DIEP Flap Reconstruction

Reconstruction, oh what a word.  Well the next step in my journey, path, process, <insert your favorite term>, is a big step.  On April 21st I will be having my final reconstruction surgery.  I will be having DIEP Flap surgery at the Hospital of the University of Pennsylvania in Philadelphia, also known as Penn Medicine.  Penn performs this surgery more than any other facility in the US and has a success rate over 99%.

DIEP (Deep Inferior Epigastric Perforator) Flap is an intense surgery that involves taking tissue, veins, and arteries from my abdomen and essentially transplanting them to my chest.  That is the simplest explanation, I’ll give a little more detail down below so those that are somewhat squeamish can bail out before then.  You may recall that I fainted during my first biopsy so I completely understand, as fate would have it I am not as squeamish as I was two years ago. 🙂

I mentioned that this is an intense surgery, I typically understate things and am probably doing that here. The surgery itself will likely be about six hours long, my surgery will be a bit shorter than some experience, since I already had my bilateral (double) mastectomy, my surgeons will not have to remove any breast tissue.  I will be in the hospital for five days including the day of surgery, the nurses and doctors will follow me closely during the hospital stay to ensure that the blood supply to the “Flap” or transplanted tissue takes and stays working.  Because Penn has such a large focus on this surgery I’m not too worried, I know that I’ll be in good hands, the best, actually.  I will come out of surgery and from the hospital with four drains (an all time high for me), these drains are basically tubes that go into  little grenade-like things, I like to call them blood grenades.  They’re annoying, somewhat uncomfortable, but they perform an important job of preventing fluid build-up in the area of surgery.  I’ll have two drains on my chest and two on my stomach, they’ll remain in for 10-14 days, perhaps a bit longer.  I will be staying in Philadelphia for about two weeks following surgery, I may be able to go home sooner but we’re planning on two weeks.

All of this does leave me a bit nervous. Being four hours away from home, relying on the kindness of family and friends in CT and PA, having another significant surgery, going back into recovery mode, etc.  I don’t doubt that this is the right choice for me, but I know the road ahead will have pain and work to get back into full health.  Before my mastectomy I had no fear but also no firsthand knowledge of the extent of what I was facing.  Now I have a much better picture of recovery.  I’m not fearful, but I’m aware, much more aware, and that’s OK.  Please pray for me, for us, during this time.  God has been beyond faithful to us, meeting our needs and giving us strength when we had none.  We will be praying for a smooth surgery with great veins and arteries to use, good pain management, smooth healing with no complications, and a good transition for all of us.  Please hold our girls in prayer too, they will be cared for by my parents (pray for them too) and some friends.  I expect they will thrive, but it’s been a long road for them as well.  Matt or I will keep you posted as we continue!! 😀

—— Bail Out Warning ——

DIEP Flap has been around for several years now.  It involves cutting a hip-to-hip ellipse shape (or eye shape) on my abdomen.  Then the primary veins and arteries circulating blood are found, these are followed further into the abdomen by cutting through the fascia and muscle and tails to both vessels are cut.  These arteries and veins will be attached to the mammary vein and artery near the sternum.  The tissue (aka fat) will then be used to form a breast or foob (fake boob).  The fascia and muscles in my stomach will then be sewn back together and my skin pulled together.  For the curious, here are a couple links: a basic description of DIEP Flap and a really interesting abridged video of a DIEP Flap surgery.  I actually watched the video and I did not pass out (!!!) it’s really interesting and further confirmed my conclusion that these surgeons (really all of my Docs) are rockstars.

For the Post-op Curious

I haven’t posted too many pictures here on the blog, mainly because of lack of energy and/or time. I know heading into my surgery I was curious about what this was going to be like. I knew I would have drains and these things that would slowly release pain med over a few days. I had no idea what that would be or look like.

It hasn’t been as bad as I expected.  I have more range of motion that I anticipated having, that’s not to say I’m anywhere near normal but I could wash my hair if I needed to but showers are a no-go for now, I’m hoping my plastic surgeon will clear me for careful showers today.  There’s quite a bit of pain, especially if I haven’t moved much, getting in and out of bed is tricky though it is made easier by our bed being very high off the floor.  The stairs in our home haven’t been awful, but the meds I’m on mean I need to “proceed with caution”  Matt generally tries to chaperone me.

Now for the appearance side of things.  My plastic surgeon was almost like a child on Christmas, he was very pleased with how the incisions look and how my “breasts” appear.  I’ve seen the incisions and I didn’t pass out which is noteworthy given my experience with my first informed consent of this entire process.  I have some pictures below (NOT of the incisions) that show my super haute fashion surgical bra, the drains (we call them blood grenades), and the OnQ pain pump.  I’m sharing these because I was curious and that’s normal and healthy.  Breast cancer is a big deal and it affects thousands of women, many of whom we know personally.  Any women that has a mastectomy (single or double) will have a similar set-up to me.  This is about information and sharing what this experience has been and is like for me.  My hope is that this is a help to someone, just as sharing this is a way for me to process through all these changes.

NOTE: if you are sqeamish and don’t do well with medical stuff or blood, feel free to skip the pics. 🙂

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So this is it! Part of what my surgeon was so excited about is that I am not 100% flat. When he inserted the tissue expanders he was able to begin the expansion process (at least thats how I understand it). Those bulb-y things are the drains. The tiny tubes lead to the OnQ pump which is in the black bag/fanny pack thing. The surgical “bra” kind of redefines compression wear. I mean I love compression leggings for working out but this is to tight that I have breathing exercises to do each hour.

