Reconstruction group-Nov-07

jade56068

Thank you

I will be sure to say an extra prayer for 2curvy, cc01 and all the other fab women out there.

j

Deborah

Hi Ladies,

I had my surgery last Tuesday. The doctors were able to perform a true bilat DIEP. (At first during pre-op exam my doctor thought I would have a DIEP on one side and a pedicle tram flap on the other.)They were so pleased with my anatomy. It is quite fun watching people  get excited about such things, but it made for an easier surgery -- though not necessarily shorter. It still took ten hours.

Let me tell you about my care and recovery. The nurses were so extremely diligent in monitoring the vascular activity with a doppler machine on each flap. You can actually hear the vascular action -- very fascinating and encouraging! This was done every hour for over 24 hours and then every two hours for the next 48 hours. They also visually checked my breasts for color). I was kept under a temperature control blanket (made of paper and filled with warm air). They were very specific about lack of movement of my arms. No weight bearing of any kind. I was out of bed around midday the day after surgery with the help of a pt and ot. By the second day of post-opt I stopped the pain medication being given intravenously. I just became sick each time I was out of bed. Though the nurses were very quick with medication to counter it. My pain was only in the abdomin and was moderate. On the second day I walked down

the hall and up two flights of stairs. On the third day, I had the

option to go home or stay for another day. I decided to go home.

My husband has been taking very good care of me. He washes and blow dries my hair and takes care of my every need. We both want the DIEP flaps to be successful so we can move past this as well.

I am 57 years old and physically active, which I know has helped me through the early stages of post opt . Overall, going for this surgery four and half years after my bilat was a difficult decision. Afterall, I was choosing to put myself through it. I believe now that it is a good decision. I am anxious to see how I feel once the drains are out. To the rest of you who have yet to go throught this, you are courageous ladies because this does take guts! Rest easy in the fact that it feels great in being on the other side and you will be there very soon. I will keep  you posted.

ShannonM

Thanks for the encouragement Deborah....so glad you are doing well.  What a sweet husband you have!

mommytms2

ShannonM-

I had very little pain, I had an epidural in for pain.  I had a headache from the epidural, but that was about it.  I didn't get up until the 3rd day when they took the epidural out.  Once it was out, I still had little pain.  I had some nausea in the beginning, but was given something to counteract that.  I was able to leave the hospital with only 1 drain.  I had 6 when I came out of surgery.  I had that last one removed on Friday at my post-op appt.  I was told no stairs for 2 weeks and no lifting for 6 weeks.  I know all PS are different, though.

Good luck to all the ladies in surgery today!

Laura K

ShannonM

Thanks for the info Laura.  I might call my ps and ask about the epidural.  I don't remember any mention of it and I'm sure they all have their own ways.  I did call today and ask his nurse if I could start taking some anti-anxiety medicine I have left from last year's surgery/radiation.  She said go for it so that should help with these last 5 days of waiting....I hope!

marsha2664

I had lat flap reconstruction on both breasts (bilateral mastectomies) in January 2007.  I have some areas in my back that still have nerve damage...I can't feel anything except pressure in those areas.  This doesn't really bother me and the feeling may come back.  

My new breasts are natural looking under clothing.  I can go without a bra.  I have more "tissue" under my arm than I did before, so wearing a bra kind of brings it forward.  For a while, it was painful to wear anything except a sports bra...now I can wear an underwire all day at work with no problem.

I decided to not do the nipple thing....I'm 55 yrs old.  Done been there and done that,  so I just wanted the smooth look under clothes and so far I am so so happy I did that...can always go back and get those nipples dones if I choose to. 

If you've got a good PS, you'll probably be pleased with the results.  Just give it a little time. 

Hugs,

Marsha

katie-nc

I had the lat flap on November 12.  Everything is going great, but still having to have the back aspirated every week....I guess that will stop eventually.  Had my first fill last week 100cc.  Only had pain at night when I was trying to sleep, took some ibprofen and was fine.  I go back today for another fill. 

Question for anyone....when my doctor did the lat flap, she took the muscle and skin from my side, so I don't have a scar and anything on my back.  I have full range of motion.  I didn't know she was going to take it from my side until the day of surgery....anyone else ever have this?  Perhaps this is why my recovery has been so quick.  I was back to work 1 week after surgery, and was driving after 5 days.  I can sleep on my side, and can do anything really....anyone else have this?

maryannecb

Hi, had follow up for my unilateral lat flap without implant. I am three weeks out. The surgeon removed my drain although it was still draining 45-60cc/day. So Katie I can imagine I will develop enough seroma to have it needled too.

