September 2014 Surgery Sisters

I found a good description of possible problems on the University of Michigan Dept of Surgery website. It explains the difference between a seroma (like the fluid in a blister) and cellulitis (infection). I had heard of Mondor's Disease but didn't know the details. Also good info on hypertrophic scarring.

1. Hypertrophic Scarring - This is a very thick, raised, red scar that develops after surgery. Hypertrophic scarring occurs in 2%-5% of patients and may require treatment with additional operations or steroid injections into the scar.
2. Hematoma - A hematoma is a pocket of blood inside the wound. It occurs in 1%-6% of patients and is usually occurs within 2-3 days after surgery. Hematoma symptoms are swelling of the breast and severe pain that does not respond to pain pills. Treatment includes putting a tube in the breast to drain the blood. This procedure often requires a trip back to the operating room. Sometimes, if the collection of blood is small, no treatment is required and the body is able to clear the hematoma on its own.
3. Seroma - In the days or weeks following the surgery, fluid can collect around the implant, causing pain or swelling. This can be thought of as "blister fluid." Just like a hematoma, it can leak from vessels damaged during the surgery and form a collection. Removal of larger seromas is recommended since they can become infected. Usually, the fluid can be removed carefully by a needle and does not require additional surgery. However, this technique of draining the seroma with a needle also may create a path for infection to develop.
4. Wound Separation (Dehiscence) - A relatively rare complication within the first 2 weeks where the edges of the wound separate resulting in an open wound or possibly exposure of the implant. This can be solved by using Steristrips to close the incision, or may require additional surgery.
5. Infection (Cellulitis) - This complication occurs in 2%-4% of patients, and is usually from bacteria that normally live on the skin. Most surgeons will give a single dose of antibiotics before the surgery, and use an antibiotic solution in the wound before implant placement to help reduce the chance of infection. Symptoms of infection include pain, redness, swelling, and fever. Doctors may treat this complication with antibiotic pills, or if the infection is severe, by having the patient go to the hospital for intravenous antibiotics until the swelling and redness go away. After leaving the hospital, antibiotics pills are taken for 1-2 weeks. For infections of the implant itself, surgery to remove the implant is often the only option. Though some surgeons will attempt to save the implant from being removed by reopening the pocket and washing out the wound, this may not be effective. Infected implants put the patient at additional risks including: scar contracture, wound separation, and (in very rare cases) a severe illness called Toxic Shock Syndrome. After removal, healing and softening of the breast need to take place before the implant can be replaced, which often takes several months.
6. Mondor's Disease - This is an inflammation of the blood vessels that run under the surface of the breast and it occurs in about 1% of patients. Fortunately, this condition requires no additional treatment and will go away on its own.

SU-CQ51, nope Inever envisioned this, sometimes Istill get overwhelmed by it all, but I gotta fight on, thanks so much for the encouragement!

frostecat, thanks I also had the thought of something may be still lingering if I chose not to have chemo. I've shed some tears through out the day but I know this is the best decision for me. I'm just praying that it won't go so bad but I know it won't last forever so that's keeping me a bit more stable. It's meant for me to experience this otherwise it wouldn't have happened. Thanks for the encouraging words I really needed it on today. 

Thanks Lonnie, the chemo will be once every 3 weeks Cytoxan Taxotere 4 rounds, so it will take a few months. I'm not sure of the dosage yet. I'm not too upset about the exchange surgery being put off, but what about the fills? Well they be put off as well?  And yes I'm happy about no radiation, that's on my "something to smile about list" I just joined the Cytoxan/Taxotere group so I'm sure I'll get some good advice and tips there. I hate you had a hard time but you made it through and now its a memory! like u said we can be happy in the fact that we did what we had to do to kill the cancer. Thanks for the support. ((Hugs))

Enlm, ugh...I hate that you have to get chemo.  My friend had her fills during chemo.  She would have a fill and then go to chemo on the same day. Hopefully you can stay on track as far as your fills go.  A little ray of sunshine in the storm..  Praying your side effects are minimal. 

Thanks everyone for your thoughts and prayers!

 The nurse came to do the pre op stuff and go over the list of things I was scheduled for. She got to "bilateral nipple removal" and I said. "I've decided to keep them for now."

Then my surgeon came in. She told me the fluid she aspirated from my right breast last week came back with infection and they cultured it to make sure they're treating it with the right antibiotics. However, because we're now opening that area it is very possible I will develop much more significant infection so I will need to make weekly visits until I'm past the risk period.

