This blog entry contains consistent photographs documenting my journey with the DIEP surgery. These photos include photos of my breasts and stomach incision. These photos may seem graphic in nature and are intended for educational and documentation purposes only. These photos are not sexual in nature and should not be considered as such. Please do not continue reading this blog if photos of this nature are offensive to you. I appreciate the understanding of my readers that photos of this nature are necessary to assist those facing breast cancer, mastectomy surgery, and reconstructions.
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March 5, 2017
If you've been following my blog, you know I was scheduled for the DIEP flap surgery for July 2016, but I backed out at the last minute. I backed out mostly from fear since it's such an invasive surgery, and I'm tired of being in paid and recovering from surgeries. On December 27, 2016, I had a surgery to remove the implant in my left breast and all the scar tissue that had formed around it, and a new implant was put back in. While this surgery gave me the relief I was looking for from the tightness in my breast and it allowed my breast to feel soft and look normal again, the victory was short lived. A spot showed up in an area where a small, extra incision was done to remove deeply radiated and damaged skin, and the skin in this area as breaking down and slowly exposing the implant beneath. As much as I tried to avoid doing the DIEP flap, I now have no other options if I wish to have a breast on my left side. The skin currently covering my implant is so severely damaged from my mastectomy and radiation there's nothing left to salvage.
For those that do not know what a DIEP flap surgery is, the most simplistic explanation I can provides is there will be two incisions made on my abdomen--one about an inch below my belly button and one about an inch above it from hip to hip. All the skin and tissue between the two incisions is removed and reattached to my breast to create healthy skin and create a new breast. The skin on my abdomen is then stretched from the top incision to the bottom and sutured. Yes, this means I'll have a large incision on my stomach, which is the reason I've tried to avoid this surgery. However, this is my last option to find relief from daily pain I've had since my reconstruction journey began.
I will be updating this post regularly with progress of how I'm doing to include photographs at various stages through this surgery and the healing process. It is my goal to provide my readers with an idea of what to expect with this surgery and what my experience was like. I have to be at the hospital at 6 am in the morning as this surgery takes anywhere between 6 and 9 hours, and I'm expected to be in the hospital through Thursday. I'm very nervous, and fear has gotten the best of me the past few days. However, I've been putting on my brave face and trying to face this head on. I've tried to stay busy, and maintaining this blog will help me focus during my recovery period.
On a closing note, I would like to say I'm not fearful because of lack of trust in my physicians. I'm terrified of the outcome I will personally have, the pain I will be facing, and the long recovery ahead of me. While the DIEP flap is generally a successful surgery with great outcomes, there are those who face healing issues and there are even times it simply fails. I'm scared I'll be one of these women. I'm scared I'll be in so much pain it will be unbearable as I'm allergic to any pain medication that's truly beneficial. I'm scared I'll be put under and never wake up again. I'm just scared! I don't think any of my fears are abnormal for someone in my position, and I am moving forward knowing that no one accomplishes great things without taking risks. I gain nothing if I don't try!
Stay Tuned........... <3 Teresa
March 8, 2017
Hello All! It's been two days since my surgery, and although I'm still in the hospital, I'm feeling pretty good. I ended up being in surgery about 6 hours on Monday (6th). Since I was only doing one side, my surgery went a little fast than the standard DIEP in which both sides are done. I don't remember a lot from that day after waking up as they gave me plenty of pain medication plus I as very drowsey the rest of the day and night from the anesthesia. I remember being in a lot of pain, but they doctors and nurses did a great job of helping me stay on top of it. I had a pain button where I could press the button every 30 minutes to have pain medication delivered via my IV, and I took advantage of that button every chance I got.
- Day 1: Yesterday morning, which was Tuesday, March 7, was my "day 1" after surgery. My foley cath was removed, which meant I had to start getting out of bed to use the bathroom. As much as a folly cath sucks, they are a blessing from above when you're too sick or sore to get out of bed. As I was preparing to get out bed, I began feeling sick. I threw up a few moments later, which was just liquids as I hadn't had food since Sunday night. After getting up, brushing my teeth, and using the bathroom, I sat in the chair in my room for a bit. As difficult as it was to get up, it did feel good to get out of bed for a bit. While sitting in the chair, I threw up a second time, and after throwing up, I felt better, but I felt I had been through enough, and it was time get back in bed. The pain was definitely kicking my butt at this point, and I no longer had a pain button I could press, so everything I received was orally. Needless to say, I asked for pain medication. I had to get up to go to the bathroom several times during the evening, and it was painful getting up. It was more difficult to walk and move if I had went too long without pain medication.
