Reconstruction 101 - GRAPHIC PHOTO WARNING

Some of you are aware that Rosey has been in Crisis.  On Wed. this week, I was doing chores and realized the "radiated skin and muscle" over my tissue expander, suddenly felt squishy and mushy. I called the office immediately, as I knew this was not normal, and it was not good.  They have always been a rigid and stiff feature of my body.  Hard like baseballs stuck under the surface of my body... requiring my arms to hang like a gorilla.   

I was shocked to find that having my photos on the blog did not just make them visible to you who are reading the blog.  It made these photos visible on google search with my name and personal information.  I have removed my photos and replaced them with this space marker and the link to take you to the photo site.  If you asked for a password, it is rosey2012  I don't mind sharing them with women who are looking for information.  But not for the world to view with my address, and personal information. If you right click you may choose "open link in new tab" and not lose your place here.  I know it's a little more inconvenient.  I apologize for that.
     

They have been in my body since 12/6/2010.  We have a love/hate relationship.  They have for the last year and 7 months been sources of great pain, discomfort, agony or torture.  I hate the pain.  I love that I have the option to build foobies (fake + Boobie = foobie) and to feel feminine in a dress.  Not so much like a trussed turkey with hot silicon "chicken tenderloin" breast prothesis, harnessed inside a chicken wire bra.  Okay the bra is not quite that bad.  But the whole kit is heavy and hot.  I am so ready to pass them on to a needy person.
     They wanted to see me asap, which happened to be this morning. Dr. Jon poked and pushed and said..."You are right, you are way softer than you have ever been but there is still some tissue expansion in there."  But he was proceeding with the idea of surgery this Monday, July 2nd for my "second" stage exchange.  That means replacing the TE with real implants, the Second Stage surgery.  Then Dr. Puckett made a visit and decided he was not convinced it is a leak, perhaps there was just to change to my "capsule cavity" or to the muscle itself.  They all agreed I was mushy/smushy so Dr. Puckett said, "Let's fill you up to the rim and see what happens.  They did a 90 cc fill and I did not feel any pain, none of the "dislocating my ribs" level of pain that I considered normal.  I had only the sense of pressure against the skin and the weight.  
     I have reached the holy grail....750 cc. The largest silicon implant in the Mentor brand is 800 ccs.  So when you reach 750, they know you will accept the 800 without trouble.   I did leak back though the needle site.  Once home, it FELT like the TE was softer.  I fully expected to call and tell them there is a leak.  But upon observation, I realized I still feel pressure against the skin and the ribs, so if there is a leak, it is not a gushing leak.  I am in a holding pattern until Tuesday morning when I see Dr. Puckett again.  I will report the results to you.  Do we have a miracle or do we have a leak.?   Dr. Jon asked me if I believe in magic.  I told him 'no.  I believe in miracles."   At the end of the post, I will show photos of fully expanded pucketts.  
     Let me me clear.  As you scroll down, you will see NAKED reconstruction photos.  They are not gory.  Certainly not pornographic, but you may not want Jr or Juniorette walking by as your scroll through this page.
     I have also gotten a few questions of curiosity from some by email, who just aren't really certain "breast reconstruction" meant or what the result is.  So I have bravely set forth to assist in your education.  A reconstructed breast is nothing like what Pamela Anderson sports around.  At the VERY end I will show successful before and after reconstruction images so you understand what is possible as well as what a normal expectation may be.
     Mine are fondly referred to as the "Pucketts".  Of course some of you may not know that Dr. Charles Lin Puckett is the surgeon who PLACED these instruments of torture in my body.  I love him.  sigh.  I got recommendations of him as "an excellent knowledgeable doctor with no sense of humor."  I don't know which Dr. Puckett they saw.  My Dr. Puckett, an older gentlemen who is slow to speak, listens intently, grins widely at me and maybe it's just cause I'm his favorite patient.   *wink*   He jokes with me and laughs.  So if a friend or reference says...this doctor is excellent in skill but he has no sense of humor, go interview him.  It may have been your friend without the sense of humor.  Doing a consult with a doctor is not hiring him to be your doctor.  Making a second appointment isn't either.  You haven't really hired a doctor until you sign the consent for treatment form.  And I suspect at the last minute you could still climb down from a table and say..whoa, I'm done, outta here, I have changed my mind.  I'm not doing surgery...and you could probably pull it off.
     To add clarity for those who do not know me, I had a Bilateral Mastectomy in Dec 2010 for Lobular Breast Cancer.  After research and determining who I was and how I dress, I decided that while I might be able to deal with a breast prosthesis on a temporary basis.  I could not however look at the future and accept that I would either be flat or wear the whole mastectomy bra get up.  I did not want to think about it that much.  So I interviewed with Dr. Puckett and made arrangements to have him do my Reconstructive surgery.
     My first visit with him after the surgery, I sternly told him that I had not been informed that Tissue Expanders (TE) were constructed of concrete and rebar.  I love my doctor and he listens to me, but I found it pretty much across the board; plastic surgeons typically don't volunteer information such as THIS IS GOING TO REALLY HURT.  My actual breast surgeon (The doctor who actually the removed the breast tissue before Dr. Puckett came in to rebuild) asked me later if I felt I had been prepared for the reconstruction process.  I emphatically answered NO.  I was told, "It will require a longer recovery than if I just had a mastectomy with reconstruction coming later."  I was not told "Because it will hurt, spasm and burn like fire from Hades itself."  

