Another 40ccs

So now I am at 390ccs.  Dr. Ferguson thinks that I am filled pretty much as far as he feels comfortable going.  I have another appointment in 2 weeks and we will see if there is any more "filling" to do.  He showed me some implant "stats" (height, width, volume and profile).  It looks like the implants that might be right for me are right about 400ccs.  There are two brands that he uses and they both have different stats available (Sientra and Allergan 410).  He is most familiar with the Sientra brand, having used it already.  The newly FDA approved implant, Allergan 410, that is heavier and denser, claiming that it holds its shape better and doesn't "wrinkle" or "slouch".  Dr. Ferguson thinks that a rep for these new implant models will be stopping by and might leave a few examples that we can look at. 

My Mom is losing her fourth battle with cancer.  Last week, she would open her eyes and look at me with a smile when I went into her bedroom and told her, "Mom, it's me, Lisa."  Now, she barely opens her eyes at all when we speak with her and kiss and kiss her cheek. I long to be on the backyard garden swing beside her, enjoying the warmer spring days, or going for a "country walk" with her, my sister and our kids.  Just to be with Mom, with Grandma.  At my daughter's soccer practice last week, a soccer mom was talking with her mom on the phone the whole hour.  I see girls my age with their moms at lunch or in the store...and I wish I had more time.  I am grateful for a wonderful mother-in-law, though!  Today I held my 3 year old daughters hand as we walked around the house.  Love that little hand!  I squeezed my 1 year old in my arms and stroked his hair and cheek.  It was nice to take small moments.  I have to remember to do that more.  The small moments make me so happy.

  

Surprise under the arms

A fun little surprise as I was shaving last week... I discovered that I had a nice little patch that I had missed for a while under my arms.  Perhaps a little unpleasant to talk about, but it made me laugh embarassingly at myself.

My expanders are under my pectoralis muscles, which is inserted at the clavical/shoulder and extends across and down my chest.  Since this muscle is raised (more and more each week with expansion), when I now lift my arm...there is a muscle "bridge".  The muscle raises more now, so that I can't see my whole armpit now.

I used to be able to see my whole armpit when I raised my arm to shave, so out of habit I was just shaving only what I saw and I thought I got it all.  Now I am realizing that I can't just shave what I SEE!  I need to look under the "bridge" and shave in the unseen pocket area too!  That is a TOUGH area to shave!  Imagine trying to shave inside of a small bowl.  No flat surface when my arm is raised up forming that bowl...and I have to raise my arm to be able to access that area to shave.  I'm trying to figure it out!

Anyway, I "apologized" to Dr. Ferguson on Friday for having this unkempt spot.  I "insisted that hygeine is actually pretty important to me".  He just knowingly laughed.

Expanders are Full

I asked Dr. Ferguson if we can fill a little more than the 350 cc capacity of the expanders.  He said that he didn't suggest much over 410 if my skin would allow it.  Dr. Ferguson readied 60ccs and pushed a lot of it into my expander, but then backed out a lot of the saline so I only have the 350cc in each breast.  He said that my skin was looking too tight and he's not certain that we will be filling my expanders over capacity.

You have to understand that with a mastectomy, there is NO tissue to supplement the volume of the expanders.  So while, for breast augmentation, 350 ccs might be quite a bit, it's not the same when the only volume present is what is filled into the expanders.  I have to say, I am happy with Dr. Ferguson's work.   My breasts look very good so far.  The expanders poke straight out and are very, VERY firm!  Dan calls them "rocas"...they feel like rocks.  When the implant goes in, it will be squishy.

Dan took a photo for me of the HUGE Syringe that injects the saline into my expanders. It's so "mad scientist" crazy to see this huge thing being stuck into your chest!

Dr. Ferguson showed us a tear-shaped implant that just became available for reconstruction patients (because the FDA took forever to approve them).  With the normal round implant, you can see many ridges and valleys that form when its laying flat.  Then when the round implant is brought vertical, those ridges and valleys are still quite prevelant, but droopy.  Since I only have a thin layer of skin and no fat or tissue to smooth out those ridges and valleys, you would see "wrinkling" under my skin.  With this new teardrop, the ridges and valleys are much less noticable.  Also, if they are aestetically unpleasing, Dr. Ferguson can fat graft.  Using fat from another place on my body, Dr. Ferguson can inject some of that fat into areas on my breast where there is rippling or other imperfections.

