...and here we go!

As I said, I met with the plastic surgeon on Thursday. The office staff was great and the doctor was fabulous!  They spent a lot of time with me...I mean a lot...discussing options and answering my questions. There are several options for reconstruction. In the interest of time (and relevance) I will only cover the 2 options for which I am a candidate. If you want to know about the others, let me know and I'll post information in a separate post, with links to the details.

Here is how the rest of the post will work. I will take the time to type, at length, the procedures and how they were described to me, including length of procedure and recovery time. I will also post links to sites which will provide diagrams and general information about the procedures including length of procedure and recovery time. I'll tell you now, the numbers I was given vary quite a bit from the standards. From what I can tell, the difference is the fact that I had radiation. I could be completely wrong there but that does introduce some additional complications for this whole process.

For reasons which will become clear with the review of procedures, the first step in this process will be to have a CT scan to ensure that blood flow is good to the muscle that will be moved. That will happen in the next couple of weeks.

When we get closer to the actual surgery (planned for January) I will have to start the preparation well in advance. I've had about 10 surgeries in my life so preparing for surgery is not new to me. The preoperative bathing instructions for this procedure are real. Not because of what needs to be done but because of the length of time I will have to do it. I will have to start the process 2 weeks prior to the procedure. In addition to the Hibiclens, I will also have to use Bactroban Nasal Ointment for a week prior to surgery. This is an effort to help minimize the risk of a MRSA infection. Infection is, obviously, a big concern with these procedures.

This procedure uses a flap of skin, fat and blood vessels - Deep Inferior Epigastric Perforators - to reconstruct the breast(s). There are positives and negatives with this procedure. For me, the negatives outweighed the positives so this was not the procedure I selected. Let's do a bulleted list for this one, shall we?

She offered to refer me to the other plastic surgeon for a consult, but I graciously declined. That leaves with me with one option...well, one option other than choosing to skip reconstruction completely. I considered that for a minute but I have decided to move forward.

Here we are. The information on the "winning" procedure. I am not terribly excited about this procedure BUT my outlook has improved in the past 24 hours.  I've watched a series of videos on the procedure and at the end of one them, the doctor interviews the patient and she discussed her pain and recovery time and her experience wasn't bad. I typically recover pretty quickly from surgery so I'm hoping the same may be true for me. Her situation was different because she had her mastectomy and reconstruction at the same time. It still makes me feel better about the whole thing. We'll just have to see what happens for me.

First I'll have to provide you with a little bit of background information. My reconstruction options and the experience will be a bit different because of radiation. They told me from the very beginning that I would have to delay reconstruction for at least 1 year after radiation because of what it does to the skin. I mistakenly thought that my skin held up well and that meant that reconstruction wouldn't be too challenging. I was wrong. How your skin looks doesn't matter. Radiation changes your skin at the cellular level. It may look normal, other than being a little tan, but it most definitely is not. To give you a better idea of what we're talking about, the doctor told me that if we were to proceed with the placement and filling of the expanders without doing the flap procedure, the skin (on my left side) would simply split open. No exaggeration and it's 100% sure to happen. Ew. I mean really, EWWWWWWW. Even with the flap procedure, she warned me that my skin will open up but she'll be able to put a few stitches in and send me on my way. This could possibly happen multiple times during the expander phase. I got a little nervous at this point and asked her if she had ever had to stop the process completely and she said no - not yet. :-)

 Doctor and nurse friends, please don't judge my feeble attempts to explain this correctly. Know that I am including a link to a page that explains it correctly. Now, on to the procedure itself. My plastic surgeon expects that procedure (for the left side only) to take approximately 6 hours. I assume that means that by adding the work on the right side, I'm looking at up to 8 hours of surgery.
The Latissimus Dorsi muscle is the muscle in your back that runs from just below your shoulder blade down towards your hip. They will make an incision in my back, release the muscle from it's current position (cut it out) while leaving it attached to its blood supply. It will NOT be cut completely free. There will be a band of muscle that stays attached and the whole thing will be pulled around from my back to my chest. They will cut open my existing scar then pull the lat muscle through, situate it, and sew it in. Once this lovely procedure is done, they will insert the empty expander and stitch me up. This is a very oversimplified description but you get the idea. I will wake up with 3 drains (you know how much I loved those things the last time around- SARCASM ALERT), 2 in the front and one in the back. I'll also have a catheter in my back for pain management. I'm not sure how long that will stay in. I will be in the hospital for 2 days. I will keep the front drains in for at least a week but the back drain will stay in for 2-3 weeks. Did I mention how much I hated the drains the last time? Anyway, recovery time is estimated to be 8 weeks. If you want the professional explanation, here you go. There are diagrams and everything!

Latissimus Dorsi Flap Reconstruction - TownsendMajors.com

After surgery (and recovery) I'll get a wee bit of a break. They have to wait for my surgical site to heal and the new tissue to work its magic. The increased blood flow will improve the skin situation but we have to wait and let it do its thing. I will have to wait approximately 6 months before they can start expanding the expanders. When that process starts we'll get a better idea of how long it's going to take. They will gradually fill the expanders and we'll see how my skin holds up. Like I said, she expects to have to stitch me up a few times but she says we'll be successful, even if the going is slow. It will likely take a few months, at least. I've heard that the expander experience isn't so bad and I've heard from others that it was excruciating. As always, I'll plan for the worst but expect the best.
After the expander experience, we'll then plan the actual implant surgery. That surgery will consist of an outpatient procedure with small incisions. I'll go home the same day and have a 2 week recovery. OH, and NO DRAINS!!
After the implant procedure, I have to wait about 3 more months before we can proceed to the tattooing phase.
I told you it was going to take a year...no kidding.  We are going to start in January so we can try to wrap it all up in a single calendar year. That sounds really far away but I have a little over 2 months to get mentally, physically and generally prepared. This is a significant improvement over the 2 1/2 weeks between diagnosis and mastectomy, so I won't complain. It seems like an eternity.

I think that covers the basics. If you have questions, feel free to ask. As always, I'm willing to answer.
Whew! I made it! 

As always, I will keep you updated on the process and planning and, when the time comes, the really real truth about the procedure and the recovery.

Bye for now.

Love to all,

Andee