These are filled Mentor brand
 Tissue expanders

 aka "the Pucketts" ----->

The tissue expander looks like when empty--->
It has a soft ridged texture...kind of like that piece of gummy that got lost in the bottom of your purse, with all the fuzzies stuck to it.  That's how it felt.  Not velvety, not bumpy.  But when you ran your fingertips over the surface there was a soft drag of  resistance.

Some expander brands have ports that are not part of the actual expander, but the expander has tubing connected to a port sutured in the skin.  Thank you Jesus for sparing me of that.  I'm a side sleeper (Once this all healed enough) and if I had those ports sewn into my sides, I would still be sleeping on my back.  *shudder*

The round dark circle is where the needle is inserted IN your port to fill the expanders once they are.... implanted.  The circular port is magnetized metal.  The doctor takes this small magnetic device (shown below) and moves it across your skin.  When the device is moved over the area where your post is located, the magnet immediately stops and essentially POINTS at the port.  The doctor presses down on the pointy end piece and it leaves a small X imprint on your skin.

I looked for a non bloody image of the expander in place.  I didn't want to gross you out too much.  The expander is pushed under the pectoral muscle and as it is expanded, scar tissue surrounds creating a "pocket" or "Capsule".     The implant is "exchanged" months after the surgeon feels he has expanded enough OR the patient has decided this is enough or can't tolerate more.  That is called your EXCHANGE or Second stage surgery. and it supposed to be less painful.  A resident told me Dr. Puckett doesn't use drains for the exchange surgery, I hope he doesn't find a reason to make an exception for me.  Supposedly the concrete bra sensation goes away.  Many women after the exchange surgery refer to the implants as smooshies, squishies or foobs.                               

This photo is nice and all but the depiction of the
syringe is totally out of scale.

This is what they bring in to do the actual expansion,not that little syringe shown in the above photo.  Those two HUGE syringes contain 60 ccs each (one for each side) but they connect to a itty bitty (diameter/gauge wise) long...butterfly needle.  You can see the green "needle butterfly wings" lower on the photo than the syringes, right above those foot long needles.  Ok. Maybe not foot long.  But they are 5 - 6 inches long.

Magnafinder is use.

For more photos of this woman's bravery through cancer treatment
and reconstruction go to Angela's Cancer Story

This image is of a brave young woman who upon finding out she was BRAC2 positive made the decision to prophylactically remove her breasts to lower her risk of breast and ovarian cancer.  She had an 85% risk before this, but her prophylactic mastectomy (PMX) reduced it down to less than 12%.   She having a "fill" or "expansion" in progress in this photo.  You can read more of her decision to prophylactically remove her breasts at April's Story

Read more of her story at
http://cancerfnsucks.blogspot.com

This is what radiation can do your skin,  muscle. This is NOT my puckett.  But this is almost as bad as mine was on day 24 of radiation when the radiation techs pushed my right elbow into my left ear.  I screamed in pain and they jumped back in horror as my red swollen tissue split and slid off to the side.  Doctors and nurses came running.  I loved who grabbed the pain meds on her race to the Rad. room.  I was given the pain medication, the scans were quickly done and then the nurses coated silvadene cream onto telfa pads to lay across the open flesh that was now weeping fluid and blood onto the pristine steel table.  They bandaged me up and then my Mr. Rosey marched into the women's dressing area, DARING anyone to stop him.  He gently covered my body with his large soft white undershirt (silvadene turns black on cotton...just be aware, the garments will be ruined) and wrapped me in my fleece cape.  He took me home.  I think he hurt almost as much as I did.

