This Princess Has A Pea
Posts tagged Alloderm
New Year, New Sisters
Jan 1st
Just the Facts: I had revision to breast reconstruction surgery 5 days ago. I handled the surgery and anesthesia well and returned home the next day, after 24 hours on antibiotics. The doctor actually did more revision work than he had planned, spending almost 5 hours instead of 3 in surgery. I went home with 2 surgical drains, but they were removed after a couple of days.
Details: On Monday, December 27, I underwent more plastic surgery to correct problems with my prior breast reconstruction. Alloderm was to be used over both of my breast implants. I was to receive new implants, and the left side was to be reconstructed, pulling it toward the middle. All of that was accomplished. In addition, the doctor revised the “pocket” that held the right breast as well. He discovered that this was necessary when he assessed the situation at the beginning of surgery, and discovered that the right side was beginning to shift just like the left had. This lead to an addition 1-2 hours of surgery to correct that problem, but I am very thankful that the work was done then. It potentially saved me from another revision surgery in the future.
I stayed in the hospital until the next morning when my course of antibiotics was complete. I had 2 surgical drains, one on each side, but the drain tubes were much smaller and easier to manage than those I had after the mastectomy. They still had to be tended, and pulling, twisting and catching them wrong had to be carefully avoided. I was only able to do sponge baths while I had the drains, but thankfully I was able to have the drains removed on Thursday and I’ve had no fluid build-up or other problems since then.
The pain has been a bit worse this time. That’s probably because so much work was done on both sides. The right side is especially tender. The pain meds help but I don’t like feeling groggy from them, so I’ve stopped taking them except at night. Of course, I’m still groggy from the general anesthesia anyway. But going off the narcotic pain killers is the first step toward feeling more normal, and that’s a good thing!
As usual, the “breasts” are covered with bandages. I can only tell so much about how they are going to look. But what I see looks SO MUCH BETTER than before!! I am thrilled, relieved, and also concerned that I will somehow “mess it up” again. Every time I use my arms to reach or pick something up, I think about taking it easy and worry that the glass of water, piece of laundry, etc that I just picked up will stretch or pull me too much. It’s nerve-wracking. I’m really looking forward to my appointment next week with my plastic surgeon so I can review what is safe to do. I DESPERATELY DON’T WANT TO MESS THIS UP! It looks good. I like these “Sisters”. I want to keep them!
This time around we have a recliner for me to sleep in. It has made a huge difference in how comfortable I am at night. After this type of chest surgery, lying flat is really uncomfortable. Being able to be in a semi-reclined position makes all the difference. I am so thankful for my recliner, but at the same time, I’m really looking forward to getting back to my real bed. Based on my past experience, it will probably take several weeks before I can tolerate lying flat.
Me: Nervous that I will damage the delicate work that has been done, but very hopeful. Thankful for a great doctor, good insurance, and a wonderful husband who has selflessly taken care of me every step of the way.
What’s Coming Up: Bandages come off on Thursday, when I see my plastic surgeon for a post-op appointment.
Prayer Requests: Please pray that this time I would heal properly, that the “Sisters” would stay in their current positions! Pray that my pain would continue to diminish and so would the grogginess. Pray that the blues would stay away.
Thank you: to Frances for taking care of my children while I was in the hospital and to Paige, who always finds the perfect way to help. Thank you, everyone, for reading, tweeting, commenting and encouraging me in so many ways. It has meant so much!!
All I want for Christmas
Dec 18th
Just the Facts: Surgery to revise my breast reconstruction happens on Monday, December 27. I will be in the hospital overnight for antibiotics. I have had my pre-op appointment with my plastic surgeon and the hospital pre-op appointment, to speak with an anesthesiologist. Everything is ready to go. The surgery will fix cosmetic problems, so by nature, it is much less serious than what I have gone through in the past. However, I have been very unhappy with the outcome of the reconstruction, and am excited that the problems will soon be corrected.
Details: All I want for Christmas is not my two front teeth, but two reconstructed breasts that face the front! Back in late August, my plastic surgeon (who I still believe is top-notch) performed the second phase of my breast reconstruction: exchange surgery. The hard and uncomfortable tissue expanders were traded for soft silicone-filled breast implants. He also did some repair work at that time, since my left side was troublesome-looking and had been ever since the mastectomy. The doctor re-sected and restitched the left “breast” to make it move more towards the right, creating a little cleavage. However, over the next few weeks, those internal sutures gave way, and the left implant began shifting back to what seems to be its desired destination: my left armpit. It is not evident with clothes on, but the reality is that the left side is messed up. One messed up side is one too many.
