Drain free, baby!

With all three of my bigger surgeries, the worst part of recovery has been the surgical drains. This surgery was no different. Up until this morning, I was afraid I might have to keep at least one drain in longer than a week (the left side would not stop producing), but last night's measurements were slightly lower and this morning's even lower. Dr. Kinney obliged. Hooray!

I really thought I'd written about the surgical drains before, but can't find a post. So forgive me if this is a repeat. With each major surgery (bilateral mastectomy, implant placement, explant) I've had Jackson Pratt (JP) surgical drains placed in my chest to remove the build-up of fluid (blood and lymph, mainly) that can impede healing. They look like this:

That flexible end is wound around the area where the surgery was done, and then the clear tube feeds out of the skin, where it's secured by being sewn in and taped, and the grenade-shaped bulb has a cap that can be opened to create or release pressure. Two or three times a day you need to "milk" the tube from where it exits the body to force the fluid down into the bulb. Then pressure is released, the bulb is emptied into a measuring cup, and the volume of fluid is recorded before it's flushed. Finally, the bulb gets compressed, the cap is closed, the bulb is secured to clothing (or a lanyard) and the negative pressure continues to suck out that excess fluid.

I didn't feel the tube inside of me--except when it was being pulled out (squick...). But the stitches and adhesive where it exits the skin alternate between pinchy and itchy--especially as my body was healing and the wound started to dry up. In addition, my drains all ran out the side of my body, so they were near the ribs and would prevent me from turning on my side in bed or otherwise. Mostly they just impede movement in general, and that is why it's so amazing to have them pulled! Now I just have gauze taped over the wounds to absorb any extra leakage. Hopefully they'll heal up in a day or two.

In addition to removing the drains, Dr. Kinney said nothing bad showed up in pathology (YAY!), and he showed me photos of the full capsules and intact implants that he removed. (If anyone wants to see the photos, I'm happy to share, but don't think I should put them up on a public blog in case people are grossed out by that kind of stuff.) The capsule (which is the scar tissue that forms around an implant) on my right (cancerous) side was a mess. The alloderm (cadaver tissue) that Dr. Sterkin used to make a big enough pocket to hold my implant on that side, since it had radiation, and the grafted fat did not take as they should, which is likely what led to the capsular contracture and extreme pain on that side. Seeing the mess of dead fat and alloderm taken out on that side made it pretty obvious why my chest is not flat but concave. It's essentially skin and scar tissue on top of muscle. Dr. Kinney also verified that the implants pressed in on my ribcage and that is responsible for the concavity and is not reparable (unless I did a flap surgery in the future). If I only knew then what I knew now...

In the week since surgery, I think the concavity has lessened somewhat. Either that or I have just gotten used to it. I'm able to start doing some gentle stretching to keep my shoulders loose, and in a few weeks I'll return to PT to see what I can do about releasing some of that scar tissue. I continue to be able to take big, deep breaths, which I didn't know I'd missed until I was able to do it again.

Finally, I asked about when I could return to biking. Dr. Kinney said that the biggest risk to me post-surgery is too much motion of my arms and chest area, which would increase fluid build-up and possibly require manual drainage. But biking doesn't use much arm motion (unless you're mountain biking, which I will refrain from for at least a little while), so he said I could bike whenever as long as I watched for any fluid build-up. Guess what I'm doing tonight... :)

After my appointment, Greg and I went to Bel Air for Taco Tuesdays. Tomorrow I return to work. I'm so glad I asked around for second opinions on surgery, and went ahead with the implant removal. It's not perfect, but I have confidence that it will be much better. And I'm pretty excited to only miss a week of biking. I don't think I'll be riding with the fast group for a few weeks, but I'm excited to get back on my bikes.

Thank you to friends who brought me delicious protein-heavy snacks, sent me beautiful flowers, kept me company on walks or chats, and who checked up on me by texting or messaging. You've helped heal my body as well as my mind. Now there's nothing holding me back. Onward and upward!

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Explant done! And hopefully my last breast-related surgery.

When I first started researching implant removal, I joined a Facebook group called "Flat & Fabulous." Unfortunately I look neither flat nor fabulous right now. I look like someone took a giant melon baller to my chest and left me with a double bowl for serving dip.

About that uneven, too

I'm a little embarrassed to say that I teared up when I first saw how I looked. I'm not sure what I expected, but I guess I was hoping for some miraculous outcome. Unfortunately my previous surgeries resulted in scar tissue and skin sticking to the muscle, and (I think) 4 1/2 years of having expanders and implants pushing on my ribs may have also pushed them in. My mom used to tease my dad about having a "chicken chest" because his sternum stuck out so far. I guess I'm more like my dad than I thought.

