Thursday, February 25, 2010
Building a foob...
Well, yesterday I hope I didn't bore you guys too much w/ my terminology. Today I may bore you again b/c I'm going to explain how my foobs are being built. Since I already have been diagnosed with breast cancer its a different process than breast augmentation, but many of the same things are used. Here's Foob Construction 101!
*NOTE* if you're squeamish about the words breast or nipple, you're probably going to want to skip today's post!
First, my breast surgeon cleaned out all my 'bad' breast tissue. To do this she cut slits running vertically under my arms. She must have used something to scrape it out, but I'm not going to go there b/c it may make me psych out & gross you guys out! However, I do know & find it interesting how she preserved my nipples. Typical mastectomies (even w/ reconstruction) throw away both nipples. That's initially what I figured I was going to do. Afterall, how can you keep nipples & expect to get *all* that possibly cancerous breast tissue out? Initially, I thought - nipple sparing must be a *BAD* idea! However, when I found out I wasn't going to be able to have the reconstruction done with my own tissue I was more than willing to keep a little bit of normalcy, so when the breast surgeon asked I said yes. It also helped that my breast oncologist didn't shy away from the idea. Actually, she said that if it had been any other surgeon, she probably wouldn't recommend it, but since she knows how thorough this surgeon is, she thought it would be a good idea.
Anyway, back to building a foob... While the breast surgeon was cleaning out all the possibly cancerous breast tissue, somehow she *turned my nipple inside out* and scraped it free of tissue. Yes, I said *turned my nipple inside out*! Isn't that nuts? I've got a mental picture of how I clean a bottle nipple in my head only its *my nipple* that's getting cleaned! After removing all the breast tissue, the breast surgeon was finished. Then it came time to build in the newly excavated space! That's where the plastic surgeon comes into play.
The plastic surgeon evaluated my skin, muscle, and nipples to see if he thought he could produce aestheticly pleasing results. I had already agreed that he got to make the final decision in the OR. He apparently approved of the breast surgeon & my overall anatomy, so he began his work. His first step was to create a 'pocket' under my pectoral muscles for the expander/implant. I'm not exactly sure how he did that, but I'm guessing its one of the reasons I'm in pain. Then he placed an expander in that pocket. This pocket us kind of an upside-down envelope - the open end is down. Placing something in a pocket of that orientation doesn't do you much good unless you close the pocket somehow.
So, they've developed a biological mesh that they seal the pocket with after expander/implant placement. The mesh was actually live skin at one point, but it has been stripped of all cells until it is only fibers. Some of the mesh is derived from human skin (cadavers). Other types of mesh are derived from animal skin. I think the ones used in me are from animals. It was the plastic surgeon's choice basically. I don't know what the benefit of animal vs. human mesh is, but since I'm trusting these people w/ my life, I'm pretty much giving them free rein if it sounds reasonable. Anyway, the plastic surgeon stitched the mesh to both my stretched pectoral muscle and my underlying chest wall. Eventually, the mesh will be completely covered with my own tissue as my body heals. The final steps were installing the drains and sewing me back together.
I don't know the reasoning, but apparently expanders do *not* look anything like a normal breast. I'm guessing that he placed it in the position that he did because of my anatomy and what I eventually want to look like (me). The beauty of the expanders is that they can be filled with different amounts of saline to stretch the pectoral muscles enough to allow a decent sized implant to be placed. At this moment, I think mine is filled with 300cc of saline or about 75% of its contents. I think that's what the plastic surgeon told Andrew & dad while I was still practically unconscious.
Hopefully, tomorrow when I visit the plastic surgeon, he's going to add some more saline to the expander before sending me home. I think this will be a weekly or bi-weekly process for at least a month. The plastic surgeon here in Houston has *hopefully* arranged for me to see one of his friends at UofL that is chief of plastic surgery for my other fills.
When the expander has met its maximum and/or I achieve the size I (the plastic surgeon?) want, it will be left alone for a month or two (or more depending on what you read/hear). This is to make sure that when the expander is replaced with the softer implants the tissue won't shrink back to its normal size. That's one of the biggest complications of this type of reconstruction (and even augmentation) - contracture. Basically, my body is allowing this foreign body for now, but once its removed, my body will want to go back to its normal shape. Regular breast implants are not structural at all - they're meant to be as soft and flexible as possible, like a real breast. So if the implant is placed too soon and my body still 'remembers' what my pectoral muscle was like before, my body will build scar tissue around the implants and destroy them. Not the end goal I want.
Once my body has accepted its new shape, I'll have another surgery to replace the expander with the implant. At this moment I don't know whether I'm going for saline (safer, but more prone to fake-looking problems, etc) or silicone (more natural-looking/feeling, but can cause problems if it ruptures). I also don't know exactly what size I'm going to be. These are things that I plan on asking the plastic surgeon tomorrow. I'm also going to ask him to remove at least one drain and hopefully replace the ones I have with smaller ones. These things are driving me crazy!
Well, its time for more pain meds & maybe something to eat, so I'll say g'bye for now!