Exchange Surgery, Fat Grafting, & Week 1 Recovery

The short version: 

• Surgery went well. 
• Fat-grafting is much more significant recovery-wise than the implant exchange has been so far.  I am still very swollen and sore at the fat grafting donor site and where it was injected, but my new breasts and incisions aren't bothering me much at all other than being a little itchy from the surgical tape.
• My arm mobility is almost 100%, although I'm intentionally not over-extending or lifting more than 5lbs to allow my incisions to heal. 
• At one week post-exchange surgery I feel more like I did 4 or 5 weeks after my previous surgery, so it's significantly more tolerable this time around. 

The longer version:

Surgery Day

Ben and I got to the hospital around 6am on Monday, surgery day.  I really wasn't too nervous about the process this time.  Just ready to get it done and put it behind me.  Surgery day itself is pretty easy for me.  I just have to show up.  Everyone else is doing all the work!  

I brought significantly less stuff with me this time, since I would be going straight home afterward that afternoon--basically just the clothes I was wearing, my phone and my Kindle.  I was glad that I brought my book to read while I was waiting back in the pre-op area though, because they didn't let Ben come back there until after I had gotten my IV and talked to the doctor, which was almost two hours after I went back.  So, I guess I was pretty chill since I was casually reading fiction while I waited...

When I talked to my surgeon, he re-explained what we were doing -- exchanging my tissue expanders for silicone implants, pulling both my breasts in just a little bit to have less of a gap between them, removing my port, and fat grafting from my lower back and inserting it into the upper cleavage to soften the edges of the implants, since there was no breast tissue to do that naturally.  I told him I liked the size we'd gotten to with the expanders, but I didn't care so much about what size they ultimately were, as long as they were fairly symetrical and "fit" my body.  I think it's helpful in this process not to have too specific of a picture in your mind of what they will look like finished.  For me, that leaves less room for disappointment, and more likely to be accepting of the final result.

One thing to note (should you be going through this), is the amount of saline in the expanders does not necessarily translate the same number of CCs for the implants.  So, although I had 300cc of saline in each breast in my expanders, I knew in order to achieve the same size with silicone implants, they would likely be a larger number.  I didn't have the opportunity to choose which kind or size of implants I wanted.  I trusted my surgeon to pick the right size based on the way the expanders looked and our conversations.  So, of course my first question when I woke up in the post-op recovery room was "What size implants did he put in?" And I had to ask twice, because I was completely drugged and incoherant and didn't remember the answer the first time.

But, I got my answer:  415cc on the left and 385cc on the right.   The implants I ended up with are Natrelle Inspira SoftTouch SSF by Allergan, which are one step below the highest profile (roundest) option, and described as "smooth, full profile".   It's not uncommon to have two different sized implants in order to make them symetrical.  Since natural breasts are rarely exactly the same size (mine were not), one side might need a little larger implant to match the other.  The size and type of implant is really determined more by your chest width and size of your chest cavity.  I've read stories from other mastectomy patients that said they had 700cc implants and ended up a small C-cup. Clearly 700ccs would make me look enormous, but on someone with a wider chest and deeper chest cavity, it might not be very large at all.  It's also worth noting that the number of CCs of implant used for a reconstruction has a completely different meaning than a breast augmentation, which would be adding the size of the implants plus your natural breast size.  The point is, don't get caught up in the numbers. They mean different things on every person's body.  

But really, beyond collecting that information (and the time...I always want to know how much of the day has disappeared when I wake up from surgery), my main focus was to try and wake up and evaluate my pain levels.

It took me a little while to not feel so groggy, and they let Ben come back with me before too long (the details are fuzzy now).  I do remember having a very dry and sore throat from the breathing tube, and feeling VERY nauseaus.  I threw up several times before we left the hospital.  Evidently that's my typical response to the anesthesia.   I wasn't in too much pain, though I could feel that my chest was very sore, particularly the top portion (where they added fat).  My lower back was mostly numb, so it wasn't bothering me much (yet).  

Once I was feeling pretty alert and had finished throwing up, they let me get dressed and leave--in a wheelchair of course, which I was thankful for, because the walk from my hospital bed to the bathroom was pretty shaky.  

We got home a little before 2pm, and I went directly to bed, propped up on my pillows.  I was able to check my phone and text a few people, but my throat was hurting so bad, and it was hard to swallow and I kept falling asleep.  In fact, I fell asleep sucking on a cough drop.  Thankfully, I didn't choke on it, but it was still there when I woke up an hour later.  I was able to eat some yogurt and scrambled eggs that afternoon, but anything more solid than that was impossible for me to swallow.