Then I told her I decided to keep my nipples. She was ok with it, however she pointed out the problems with my left nipple - the one pointed west - and why she thinks it will be a problem when I have my exchange surgery in a few months. So, with that, I said goodbye to my nipples yesterday.

In surgery on the left side she removed the nipple, a bunch of scar tissue and replaced the expander. Filled it where I was before 200cc.

Right side she replaced the ruptured expander and filled it to where it was previously - 175cc - then cleaned up all the fluid and A TON of scar tissue. It is scar tissue that had pulled the expander over under my arm. 

Pain was a major issue after surgery. A 9 or 10. They gave me another boost in my IV to get me home  but ti didn't really cut it. My doctor came to check on me and offered to send me over to the hospital because my pain level was too high. I was so frustrated because I used to have a really high threshold and now it seems the slightest irritation is a major ordeal. She told me sometimes the bodies of cancer patients are just DONE fighting pain and they needs more narcotic support than is typical. After discussion with Dean (because I was not clear headed) she gave me a written script for oral dilauded and bump though my IV to get home. Unfortunately there were problems filling that script and my pain level was climbing. Eventually, with many phone conversations between Dean and the surgeon they got it sorted out and I was able to sleep the whole night.

This morning I'm feeling much better. Pain level is very tolerable. My range of motion is already better than it was before surgery! All that scar tissue was causing a lot of problems. But today I can raise my arms over my head, and the "iron bra" sensation is gone. Well, at least I'm not noticing it with pain meds on board. I was instructed to keep doing my ROB stretches, just zero lifting for two weeks. 

So sorry noonrider!   You've had a lot to deal with physically lately and adding infection to the mix is so scary too.   Glad you are feeling better today and your ROM is a really good sign.   Speedy recovery!

Good luck with your chemo tomorrow Ilovecoasters!  

So proud of you all for supporting each other! The news isn't always good and sometimes we can hardly see the forest for the trees, but knowing we are not alone is such a comfort. Hugs to you who are facing an uphill trail today.

Ilovecoaster, praying for you tomorrow.

Ilove, I'll be in your pocket.

My first treatment I got all worked up with anxiety (I don't really think that can be prevented!) and it was such a non-event. I did have some problems once I got home but at the clinic, in the chair, was just time to hang out on FB or make phone calls. I even got two phone meetings completed. Hang in there. Praying for you to be SE free tomorrow!

It did not and I'm already feeling sick. I'm feeling very overwhelmed.

Oh man. Praying you can get over the side effects quickly. All you can do is stay hydrated as best you can. Don't hesitate to go in for IV fluid if you need to. (I had to go twice with every round) Eat what tastes good to you. Only a few things tasted good to me, one of them was Banana Cream Pie blizzard from Dairy Queen. 

ilovecoasters....hoping today is finding you better.

noonrider...thanks for the reminder that we don't have to be super healthy all the time!  Not sure what will taste good to me once chemo starts.

muzakmom.....very touching.  This experience has rocked me to my spiritual core as well.  I often have no idea how to pray.  Because treatment has been so delayed I honestly wonder if I should be praying for the right new wife/mother for my kids.  Pray that God will give me courage for this journey?  Or that I accept the road I'm on?  Take me out?  Or give me strength to suffer?  It's not "why me" but "what am I supposed to be doing/learning from all of this?"  Thanks for the encouraging note.  May God be visible to you on your journey.

Muzakmom, what a lovely story. I admire people who have spirituality to help them get through this nightmare. We should be able to count on all parts of our support system whenever we need it. Too many husbands disappear and friends can develop sympathy fatigue.

Unfortunately God and I are not on speaking terms. I don't know what I did to piss him off so badly last year. First was a moderate brain stem stroke in January of last year which has left me unable to continue work as an accountant/fitness instructor/ballroom dance instructor, and exchanged those for financial problems, double vision and permanent imbalance issues. Second was the discovery of a large aneurysm in the ascending aorta of my heart which is the same thing that killed my grandfather and uncle. It is within less than a centimeter of the size it must be before they do open heart surgery. On one hand I want it to make it to 5 cm to I can get the surgery over with but on the other hand it could explode before we get that far and kill me immediately. Then the breast cancer only six months after the stroke. The final blow was the infection I acquired right after the BMX last August which wrecked the left side of my upper body, necessitated 5 more surgeries, and left me with daily pain. I rely on my husband, adult daughters, my physicians, my friends and the support of sisters on this thread. I am over the "why me" stage and on to the "why not me" stage. So far I'm doing ok...unless someone makes the mistake of saying, "God never gives you more than you can handle." For me, that's not true and it makes me upset to hear it. I'm not strong enough. I'm broken. That's ENOUGH.

Good point.