It is obvoius that my flap is at least one size smaller. In clothing I can add a prostheis to even it out. Today the surgeon gave me the option to consider mastopexy of my old breast and bilateral implants. I will think about this. How is your symmetry?

My ROM is down, I forgot to ask about stetching it out.Are you allowed to do full strtches now Katie? My incisiomstarts almost in the center of my back and extends to my old mastectomy incision. Most of my pain is in my back and I woulcall it 2/10. I am off until Jan but likely could easily have done much of my job.

Marsha, sounds like you are happy. Did you have expanders and then implants? I did not originally want implants but am reconsidering now that I do not haVE SYmmetry. 

Deborah, what an amazing recovery you are having. That is awesome. 

katie-nc

I had another 100cc put in today, so slowly it is getting symmetrical.  I had the other lifted and had an implant put in, and it looks and feels great.  I went with the saline.  I like it alot.  The expander is being expanded, and was told today I had 260cc in and need about 200-300 more.  Then they will let them sit for 2 months and do the exchange.  So far so good. 

acupunc

Hello everyone.  This is a great list!  I wonder if I could add my questions and concerns.  I had a mast and immediate implant reconstruction of my left breast on November 1.  The new breast is much smaller than my natural breast.  The ps told me that when I have a nipple attached, I can also have my natural breast lifted, if desired, for symmetry and alignment. I think that means removing my natural nipple and re-attaching it in the appropriate spot.  Does this mean I will lose sensitivity in it?

Also, the ps said I could have a small implant put in on the top of my natural breast, to match the fullness at the top of the new breast.

My original thought had been not to touch the natural breast....but the more I look at the two breasts, the more they look like they came from two different people!

My ps said most women like to get the whole process over as soon as possible and he recommended attaching a nipple about 3 months post-

surgery.  Yet I'm hearing a lot of women saying that their new breast

doesn't even settle for up to a year.  If so, it would seem to make sense

to wait.  Any thoughts on this??  Thanks so much.

Blessings to all of you on your upcoming surgeries!

acupunc

P.S. I forgot to mention that I got a silicone implant, and did not need tissue expanders because my natural breast is large.

maryannecb

Hi Acupunc,

I have a similar problem. I did a unilateral reconstruction last month. Now my new breast smaller than my old one.that wouldn't be so awful except I was already small. Now I am small and smaller.LOL.

i plan to wait 3-4 months to see if I can adjust. If I can't I may go on to lift the other side and add implants for better symmetry. I originally did not want to touch my old breast but now...symmmetry is important.

I am nt sure what the statistical cahnce of losing nipple sensation is...I do not need much of a lift as I am small and my PS seems to think I would not lose sensation. I am not sure what is more important either.Symmetry vs nipple sensation? I can acheive symmetry with a prosthesis for clothing but if I lose sensation, nothing to replace that! Maybe I will search the literature for this. But I bet there are not too many studies on this. Does anyone knw of any?

I have a seroma on my back, I will have to have it drained this week. argh. 

Sounds like you are doing great Katie.

Fists up!

Mary-Anne 

sjoc

Hello ladies - I'm 6 weeks out from having my expander placed and am feeling pretty good.  It took a while to get my rom back but my arm feels fine now.  I was really worried about lymphedema because I was so swollen, but looks normal now.  I saw my bs last Thursday and she said that was pretty normal because of moving the muscle and everything else around.  Also my ps filled 60cc's at the surgery and my bs said that could have caused the extreme muscle spasms I was having.  She said a lot of time the expander is placed flat until the start of the fills.  I go every week for a fill now.  Have had two (90cc's) each time.  I had blood tests, an ultrasound, my bs and my ps all scheduled last thursday during the killer snowstorm, but I toughed it out and made all the appts.  I couldn't stand the thought of rescheduling and having to go through all that preappt anticipation again.

I asked approximately what my time line is.  My ps said another 6 weeks of fills for a total of 800 cc's, then let that settle for a few months, then the exchange for silicone implant.  A few months after that he will do a lift on my good side.  After 2-3 months he will make the nipple for the left.  I asked him about losing sensation on the right side and he said most times they can move the nipple without totally unattaching it, so you usually keep the sensation.  I certainly want things to match, but will give it a lot of thought if he thinks I will lose sensation.  A friend of mine had augmentatiion on both sides and she said eventually she got her sensation back, but it took a while.

