painted nipples requires a letter from a physician. Even if I decide to have the surgery later, I will still have the prosthetics in the mean time.
06.16.09
Life Changing Events
Well isn’t THAT a big, screaming “DUH!!”. Of COURSE this whole miasma of misery and recovery changed my life. I feel like my entire life has been on hold for the last three years between my parent’s divorce, the subsequent complications from the initial surgery and recovery from the latissimus flap reconstruction surgery.
In future posts I’m going to go back and go into more vivid detail about the things I went through because of the complications. I want to talk about the V.A.C. machine and what a medical wonder that is. I want to posit my theory about silicone allergies and how an uncaring doctor can make life even more miserable.
Today I’m going to talk about another life changing event. Any of you who follow me on Facebook or Twitter know that I have been working on my Master Herbalist certification for the last three years. I have been seriously thinking about a career change after all of this.
Yes it would be a shame not to finish it. But once I’ve finished, then what am I going to do with it? Opening an herb shop requires HUGE overhead. Buying the herbal inventory and storage media, etc plus there are state regulations to follow out the ying yang. I do not have that kind of cash. I have also seen how most herbal stores flounder. You have to teach classes just to make enough money to stay afloat. That takes up your nights or weekends.
If I did herbal consultations, that would be $60 for 1-1/2 hours. Then what? Send the client to another herbalist to get their herbs? I just can’t see a way to make this work.
Here, I must admit a deep, dark secret. In my personal experience, when it comes right down to it, for more serious issues herbs alone just don’t cut it. I’m watching someone dear to me lose their life because when cancer first developed, they decided to use natural methods to combat it. And it DID work for a little while. They battled back stage four cancer. There were extreme measures involved but they accomplished it. Now this person is in hospice because it came back and became systemic. I can’t help but think that if this person had just knuckled under and done standard treatment right out of the box, what would be happening now?
I am considering apprenticing to someone locally for six months to see if a career in Interior Design is something that really appeals to me. Or if it’s just something I got hooked on because I watched so much HGTV while recovering from surgery.
Why Interior Design? Well, the cool thing is that you get to make things pretty for people and they PAY you to do it. With the right education you also learn architectural stuff. When I was a kid I wanted to be an architect but I have no head for math. So I figure I get the best of both worlds: Some architectural knowledge and getting to play with pretty fabrics, lighting fixtures, which I adore, paint and all kinds of creative building projects.
My initial research tells me that, out of the box working for a larger company, I can make 32K plus bonuses OR I can make over 40K working for myself. Compared to what I’m bringing in right now working with our essential oils company, that’s a WHOLE lot more money.
After my Mom had been through her cancer ordeal, she wanted to change her life completely. She wanted to live on a farm and have animals. So we moved to Wyoming and got a ranch with horses and goats. I’m starting to think that the whole life re-evaluation thing may be part and parcel with surviving major trauma. Yes, I know we hear stories and see movies about this kind of thing. I just didn’t think that I would be oe of those people.
I have tried very hard to stress that I have not gone through what cancer survivors go through. They go through so much more. The more I learn and observe about myself, however, the more I believe my own journey is at least very similar.
06.15.09
It’s More Complicated Than That
Something that isn’t really mentioned much is that eventually many breast implants may need to be replaced. An article released in 2005 by the New York Times reports that up to 93% of silicone implants fail within the first 10 years. http://www.nytimes.com/2005/04/07/politics/07breast.html .Those implants need to be removed and possibly replaced as soon as possible. This is another surgical expense that you will have to cover. Usually these costs must be paid out of pocket. In one study by the New England Journal of Medicine, the complication rate for augmentation was as high as nearly 25% http://content.nejm.org/cgi/content/abstract/336/10/677.
Other things surgeons are unlikely to tell you are that sometimes the skin thins and wrinkles and the silicone shell of the implant become visible. With saline implants, if you push on your breasts, you can hear the implant sloshing around. Ever fondle a breast with a saline implant? It feels like you’re fondling a water bottle. When it comes down to it, saline breast implants are really only good for looks. The other option is silicone implants. Although there is not a conclusive group of studies, it is widely believed that leaked silicone is responsible for, or at the very least, contributes to, autoimmune conditions such as fibromyalgia.
