PAP vs. TUG
Comments
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Wow! How long did it take for you to go back to work? How long were the drains in?
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Hi sweetbean, I just had my flaps (April 19th). Two of my drains came out before I left the hospital (day 6). Those two were the PAP drains (both the leg and the chest). The other chest drain, from my TUG came out day 8. The last one, the leg TUG, came out day 14, but it probably could have come out on day 12. Hope that helps
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Thanks! I heard the PAP drains come out faster than the TUG drains. When do you think you will be back to work?
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I will be 3 weeks out this Thursday. I plan to start driving in the next day or two. Depending on how comfortable driving is, and whether my lifting restrictions are removed Thursday, I will probably go back next week (about 3.5 or 4 weeks off). But I do get tired more quickly than I realize, so maybe part time at first? I'm basically self employed, so I have a lot of flexibility. But no work no $$$, so it's in my best interest to go back at least part time.
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Yes, I work for a non-profit foundation, but it's very flexible and I can work from home. I'm glad to hear that you are recovering well! I get more and more encouraged about this procedure. I'm very slim but have always had (ahem) some junk in my trunk. However, I didn't know that the PAP was even available until last week after my implant exchange. I'm supposed to go in for a consultation with Dr. Chen on the 16th.
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My drains (all 4) were taken out 8 days after surgery. I actually had to stop the surgeon from removing a couple in the hospital b/c I had read on the forums that the output should be below 30cc before removal and they were not that low. Even though they are a pain they are performing such an important function I wanted them in until I was sure it was as safe as possible to have them removed. I went back to work 6 weeks after surgery which was a very gentle path. That is, I could have gone back to work by the 4th week.
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Interesting! Wow, this is really exciting. So, what is sitting down like? I read that sitting on hard surfaces is difficult - is that true?
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Yep for 2 or more months it is uncomfortable. Imagine sitting on a nylon cord (like a ski rope), not a killer, but just not comfortable for awhile.
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OK. But it eventually goes away?
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I find sitting down generally uncomfortable and avoid hard surfaces at all costs! There's just no way around the back of the leg incisions hitting where you sit. Frankly for me it's the most "painful" part of this option. I'm hoping it goes soon!
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So it's really the incisions in the back of your legs and not the loss of butt fat that is making sitting painful?
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For me it is the incisions. I still have plenty of butt fat. I'm missing a fair amount of inner thigh fat, but I still have a bit left there too. The incisions extend from the middle of the front of my legs, around the back about 1/2 inch below my butt crease, to the middle of the back of my legs. Everything is still swollen there, so there isn't much of a "crease" at the moment, just swollen and healing incisions--hence the pain in sitting directly on the incisions. Toilets and sliding in car seats are the worst (and hard surfaces). Cushioned stuff is OK. You just learn how to avoid putting direct pressure on them.
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Hi Everyone - Just want to say a quick thank you to all of you who have already had your surgeries and are posting "specifics" for the rest of us. For those of us scheduled ,or evaluating a PAP or TUG procedure, I cannot tell you how incredibly helpful this is .... and how very appreciated !!
I'm gratefully keeping notes of all the helpful inormation and good tips each of you has posted.
THANK YOU - KEEP IT COMING !
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I've got a consultation on the 16th. I'll let you know what the PS says.
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For anyone who is interested in the on going PAP vs. TUG debate, I thought I would give an update. I'm doing very well. Ahead of schedule according to my docs. I feel great and am sooooooo glad I did this. I gave my hubby a hug today for mother's day, and I swear it's the first real hug we've had in almost 3 years. He looked at me and said "they are real!" I feel that way too. Lots of happy tears around here. Best part was snuggling my kids tonight and feeling normal again. Makes it all worth it!
