Long drive...

Well, Friday after my doctors appointments we got immediately on the road & headed North on Hwy 59. Man was it a LONG trip. I keep myself doped up with hydrocodone (10 mgs) every 4 hours and Ativan every 6. I was still pretty uncomfortable. We got home around 130 am. It felt really nice to be home! My brother-in-law had stayed at our house & cleaned it for us. It was really nice.

Recap of my doctor's appointments... The breast oncologist didn't have my pathology reports yet, so she didn't have much to say to me. She gave me a hug though & looked really pleased at how well I came through surgery. She reiterated for me that she didn't think I had anything to worry about by skipping the last chemo or by keeping my nipples.

The plastic surgeon was pleased with my progress as well. He told me that the swelling will go down & that these expanders are not indicative of what my future shape will be. They removed one drain on each side and replaced the remaining drains with much smaller bulbs. They also filled my expanders with about 100cc more saline. Hopefully, tomorrow (Monday) he'll get in touch with his friend at U of L to be my 'local' doctor. According to Dr. S, the U of L doctor is head of the plastics section at their hospital (or something). The plan will be for me to get expanded weekly for about a month. Then once I'm all expanded, the expanders & my foobs will get to 'rest' for 2-3 months. The worst complication that could happen right now is if my expander comes out of the pocket b/c the mesh hasn't completely bonded with my muscle tissue. He's pretty confident I'll be fine though.

Right now the worst thing is that I'm almost completely helpless. I can't raise my arms/hands above my head both b/c of doctors orders & the pain it causes. I can't pick up Rachel or even lift her from laying to sitting for the same reasons. I'm shaky & weak from the medicine. I'm also really emotional. Its awful. I'm such an independent person and it kills me to need help with almost everything. Its probably going to be at least 2-3 weeks before I'm able to lift &/or do some more normal stuff.

Andrew is doing pretty good. He's stressed b/c this puts a lot extra stuff on his plate. He's also worried about me. The kiddos are doing well. I think Rachel grew another chin or 2 while we were gone. Simon is even worse/better at his parroting abilities. They're adorable though!

My brother & his wife moved in next door too! Its great - they have an almost 4 year (in March) girl, Abby, an almost 2 year old (in March) girl, Sarah, and a newborn (January) boy, Lukas. Laura, the wife, is a dentist for UK. She sees all the kids on state programs & such. My brother, Rowan, is in aeronautics. He owns his own business (partnership) called Ron Collins Avionics, now located in Henderson. Anyway, they're a lot of fun to have araound! It's going to be great for Simon & Rachel to have similar aged cousins right next door! Laura & my parents are also great cooks, so I'm looking forward to some AWESOME meals! Anyway, welcome home Jones family!a

Foobie goobies...

Well, I typed too much earlier & made my arms swell up, so I won't do as much tonight. My drains are also leaking out my back. A good portion of the fluid is still going through the tubes (I had the doctors check yesterday), but its also soaking through some of the gauze. I keep feeling like my back is wet, but apparently I'm just paranoid!

I'm hoping that tonight's drain output will all be below 20 ccs like it was this morning! I'm *REALLY* hoping that the plastic surgeon will take some of the drains out tomorrow. I'm just afraid that in addition to having a minimum output, there's also a minimum time for the drains. Theoretically, from my information, as soon as the drains are putting out less than 30 ccs for 2 24 hour time periods they can come out. However, I realize that it has only been a week since my surgery (tomorrow night) & its kind of quick. There can be complications if the drains are removed too soon, so I don't want that either. The fluid that goes into them is best *not* going into my body, so its a fine line. However, as of this morning I only had 1 drain that had 20 ccs in it, the others were 8, 8, and 10 ccs. I'm typically a fairly good healer, so maybe I am ready. I guess he'll let me know tomorrow morning.

Tomorrow's appointments are with my breast oncologist & the plastic surgeon. I'm not sure what the breast oncologist wants with me, but I've got *HIGH* hopes for my visit with the plastic surgeon. After my appointments we're going to start our journey home. We may make it all in one drive, but we may also have to stop for the night somewhere. It will depend on my chauffeurs! Anyway, I'll be updating again soon. I'd better quit now though b/4 my arms swell again!

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!