A tale of two surgeries

Considering I've discussed my surgeries, deciding to have surgery, and complications from my surgeries at length, I thought I'd talk a little bit about them. I don't like to dwell on them and want to move forward, but it goes a long way to explain how far I've come. This is a long one folks, buckle in.

The first surgery was a prophlactic double mastectomy, which I had on February 16 at Northwestern in Chicago. Mom and Tim were there, and the entire thing was scheduled to last about 4-6 hours. (See I already forgot, it's been so long!) The plan was to perform a nipple and skin sparing mastectomy, where my breast surgeon, Dr. Seema Khan, would take away as much breast tissue as possible.  The nipple sparing type of surgery was good in my case, because there is a small amount of tissue that remains in the nipple, which would be a risk for someone with cancer. For someone who has cancer, the nipples are removed and are often reconstructed if the patient opts for it. In my case I kept natural nipples and would require no further reconstruction after the implants. The incision is below each breast, rather than the standard incision across the middle of the breast for women who are not keeping their nipples. Cell samples are also taken from the nipple tissue remaining and the lymphnodes to be tested for signs of cancer. There were no reasons to believe they would find anything, but it is essential to know. My pathology report came back a-okay, so as far as I know, I have nothing to be concerned about. Then, Dr. Kim, the plastic surgeon, would go in and place tissue expanders under my pectoral muscles, which we would slowly fill to stretch the muscles. These are what the tissue expanders look like:

Tissue expanders with metal port

Tissue expanders and breast implant cross section. 

When I woke up, I was deflated (physically, and a little mentally). I kept saying I felt like there was a giant sitting on my chest. I wasn't really prepared for this aspect, no one told me I wouldn't be able to breathe normally. In fact, I couldn't breathe completely normally until after my second surgery. There was a lot of pain (bless that morphine drop button), but it was kept under control. I spent one night in the hospital and what they say is true, you can't catch up on your sleep at the hospital. One side was very bruised, and my breast surgeon explained that many blood vessels serve the nipple and it is impossible to tell which is the dominant one. In some large breasted women, the blood supply is not easily determined, so one of them could have been affected. For awhile it looked like a real possibility that I was going to lose a nipple, which would have been pretty crappy. Instead, the nipple scabbed over, fell off, and it looks like a real live nipple underneath!

I also had four drains. Lemme tell you a little something about drains. I hate them. They are the worst. They hang off your body and are impossible to hide and constantly remind you that you just had surgery. Tim and I called them "juice boxes," much to the horror of one of the nurses (it's pretty gross, really). I hung all my drains off of a lanyard and would repeatedly say "Flava-Flav!" Worst bling ever. 

This woman looks too happy to have drains. 

The drain is a long tube with little holes to collect fluid. Like in the picture above, the tube is wrapped around and across the length of your breast. The purpose of the drain is to drain excess fluid, so it cuts down on the swelling. You have to empty the fluid 2-3 times a day, and you're looking for the amount of fluid to go below a certain threshold (something like 30cc per drain). And the drain tube comes out of your body through a hole they create. Let me say that again: they cut a hole in your side/armpit for the drain tube to come out of. The feeling of the drains was so awkward and you have to be extremely careful that they don't get caught on something or that they don't become infected. The mastectomy bra/tank I got at the hospital had little pockets that I could put them in and velcro to the tank, but it's impossible to hide the bulges in real clothes. Not a good time, all around. Oh yeah, and when they finally do take the drains out, they just yank them out from the hole, it's the strangest feeling. It's pretty gross. 