- Day 2: Today, which is March 8, was day 2 after my surgery. I had some pain during the night last night, but it wasn't unbearable. Today, I noticed getting up to go the bathroom was easier than it was yesterday. I do walk slightly bent over because the skin on my stomach is stretched so tight, but I'm okay with that. It's been a long time since I've seen my stomach this small and tight. I walked around the halls two times today to encourage movement, and I actually felt really good while walking. I'm getting and better each day. The pain is never above a 4 now, which is a great thing. When I came out of surgery, I rated my pain as a 9 (out of 10), so that's definitely progress. Below are some photos for your comparison. However, please keep in mind that I previously had implants, which the doctor said it's a good thing I did this surgery as the black dot that showed up was a scab, and the hole went all the way down to the implant and wouldn't have healed, so I did the smart thing by doing this surgery before it became an issue of infection. Also, this is phase 1 of the DIEP surgery, which means tissue and skin is removed from my abdomen and placed in my breast area where radiated skin has been removed. This allows healthy skin to be used along with implants. What you see right now is just the flap and tissue itself--without an implant. The area needs months to heal before an implant will be replaced. So, at this time, I look uneven, but I have no doubt I'll get there.
Photo taken night before surgery
Photo taken on Day 2 (you can see how much skinnier I look)
Hospital Selfie (Day 2)March 11, 2017
Today is day 5 after surgery, and I'm finding I'm able to get up from the couch a little easier without as much pain. Does it still hurt? Of course, but I'm seeing some improvement as well. I'll try to document various items that seem to be topics of discussion below.
- Pain Medication: I was sent home with Vicodin and Flexarill to use for pain. The vicodin can be taken 1 or 2 every four hours, and the Flexarill once every 6 hours. Through yesterday, I've been taking two vicodin every four hours in an effort to stay on top of the pain, but around noon yesterday, I dropped it down to one every four hours. Mostly because I was having issues with my skin itching everywhere, and it was making me crazy, but also because I wanted to see if I could begin backing off the pain medication. While this solved the issue with the itching (I also began taking benadryl), my pain levels began to get the best of me as the day went on. By the evening hours, I was in quite a bit of pain and had to go back to taking two at once. The majority of the pain is in my abdomen.
- Sitting, Standing, Sleeping, & Walking: I didn't even attempt to move from my hospital bed until the day after my surgery, and to be honest, the only reason I did then was because they took out the cath, and I had to begin moving to use the bathroom. Getting out of bed was extremely painful, but once I got up, it wasn't too bad. As difficult as it is to believe, moving around a little actually made me feel better once I was up. Here I am on day 5, and it is still painful to get up, but it's manageable. I'm most comfortable on the couch with a pillow roll beneath my knees and heat on my lower back. Speaking of my lower back, it's on FIRE thanks to having to walk slightly bent over. While I do move around slightly bent over, I'm told I'm in more of an upright position than most women. At any rate, I feel like a 90 year old woman who should be walking around with a walker. I try to get up and move around just a little each hour when I go to the restroom. Just to keep things loosened up and from getting stiff.
- My Incisions: My breast is looking good although the flap is yellow at the moment from bruising. Overall, it appears to be healing very well. The incision across my tummy is very tight. I barely had enough skin and tissue to create a breast mound, so that didn't leave much to sew back together. My abdomen is swollen and slightly distended at this time.
- Constipation: While some may avoid talking about pooping, I'm going there because it's very important! My stomach is already very tight from this surgery, and adding a swollen belly due to constipation to the mix is absolutely terrible. Yesterday, I could tell I really needed to go, but I simply couldn't get "it" to happen. I had issues with constipation while on AC, and a breast cancer sister told me to try a bottle of the Magnesium Citrate. It worked miracles then, and I keep it on hand at all times now. While preparing for this surgery, I had purchased a couple bottles and put them in the fridge (they are easier to chug if they are cold). I chugged a full bottle yesterday before I found blessed relief.