Quite a process:

Jan 24       Mastectomy and expanders put in (60 ccs of saline)
Feb 1        Fill with 30ccs
Feb 8        Fill with 110ccs
Feb 15      Fill with 60ccs
Feb 22      Fill of 60ccs
March 8    Fill of 30 ccs to bring my expanders to a full 350ccs.
March 22   Possibly another fill, but don't know if my skin will allow it

Wait 3 months for the breast "cavity" to form and firm up

Surgery to switch expanders for implants

Fat Grafting possibly...

2 weeks

I went in for another fill on Feb. 22 and they filled me with 60 ccs.  I am at 320 ccs now.  Because it was a large fill and I am reaching the 350 capacity, Travis PA, suggested that I wait 2 weeks before coming in again.

I think I could've come in the next week and not waited the two weeks, in terms of pain.

I asked about needing to massage the scars so they will disappear.  Travis said that actually, since my skin is so thin that I shouldn't massage the scars.  He said that even when patients do massage their scars, really it doesn't matter what type of expensive cream you purchase.  It's the process of continual massage that matters.  He said you just use normal lotion and massage.  But, for me, the risk/benefit is not worth massaging my scars.  Since my skin is thin, I might be doing more harm than good.  Travis mentioned a study where they put skin cells into silicone and continually stretched the cells vs cells that just sat.  The stretched cells secreted a hormone that aids in keeping the scar tissue to a minimum. Because my skin is constantly stretching, I don't need to massage.

Glue seal

Today I went in for another fill.  Dr. Ferguson and Travis both came in to fill both breast expanders. I was filled with 60ccs more in each breast.  So now I am at 260 cc on both sides.  They are 350 ml expanders, but Dr. Ferguson said we can overfill them a little, depending on how my skin does.

I asked Dr. Ferguson if he thought it would be okay if I lifted my 18month old now after 3 weeks.  He said to just be cautious since my skin and muscles still have a lot of healing to do.  I'm so grateful to my wonderful in-laws for helping me care for James.  I couldn't have done it without them!

It was encouraging to hear that Dr. Ferguson said that it looks like things are moving along well and that all looks good.  They told me I should probably start peeling off the glue seal that was placed over my incisions.  Travis gave me some glue remover pads to use.

Tonight, it was so weird to peel off that glue!  It wanted to stay on there, but the glue remover pad helped.  It was scary to peel it off because some of the trapped dead blood was coming off on the glue and I wasn't sure if it was scab that was supposed to stay on the incision.  Most of the scab came off though and my scars look really good.  I am surprised at how well I am healing.

It's crazy to think that Dr. Ferguson will go back through these incisions to swap out the expanders for implants.  (I am hopeful that my scars will eventually fade well.)  We have to be careful how far my breast skin is expanded.  It's not like normal augmentation where there is a lot of breast tissue to "cushion" the skin as it expands.  I just have a very thin amount of skin that is being stretched and can't be pulled like a normal breast.  Also, if we put too much pressure between my skin and ribs, my ribs can actually be pushed out of place over time, causing problems.

I have been thinking about how healthy and active my body was before all of these surgeries.  I had just completed a family triathlon with Dan and Daniela, was running regularly and feeling great!  Now these surgeries have slowed me down so much and I feel my muscle tone declining.  I fear pushing too hard and look forward to when I am fully recovered.  I feel sort of "broken" sometimes because I'm not as fast at doing things like I used to be (reaching for a pot up high, bending down to pick up a hair ribbon off the floor...I have to sit on the floor to be with James, which takes so much more time than just carrying him and holding him...) and it sometimes feels like my body will never be back to normal.  I feel more fragile than I've ever felt.  I wonder... if I had known exactly how recovery was, I probably would have stalled longer from the fear of not being able to function like normal.  I hope it's possible.  It's good that I didn't have a full knowledge of what to expect, despite all of my research.  This was important to do and it was better to just jump into it.  I just had to get a good night sleep, wake up and go to the hospital for surgery...one foot in front of the other...My brain taking over and supressing any reservations because I had already made the choice to go forward with all this.  

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Expand-o-Boob

Daniel drove me into my appointment and we met with Travis, PA.  He said everthing is looking good, no signs of infection and my incisions are healing well.  He also said I won't be wearing my compression bra anymore and can keep it as a souvenier.  He said I could let the glue on top of my incisions peel off now. 

He also gave me some exercises to do to improve my arm mobility.  I am to hold a soup can straight out in front of me and write the alphabet in the air, then do that with my other arm.  With my arm hanging straight down, I am to make arm circles both ways.  Also, I should slowly finger crawl up the wall to a point where I am stretched and hold it for 30 seconds and repeat.  I should do these exercises a few times a day.

Travis said at this visit we would try to fill me with 120 ccs.  We actually filled each expander with 110ccs this visit, bringing my total volume so far to 200ccs.  Apparently these expanders hold 350ccs.  Travis said that after they are filled, I will have some pain for a few days...a mucle aching, like I worked out too hard. 