My doctor has other techniques to use to remedy the situation. This time, he will add Alloderm to give the left side more structure, and will move the “pocket” for the implant permanently towards the right by re-secting and suturing extensively in several different places. Alloderm will also be used over both “breasts” to correct fairly severe rippling, which often happens when someone “thin” gets implants. (If you are thin, your skin is thin and cannot camouflage the implant under it very well.) Excess skin will be removed from both sides, which should also help with rippling. Both of my scars will have to be re-opened for this surgery. I will receive two new implants, and I will need IV antibiotics for 24 hours. I’ll be in the hospital overnight and will have a surgical drain on each side. The drains will need to stay in place until there is minimal output, likely several days.
When I look, I see “DEFORMED” right now, and am so glad to be doing something about this. No one else (other than Tracy and the doctor) have seen the problem because it can be covered up in clothing. But in bathing suit season, it would be no secret. If there is a way to fix this, I want it done, and ASAP. Thankfully, we have excellent insurance which is paying for this re-reconstruction. Were it not for that, I would probably live with having a breast under my arm. I am truly grateful that I don’t have to do that.
Me: Looking forward to getting this over with! Excited about what the doctor described as my potential outcome. I will forever be changed from breast cancer and my mastectomy surgery, but hopefully I will not always be uncomfortable with the way I look. I am grateful too. This is cosmetic stuff, after all.
Prayer requests: That nothing, including a pretty severe cold (or is it the flu) that I have right now, will stand in the way of a smooth, uneventful surgery. Despite my earnest desire to have this surgery, anxiety over the process in general has crept in before my other surgeries in the past. Please pray for peace for me. Pray that my children and husband would stay healthy and that they would also be free of stress from this.
Exchange Ahead: Details
Aug 15th
Just the Facts: In sixteen days I will have outpatient surgery to complete this phase (the major part) of my breast reconstruction plastic surgery. This is a follow-up to the immediate reconstruction which began on April 6, after my complete double mastectomies. The upcoming surgery is known as “exchange surgery” in which the doctor removes the hard, saline-filled tissue expanders and replaces them with breast implants. The implants will be much more natural feeling. After a few weeks’ recovery, I should look and feel much better, and at that point most of the reconstruction will be complete.
Details: Breast reconstruction began for me right after the mastectomies. Literally, my surgeon finished his work, and then my plastic surgeon began the reconstructive surgery. That’s one reason I was in surgery nearly 6 hours back on April 6.
At that time, my plastic surgeon placed rigid plastic tissue expanders on my chest wall. They resemble dome-shaped baggies, and each one has a metal port. At the time of that surgery, he was able to add some saline to the expanders. I believe that was 100ccs in each side. It gave the effect of still having (small) breasts, which was wonderful, mentally! It was truly a blessing to never have to experience flatchestedness. More saline injections were needed to make me look like a grown woman, though. 
After a few weeks, my plastic surgeon began the process of inflating the expanders with additional saline injections through metal ports. This was a very cool thing to observe. Remember, a sense of humor is absolutely REQUIRED here! Each week I returned to his office to be injected with anywhere from 30-50ccs of saline in each expander. This gradually stretched my skin, forming a somewhat normal looking bustline for me. Although we didn’t have much choice, Tracy and I were able to offer some input on how much saline was ultimately added, thereby choosing my final “size”. There was only so much room for discussion, since I literally have thin skin, according to the doctor. (Thin skin comes with lower body fat.) I could only go “so big” since bigger would have stretched my skin too thin, making the edges of the implants visible once the final surgery was done. Given that my build is fairly athletic these days (and I expect to keep it that way), I am content with the size we have achieved. It is acceptable, although I won’t stop traffic or anything.
