Tag Archives: tissue expander

9/11. Glass half full?

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So I went to the doctor to pick out new breasts. At least I hope they’ll be breasts. Or like breasts. Breast-like will do in a pinch. The things my chest has been hosting are definitely not. And I’ve found some other blogs where women are talking frankly about their breast building “process” (note how I avoid the word “journey”). Damn, they’re brave. I’m just worried. Really, really worried. Some journeys take a lifetime.

Surgery is on 9/11. Anybody got a glass-half-full line for that one?

Ok, beat you to it. I still don’t have to do chemo. This is a very good thing.

So from the get-go I knew saline implants were out of the question. I’ve examined enough women who had those placed during the 90’s moratorium on silicone to know you CAN hear them slosh. And thank G-d silicone is supposed to be lighter, as these saline tissue expanders are heavier than I could have imagined. I’ve lost weight just lugging them around. I even chickened out and had them reduced.

What a world. They’ve got “gummy bear” implants now. Feel like candy, look like pears, but are textured like expanders and scare the heck out of me because they’ve got to be bigger than those are to prevent flippage. You know, that embarrassing condition when your breast turns upside down at dinner. Maybe while serving the spaghetti.

So, I’m gonna go with the old tried & true, half-round, slick model. These are meant to slip and slide and smoosh. Kinda like breasts. As a friend said, “my mind breathes a sigh of relief at the soft ones settling into the space that’s already there. Like real breasts after menopause.”

There is sense in that. It resonates. I can do resonate. I just can’t do journey. At least not the whole thing. At least not right now.

I’m wounded and can’t get my bra off.

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Anyone tired of pain and angst and wimmen’s stuff can go home right now. But I can’t get off this bus and writing’s a distraction, so I’m gonna stay right here and bore y’all to death.

I’ve taken the muscle relaxers (the ones that cause 6 hour crying jags). And the lorazepam (goody, now I get to wake up feeling like the world’s going to end). I’ve got one NSAID pain patch plastered to my front, another to my back, and my husband nearly broke his thumb trying to push the muscle spasm or rib or whatever it is that hurts like hell back to where it came from.

Ain't it cute? Don't it look nice and soft and squishy? Nawp. They lie. And where's the stud-finder, dammit?

Ain’t it cute? Don’t it look nice and soft and squishy? Nawp. They lie. And where’s the stud-finder, dammit?

So I lie on the “Miracle Ball” for the requisite minutes and then do it again out of sheer desperation. Now I’m sitting against a yogic torture device called a Spoonk that’s advertised as the Western answer to acupuncture. All this because I’ve got what feel like armadillo plates riding against my ribs and the suckers are pulling my back out of joint.

And I still don’t have to do chemo. Yay! That heads up my gratitude list every day of the week. But tonight I’m doing my best imitation of British whinging, just for fun.

Actually, the anatomic explanation above isn’t quite right. I quizzed my plastic surgeon about exactly where these tissue expanders live and learned they aren’t just lying quietly on top of my ribs “under the muscle,” as I so casually assumed. During surgery the pectorals are actually butterflied lengthwise, their points of insertion left intact, and the expanders jimmied between the layers like stuffing in mock duck.

All’s quiet for awhile (or else surgical pain overrides awareness of anything else), but a couple weeks later, when they whip out the stud-finder to start filling the expanders (see previous post), the muscles stretch and spasm. And in my case have pretty much never stopped. I wake in the morning with the equivalent of tennis balls stuck under my skin. That’s if I slept at all overnight. I don’t remember having any dreams at all during these last two months. Once things quiet down I should have quite the cinema line-up for REM sleep.

So maybe the surgeon’s right and I have what he calls “reactive” pectorals (he is a pretty smart guy). You mess with them, they kick back. Like the frogs’ legs my mother once made me watch her cook. I see this fairly often during cesarean section; we’re not anywhere near the pecs, but similar slabs of muscle in the abdomen can do the same thing. It’s usually handling the peritoneal membrane underneath them that causes spasm and vomiting even with adequate anesthesia, but in some folks “just” pulling apart the abdominal muscles produces the same effect.

Trouble is, these suckers are STRONG. There is no denying a pissed off pectoral. Because of where they are, they pull on the ribs and yank those circumferential items slightly off-kilter, causing spasm in other, unforeseen areas. Which has been my problem lately.

This is more like it. The deflated inflater. More like what I just got at Petco--a dog toy with "squeakless technology." Yep, that's what this thing is.

This is more like it. The deflated inflater. More like what I just got at Petco–a dog toy with “squeakless technology.” Yep, that’s what this thing is.