Katie - did you have the lift and the expander placed at the same surgery.  My ps only does one side at a time, would have been nice if I could combine some of the surgeries.

Maryanne - sorry to hear about the seroma.  do you need to keep having it drained or does once usually take care of it?  Hope you are feeling better.  Good luck to all - Sandy

maryannecb

SJOC, so glad you are doing well. It sounds like you have a few more surgeries ahead of you, too. I was really trying to avoid multiple procedures but...I think I may go ahead with implants so will likely need expanders and such muself.



My back feels much better with the seroma drained. I am hoping tht is the end of the story...



I want to start geting full ROM back. Have any of you with flaps been told to restrict movement at your shoulder? I am afraid if I push it my flap will shift.



Fists up!

maryannecb

Hi November crowd, just wondering how you are all doing?

I found a great bra at La senza and can now go wothout a prothesis so am happier with my"somewhat too small" lat dorsi flap. I have recovered full  ROM but will need to work on getting strentgh back. I find it hard to open heavy doors and put things away in high cupboards.

Check in with your good or not so good updates.

Fists up!

Mary-Anne

susi-b

Hi, I'm 38 and had left mastectomy in May 06.  I was keen to get recon sorted asap so had small implant put in Oct 06 to stretch the skin (rather than expander - on advice of my ps) and nipple recon in March 07.  Due to have bigger implant put in left side and small one in right to even me up in March.  I'm really pleased with the results and almost feel back to normal.

sjoc

Hello everybody - haven't checked in on this board lately.  I am still being expanded weekly - 90 cc's every Thursday after work. 
Originally my ps said 800 cc's., now he's thinking more like a thousand!!  I think I'm up to about 780.  Then he said he will do the exchange and reduction/lift at one surgery.  The fills haven't been so bad after the initial placement.  Right now though, the top seems very full and also under my arm, but not much on the lower part.  I can't wear a prosthesis anymore, so now I'm having to stuff my bra again.  I'll be so glad when this whole process is finished.  I have to have an US, mammo, see my bs and onc before my surgery.  I guess they all want to make sure that everything looks OK on the good side before we start changing that too.

Maryanne - have you decided against implants and to stay the size you are, or are you still considering more surgery?  I find I have my ROM back also, but have noticed that I still don't have the strength back 100% with my left arm.  I had a bad fall about 7 years ago and totally lost the use of my arm from my shoulder to my fingertips.  I worked many months to get the use of the arm back and find it frustrating to have lost some of the strength I had regained.  Right now, I'm not supposed to lift much weight with that arm, so I am limited with my exercises.

Hope everyone is doing well and happy with their results. - Sandy 

maryannecb

I am tempted to add an implant, in which case I have to have a lift on the other side....and if I do that Iwould likely add an implant to my unaffected side too....why not be the size I would like.  But...I am hesitant to mess with my good side....

This week I hope to begin more formal exercise and I am hoping my arm will get stronger. I still have trouble opening jars.LOL.

Oh, I don't know what I want...time will tell.

Nice to hear you are getting alon well with your fills. When is the exchange?

Fists up!

Mary-Anne 

sjoc

Hi Mary-Anne:  I'm still not sure when my exchange will be, I'm not done with the fills yet.  When I ask, my ps just says that I still have a ways to go yet - I'm a 46DDD on the right so he wants to expand me as far as possible.  He says the largest implant is smaller than my good breast, so he figures he'll expand as far as possible, and then try to match me up as best as he can with a reduction/lift at the same time as the exchange.  I was surprised when his nurse told me that he doesn't use the mast/expander incision for the implant.  She said that he will make a smaller incision where the crease will be and slide the expander out and slide the implant in.  If the mast scar has healed nicely, he doesn't like to compromise it with opening it up a third time.  I had told my bs that I wasn't planning on ever doing recon, but she thought I might, so she left a good bit of skin.  The scar was kind of crooked and you could actually grab the skin she had left, which I really hated.  Now I realize I'm lucky she did it that way.  I also have excess skin under my arm -  I hope my ps can neaten that up with the exchange.  His nurse said that he might actually use that skin to stretch the side for the implant.  She keeps telling me that he does great work and that I will really be pleased with the end resuts.  I wish it were done so I could see what I'm going to look like - it's gotta be better than what I have now, right!?!

