Looking back on 2016

It's December tomorrow...DECEMBER, PEOPLE! What the heck?!
I was answering some questions about my upcoming procedures today and it hit me. This time last year I was trying to mentally prepare for 12 months of reconstruction work. It seemed so daunting at the time. It hasn't been easy, in fact, it's probably been the most physically challenging part of my cancer journey so far. But here I am, just 21 days from the final steps in the year-long process. The key is keep looking forward, don't focus on the challenge of the moment, but on the goal at the end.
I don't bore you with a long narrative...not right now, anyway. So here is 2016 in summary.

• January 11 - surgery 1 - release the lattisimus dorsi muscle to increase blood flow prior to moving it
• February 1 - surgery 2 - move the muscle (with some skin) from back to chest on the left side. tissue expanders implanted on both sides.
• March - September - tissues expansion - saline added to expanders every 2 weeks.
• September 26 - surgery 3 - tissue expanders removed and replaced with implants
• December 21 - surgery 4 - multiple procedures including tattooing, fat grafting and some surgical adjustments
• Also
• DRAINS - have I mentioned how much I loathe those things?
• Scar tissue
• Seroma
• Buckets of fluid
• Physical Therapy
• ASTYM
• Cancer Scare
• Physical challenges
• Low points
• Upswings

All that for some Frankenboobies.

 

I'm often asked if I would go through it all again. HECK YES! All of the procedures have been tough but the end result is worth it. Though more invasive, the process has a better success rate than other options. I would go through all of it again without hesitation!

 

 

Back soon!

Love to all,

Andee

Save the Date

Well friends, it is almost time. It's been a 7 month process, so far, and now there's a light at the end of the tunnel! We expect that today was my last fill. That doesn't even sound real. I go back in 2 weeks for a final status check. If any adjustments are needed, we'll take care of them then (meaning fluid can be added, if necessary) and then we wait 4 weeks and BOOM surgery! It's officially on the books so lookout. September 26 is the big day. This won't be the last procedure of the year but it will be a big milestone. As always, I'll keep you posted on all of the details.
For those that might be new to the blog and have no idea what I'm talking about, I had surgery in January and February to prep for actual reconstruction and then to transfer muscle and implant tissue expanders in February. Since then, I've gone every 2 weeks for some sort of adjustment. Whether it be to remove fluid from my back (where the muscle was removed) or to add fluid to the expanders. I am quite ready to the have these croquet balls removed from my chest.
I'm exhausted so I'm heading to bed but check back in over the next few weeks and I'll do my best to keep you updated.

Cheers!

Love to all,
Andee

I'll do my best

I have 2 IVs in one arm, I'm not supposed to use the other one (even worse than T-Red arms). I also have a drain and a pulse ox monitor on my finger. Wires, tubes and cords everywhere.  I've pulled out my mini keyboard so hopefully the mistakes will  be few. It's still awkward but it has to be better than trying to do this with one finger.
So...updates...
Surgery day for procedure #13 started out with some challenges but we worked through them. Prep went pretty quickly, procedure took less time than expected and I was in my room a little after Noon. Pain was managed pretty well but for the first time I had some nausea. They acted quickly and soon that was under control. as of now, I've only had 2 doses of pain meds post surgery. if I move my arm the muscle gets angry but if I keep it still the pain is tolerable.  I'll take something before I go to sleep but pushing through for now.
Let me just say that you have no idea how  much you use this muscle until somebody cuts that sucker loose. Oh my. My throat remains a little irritated from the tube but it's not too horrible.
The return of the "bulbicle" has been uneventful, thus far but I still loathe drains!
Bobby has been an awesome caregiver. We've been up walking the halls, watching some football and he's been learning drain maintenance and checking out the surgical site. He says I'm pretty bruised. I guess that's to be expected since someone cut open my  back, stuck their arm in and detached a muscle and then stitched it back.  Ouchie.
 before I sign off, I just want to say thanks for the calls, texts, facebook messages and posts. You are too kind.

I'm going to rest a bit and hopefully sleep. I will update tomorrow. The clock is now counting down to surgery #2 which is now 20 days away.  Whew!

Love to all!

1. Andee

Let's Talk About Surgery

...and here we go!

As I said, I met with the plastic surgeon on Thursday. The office staff was great and the doctor was fabulous!  They spent a lot of time with me...I mean a lot...discussing options and answering my questions. There are several options for reconstruction. In the interest of time (and relevance) I will only cover the 2 options for which I am a candidate. If you want to know about the others, let me know and I'll post information in a separate post, with links to the details.

Here is how the rest of the post will work. I will take the time to type, at length, the procedures and how they were described to me, including length of procedure and recovery time. I will also post links to sites which will provide diagrams and general information about the procedures including length of procedure and recovery time. I'll tell you now, the numbers I was given vary quite a bit from the standards. From what I can tell, the difference is the fact that I had radiation. I could be completely wrong there but that does introduce some additional complications for this whole process.

Surgery Preparation

For reasons which will become clear with the review of procedures, the first step in this process will be to have a CT scan to ensure that blood flow is good to the muscle that will be moved. That will happen in the next couple of weeks.

When we get closer to the actual surgery (planned for January) I will have to start the preparation well in advance. I've had about 10 surgeries in my life so preparing for surgery is not new to me. The preoperative bathing instructions for this procedure are real. Not because of what needs to be done but because of the length of time I will have to do it. I will have to start the process 2 weeks prior to the procedure. In addition to the Hibiclens, I will also have to use Bactroban Nasal Ointment for a week prior to surgery. This is an effort to help minimize the risk of a MRSA infection. Infection is, obviously, a big concern with these procedures.