To view photo, click link and enter rosey2012 if asked

      It was a pretty horrendous experience.  If you can remember the worst sunburn of your life...then think about going out 5 days a week, day after day to get that burned all over again?  That's how radiation burns feel.  My skin literally dissolved over the whole region.   The skin, muscles and blood vessels are so traumatized and fragile, my Plastic surgeon wouldn't consider doing further expansions or surgeries for a year after this is done.  You can have skin issues up to a year after radiation is over, so he waits to pass that window.  I in fact DID have issues in the eleventh month.  I went through physical therapy and the blessed Ginny and I got the puckett ready to expand.  

     Alrighty then, I have done my best to educate you on the PROCESS of reconstruction.  After 14 months of waiting, I am able to restart the expansion part. When I first unveiled the pucketts TO Dr. Puckett, he kind of exclaimed "WOW!"  And he told me I had done an excellent job both healing AND rehabbing the skin and muscles.  He did a 60 cc expansion just moments later.  I'm now three expansions later and at 660 cc's.  And it hurts again.  It doesn't hurt too bad IF I DON'T MOVE.  But even lifting a cup to drink pulls on the muscles.  Picking up the laptop makes the muscle yell at me.  And there's a lot of pain under the scar as well.  WHICH is good in one sense as it means things ARE expanding.  Adhesions are breaking, scar tissue is being stretched and my knarly scar is being stretched and pulled.  It SUCKS.  But it's doing what it has to do.

To see photo, click link and enter rosey2012 if asked

These are my knarly pucketts.  On the left side of my chest (think backwards of this photo) you will see loose skin hanging out below.  I refer to this as my "chicken fat".  Dr. Puckett was very pleased to have that excess skin.    Having extra skin like that is helpful to the plastic surgeon. It can be pulled up and over the implant. Now the right side....this is the radiated side that is giving me all this trouble.  You will note the absence of "chicken fat."   I had some to begin with, but radiation ate it.  It is taut all the way around.  If you look closely you may note some indentation on that scar, where the other scar is nearly invisible.  A lot of my "discomfort"  this fill is stretching that scar as well.  So owie.

     So many people ask me "is it worth it?"  I think the answer will be yes.  Right now?  Well right now is not a good time to ask me ANY question.  It hurts like Hades, and I don't have great mobility around the pucketts as one does with regular breast tissue.  The pucketts are hard, baseball structures attached to muscles under your skin.  As one doctor states, turn to fast and those expanders could knock someone out.  Shove a baseball under your armpit, walk around and you have a good idea what a TE feels like.  I push through this pain because one day I want to put on a dress without having to wear those hot, heavy mastectomy prosthesis.  I want to have that confidence back.  While the pain is obnoxious and restricting, I know it won't be here forever.  It will go away and I will have a bosom that I don't have to think about.  THEN ask me if it was worth it.
     As promised, I saw Dr. Puckett today, all of us thinking I had a leak.  So after a 90 cc fill now nearly 2 lbs of water (which I will be sure to subtract tomorrow morning from the scale) this is how the Pucketts are looking.  Total in - 750 ccs.

To see Photo, click link and enter rosey2012 if asked

This front view shows the puncture mark from the needle.  Nice bilateral view of the chicken skin.  The chicken skin on the right is new.  The bandaging on the right puckett looks serious, the saline was leaking back from the injection site.  They placed a small pressure bandage there to soak up the back flow.  It still soaked into my bra and left a dollar coin size stain.  6/29/2012 

To see photo click link. If asked password is rosey2012

Bird's eye view (so to speak) of the skin and tissue damage left  from radiation.  That rippling is not supposed to be there.   I fully expect that Dr. Puckett will pull that chicken fat under the arm forward as much as possible and try to excise that damaged skin. 6/29/2012

To see photo click link and enter rosey2012 if asked.

Looks are deceiving.  These are not as huge as they look.    haha But this is a good view of the tissue expander "shelf" that is created when they are fully expanded. Much like how a pregnant woman will rest something  on her abdomen, I have been known to set the computer mouse, the remote or and my phone on the puckett shelf.  6/29/2012

I'm feeling pretty confident in saying there is a slow leak...but there is also a big change in the muscle and skin.  I am very pleased they were able to expand to 750 ccs, even if it is slowly leaking.  The skin and muscle will easily manage the implant I desire.  :)  But I must wait for Dr. Puckett to concur.  So that will be July 3rd.  I expect they will schedule surgery in the next week or two.  In surgery Dr. Puckett will cut open the lower "capsule" to let the implant fall down the chest a bit.  He will cut the inner "cleavage side" on both to move the implants closer to center and pulling them out from under the arms. (Hallelujah, Praise God and Amen!)  Then Dr. Diana told me to expect a TIGHT band will encircle my body at armpit level.  I will wear that for a certain amount of weeks until Dr. Puckett is satisfied that the implant/foobies have settled into their new home and will not attempt to climb over the shoulder.