Recovering from the first surgery took many weeks. I have been mostly very healthy my whole life, so I was not used to being limited or incapacitated like this. Mom was here for about 2 weeks, doing everything from cleaning, cooking, washing my hair, and helping me get dressed. I couldn't raise my hands up over my head for a long time. Slowly but surely I was able to do new things. My aunts and cousin came the first weekend and we would go for walks, a little further every day. For a runner, not even being able to walk a mile without getting winded was defeating, but I did get better every day. I am so very grateful for everyone who sent me flowers, well wishes, or came to visit during that time. It meant so much that people were thinking of me! I didn't actually take too much time off of work, and I felt comfortable working from home pretty quickly. I was off the radar for about a week, working from home after that, and back to work after another 1.5 weeks. Sleeping was another story. I was totally uncomfortable, as I'm used to sleeping on my side, and had to stack up lots of pillows and find a good spot. I would wake up with awful back pain, which would thankfully go away once I started moving. I also couldn't wear my own clothes and everything had to be stepped into or buttoned. I wore a lot of Tim's shirts. Putting on "real clothes" was a big deal for me. In fact, every new thing I could do (dress myself, comb my hair, shave my armpits) was a victory. 

Aside from the physical recovery, I also was getting fill ups in my tissue expanders. Each week I would visit the nurses, who use a magnet to find the metal port in the tissue expander (the silver part in the picture above), and using a cartoony like syringe I would get filled with 60 cc or so of saline. The expanders don't look or feel anything like real breasts, and they are really there to just push the muscle and skin to make room for the implants. And push they did. At first I would just have a bit of soreness for a day or so, but the last few expander fills were awful and I was in pain, having trouble sleeping almost all the time. They are hard as a rock and they don't open out the skin quite evenly. They happened to be placed a little high, and as a result a little fold was created under my right breast. I think this may be the cause of the "thin skin" I learned about this week, but who knows.

The second surgery (the implant exchange) was kind of a whirlwind. I went to see Dr. Kim when we thought my expansions were done, and he told me he had a surgery cancellation for the NEXT week. I was going out of town for the weekend and there really wasn't much time to prepare. But I sure as heck wanted those tissue expanders out, so I took the appointment. He warned me that drains were again a possibility, but that recovery from this surgery would be much easier. In fact most women say they feel better when they wake up from this surgery. So on April 18th, I had my implant exchange. When he was marking me for surgery, he started marking my belly, and told me he planned to do some microfat grafting, which is basically a little bit of liposuction, and injecting the fat back into your breasts to smooth out any contours. Not a problem, doc, take it all!

Big smiles, ready for my implant exchange!

Unfortunately, I woke up with 2 more drains (hate those things). I was disappointed, but the surgeon spent a long time fixing some "gnarly" scar tissue, so in the long run it's worth it. He also didn't get to do any of the fat grafting, but from what I understand this is really  for aesthetic purposes, so we can address it down the road. I actually felt so much better when I woke up. The implants are much softer, so it relieved a lot of the pressure I was feeling in my chest, back, and arms. And of course they're breast shaped, so they actually look like breasts, not the frankenboobs I had before with the tissue expanders. Recovery from this surgery was not bad at all, just the damn drains! I did manage to strategically hide them to an acceptable level for Tim's fancy birthday dinner two days later, but thankfully he loves me anyways, even if I have drains. They came out after a week, and I was back to work as soon as they were gone.  

Home with my new boobs and Penny on my lap. All is right with the world. 

You can see why something like "thin skin" is so frustrating for me. In my mind, I'm done. I had my surgery, reconstruction, my incisions look good, and I feel great. I just want to move on. I realize that I am lucky; most women who have a mastectomy are sick. They have to go through radiation, chemo, losing their hair, possibly nipple reconstruction, and are facing a life threatening illness. Their road to recovery is long and they may never be back to "normal". But I am selfish and impatient and want to be back to normal as soon as possible! I've also talked with Tim about this a lot, but I think it's part of my personality to be a "finisher." I like to finish things, whether it's a bottle of ketchup in the fridge, a book, a knitting project -- I just like to be done. I want the mastectomy and reconstruction part of my life behind me, I don't want it lingering like a stale fart. I made the decision, went through the surgeries, recovered (for the most part), and I feel like the hard part should be over. I signed up for the marathon, so I want to DO it -- hopefully that finisher mentality can take me all the way to the end!