OPTION #1 - Free DIEP Flap Reconstruction

This procedure uses a flap of skin, fat and blood vessels - Deep Inferior Epigastric Perforators - to reconstruct the breast(s). There are positives and negatives with this procedure. For me, the negatives outweighed the positives so this was not the procedure I selected. Let's do a bulleted list for this one, shall we?

• Only a single procedure is required. (PRO)
• Bonus tummy tuck (PRO)
• My plastic surgeon does NOT do this procedure and there is only one PS in Kentucky that does enough of these procedures to make her comfortable to refer me to him. She said you want someone who does a lot of these, not anyone who "dabbles". The success rate for someone who does a lot of these is about 95%.  (CON)
• The surgery itself would take 20-25 hours. You read that correctly. (CON CON CON CON ) The information on the "standard" shows less time but she said for cases like mine it could take this long. She said the shortest time she'd seen was 14 hours. I'm not interested in being under anesthesia that long - neither 14 NOR 20+ hours.
• If you want to learn more detail about this procedure, take a look at this...
  
  DIEP Flap Information - TownsendMajors.com

She offered to refer me to the other plastic surgeon for a consult, but I graciously declined. That leaves with me with one option...well, one option other than choosing to skip reconstruction completely. I considered that for a minute but I have decided to move forward.

OPTION #2 - Lattissimus Dorsi Flap Reconstruction

Here we are. The information on the "winning" procedure. I am not terribly excited about this procedure BUT my outlook has improved in the past 24 hours.  I've watched a series of videos on the procedure and at the end of one them, the doctor interviews the patient and she discussed her pain and recovery time and her experience wasn't bad. I typically recover pretty quickly from surgery so I'm hoping the same may be true for me. Her situation was different because she had her mastectomy and reconstruction at the same time. It still makes me feel better about the whole thing. We'll just have to see what happens for me.

First I'll have to provide you with a little bit of background information. My reconstruction options and the experience will be a bit different because of radiation. They told me from the very beginning that I would have to delay reconstruction for at least 1 year after radiation because of what it does to the skin. I mistakenly thought that my skin held up well and that meant that reconstruction wouldn't be too challenging. I was wrong. How your skin looks doesn't matter. Radiation changes your skin at the cellular level. It may look normal, other than being a little tan, but it most definitely is not. To give you a better idea of what we're talking about, the doctor told me that if we were to proceed with the placement and filling of the expanders without doing the flap procedure, the skin (on my left side) would simply split open. No exaggeration and it's 100% sure to happen. Ew. I mean really, EWWWWWWW. Even with the flap procedure, she warned me that my skin will open up but she'll be able to put a few stitches in and send me on my way. This could possibly happen multiple times during the expander phase. I got a little nervous at this point and asked her if she had ever had to stop the process completely and she said no - not yet. :-)

 Doctor and nurse friends, please don't judge my feeble attempts to explain this correctly. Know that I am including a link to a page that explains it correctly. Now, on to the procedure itself. My plastic surgeon expects that procedure (for the left side only) to take approximately 6 hours. I assume that means that by adding the work on the right side, I'm looking at up to 8 hours of surgery.
The Latissimus Dorsi muscle is the muscle in your back that runs from just below your shoulder blade down towards your hip. They will make an incision in my back, release the muscle from it's current position (cut it out) while leaving it attached to its blood supply. It will NOT be cut completely free. There will be a band of muscle that stays attached and the whole thing will be pulled around from my back to my chest. They will cut open my existing scar then pull the lat muscle through, situate it, and sew it in. Once this lovely procedure is done, they will insert the empty expander and stitch me up. This is a very oversimplified description but you get the idea. I will wake up with 3 drains (you know how much I loved those things the last time around- SARCASM ALERT), 2 in the front and one in the back. I'll also have a catheter in my back for pain management. I'm not sure how long that will stay in. I will be in the hospital for 2 days. I will keep the front drains in for at least a week but the back drain will stay in for 2-3 weeks. Did I mention how much I hated the drains the last time? Anyway, recovery time is estimated to be 8 weeks. If you want the professional explanation, here you go. There are diagrams and everything!

Latissimus Dorsi Flap Reconstruction - TownsendMajors.com

After surgery (and recovery) I'll get a wee bit of a break. They have to wait for my surgical site to heal and the new tissue to work its magic. The increased blood flow will improve the skin situation but we have to wait and let it do its thing. I will have to wait approximately 6 months before they can start expanding the expanders. When that process starts we'll get a better idea of how long it's going to take. They will gradually fill the expanders and we'll see how my skin holds up. Like I said, she expects to have to stitch me up a few times but she says we'll be successful, even if the going is slow. It will likely take a few months, at least. I've heard that the expander experience isn't so bad and I've heard from others that it was excruciating. As always, I'll plan for the worst but expect the best.
After the expander experience, we'll then plan the actual implant surgery. That surgery will consist of an outpatient procedure with small incisions. I'll go home the same day and have a 2 week recovery. OH, and NO DRAINS!!
After the implant procedure, I have to wait about 3 more months before we can proceed to the tattooing phase.
I told you it was going to take a year...no kidding.  We are going to start in January so we can try to wrap it all up in a single calendar year. That sounds really far away but I have a little over 2 months to get mentally, physically and generally prepared. This is a significant improvement over the 2 1/2 weeks between diagnosis and mastectomy, so I won't complain. It seems like an eternity.

I think that covers the basics. If you have questions, feel free to ask. As always, I'm willing to answer.
Whew! I made it! 

As always, I will keep you updated on the process and planning and, when the time comes, the really real truth about the procedure and the recovery.

Bye for now.

Love to all,

Andee