- Drains: The worst part about these surgeries is the drains. I absolutely HATE them with a passion. They are so uncomfortable and cumbersome! While in the hospital, they were pretty full each day of bright red blood. It was pretty gross, and it looked like something you see in the movies when a vampire is drinking "blood" from a cup. I giggled in my hospital bed as my drug induced brain imagined some behind-the-scenes agreement between humans and vampires and the blood from the drains was to supply "responsible" vampires with blood. Yeah, it's crazy, but that's what happens when I take pain medication! Over the past two days, I've noticed the total ml per day reading is 10 for each side of my tummy, and my breast drain is no more than 5 ml for the entire day. They were emptied this morning and were even less than that, and there still is very little to nothing in them. I have checked them to make sure they are still working, and they are. Hopefully, this just means they don't have to stay in too long.
- Overall Opinion: For just a moment, I want to talk about the DIEP flap surgery. This surgery is often avoided by many women because it is so invasive, and I can say this with confidence because I was one of those women. I had my double mastectomy April 2014 with immediate reconstruction, which meant expanders were placed at the time of surgery. After expanding weekly and enduring a lot of pain associated with the expanders, I finally had surgery in July 2014 to swap the expanders for implants. Overall, I was happy with the results. My left side (cancer side) constantly ached though. I had developed scar tissue and cording that was very painful shortly after. I had radiation from July - September, and not long after completing radiation, I began to notice the shape of my breast changing. It was no longer soft and round, and it moving up my chest higher and higher. I was unable to get an assistance with this to fix the issues even though I had photos that showed the progression of how things were changing. It was then I found Dr. Tiwari. He was very honest with me and told me I was grade 4 CC and that I needed a DIEP flap. My skin was a mess from radiation, and there wasn't much left to work with. I was scheduled for a DIEP July 2016, and I cancelled the appointment a week before my surgery. I cancelled because I was afraid. I had did my research, and I had watched women talk about all the things that could go wrong and issues they faced after the surgery. The idea of being off work for such an extended period of time (again) made me want to scream. In November 2016, I reached out to Dr. Tiwari again, and at my request, he agreed to try a capsulectomy. He very clearly explained to me this would not be permanent, and I was simply buying myself time until I would have to do the DIEP and attempting to alleviate daily pain I was facing. I can't even begin to explain the pain I had lived with for two years--only those who have had CC knows what I'm taking about. On Dec. 27, Dr. Tiwari did a capuslectomy, and the scar tissue was even worse than he had expected. I was in surgery longer than planned, and an area about the size of a quarter had been removed and stitched together because the skin was beyond repair. This area is where the radiation was targeted, and it had suffered the most damage. He was skeptical but hopeful the surgery would work for me. I ended up developing a fever three weeks after my surgery that landed me in the hospital for three days. Since we weren't sure where the fever came from, the implant was left in place and a "wait and see" game began. I had a drain for six weeks because it simply would not slow down with fluid output. I could never get it below 40 ml a day. So, between the surgery itself, recovery, landing in the hospital, I dedicated six weeks of my life to a surgery to "patch" things. Two weeks ago, I was in San Antonio, TX for a work function, and while drying off after a shower, a spot on my breast caught my eye. It was the size of the end of an ink pen, and it was black. I couldn't tell for sure what it was, but since it was in the area where the skin was severely damaged and the area Dr. T was most worried, I had a feeling it wasn't "okay". When I saw Dr. T on Saturday for my follow up, he confirmed my worst fears. While there were no signs of infection, the dark spot was a hole (which was later confirmed that went all the way to the implant itself). The skin was so thin it was literally ripping apart. My chance to avoid the DIEP was gone, and I no longer had any other choice but the DIEP.