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Initially when I came home from the hospital the OnQ pump (black bag/fanny pack-type thing) was pinned to one of the drains. Wearing it like a fanny pack is much more comfortable.

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I have two drains (one on each side) they connect into my side and are pretty basic, they help drain excess fluid which helps to prevent infection and speed healing. Matt empties them 3x a day and records how much fluid is in each “grenade”. I mean really don’t they look like little blood grenades? But don’t worry most of the fluid in the drain is not blood, it’s a mix of water and other fluids with a bit of blood. These drains will probably come out in a week or so.

So that’s it.  I hope this has been or will be a help and encouragement to someone.

Love, Hope, and Laughter!!

The Surgery

Bilateral mastectomy with sentinel lymph node dissection and possible axiliary tail dissection with reconstruction.

That is the name of the surgery I will be having tomorrow morning (8/11) at 11:15.  In non-medical terms it means I will be having both breasts removed, during surgery the Doctors will remove and biopsy the primary lymph nodes, there’s a possibility of removing more lymph nodes but that will be determined during surgery.  The plastic surgeon will also begin reconstruction, this process will take a few months to be finish.

I am as ready as I can be for this surgery.  This is what I had decided to do in March and I haven’t really had any doubts about whether this was the best option for me, it is.  Removing the breast that has the cancer is kind of a no brainer for me, since I have two confirmed tumors and a possible third (which was not biopsied because I planned to do a mastectomy) even if a Doctor would recommend a lumpectomy there would be very little breast tissue left.  Most Doctors that I have spoken with recommend a mastectomy because of the multiple locations and that the locations are in different quadrants of the breast (they view the breast as a pie divided into quarters, the tumors are in different quarters).  Removing the unaffected breast isn’t really necessary from a medical standpoint, the statistics say it is very unlikely that the cancer would move to the other breast in the case of recurrence.  So while I am only changing my chance of recurrence by 1-2% I still feel that 1-2% and some peace of mind is worth the extra recovery time.  And to be honest I like symmetry and let’s face it a single mastectomy with reconstruction would not be symmetrical.

This is clearly a deeply personal and difficult decision.  Breasts are a source of cultural controversy and over-sexualization in our world today, whether it’s talk of public breast-feeding or the exploitation of women it’s easy to forget that at the end of the day this appendage can nourish my children and attempt to kill me. 😉  All joking aside, this is not a completely simple choice, though in some ways it was for me, I have spent many hours working through this choice.  For the many women that face breast cancer each day this choice looks different and there is no “right” decision, there’s also no “right” way to come to a decision.

So as we stare down the final hours before surgery I have complete peace in my choice, in my Doctors (seriously, they are great!), and in this time.  I know that recovery will take time and effort and will bring pain, but nothing in life is easy and the plan is for this to bring me many more years of life so it’s worth the work.  If you pray, please join with us tomorrow and know that the support, care and love we have felt is simply overwhelming.  Thank you all for loving us.

This verse was shared with me and it has carried me through much of this time:
Isaiah 43:2
When you pass through the waters,
I will be with you;
and when you pass through the rivers,
they will not sweep over you.
When you walk through the fire,
you will not be burned;
the flames will not set you ablaze.

 

Love, Hope, and Laughter!!

Short changes

When my first Little was born I had short hair, think pixie short.  I knew I’d never get it cut often enough to maintain that, plus my hair grew so fast during pregnancy I had to let it get a bit longer.  I had been working with pediatric hematology/oncology patients and their families during my pregnancy so I decided to let my hair grow and possibly donate it in the future.

Cut to (no pun intended) three years, or so, later and I was ready to donate.  Last Wednesday I cut off 13 inches of hair, then to get the cut about another 5 inches went.  Here’s the photographic evidence of the event (read: fantastic event).

Front before

Back

Front after

Back 🙂

So I have 13 inches of hair being sent into Pantene Beautiful Lengths: (http://www.pantene.com/en-US/beautiful-lengths-cause/Pages/default.aspx).  I’ve had my hair all sorts of different lengths from very long to very short.  I have never donated my hair before and I’m not sure that I will again but I’m glad that I am this time. 🙂

New Year, New Starts?

Just when I’m starting to get used to write 2010 (I don’t write the date that often apparently) its going to become 2011.  Maybe I should just start writing 2012 and I’ll settle on 2011 for the year… 🙂

I find the change of the year to be a thing of new starts or fresh starts.  Kind of like a reset button for life.  But I really think that is somewhat a mental thing because nothing magical happens at midnight tonight.  Its just a time and date that was settled on a few years back, or many years back as the case may be.  It isn’t actually a reset button for life.  The joys and hurts of today will remain tomorrow.  I think its easier to look ahead when something is beginning rather than in the middle or end.  Perhaps we tend to look backward more than forwards when something is drawing to a close.

I’m not one for resolutions but I think this year I want to try to keep my gaze forward.  Looking to what has yet to be fulfilled in my life and the lives of those around me.  Rather than looking behind and wishing or hoping that I had done better or differently.  I want to strive to learn from my past and grow from it but live in the present and prepare (to the best of my ability) for the future.