My husband was horrified to find thumb-shaped bruises where he’d been pressing on my back. I assured him I’d not complain to authorities, as this was likely due to my using twice the recommended number of non-steroidal patches (along with a handful of naproxen, if truth be told). This all messes with blood clotting abilities. Whereupon he’s horrified I exceeded the recommended dosage. Whereupon I’m amazed that we’ve been married lo these 23 years and my MO still surprises him.

Now something I forgot to mention is the saving grace of having a physical therapist who really knows her wimmin’s business. Also high on the gratitude list. Every whining complaint I’ve thrown at her has been no surprise. She’s heard it all before. Thank heavens.

Thank heavens I’m not the only one who feels these plastic things getting hot against my chest wall. That the saline ports are hard, and hurt. That tissue I’m told has been denervated may be numb-ish to the touch on the outside, but has plenty of sensation pushing through from the inside.

But hey, Dr. Susan Love says says most women don’t even finish their pain meds. Must be true, right? She’s written a fat book about everything breast. If Marcus Welby, Dr. Quinn, and Hawkeye Pierce joined her for a focus group and came to the same conclusion, well, maybe I’d suspend disbelief. We’ll just not consult Dr. House.

Thank heavens the therapist knew to insist I request a reduction in the bigness of these things before I had more trouble with an already compromised right hand (that would be from the heartbreak of thoracic outlet syndrome, which is a wastebasket diagnosis and doesn’t really exist, as we all know). As soon as they let a little–a measly 2 ounces–of fluid out of the right breast my hand stopped its neurogenic tingling, my breasts regained just the eensiest bit of squishiness, and I felt like a new person. This is what I’m told will happen when the expanders are exchanged for “real” implants. We’ll stick with the smaller size, thanks very much.

But now the pecs have caught on and decided to take up the slack. Hence the new muscle spasms and this new-ish rant of mine. Bear with me and I’ll apologize (again) next I see you.

What follows is something not for the faint of heart: placement of the expander within the muscle.

I really don’t want to freak anyone out, but can’t seem to post the link without opening the graphics.

Treat your children well…

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I don’t know what I was expecting going into this Angelina Jolie-breast-preservation-mastectomy thing. Or maybe I do, if I get honest. I think I was expecting to look and feel pretty much like I did before the two, Two, TWO surgeries in one. Yeah, the Wrigley’s gum commercial dates me. I’m speaking of mastectomy followed immediately by “reconstruction.”

I’m feeling stupid because I let myself believe reconstruction meant restoration. They’re not the same. I’ve got what pass for breasts (very nicely, under clothes), but are really nothing but foobs (fake boobs, previously discussed). Kinda awful to look at without the clothes. They’re shaped by triangular-ish plastic inserts with a port for sequential infusions of saline. They could be made really, really big if I was into that sort of thing and wanted to lose the use of my right arm. More on that in another post.

And you know how they find the port to do the infusions? (Boy, what an education this has been.) With a stud-finder. Now that got my husband’s attention. He has mostly averted his eyes from the foobs, but pull out that stud-finder and he’s Johnny on the spot. It is kind of interesting. The expanders can shift, and they do, so the ports have metal in them to help with detection. Out comes the stud finder, for every infusion. First to “X” the spot, and again to check right before they stick the needle in. My doctor’s stud-finder is blue.  Hmmm.

Wall sculpture

Does she, or doesn’t she?

Weird as it is, the process works, even if the result doesn’t look quite right and the “foreign body sensation” means they’re always on my mind. Always. It’s like having something in my eye. I feel them moving against my chest wall, and I can’t keep my hands off them. I’ve had to tell my husband to poke me if he sees me holding my chest in public. The edges of the expanders wrinkle and flex just like an IV bag. Or a flattened beach ball. The ports feel exactly like the squeaker in a dog toy, only harder, and the right one hurts from the inside when I lift something and my pecs flex. You wouldn’t believe all the little things we do without thinking that require pectoral muscles. Opening a mayonnaise jar, for one.

In the mirror (and I’m always looking in the mirror), I’ve got mounds. And that’s what they’re called in surgical parlance. “Breast mounds”. Don’t know how I feel about that. I get the mental image of a bunch of men in lab coats thoughtfully considering the desirability (in one way or another) of various breast shapes and how to achieve them. I joke with the nurses that in terms of shape, my left one is Mt. Ranier and the right one, the one that gives me trouble pain-wise, is Sugarloaf. I actually like Sugarloaf better when I look down and compare the two, but they’re certainly not the breasts I’d grown to know over time. The ones the surgeon frowned at for their degree of ptosis (read sagging).

I was never taught to appreciate what I had while I had it, as I imagine many of us find, plodding through life. In the words of that gawdawful song, “you don’t know what you got ’til it’s gone.” I’ve got old photos that catch half of me sitting naked on our porch in California (because that’s what we did in California), and wonder why the hell I ever hated my little booblets. Or my not-quite-flat stomach. Or my skin that wouldn’t tan. They were fine. They were lovely. But nobody told me so because that’s not what’s done in our world.