At my last appt, I realized that my ps always has his hands in his lab coat pockets when he comes in to chat before his nurse does the fill.  I noticed that if I ask a question about size or placement, as soon as he starts to talk, he takes his hands out of his pockets and gestures with them like he is feeling my breasts.  He holds them right at chest height as though he is cupping my breasts.  Gotta find humor in this process somewhere, right??

I'm glad you're a bit happier with your results.  It must have been very disappointing to go through the long surgery and recovery  like you did and the not be happy with the outcome.  Do you have to make a decision soon re the implant or do you have some time to decide what you want to do?

You mentioned that you still have a hard time opeming jars.  I was in the basement doing laundry tonight and decided to have a wine cooler while I was waiting for the last load to dry.  I couldn't get the screw top off.  My son came downstairs and found me at my husband's workbench with a pair of pliers trying to get the bottle open.  He opened it for me because he said I looked really pathetic.

It did taste quite nice.  Anyway...glad you are doing well. -Sandy

maryannecb

Sandy, LOL, on your PS "sign" language.  I can picture it.

Just prior to my surgery my surgeon and his resident came in to measure me and do their planning. There I sat in a curtained off area in the preop area...my husband, my Mom and these two very serious docs. After waht seemed like hours they were looking quite pleased with their calculations. ..I couldn't help my next question...it was kind of to get my family to relax as they watched this strange scene of touching and checking etc. I asked my Mom if it took her that long to plan my original 2 breasts. She smiled and said well no it only took a single thought. LOL.

I can decide to do the implant at any time...I think it would be no more difficult than having an expander added, filled over time and then exchanged. The flap was still a good idea as it has given a natural covering for any future implant. Because I had rads the pec muscle is likely damaged and good have caused capsular contractures.

I am 85% happy with my flap...but could I be 100% if I complete what the surgeon originally planned...a flap with implant?  Maybe...

Fists up!

sjoc

Hey Mary-Anne - I finally had my last fill this past Thursday

 (960 cc's).  The last one was a killer with muscle spasms (thank God for flexarill) in my chest and back and even my arm was pretty sore.  Right now my chest is rock hard.  It's difficult to wear a bra because the expander is so high.  I mentioned to my ps that I was hoping that the implant would be lower.  He said he thought I might like my "new look" but if I really want him to bring it lower, he would. Ha, ha.  I will be much happier after the exchange, I'm sure.  My ps wants me to wait 2 months now for the exchange.  My next appt. with him isn't until early April.  He said that he will choose what type of implant and then will schedule surgery soon after.  I woke up half way through the expander placement, luckily only for a moment.  I only remember hearing voices, thank goodness wasn't awake long enough to feel any pain.  The anesthesiologist called me a few days later to make sure I hadn't felt anything and to reassure me that there are other drugs to give me to make sure that I stay out through-out the whole surgery next time.  This was my eighth time to have general anesthesia and I never had a problem before.  My ps also changed his mind and said that he won't do the reduction/lift on the right side the same time as the exchange.  He thinks it would be better to let the implant settle before he tries to match me up.  He said he might possibly do the nipple with a skin graft when he does the lift.  This whole process has been much more uncomfortable than the lumpectomy, SNB, mastectomy routine.  Just can't wait to be finished so that I can feel "normal" again.  Have you had any difficulty adjusting to the "new you"?  I'm excited about the whole thing but I find myself quite apprehensive also.  Wish I knew what I was going to look like after.  How long did it take for you to feel like your new breast was really part of you.  Right now I still get kind of creeped out thinking I have something foreign inside my chest.  I'm sure it's just a matter of time.  Hope you are doing well - Sandy

maryannecb

Hi Sandy,just checked this thread so seeing your comment for the first time today.

Yikes waking up!

My new breast is a tissue flap so it feels surprisingly a lot like breast tissue. it has no nipple yet so the visual isn't right yet. I see the PS again in early April so I have to decide whether to improve what I have by adding implants and lifting my 46 year old breast.

The skin of my back is sticking to the underlying tissues and I have a contracture under my arm which tightens when I lift my arm. I am stretching and massaging to try to free up the adhesions. I just wonder what adding more surgery will do?

i did not want implants because of the foreign body thing but did not get great symmetry in the nude. Still fiercely debating whether to leave almost good enough alone or go for it.

I hear expanders are "rock hard" so hopefully your exchange will change that. I have felt silicone implants in other woman and they feel like breasts .

My MIL thinks I am foolish to do any recon...thinks i have some kind of hangup. But so far I am happy with the improvement and am optimistic that further surgery miight make me more so.