Sex may not be the same either. You have water bottles sloshing around in your chest that feel totally different from your natural breast tissue. Many women also report numbness or reduced feeling in their breasts and especially the nipples after augmentation. Sometimes it’s temporary. Sometimes it isn’t. This is surgery and it can cause permanent nerve damage just as with any other surgery.
Before you sign your paperwork for the surgery, someone in the doctor’s office will go over the list of possible complications. In my case the person stressed repeatedly that these complications were extremely rare. I’m sure that there are women out there who have gone through the procedure with no complications and no issues at all. I would LOVE to talk to one of these women.
The list of possible complications is as follows:
Seroma (pooling of serous fluid)
Hematoma (pooling of clotted blood; risk is 3-4%)
Symmastia
Double Bubble (also known as “double fold”, “snoopy effect”, or “snoopy breast”)
Mondor’s Cord
Bottoming Out
Deflation Photos (approximately 7%)
Capsule Contracture
Traction Rippling & Rippling Photos
Photos of these complications can be found here: http://tinyurl.com/5gz6mc
Other lesser complications include:
Asymmetry
Bleeding
Breast droop
Displacement
Implant leak
Infection (risk is less than 1%; always involves removal of implant)
Interference with mammography
Keloid (heavy scar)
Nerve Damage
Nipple numbness
Pain
Permanent numbness (risk is 15%)
Reactions to medications
Rippling
Rupture of the implant (often due to injury)
Skin irregularities
Sloshing
Slow healing
Swelling
Visible scar
The above are relatively MINOR complications, however. Seroma and hematoma can lead to necrosis because of the pressure on the small blood vessels reducing blood flow to the affected tissues.
Necrosis is the death of tissue. When necrosis occurs, the area must be debrided. This means that the dead tissue has to be clipped out and the remaining, new tissue cleaned. Debridement doesn’t hurt. That tissue is dead which mean there are no living nerve endings. To leave dead tissue is to invite infection. So even though the thought is terrifying (and believe me, it was TOTALLY terrifying when I went through it), it’s better to get it done and over with. Then the body has a clean bed of underlying tissue to grow from.
The complication percentages listed above are reported to be low. Most are under 10 percent according to the statistics I have found. This does NOT mean that surgery of any kind is completely safe. Do not believe that just because your friend had a boob job that went perfectly that you would have the same experience.
Your surgeon and his or her skill level play a big part. So does your body and how it heals. Even though I got a clean bill of health from my pre-surgical physical and blood test, I developed several complications. I had seroma and hematoma that were NOT addressed by my surgeon. I believe those contributed to the development of necrosis. I also talked to a nurse about a year after my complications. From the description of my waist to collarbone bruising, the nurse was completely convinced that something had gone wrong during the surgery that led to the development of the necrosis.
I’d like to stress again that you should be educated about your choice of surgeons. He or she MUST be board certified by a plastic surgery association. ANY doctors can call themselves a plastic surgeon but the ones who are actually educated for that specialty are board certified.
Do NOT try to find a deal. Trust me when I say that cheaper is NOT better. I learned this lesson the hard way. It cost me more than money to learn this.
If something does go wrong, you may not be able to sue. In the state of Florida a plastic surgeon is only required to carry $100000 in malpractice insurance unless they are affiliated with a hospital. By the time your lawyer proves malpractice, most of that $100K will be gone to lawyer’s fees. You will, in all likelihood have little to nothing left for any repair procedures.
Use my story as a cautionary tale. Know your body, know your family medical history, know your surgeon, and know the risks.
06.11.09
iHurt ver. 2.0
The last four days I have been much more active than I have been for the last eight weeks. We had two days of running errands, two days in a row at the salon getting my hair done and then fixed when all FOUR tubes of pink dye were defective, resuming “normal activity” (ahem)…three times and recording another episode of Chipped Plate Chronicles, our food review podcast. Yesterday I spent clothes shopping. By the end of the day yesterday I had to take not one but TWO Darvocet halves. I was spiking a four on the Oh-My-God-It-Really-Fuckin-Hurts Scale. Number One Son noticed that I was breathing raggedly and practically MADE me take the second 1/2.