In our world–the world of women anyhow–there’s always room for a lot of improvement. And when I was  kid, I was one of the many victims of the depression-era hangover that said children shouldn’t be encouraged. Certainly not about body-related stuff. The closest I ever got to a compliment from my mother was, “there’s nothing wrong with you–you’re not deformed.” This in response to my teenaged despair about never finding pants long enough outside the boys’ section of the store.

My dad was better, always ready with a “don’t you look nice” at odd times and when I got dressed up. Much of his life was spent around female models, and he did them the favor of always being professional, never making comparisons, and as I mentioned in another post, never “improving” on them in paint or bronze. He also didn’t make the mistake of being afraid to include me in his life or touch me once I reached puberty.

I’m glad I took photos of myself before surgery, because even at 53, even with “ptosis,” my breasts were still lovely. Not because they met media criteria, but because they were mine, they were intact, and I was used to them. And for most of my life they weren’t diseased.

These new things, these foobs, aren’t mine yet. I’m reminded every time I lift something that they aren’t breasts, they’re pectoral muscles. They clench. They spasm. They can be seen doing so under the skin. My skin is stuck to them. But only just. Skin without fat under it is thin. Transparent, really. Foobs are a constant reminder that man cannot improve on divine intent, evolution, or whatever it was that got us here.

But I’m going to have to develop some affection for these poor, benighted things, as they’re being asked to do what muscles were never meant to do–masquerade as fat. And I’m going to have to do all the exercises the physical therapist prescribed if I hope to get strong enough to stay up all night and catch babies.

The plastic surgeon tells me I’m not a “high needs” patient–the kind we health care providers all know and dread because they can’t be helped–yet I certainly feel like one. I’d kind of like to be one. I have no reason to keep going to his office,  but the support from the nurses there makes me miss having an appointment every week. What a catch-22. Something helps, yet availing myself of it feels wrong, or weak, or…well, just weak.

Foobs aren’t exactly trouble-free. I still have pain when I first wake up and the continental plates shift across my chest. Then there’s the end of the day when I just can’t stand myself any more. Fatigue hits like a ton of bricks when I’ve simply pushed a cart around the grocery store. My brain functions like Swiss cheese. Honestly, NOBODY would want me delivering their baby right now. But I feel like I should be better than this. I just know my friends would be stronger–they’d be done with it all and probably back at work again, ignoring the fatigue. Like midwives always do. Like women always do.

It scares the hell out of me, but I’m going to do the polar opposite of what my work ethic wants. I’m staying home until all this is over with. You’re all invited to join me.

The Heartbreak of Phantom Bra Pain

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One of the more irritating features of this breast-building business is the tissue expander stage. Folks who have augmentation without mastectomy will have smaller implants placed either behind the existing breast tissue (fat & glands we associate with breast shape), or behind both breast tissue and pectorals (the large chest muscles so popularized by Jack LaLane). It’s a choice they make with the help of their plastic surgeon.

Folks like me, who have breast and underarm tissue removed in any of the various mastectomy surgeries, have a couple of reasons for needing to go the tissue expander route. If their own skin is spared, there’s no support for the implant within that empty pocket, so space must be created behind the pectorals to both support and hold it in place. It needs to be a larger space, for a larger implant, as there’s no more breast tissue to help shape it. Those who have a complete mastectomy that includes removal of skin and nipple will also need tissue expanders to stretch not only muscle, but the overlying skin as well.

I’ve said it before, and I’ll say it again: this is NOT a comfortable process. Aside from the requisite stretching and burning, I have this sense of something foreign–something large and foreign–strapped to my chest wall. All the time. It’s uncannily like wearing a too-tight bra every waking moment. And every other one, too. I’m constantly reaching up to tug on the elastic, pull at the underwire, or actually unhook the back. But nothing’s there.

Oh boo hoo. There are waaay worse things that could be happening right now.

But it is really strange. It’s exactly the sort of deja vu experience I’ve had ever since my parents died. Where I think before my brain stops itself: “Dad’s gotta see this…” or “let me just call Mom…”

I suppose in addition to grooves in my brain that track to the Mom and Dad thoughts, I’ve got another groove that tracks to the “gotta get this bra off” thought. And not just the thought, but the actual motor impulse that has me reaching up to find the thing. They’re the kind of impulse pathways that plague amputees with phantom sensations they’d swear were coming from the missing limb. Or the missing breast.

So if I’d gone with my health ed teacher’s advice and worn better fitting bras all my life–bras that didn’t create the need to reach up and yank down–would I still be doing this? Maybe some PhD-type will do a study. And give us a new ICD-9 code: phantom bra pain. I want my name on it.