Jan. 22, 2019 -- It's been almost two weeks since I last posted. A lot has happened! Everything was going perfectly: the drains were out, my skin and nipples were doing fine, and I'd had my first fills. Then on Sunday morning, Jan 13, about 3.5 weeks since my surgery, I woke up and my left breast was rock hard. I knew something felt different. Also, that problem area of inflammation and edema that I'd had after my breast reduction was back. I was concerned. I emailed Dr. Brown (plastic surgeon) and told him what was going on, attaching a couple photos. I mentioned that I had about a week's worth of the antibiotic he had prescribed post-surgery. (They had re-prescribed it when my mastectomy date changed and I decided to pick it up just in case.) Great doctor that he is, he emailed me back right away and said to start taking the antibiotic just in case it was an infection and that he'd see me on Thursday for my already-scheduled appointment.
Fortunately, I had my surgical follow-up with Dr. Wright (breast surgeon) for the next day, as I really didn't want to wait until Thursday to be seen by a doctor. Over the weekend, we'd gotten 10" of snow and I was worried that Dr. Wright's office would be closed, but it wasn't.
Dr. Wright examined me and I described what had changed. She decided to do an ultrasound and discovered that there was fluid buildup between my skin and the expander (temporary implant). She left the exam room to call Dr. Brown, and then returned to say that Dr. Brown wanted me to stop by his office after I left Dr. Wright's office! I feel so fortunate to have a team of doctors who really care about their patients and take the steps necessary to make sure you are OK.
So, off we went to Dr. Brown's office. To remove the fluid build up, he took one of those gigantic 60cc syringes (that I described in my last post), and took out about 75ccs. It looked like the fluid that I would see in my drain bulbs. I did feel some relief from the pressure, which was good. He decided to switch my antibiotic to Doxycycline, which he said was more targeted. He told me to keep my Thursday appointment.
Back I went on Thursday of last week. The area of inflammation was not much improved. It tended to be worse at night, and better in the morning, but it wasn't going away. Dr. Brown decided to go ahead and do my 2nd (and last) fill of 60ccs each side, and then withdrew more fluid from around the left implant. The amount was way down (about 25cc), which was a good sign. He also decided to put me on a SECOND antibiotic, Sulfamethoxazole. He wasn't sure if it was an infection or not, but if it was, he said it's important to knock it out. Otherwise, worst-case-scenario, I would have to get the entire implant and pocket removed and then redone later. The two possible things he said might be going on are "hyperemia" and "cellulitis". [Passive hyperemia is when blood can’t properly exit an organ, so it builds up in the blood vessels. It's also known as congestion. Cellulitis is a bacterial infection that typically occurs in the deep layers of the skin.]
Now it's Tuesday, 5 days later (today). Saw Dr. Brown this morning. Since my last visit, the area of redness has extended slightly, but other than that, not changed much. Dr. Brown explained to me that my case is kind of in limbo. Still not clear what is going on. He said that what he recommends is that I have an outpatient procedure next week (currently scheduled for next Wed afternoon, Jan 30). The procedure involves removing the current implant from the pocket (but leaving the pocket in place), flushing out the area to make sure there is no bacteria, inserting a new implant, and sewing me up. They will culture the fluid to determine if there was an infection. It will take about an hour and a half. Not exactly what I wanted to be doing next week, but oh well!
I'll come out of surgery with 1 drain and he said he plans to try another Prevena Wound Vac since that worked well for me. (See this post for more on Prevena.) So, out come the drain aprons again!! Since I'm an optimist, I'm choosing to look at the bright side. My nipples are fine and I'm SO happy I decided to save them, I don't have any skin necrosis (where the skin turns black and dies and has to be cut out), and this procedure is to make sure nothing more serious happens.
I had scheduled my "exchange" surgery for late April, but we'll have to see if that date still works.
One thing I love to do while I'm recuperating from all these damn surgeries is to work on jigsaw puzzles. It takes a lot of mental focus and I LOVE doing them. The one in the upper-left is 2000 pieces and took me about 5 days. The others are 1000 pieces and take me about 1-2 days. After I finish a puzzle, I admire it for a few days and then put it back in its box. If it's one I think I might want to do again, I keep it. Otherwise, I donate it to my Mom's retirement community. They have a couple puzzle tables set up in a hallway in the main building where anyone can stop by and work on whatever puzzles are in progress.
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