I have had a love/hate relationship with the tissue expanders. I’m so glad just to have a feminine shape! But since the time I woke up from the initial surgery, they have been uncomfortable. They make it difficult to sleep, to move normally, and to give hugs. At one point, the pressure on my ribs from the expanders was so great I was in heavy pain and felt nauseous. On the other hand, the expanders have been a constant source of humor for our family. Everyone knows to (physically) avoid them in order to avoid injury to themselves! We have also laughed at the way they have morphed through this process. Seeing them grow was funny on its own, not to mention the tricks I can perform with the metal (magnetic) port just under the skin on each “breast”. But over time (due to my rigorous exercise, according to my doctor) the ports have shifted, which has made the overall breast shape distorted. Also, I have noted that for whatever reason, the expanders just look different every day. Maybe it has something to do with the barometric pressure or something! But each day I wake up and take a look to see what in the world I’m working with that day. It has been over three months since my last saline injection, and I’m finally finished with this waiting period, which was designed to ensure that my skin had adequately stretched, making a nice “pocket” for the future implants. As interesting as this has been, I will not miss the expanders at all when they are gone!
Some decisions about exactly which implants I will receive still remain, and will be made by the plastic surgeon during the surgery. My general size has been already determined, based on the total amount of saline that was injected. The doctor explained that there would probably be two options at surgery. He would order a set of implants in two different types: the High Profile and the Moderate Plus profile. The difference has to do with diameter and projection. Each type has more of one or the other. Personally, I’d like to maximize both. When my children were in preschool they learned a helpful adage, which perfectly applies in this scenario: “you get what you get and you don’t mind a bit”. I will be content with whichever I get, but If I could choose, I think I’d prefer a larger diameter. This would create a more normal looking cleavage (hopefully). After dealing with two mounds separated by a mile for the last 5+ months, I am really hoping to once again have breasts that exist in the same zip code.
The final decision making will be done by my plastic surgeon and his team in surgery that day. Apparently, they will try both types out, sit me up, take a look and vote. I can’t tell you how weird that makes me feel. But they do this all the time. I trust that the nurses, the doctor and the representative of the manufacturer of the implants want me to look as good as possible, and will choose the most natural looking implants. Nevertheless, I still cringe at the thought of the whole “trying on” affair while under general anesthesia!
The surgery itself will closely resemble the original breast surgery. I currently have two large horizontal scars from armpit to mid chest on each side. The plastic surgeon will open these again, so at least there will be no new scars. I had hoped that the incisions would be smaller this time, as the bigger the incision, the bigger potential for discomfort afterwards. (But you get what you get . . .) After the doctor experiments and chooses my new implants, he will then complete some additional reconstruction, focused primarily on my left side. For whatever reason, the initial work on that side did not turn out as well as hoped. This time, we are looking for more symmetry and balance. This is going to require additional use of Alloderm, a special type of grafting tissue. The Alloderm was used extensively in the initial surgery to form the bottom “sling” part of the future breast area. This time, it will be used to rebuild part of my chest wall and reposition my left “breast”. Unfortunately, use of the delicate Alloderm requires a drain or drains in the days or weeks that follow surgery, so that fluid doesn’t build up and ruin the special tissue. So, I can look forward to going home with a drain after this surgery, but one drain beats four (what I had last time). Hopefully I’ll be able to have the drain removed soon after. I will once again have numerous internal and external stitches, basically mimicking what I had from the prior surgery. I’ll probably just have a small bandage covering the whole thing.
My recovery should be easier than after the mastectomy, but very similar. The doctor said to expect to feel beat up again. I guess that means sleeping in my bed will not be happening for a while. Tracy and I are going shopping for a recliner for me this week, which should make sleeping and resting a bit more comfortable. I won’t be able to perform my normal exercise routine for at least a month. After a week or two, or around the time the drain is removed, I should be able to gradually build back starting with light weights.
What will be different is that this time I’m also dealing with a body under the effects of Tamoxifen. I love its ability to starve cancer cells of their needed estrogen, but Tamoxifen is making me feel like an old woman in many ways. I’m tired. I’m grumpy a lot. I like to sleep more than most anything else and I want my way. (Wait, maybe that’s nothing new? 
) Bottom line, I’m not really sure what to expect. I think it will be much like last time, but who knows. At least we are in the home stretch of the whole ordeal this time. That’s a huge mental boost!
What’s coming up: A hospital pre-op visit with an anesthesiologist on August 18, an appointment with my oncologist on August 25, then surgery on August 31. School starts August 25, so I’ll have 5 days for some last minute prep and mini-nesting.
Prayer Requests: I am truly thankful for this plastic surgery. As much as I complain about the intricate details, I appreciate the fact that all this can happen. Please thank God for the gift of breast reconstruction. Please also ask Him for wisdom and skill for the doctor and the hospital personnel who will help me. Also please pray for no complications from surgery, and for quick healing and drain removal!