To address the TUG vs. PAP specifically, they are both doing great. I do notice a difference between my legs in mobility and general tightness. The TUG leg is tighter in the inner thigh and hamstring area (to be expected). I notice it bending over, shaving my legs, etc. Both are about the same in soreness around the incisions, which continue to be the most uncomfortable part of this surgery for me. My PAP leg is really going great feeling wise. However, I have more numbness on that side down the back of my leg, my inner thigh has more of it's natural shape and fat deposits (as compared to my TUG leg which looks GREAT--I'm so excited about it), and there is a more interesting deposit of either fat or swelling under my butt on that side. PS says when the swelling is gone, if it still looks puffy we will fix it in stage II, so I'm not worried. On the upper half, TUG side is bigger (by a fair amount) but firmer (more massage necessary). The PAP side is softer but more "hollow" on top. Again, all of this to be fixed in stage II.
All in all I am thrilled. I love the look of the TUG side (top and bottom) more than the PAP side, but I like the feel of the PAP side (recovery and result) more. So it's a TIE! Hahaha. I feel very fortunate to be standing here with two successful flaps looking forward to feeling good in the future. Happy mother's day to all and hope everyone had a great weekend.
Andi
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OMG, I am so excited for you. Wow, the idea of a real hug makes me tear up. I haven't had a real hug for over a year.
How long will you have to wait for Stage II? And I'm sorry if I already asked you this - have you had radiation? I had radiation,so I am already asymmetrical.
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Ok, I just read your original post - you had rads. we are like twins! can't wait to talk to the doctor and PRAYING that my insurance will grant the exception.
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Yes rads. As my PS says "the gift that keeps on giving." But honestly I think I would have hated the implants anyway. I just hated the way they felt on my chest and couldn't get used to the way they felt when I moved. Got more real hugs tonight. They are the BEST! I want some for you too sweetbean I'm praying insurance covers it too!!!
Oh and my docs said Stage II can be done after 2 to 3 months but I am waiting until the end of summer. I think it's generally better to give your body more time to heal and I don't want to mess up my summer with surgery fun.
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OK, I saw Dr. Chen today. She's amazing. She said that I am a perfect candidate for a PAP flap. (She said the drains would be in 2-3 weeks, though - is that routine? Eeeek!) I saw pictures and was SO impressed. We are looking at the end of summer for the surgery - that will give me time to get the insurance approval, get second opinions, etc. She wants me to wait three months after the PAP flap for any tweaking. As long as I get it all in on this year's insurance, that's fine with me! They were also super optimistic that they will be able to get me an in-network exception. Fingers crossed!
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Great news sweetbean!!! And Amac thanks for the update on you. I am glad your recovery is going well and that you have two successful flaps and that you are enjoying hugs more!
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Stac, how long were your drains in? Thanks!
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8 days (see May 8th post on this thread for details). Longer is Ok...you want them in as long as you need them.
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Oh, I know that you are right. I had three for my BMX. I found them pretty uncomfortable, so I kind of had heart failure when she said 2-3 weeks. However, maybe that is just the outside and she is preparing me. Then if they come out in 8 days, I'll be thrilled. I only had them in 8 days after my BMX, so I'm hopeful! Thanks!
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Amac, how is it going? How is everything looking?
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Hi sweetbean, everything is looking GOOD! I'm getting tons of compliments, but of course everyone has to say that right. We went to the pool for the first time tonight. Not in a swimsuit yet, but I'm not afraid to be in one. It's just still too cold! The scars are there, but they are fading, and my legs look so much better than before that I generally feel better about myself, and my boobs are amazing. Very natural, youthful and perky--yea! I am 5 weeks out as of yesterday. I had a check with my PS on Wednesday and was cleared of all restrictions, although I'm supposed to start back to exercise slowly "listening to my body." My body says "you are a slug and enjoying it, keep up the non-work." What am I supposed to do with that!?! My swelling is nearly gone (just a little in my PAP leg and some in my TUG boob). Spanx are my friend. Couldn't live without them.
Overall, out of everything my TUG leg is the one with the most noticeable lasting effects. It is tighter and I have a smaller range of motion than with my PAP leg. But not too much. I can do lunges and squats and touch the floor with my legs straight, so not too bad. My arms/chest feels great. My radiation side has tightened back up a little, but it feels 50% better from just one PT session. I don't think it's anything that stretching won't fix, and I don't feel as if I am constantly fighting the implant. Just stretching out the muscle and tissue. My lymphadema appears to be gone, hopefully for good. So at the moment I even get to ease back into exercise without my sleeve. Yea!!!!!