When I woke up later in the afternoon, I had a rude awakening.  The numbness on my back was wearing off and OUCH.  Suddenly the soreness there was MUCH worse than my chest.  I took pain pills pretty regularly through the next evening, which definitely helped, but when you can't lay on your side or front, and your back is sore, there's nothing super comfortable.  I ended up piling pillows on top of the wedge pillow, leaving a gap at the bottom so my lower back didn't rest directly on the pillow.  That kind of worked.  But then all my bodyweight was put on my bottom and my tailbone, so eventually that gets sore too.  Getting up and walking around a little bit every once in a while was a good relief.

That evening, I was able to change clothes and take a look at myself and see what kind of damage had been done.  I noticed immediately that my arm mobility was significantly better than it was after my mastectomy surgery.  I had no problem changing my clothes myself, though I did it slowly and gingerly, and though I wasn't going to fully extend, I could lift my arms enough above my shoulders to reach the overhead light switch in our closet, items on the closet shelves, etc.  I saw that my waist was very bruised, a little swollen, and I had two small stitches on my back from where they did the fat grafting.

I'm supposed to wear a bra 24/7 for the next two weeks at least -- maybe longer (hopefully a more normal-looking one than this surgical vest that looks terrible and lumpy under every item of clothing).  My chest is taped up with clear tape, so while I can kind of see what I'm working with (which looks fine--different, but fine), I haven't focused much on what my new breasts will look like until the tape is off and everything settles down and into place. 

I did notice though that my surgeon did not use my mastectomy incisions for the exchange (which were on the sides of my breasts, kind of like sewing darts on a dress).  Instead, he made new incisions below each breast, which explained why I had some dull pain there.  I had assumed he'd use the same incisions, but I guess he decided this was better.  Once they heal, I don't think they'll be very noticable, but I was a little bummed about now having two mastectomy scars, two exchange surgery scars, two drain scars, a port surgery scar, and two new small scars on my back.  That's quite few battle wounds from this year.

Week 1 Recovery

I spent the next several days on the couch during the day and in bed at night, propped up on pillows, and just taking it easy.   

I was still taking pain meds and antibiotics, and so my main job was remembering when to take my meds and trying to avoid the post-surgery and pain pill and lack of movement-induced constipation that is inevitable.  TMI, I know, but it was a huge part of the first week of recovery and is VERY uncomfortable.  I took stool softeners and HerbLax supplements, drank coffee and lots of water, and eventually that worked and I had some relief.  It's also an incentive to STOP taking the pain pills since they cause a lot of that, so by Wednesday morning, I was only taking tylenol for pain.  The pain pills also make me itchy all over, so that was another incentive to quit taking them.

I did lots of reading on the couch, and just trying to be patient and let my body put ALL my energy into healing.  I was surprised at how good I felt compared to the last surgery. Not having drains is a gamechanging difference and were it not for the soreness and swollen feeling from the fat grafting, I think I would have felt amazing right away.  I was able to do pretty basic tasks like making coffee, emptying the dishwasher, and heating up my own food, etc. which were good ways to get me moving around a little bit each day.  Walking around definitely hurt at first, because of the bruising, but each day lessened a little bit, making it easier to move around.  

While the bruising on my back and sides went down and didn't look too bad, my lower back became much more swollen and has stayed that way the rest of the week and has by far been the main focus of this recovery.  It feels like I have a fanny pack attached to my back.  It's numb in some spots, tender to the touch, itchy as nerves come back to life, and my waist feels about 2 or 3 inches wider than it normally is.  I barely notice my incisions from the exchange, but I definitely feel the bruising and tenderness where they inserted the fat on my upper breasts.  I hope the fat grafting "takes" because I'm not interesting in signing up for this part of the process again, which is an option down the road if I'm not happy with the results. I'm gonna have to be REAL unhappy with the results to do this again though.

Thursday and Friday I did some work at my desk in the mornings, and then spent the rest of the afternoon and evening on the couch resting and reading.  Physically, I am definitely tired and moving slower than I normally would, but mostly I'm feeling good.  Mentally, I am doing MUCH better than I was after the last surgery.  I know it'll just take time and I have to be patient, but everything will feel "normal" again eventually.  

By Saturday, I was ready for my first trip out of the house, and went to Ayla's volleyball tournament, here in town.  It was admittedly ambitious, especially since it required quite a bit of walking from the parking lot to the court & back.  But I decided to take a pain pill to get me through it, which was a good choice.  

Sunday, I was able to drive myself to the tournament (no pain pills that day) and sat through several matches as well as lunch at a restaurant with Ben's parents. By the time I got home that afternoon, I was pretty exhausted.  

This week, I expect to be back to a mostly normal workload and daily responsibilities.  I can accomplish most of the things I need to do without too much physical activity, so it'll still be a pretty restful week.  I don't expect to be cleared to exercise for at least 3 more weeks while everything heals and settles into place, so I'll continue to lay low until then.

I'll see my plastic surgeon's nurse next Monday and be able to take the tape off my incisions at that point.  And hopefully the swelling will be down by then? We'll see...