So, Travis again found the metal port in my expanders and marked the area to inject with a small circle.  Then he filled a LARGE syringe (but he said the needle is very small, so that made me feel better) with saline.  I told him he looked like a Mad Scientist with that HUGE SYRINGE lurking over me.  Poke.  and up filled my expander "balloons".  It was kind of funny to see my left side filled and the right side, smaller and waiting to be filled. 

I asked a lot of questions. 
-One of them was how soon after surgery can I swim? 3-4 weeks and when I don't have any more scabs.
-When can I drive?  When I can make arm movements large enough and be able to maneuver well in a "situation" case I need to.
-What are these little pointy corners in the side of my boob that I can push in?  They are folds in the expander since they aren't filled all the way.  The expander wall is folded over and making a pokey corner under my skin.
-What about bras?  Don't wear an underwire since it can rub and rub through my skin over time.
-Why are we waiting 3 months after my last fill to switch the expanders for implants?  He said that we will continue to fill the expander until it has reached capacity and then I will wait at least 3 months before we switch the expanders for the implants.  During those 3 months my breast muscle will contract around the expander. Since the expander is harder and stiff, it will be able to push back on the breast contracting. This will help form a pocket for the implant.  It's important for the breast to come close to forming it's final shape before we slide in the implant. If the implant were put in immediately after the expanders are filled to capacity and the breast didn't have time to form it's final shape, then the breast muscle would contract around the implant. The implant, being soft and squishy, would be squeezed and bulge out in certain areas. This is called "encapsulation".

First Fill a Week after Surgery

So, for three days after my surgery I couldn't remove the compression bra.  When Dan helped me to bathe and wash my hair, we were freaked out about what we would see under that bra.  We slowly removed the bandages...and... it wasn't as bad as we thought it would be.   I thought the drain tubes would be inserted and sewed into the scar, but they were actually inserted into my skin through a hole under my arms about 2 inches from the end of my scars. The scars looked like they hurt, but they looked fine.  My boobies looked like sad little deflated balloons that were smooshed flat onto my chest.  But I wasn't worried about that, because I knew they would be filled with saline over time.  Really easier to observe than I had anticipated. 

Dan has been a dear washing and blowdrying my hair and taking care of me.  He's been vacuuming, making meals and driving the kids around.  That's another thing I didn't think about...I can't drive for a while after the surgery.

I'm not supposed to move my arms at the shoulder, just at the elbow.  The scar and my muscle should be allowed to heal and we don't want a lot of movement.

I went in on Friday for my first FILL.  First, Dr. Ferguson used a little magnet on a pivot.  It swung sideways until it was over the metal port in my expander.  Then the magnet was perfectly vertical.  The spot was marked and then a needle with 30ccs of saline was injected through that site.  The huge needle didn't hurt as much as I thought it would.  The top part of my breast is pretty numb and feels weird when it's touched.  Then the expander in my other breast was filled after they marked the spot with the magenet's help.  Dr. Ferguson said it was a good sign that both of the expander ports were level where they had been marked.

(My expanders have the metal port inside the expander)

Travis, the Physician Assistant, then snipped the stitches that
attached the tubes of the drains to my skin.  There was actually a little "o" circle that surrounded the tube of the drain in one spot where it was taped to the tube.  That "o" was sewed to my skin with a stitch or two.

Then he had me take a deep breath and let it out as he pulled out the drain tube.  That tube had been coiled all around my breast expander under my skin and it looked like a tapeworm was making it's way free.  Again, I had anticipated a lot of pain, but really, it didn't hurt much when the tubes were being removed. 

I was to put a little dab of antibiotic ointment on the drain tube holes and change my dressings daily.  I'm just using a LARGE adhesive bandaid on top of them.  A little bandaid might move around too easily under the compression bra.

I can tell a little that there is a little more saline in my expanders.  The boobies still look a little flat smooshed.

The nurse said that I will return every week for FILLS for anywhere from 4 to 8 weeks. Then I will wait 3 months until they will do the expander swap for actual implants.

I still feel a little pain from various things...the compression bra has me feeling  like I can't stand up straight, so there's some strain on my back...I feel a constant, low pain in my chest area and it seems that this pain is more apparent as I try to sleep.

Sleep is another issue...it's tough to get a good night's sleep when you are propped up on pillows on your back with your hands down at your side.  One little warm flash and it takes a bit to calm my mind to settle down to sleep again. 

I really can't complain.  I have no signs of infection so far and I have wonderful family and friends who care for me and show their love with kind acts of service so often.