At 5 weeks out, I still say if I had to choose I would go with the PAP over the TUG because it is easier on your body, but I still really like the look and volume of the TUG better than the PAP. In my case, a PAP on my left side may not have worked whereas the TUG was a safe bet. I certainly would take a TUG over a failed flap any day, so I have no regrets. Plus my TUG leg is no longer numb whereas my PAP leg is still numb in the back from my butt crease to about half way down my thigh. My PS says that's because there was more trauma to the PAP leg to access the vein. I can tell you that something happened because it has been my numb/sore leg from the start. My PAP boob is softer but smaller than my TUG boob, so I can't decide which I like better. All of these minor issues are to be fixed in stage 2, which is scheduled for August 31st.
Overall I am still just over the moon about this. Just could not be happier. I will let you all know how getting back into exercise goes. I did wall push ups at PT on Thursday and felt..........NOTHING! Yea!!!!! I felt completely normal. No weird implant under the muscle (i.e. the beach ball stuck in your chest) feeling. Can't wait to do more. When I brushed my teeth this morning my boobs jiggled. It was AWESOME.
Hope everyone else is doing well. Have a great holiday weekend!
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Holy crap, that is so amazing! I am just PRAYING that I can get this done! So happy for you! I'll keep you guys posted.
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OMG ! I can't believe your progress at 5 weeks !!!
Lunges...squats..touching your toes - incredible ! You have no idea how much hope you are giving me. I am in awe - and now greatly relieved about recuperation from my own upcoming PAP . Have a feeling you went into your surgery in peak physical condition -and that it's something we should all make an effort to do. Am going to ramp up my workouts now !
You are trulyan inspiration to all of us AMAC. Of course, you have totally spoiled your doctor - he will now expect the same result with all his patients !
Aside from numbness and the other physical things you mentioned, are you still encountering any difficulties or limitations at this point ...such as steps, getting out of bed w/o assistance , sitting, toilet , etc. ?
On behalf of all of us - thank you for keeping us all so well informed. It is greatly appreciated.
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Hi Elieen, glad to inspire but not trying to do anything special. Just doing the best I can and documenting as I go to let others know my experience. I'm so glad it's helping you. I was terrified, and don't get me wrong, it was a big surgery. But really for me, at least so far, it was about the first 10 to 14 days that were pretty intense. I feel increcdibaly blessed and grateful that this procedure is going so smoothly and hope for the same for you and everyone else here.
I was in pretty good shape going in, so I think that definitely helped. I also feel pretty in tune with my body, so I have a good sense of what I can do to push myself a little, but not too much. Honestly I left all of my limitations and difficulties behind at the 3 to 4 week mark. Some of them I don't really remember leaving behind, I just started doing things the way I normally do them. I don't need any assistance and haven't since about 2.5 weeks out. The only things I am hesitant with are running (I've only broken into a trot a few times to catch my 3 year old), lifting heavy objects out away from my body (i.e. my son or a big basket of laundry with just your arms), and side lunging (to much stretch to the inner thighs is still scary). But I'm working up to them. I really want to start back to yoga soon. I haven't been able to do it since my mast. And I woke up the other day on my stomach!
I don't think I would be ready for a game of tennis just yet, but I'm getting back into the grove of things fast. And the very best part is these boobs make me feel "normal" again. I hope you get to feel that way again too (very soon).
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I am 3 wks postop from PAP and am very pleased. Best advice...pee standing up with your legs straddled over the toilet and it will make life much easier! I only have one issue and it is a stich that popped in the back mid thigh that now won't heal but it is draining like crazy. PS doesn't seem to be concerned but I am!
Margaret -
Yay, sociologist and amac - very happy for both of you! Sociologist, how long were your drains in?
I'm having my various doctors write letters of recommendation to my insurance company. My RO wrote a great one - feeling very optimistic!
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