I can’t just relax today either. I’m having lunch with Number Two Son who needs to talk to me about some things. WHAT things, I have NO idea. This means I must drive to his place, drive to wherever we’re going to eat, probably Panera in Viera, drive BACK to his place and then home. It doesn’t *sound* like much, but when you’re already tired and sore, it is.
More than anything, it’s my back that’s hurting. Since I have to drive I really don’t trust my skills while on Darvocet. This means using the acetaminophen. That wouldn’t be an issue if I wasn’t pretty sure that it’s contributing to my bruising problem. Which puts me back on the new non-aspirin OTC pain med that doesn’t seem to work unless I take two. Which isn’t good because the package clearly stated that I should only take one at a time. Unlike many others, I don’t subscribe to the “if one is good, two is better” mentality.
The safest choice right now seems to be the acetaminophen. I’m just going to take it as slow as I can today and tomorrow I’ll spend the day resting. I don’t seem to have much choice otherwise. Number Two Son is dirt poor and he needs his gas money to get back and forth to work. I’ll just do the best I can. In the mean time, iHurt.
06.07.09
Guilt
I don’t think I’m alone in the way I feel. I’m guessing that anyone who has ever had any sort of disabling health issue has felt guilty at some point. For me, it’s hard NOT to feel like a burden. Ken still has to do most things around the house including extracuiccular things like driving Alex back and forth to his engagements this week and two weeks ago.
I had to wake him up to redress the areas on my back because the tape had peeled up while I was taking off my cami. He has to be up at 6:30 tomorrow morning. I felt awful. I thought he had just gone in to read and here I go getting him up. I TRIED to fix it myself but I just couldn’t manage it. I feel horrible that I’m not more self sufficient.
When I was dealing with wound packing and dressing before the wound vac during the necrosis era, I did everything myself. Of course it was all on my chest so that made it easier from an access perspective. I also refused to let him see any of it until I absolutely had to. And even then I prepared him to cushion the blow.
I know he SAYS it’s no big deal and it’s just maintainence, but I still worry that I am a burden. I don’t really know what I can do to assuage that guilt other than try to do more around the house. I’m afraid if I do more though that I’ll end up having a setback like I have two previous times. I want to please him but I don’t want to hurt myself in the process.
If any of my readers have been through this i would love to hear your suggestions.
05.21.09
Doctor Place
Yesterday was my one month check up with Dr. Elliott. After taking the tape off from over all the suture lines he announced that everything is looking fantastic. Even the spot on my back is just superficial. So I don’t need to see him again until after DragonCon in September!! WOOHOO!!
There is a red area just above the top suture line on my right breast and very mild bruising on the top of the left breast still but after prodding, Dr. Elliott said that he isn’t at all concerned. There is no thickening under the skin, it isn’t hot to the touch and there is no indication of infection. He thinks that it’s just the way my body is. So I’m going to defer to his expertise.
He also told me that I should leave the tape off the suture line for a week and give the areas a good (but GENTLE) scrub down with soap and water each time I shower. Then, next Wednesday, we’re to retape everything. I’m going to have to call next week and find out how long he wants me to leave the tape on this second time.
There was just one little tiny thing though. As the nurse took off the tape on the top, right side near the red spot, my skin actually tore open just a teeny tiny bit. They are just topical openings and very superficial though. It looks like I had been lightly scratched by a cat in two spots about 1/2 an inch long.
I have been unable to find any references to thin or delicate skin after my type of breast reconstruction. Perhaps it is simply my biology. It’s such a little thing though that I don’t really see a reason to worry about it. If it happens again, then I’ll worry about it. Right now I’m not going to borrow trouble.
The right side drain site is still leaking just a tiny bit of serous fluid. It also itches abominably at times which tells me it is healing. Annoying yes but it IS a step forward. It is still a bit tender but nothing like it was when the drain was still in.
We’ll be headed home to Florida tomorrow morning. On the way we’re going to meet up with my Mom. She hasn’t seen me since the surgery. I think she’s going to be absolutely stunned.
Which reminds me, I need to email the “After” Shot to my Dad. He’ll want to see that everything is just fine and he doesn’t need to worry anymore.