You know the song? 

Do your boobs hang low?  

Do they wobble to and fro,

can you know tie them in a bow, 

can you throw them over your shoulder

 like a continental soldier.....yeah.  NOT good!!

These are public images of successful reconstructions using expander to implant procedures.

The Goal is not to create porn perfect breasts.

  The Goal is to create self confidence in your clothing.  

To know that you don't have to worry about prothesis slipping, mastectomy bras that are hot and heavy, the straps that keep falling down making the prosthesis sag and roll.  We are warriors, and we have battle scars.  We are beyond that.  We just want to walk down the street and no one notice our chest region.  We want to feel beautiful in our clothing without the burden of prosthesis.

Tissue expander  - Left photos.  Finished implant reconstruction  - Rt Photos

Left photo - CLASSIC shelf appearance

Bilateral reconstruction..(tape is to hold scar formation flat)

Right Mastectomy with reconstruction and Left breast lift so they match.

Some breast reconstructions ARE nicer in appearance...

Very normal in appearance

Which is before and which is after?
I wonder if I could have Dr. Puckett give me a
tummy like that too?

...And in case you are wondering, 

this is one method of reconstructing nipples.  

The Aerola is tattooed on by a medical tattoo profesional. 

And Meet the Pioneer of the 3D Nipple Tattoo - Vinnie Myers   Yes, they are flat tattoo's inked in 3D  I might do this.  lol  I think I doubt it...

http://vinniemyers.com/home.html
This one cracks me up!  I often wonder what hubs would say if
I came wearing a "nipple ring"!  Certainly would have to be less painful
than getting a real one!  
The rippling you see can be caused by certain silicon implants.

Now you know more than you EVER wanted to know about Rosey and Breast reconstruction after mastectomy.  Soon I will be starting the countdown to My exchange surgery to Squishy foobies and posting it as soon as I know.

**Disclaimer**  Please note that this post is written about MY experience.  It is not to say that everyone will have pain, trouble with Tissue Expanders, or need radiation.  I do not pretend to think to advice anyone to choose one kind of Reconstruction surgery over another.  I CHOOSE implants because of specific reasons with my doctor.

Hand over the Brownie *Warning: Estrogen Content*

*Estrogen content:  Those things pertaining only to women.  If you be male or someone who doesn't like discussing things purely female...like periods, breasts, nursing, childbirth...all estrogen topics.  You probably want to skip this one and wait for the next posting.  *waving bye bye*

On May 1^st, I returned to my plastic surgeon, who was impressed with the progress I had made over last 14 months concerning my skin, blood vessels and muscles.  Radiation burns and scars just flat out damage the GOOD stuff with the BAD.  It can continue to affect the tissue's ability to heal for up to a year after radiation is completed.  This is why he insists rad. patients wait a full year after the last day of radiation before beginning or completing reconstruction.  But as I said, he was so impressed with my skin; he promptly gave me a 60 cc expansion in the tissue expanders aka known as the "pucketts" after the plastic surgeon who placed them there.  I barely noted the expansion.  Might have been a little uncomfortable at times, but I completed my chores despite this expansion.

On the second expansion I was fine... right until I was not. I walked through the hospital and out to the parking lot, each step felt progressively painful. I was panting, not from exhaustion or heat but because each breath felt like my ribs were breaking.  I couldn't take a breath; I couldn't even stand totally upright because of the spasms in my rib cage.  Thankfully, we had made arrangements that day that "I" would drive my husband home from his work right across the street from said hospital.  I called him, still panting from PAIN, and with a short drive across the street, he immediately met me in the parking lot and took over the driving. He took me to dinner.  He took one look at me and knew he was either fixing dinner or buying it.  Sooo Cracker Barrel it was.  But oddly the next day I felt 80% better and mostly got my work done.  I even mowed a good portion of my lawn.

This week I had my THIRD 60 cc expansion.  Again initially the process was fine.  I could feel the saline going in and pushing against the walls.  But that part isn't really painful.  This time I had the forethought to arrange this visit to coincide with the time that my son gets off work.  He met me in the hospital and drove me home.  While he was here, he also mowed our back yard. (Thank you!)  

