4 Days Post Implant Exchange Surgery

The Amazing:

• The end of the BRCA journey is near/is here! After 15 years of surveillance, I was diagnosed BRCA2 May 2013; had a bilateral salpingo oophorectomy (BSO) Aug 2013 to remove my ovaries and fallopian tubes; had a prophylactic bilateral mastectomy (PBM), nipple sparing, with tissue expanders Dec 2013 to remove my breasts; and had the implant exchange Apr 2014 as the final stage of breast reconstruction. This past year especially has been full of emotional and physical decisions and changes. But also a year of new friendships and engagement with at-risk women and survivors who have experienced or are experiencing a similar journey. And the remarkable support of family and friends who have ensured I always knew I was loved and never felt alone. Not to mention affirming my ability and strength to move through hardships with a positive mindset. I can’t express enough the continued feeling of intense gratitude for the science and medical innovations that allowed me to ultimately pre-empt a breast and ovarian cancer diagnosis — and the sorrow for those lost — to any cancer… I miss you mama. I also want to add that I’ve had an amazing experience with my surgeons, specialists and their teams. It’s been a truly seamless process and Jeffrey and I have been treated with the utmost respect and care. I’ve been in really great hands and their expertise really shows.
• Relatively short procedure. This was an outpatient surgery that began Thursday at 7:30am and took 2 hours. After spending a bit of time in the recovery room, I arrived home at 11:30am in what I cheekily called my chic festival garb of gauze and tape wrapped as a cropped halter top, waiting for the reveal on Saturday.
• The “girls” feel incredibly natural. Once we took off the bandages, it was a look and feel. I’ll address the look below. The feel, well I don’t have much of a point of comparison save my own breasts and a few I had a chance to feel at a BRCA support group meeting. Certainly after 4 months in tissue expanders that jabbed me with their metal ports, this is a welcome change! Even with some swelling, I can tell that the final result will feel pretty consistent with my “original” breasts. They have a lovely density and appropriate squishiness. Yay!
• Very little breast pain. I’m not feeling much from the reopening of the PBM incisions; I have occasional contractions in each breast in the pec muscle but nothing too startling; but I do have a very tight muscle on the left pec under the arm (more on that below). They gave me one Oxycodone in the recovery room and once home, I took only 3 Vicodin every 4-6 hours before I switched to Tylenol and now I’m not even taking that. Not bad at all! I’m also on antibiotics as a precaution.
• Size is consistent with expectations. We stayed pretty true to my original breast size. While on the small size, it fit my frame and I was happy with the proportions. The final size was up to my surgeon who ordered a number of different implant sizes, widths and volumes to “try on” while I was under anesthesia. They actually sat me up and then he and his team determined which one they felt was most aesthetically pleasing. I am now a certified owner of Natrelle Style 15 (moderate-plus profile) 339 cc implants.

The Pains:

• Chest Tightness. This lasted only the first two days and made it somewhat hard to take full breaths at times. It got better and better as each hour passed. And today, it’s gone.
• Fat grafting. In order to revise a few areas, including a natural slope at the top of the chest to the breast and an area of thin skin I had on the left breast that showed the seam of the pec attached to the AlloDerm material (a tissue matrix used to give the breast contour and stability and to provide coverage to the implant given I no longer have any breast tissue) my surgeon took fat from both of my hips to clean and then inject as needed. The transferred fat can be reabsorbed over time but hopefully that won’t be an issue. I’m very bruised and swollen in my hips and any movement has been a bit painful. Staying in one position for as long a period of time possible is optimal. I’ve taken two short walks the past few days to get the blood circulating and that didn’t have any impact on the pain. The good news is that each day it has gotten better. I’m using internal and external Arnica and again, after only a few Vicodin, and Tylenol every 4 hours, I’m now off any pain killers.

• Tight pec under left arm pit. There was more work done on my left breast for revisions and I’m assuming this has something to do with the extreme tightness I’m experiencing in my left pec muscle that sits under my arm pit. I’ve been gently massaging with arnica and doing arm raises and circles a few times a day to open it up. Now at day 3, it is getting more flexible and less painful.
• Heel sensitivity and minor pain. This has occurred during each of my surgeries. Repeated touching of the heels to the bed or couch has caused a nerve irritation. It can wake me up in the night but isn’t bothersome at all in the day.
• My sinuses are inflamed. I’m not sure I can attribute this to my pre-surgery cold, whether my immune system is compromised from the surgery or if it’s just a spring environment thing. Drinking lots of cold-pressed juice and hoping it doesn’t escalate.

Good to Know:

• They make new sounds. So I heard some sloshing in my breasts in the first day or two. I’ve read that it is from a very small amount of air and liquid that may be between the implant and the pocket and that this will get absorbed within a few weeks. It’s so quiet a sound and probably only perceptible to me and just part of the process. Nearly gone, nothing to worry about.

The Question:

• Will my left breast settle in the same way as my right? I worked hard on my mental preparation for the reveal. I read enough stories to know that swelling can affect symmetry, that they have to settle in their pocket. There’s something called “drop and fluff” where the implant will “drop” to a certain extent and the fullness in the upper breast region will descend toward the lower breast. This can take 6-12 months. Currently, my right breast is nicely perky and this may be due to swelling and I’ve read some women are unhappy when the swelling goes away and the breast seems to decrease in size (but I really like the size!). So how much could I love the right breast? It looks nearly perfect — sloped, projecting nicely and round. I also understand that the tissues soften over time and seem to “fluff” and regain some size — so no use getting attached to what is now and what may shift months from now, until we get to a place of what will be when my body has resolved its shape shifting. My left breast looks a bit mushed, wider and not as round, and my left nipple is a bit flattened — I was disappointed. There wasn’t the joy moment I was expecting. But then, what was I expecting? I kept telling myself patience, non-attachment to today or tomorrow’s outcome. But I wasn’t there. I was quiet. Internal. It’s been a long road. If I’m totally honest with myself, I wanted to feel instantly a sexy positive new normal. I had to accept there was more mental and physical work ahead. I’m in a post-mastectomy front-closure bra and I take it off every few hours to check progress. That’s not quite successful patience or non-attachment… but I will say that as my left pec muscle is relaxing and as another day has gone by, I may be seeing a slight, very slight shift in the right direction. Time will tell. And there’s always additional revisions if I need them. For now, I’ll go to sleep knowing that tomorrow is a new day. And don’t think for a second I don’t recognize how lucky I am to have a tomorrow!

   Next Steps:

• Post-op on April 25. Before then I will call my surgeon, like tomorrow. To find out a bit more about this symmetry issue, to get more details on what he started explaining just before surgery about massaging the implants which is important to reduce the chance of a firm capsule that can form around the implant (when to start?), to better understand my range of motion and strength restrictions and if I should be wearing any kind of compression garment on my hips once the swelling subsides. Updates to come.

Until next time sweet people…