But it's done, and I'm happy--I really am. If you read online about "breast implant illness," you'll read all sorts of testimonials from women whose symptoms of every sort of malady all disappeared the minute their implants were removed. As Greg, Cara and I were waiting for me to be wheeled into surgery, we started making a list of all the things that would result from having my implants removed.
1. No more feeling that I had a stack of books on my chest
2. No more extreme tightness in my shoulders
3. A disappearance of the bruised feeling from my neck to my belly button and down my arm
4. Ability to run again as I'd no longer have joint aches
5. Feeling that I was smart again as the brain fog lifted
6. Shiny, thick and lustrous hair
7. Perfect vision with no need for glasses
8. Promotion at work
9. Winning the lottery
etc...

The first one came true, so I'm just waiting for the others.

Waiting for surgery; using the "Bair Hugger" to amuse Cara

About the surgery:
Unlike my first surgery (7 hours) or my third surgery (4 1/2 hours), this one was only two hours long. In addition, I learned what worked and didn't work from my previous surgeries. And the anesthesiology team was awesome, for the most part.

My stupid veins required FOUR pokes before they got a good IV. So I'm pretty bruised from that. I explained my vomit-phobia and how when I got a nausea patch it helped with the nausea but then I couldn't focus my eyes for three days, but then when I didn't have a patch, I was nauseous all day. So they used fewer narcotics during the surgery, and some extra anti-nausea meds. Although I was insanely sleepy (kept dozing off and hard to wake up from anesthesia), I was NOT at all queasy--which I consider a small miracle.

I had asked to not have my jaw cranked open with the breathing tube like with surgery #1 that resulted in TMJ and a mouth guard for a year, and the anesthesiologist mentioned some form of non-invasive "breathing assist," but Dr. Kinney wanted me intubated. It doesn't seem to have messed up my jaw this time, but my throat is super scratchy and painful (although already better today than yesterday). It's a good excuse to eat soup and ice cream shakes!

Dr. Kinney does several things differently than Dr. Sterkin. Perhaps the best is that he uses Tegaderm over the place where the drains go in, so I was already able to shower today! He prefers not to use a foley catheter (YAY!) and doesn't routinely prescribe oral antibiotics, only putting them in the IV during surgery, so no stinky sulfa drugs! And at least for this surgery, I don't have to wear the horrible, binding, rash-inducing compression garment! Additionally, I've learned since my previous surgeries to use a lanyard to clip my drains to (instead of pinning to my shirt) and that's much more comfortable, too. I can honestly say that I feel much better on Day 2 this time around than I have after any other surgery (except maybe my local anesthesia revision).

Pain has been almost non-existent. There were obviously meds in my IV, but I didn't even take a pain med prescription from Dr. Kinney (That's another difference between him and Sterkin. Dr. Sterkin asked me if I needed more Percocet every visit for the first 3 months. When I told Dr. Kinney that I didn't want to take them and only used Tylenol last surgery, he said that was great and he liked when his patients didn't need stronger meds.)  I took two Tylenol last night before bed, but haven't needed anything since. The only thing causing me pain is my right arm. When I woke up in recovery, that was what I complained about. I think it must have been cranked back during surgery and I have a history of rotator cuff pain. I didn't think to mention it since it hadn't been bothering me. But it was all I could think about when I could stay awake--distractingly painful. And it woke me up in the middle of the night, too. :(  I'd like to be able to loosen it up, but I'm not sure how much I can move my shoulder, as I'm not supposed to move my arms much for healing.

Greg, rubbing my sore right arm as I complained about it after surgery

So there's my update. Thank you to everyone who texted, send messages or comments on Facebook, snail mailed me, and thought about me. I am constantly uplifted by what an amazing tribe I have. This week Cara and Greg and Ash are tag-teaming taking care of me--cooking, shopping, driving, helping me get shirts on, reaching high things. I'll be off work until next Wednesday (the drains come out next Tuesday, fingers crossed). I'm encouraged to walk, so if anyone wants to take walks in the next week, I'll probably be home and up for it.

I'm relieved to have made it to this stage in my journey and would be glad to talk to anyone making decisions about their own surgery and reconstruction. I'm happy to share photos, too, but don't want to put them out in public. Hopefully as I heal, things will appear less drastic. If not, I have some time this week to whip out some knitted knockers, and I can always moonlight as a chip & dip dish. :)