Until about bedtime, when the muscles across my chest, and under my arms started twitching, twanging, and twisting.  Even the non-radiated side got grouchy.   I suppose that’s a good thing, as it definitely meant parts of me were stretching.  But my ribs felt like they were being pulled from under my arm.  The muscles spasmed hysterically across my chest.  There was significant pain under the scar, and this is the first for scar pain.  Unfortunately it’s a good thing to have pain there, because my scar is adhered to the muscle under it.  The pain indicates it’s being pulled and stretched as well as the skin and muscle.  The obnoxious part is that the incision scar runs across the area where a nipple used to be.  So it feels like someone is PINCHING my nipple with a very large set of vice grips.  I want to yell at something or someone to let me loose but then remember, this is my reality.  

The image is all this

guy's fault!

That next morning, (Wed.)  lifting a cup to my lips, the lap top to my lap set off a symphony of pain that sounded forth from both sides of the foobs (false boobs - which I can't take credit for the word.  It's common in reconstruction circles.)  And mercy, don't sneeze in this condition!  I sneezed once and it felt like my rib cage split open and spewed alien babies all across the room. 

I'm relatively certain that I saw my stomach, lungs, spleen, heart, liver and pancreas fly across the room and like a rubber band - slap back into me.  I took every antihistamine in my medicine cabinet to prevent THAT from happening again.  So obviously I stayed pretty quiet through the day; reading was the only thing that didn't hurt.  I couldn't even walk without cradling the pucketts and praying that the sofa might magically appear in front of me.  I just felt yucky, achy and over tired, pain does that to you.

But yesterday was better than the day before, and today is better than yesterday.  Yesterday I could walk without pain.  I even made it to Wal-Mart last night.  (Yay, ME!) Today I can pick up the laptop without groaning.  I even managed to pick up clothes from the floor without wanting to scream OR curse.  The sensation of burning and stretching is still there but its better.  The ripping rib cage sensation is mostly gone. 

Before this week's visit with the plastic surgeon I learned from breastcancer.org that I had not been asking the right questions of my PS.  So Tuesday I went in with a list...what brand TE do I have?  Mentor.  What is their capacity?  560 cc's.  What am I currently filled to?  660!  ARE THEY GOING TO POP?  Horrors!  Pictures of bursting water balloons filled my mind. The resident chuckled and explained that there was no danger of rupture, they were made to overfill.  Then I asked what the largest implant I could have was.  She explained that in silicone, I could only go to an 800 cc. implant.  They don't make them larger.  But if I chose saline, I could go as high as I wanted.  (Again, with the bursting water balloon images!)  She spoke about the benefits of both and then the good doctor came in to do the fill.

Yesterday I hopped back on breastcancer.org because I wanted to know if other women who had radiation had successful implant surgeries.  The answer was yes.  I commented in one place how tight the skin on the radiated side was, much less the brick wall muscle behind it.  A fellow warrior popped up to tell me "Palmer's Cocoa Butter".  Liberally lubricate the skin (Boy, I have a thing for alliterations today.) several times a day.  Moisturized skin stretches better than dry skin and when I thought about it, that made sense.  So we went to the before mentioned Wal-Mart and I came home with my own pump bottle of Palmer's.  At bedtime, I pumped some into my hand and found it's more of a cream than a lotion.  It was thick, and smelled nice, rather chocolaty.

This morning, I awoke after a night of blessedly cool sleeping weather and smelled baking brownies.  I knew my husband left for work, but curiously I still smelled brownies.  In the empty kitchen, I still smelled brownies.  I was somewhat confused but decided I would dress for the day before continuing this brownie hunt like the brownie-hound within was insisting.  Brownies for breakfast sounded like a great idea!  (Psssstt - don't tell the Diabetic Educator!)  I pulled the nightgown off and was assaulted with that brownie smell again.  Grabbing the nightgown, I stuck my nose in it and sniffed.  Yep.  Brownies.  I looked at the bottle of Palmer's Cocoa butter and realized the brownie scent was obviously a result of the cocoa butter.  I should have realized COCOA butter.  I don't think I mind smelling like brownies, but my taste buds are sorely disappointed.  I don't have a mix in the house, but I could pull out the faithful Betty Crocker and make my own.

So if I run into you on the street, in church or in the infamous Wal-Mart, and you have a sudden urge for dark, rich, chocolaty brownies.  Don't look at me.  The mixes are in the baking aisle.