Tag Archive | reconstruction

Stitches Are Out!

Yesterday, I was back at Dr. Kang’s office to get my stitches out. He started by taking out every other stitch, and then said he’d take out the remaining stitches if everything looked good. Considering it’s healed completely, all the stitches came out. It was not the most pleasant of operations. Not as bad as getting a drain pulled out of you, but I could feel the stitches as he pulled them far enough away from my body that he could snip it off. I will admit to not watching. I can watch this kind of stuff in other people, but if I watch certain procedures on myself, I get a little woozy.

I asked Dr. Kang what was next. He said I have three possible options. Option #1 – I do nothing, and just leave the site as is. I would feel like I wasted all that effort with the expander, but it’s really nice not having an expander in place right now, and I’m not in a hurry to change things. If I decide I want to do something, I’ll have to wait four to six months and then, Option #2 – he’s able to put an implant in place. It’ll probably be smaller than originally planned for, but it would be something. If the skin isn’t stretchy enough, I may have to go with Option #3 if I want reconstruction – the placement of a new expander.

I already know that Option #3 is out. There’s no way I’m doing another expander. The question just becomes, do I want the implant, or do I say screw it and stick with what I have now. I’m not going to make that decision now. In fact, I can wait years if I want to and then finish reconstruction. I’ll wait until the pain and annoyance of the expander has faded significantly, and see what it’s like living lopsided before I make that decision.

I do have pictures. Not everyone will want to see them, so I’ll bury them under a bunch of whitespace. Scroll down if you’re interested in before and after the stitches come out. Close it out here if you’re not interested. You’ve been warned!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

With the stitches still in. There's a lot of dry skin around the whole area, and you can see my drain incision site.

With the stitches still in. There’s a lot of dry skin around the whole area, and you can see my drain incision site.

Stitches out. You can see how the whole thing looks kind of like a crater, and the skin doesn't slide along the incision site.

Stitches out. You can see how the whole thing looks kind of like a crater, and the skin doesn’t slide along the incision site.

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Plastic Surgeon Update

I have been enjoying my first week after radiation. My skin is almost completely healed – there’s a bit of a tan line around the main treatment area, and I’m peeling on the expander. I can still see evidence of all the hives, but at least they’re not itchy anymore.

Even though I didn’t have radiation, I did have a doctor’s appointment. I met with Dr. Kang (the plastic surgeon) this afternoon for an update after radiation. I just wanted to touch base with him and see what the time frame was for replacing the expander with something squishy. We’re talking six months down the road to schedule the surgery. The big delay is to let the skin heal and the tissue relax a bit (everything has tightened and the expander has ridden up a little in the chest wall). I was a bit surprised at the time frame. I had remembered something more like six weeks rather than six months, but I might just have thinking optimistically.

Take home message is I need to make that appointment with the Pennsylvania Artificial Limb & Brace Company (isn’t that just a mouthful – we’ve decided just to call it PALB for short) for a breast form to even up the breasts. I can get away with the unevenness pretty easily during the winter, but it will become much more obvious over the summer. I’ll put it on my list of things to do for Monday, I guess!

The next step

Last Thursday, I met with the oncologist and the radiologist. Dr. Li’s visit was really just a check-up. I had gotten blood drawn the day before so he could check my levels. Everything was back to normal – no anemia, liver enzymes were back within expected ranges, and even my iron levels were good. We did talk briefly about whether or not I would benefit from taking hormone therapy (something like Tamoxifin). The tissue from my lymph nodes was weakly positive for progesterone, which means I’ll get a minor benefit from the drug. We decided to try it (after radiation is done) and see how well I tolerate the drug. If the side effects are too bothersome, I can stop taking the drug.

The big meeting was with Dr. Figura so we could discuss what radiation would entail. Once again, the particulars of my case are causing difficulties. The normal sequence of treatment for breast cancer is surgery, chemo, radiation, and during chemo you do all the reconstruction. Having already done chemo, I don’t have that window of time to fill the expander and apparently, skin doesn’t stretch as well after radiation. Once I start radiation, I can’t make any changes to the size of the expander either since it changes the geometry of the area being irradiated.

I didn’t realize it would be such a problem. I know Dr. Engel had mentioned that reconstruction would be difficult after radiation, but I will admit I kind of ignored him. Dr. Figura and Dr. Kang talked about the case and were able to come up with a viable plan that wouldn’t push back the start of radiation too much. For once I’m happy I’ve got a small chest size since that means I won’t need too many fill sessions. In fact, with the first fill the very next day, I’ll be done in two weeks with two more 100cc fills. I’ll be carrying a giant boulder around on my chest while undergoing radiation, but at least we can get it done beforehand.

And to close, another gown pattern to add to my collection:

A particularly hideous gown pattern

A particularly hideous gown pattern

My surgery decision

You may have noticed in the last post that I decided on reconstruction. The meeting with the plastic surgeon was very helpful in making my decision, mainly because it pointed out that the procedure to do reconstruction is fairly simple. I really wanted the option that impacted my life the least. Having to deal with a prosthetic would get annoying very quickly. I barely put in earrings on a daily basis, so I could easily see myself not wanting to tuck in a prosthetic every day for the rest of my life.

In fact, the phrase “for the rest of my life” turned out to be pivotal. When I put it into perspective – a couple of weeks annoyance for ease over the rest of my life – reconstruction seemed a much more desirable decision. Yes, I know I could not do reconstruction now and still have that option available for the future. However, if I’m going to do reconstruction, I’d rather do it at the same time as the mastectomy.

It came down to being an aesthetic choice. I don’t need my breasts for functionality any more (they served that function quite well when my kids were little). I thought about not being able to wear my cute sundresses any more, and that was enough to tip me into wanting the reconstruction. Besides, several members of Linked by Pink said the inflation (the part I’m dreading the most) really wasn’t bad. Making the decision did lift a load off my shoulders. I don’t like the feeling of indecision I was having.

So, surgery with Dr. Engel is scheduled for the 17th. I have a meeting with Dr. Kang the day before so he can do his markings, but this is a doctor free week. Good – I have Christmas to get ready for.

Let’s add a new doctor to the mix

Yesterday, I had a consultation with a breast surgeon, specifically Dr. Kang. Now that I know I’m getting a mastectomy in a few weeks, I need to make a decision on reconstruction. I met with Dr. Kang mainly to get information on the procedure to help me decide on the best choice.

Dr. Kang laid out a whole series of decisions for me. First off, I need to decide on whether I want to do reconstruction or not. If I do decide to do reconstruction, I then have another set of questions to answer – do I have the reconstruction at the same time as the mastectomy or do I wait until later? Do I use my own tissue or an expander for the reconstructed breast? Do I reconstruct just the right breast (which needs to happen due to cancer) or both?

Dr. Kang couldn’t help me too much on the ultimate decision to reconstruct or not, but he did provide me with lots of information on the process and the other decisions. He recommends reconstruction at the same time as the mastectomy. There are multiple advantages of doing the reconstruction immediately. For one thing, there’s just the single surgery so just one anesthesia and one recovery. It does make the surgery longer, but doesn’t add much in terms of risk. There’s a psychological benefit – you go to sleep with breasts, and wake up and still have something on both sides (not something I’m worried about, but can be important for some people). Lastly, the surgeon can take advantage of the natural landmarks (they look for the inframammary fold) during the reconstruction to create a more natural breast, and the skin is more pliable during the expansion process.

There are two choices for reconstruction – the surgeon can use your own tissue, or an expander. If you use your own tissue, they typically pull fat tissue from your stomach and use skin from your back. It does make for a longer operation, provides another spot to heal, and could result in a hernia or abdominal weakness. If they use an expander, you have to go in for weekly visits to add saline to the expander and stretch the skin over the expander until you’re happy with the new cup size.

Finally, the question of one or two implants. If you only get an implant on one side, it tends to look a bit off over time. For symmetry purposes, it’s best to replace both breasts.

So, now that I have all that information, I have to decide what I want to do.