Monday, I walked in to the hospital so afraid I could barely think straight. I was an absolute wreck, and I was practically begging for medication so I could be put out of my misery. I REALLY didn't want this surgery, but I knew I had no choice if I wanted to have a breast. So, I put my big girl panties on, and pushed onward. I don't even remember going into the OR. Normally I'm wide awake until they put the mask on my face. Whatever shot they gave me before leaving the prep room was, it worked. When I woke up, I expected to be in excruciating pain. Was I in pain? Sure, but it really wasn't that bad. They gave me medication in my IV, and I could press the button as often as ever 10 minutes if needed. Once the pain pump was gone (the next day), it still wasn't that bad. I personally feel like the double mastectomy was worse than this. I wish I had known what I now know two years ago. I wish I hadn't wasted time doing a surgery that wouldn't work just because I was so afraid of the unknown. Although I'm still healing and have a ways to go, I'm not in daily pain anymore. In fact, my breast doesn't hurt at all. When I have pain, it's in my abdomen. I invested six weeks for a surgery that did nothing for me really when I could have did the DIEP at that time and been well on my way toward phase 2. So, while I cannot change my past and decisions, I would like to calm some nerves of those who are considering this and are letting fear drive them. I completely understand your fears, but I'll be the first to tell you that fear often makes some very bad decisions. This is a personal choice, but it's one that shouldn't be made out of fear alone. I absolutely know when you look at photos of a DIEP, all you can think is "that looks horrible". The end result looks great, but everything in between looks awful. However, it looks much worse than it is. If I could rewind the clock, I would have did this a long time ago. I am on day five, and my butt is still firmly planted on the couch, but I feel great considering everything my body has endured. It's only up from here!
Below are a few photos of how I currently look. Please keep in mind this is a work in progress of me. My right breast is simply an implant. I did not have cancer on this side but I am BRCA1 positive, I did a double. The left side as seen below is ALL my own skin and tissue. There is currently no implant in there. I'm not very big, so I will still need an implant once this is all healed up. I just had to do the DIEP to get healthy skin.
*The two bandaids on my tummy are where I developed tape blisters. This had nothing to do with surgery.
*The two bandaids on my tummy are where I developed tape blisters. This had nothing to do with surgery.
March 17, 2017
It's been 11 days since my surgery, so I thought I'd provide an update although there hasn't been a substantial change for me to write about. I did get two of my drains out on Tuesday (March 14--eight days after surgery). The two drains on my left side (one in my boob and one from my tummy) were removed, and it was a huge relief to see them go. Of all the things I've dealt with through all of these surgeries, I hate the drains with a passion. They are so cumbersome and somewhat painful. I seem to always catch them and tug on the tube and it pulls the stitch in my skin. Being down to one drain is great, but it will be even better on Monday when they remove this last drain. I fully understand the need for them, but it doesn't make me like them anymore.
I'm able to get up and down without it being painful now. Yes, my stomach is still tender and very tight, but it's manageable. Of course, I don't leave my house or do anything besides sit on my couch and watch television, read, do homework, and talk to friends, but that's pretty much what I've been told to do at this stage. I will admit I've been able to easily load and unload the dishwasher, make myself a cup of coffee or make a simple meal, and even put laundry in the washing machine or dryer and fold clothes. I'm managing just fine, but I should point out I don't have small children at home. My youngest daughter is here, but she's 19 and pretty independent. So, for all the moms with little ones who are facing this surgery and wondering what you'll be able to do and at what point, I can't imagine trying to care for little ones at this stage.
My breast really doesn't hurt that much. It's tender, and it actually feels hard and uncomfortable along the bottom of my breast. I'm going to talk to my doctor about this on Monday, but I kind of feel like there is an expander inside (deflated), and there very well may be. I briefly remember talking about expanders, but what I cannot remember is if he said it was placed during this surgery or it would be placed later? Obviously, when looking at my photos, it's obvious my breasts aren't even. That will come later in phase 2 when I get implants. The purpose of this surgery was to remove the radiated skin with healthy skin and tissue so I had healthy skin over an implant rather than thin, radiated skin that had little to no blood flow left. From what I can tell, everything is healing nicely (both tummy and boob), and I feel very good. In fact, I feel better than I did after my surgery in December, which was supposed to be an easier surgery. Of course, I admit I'm doing a better job at following the doctor's orders after this surgery though. This surgery doesn't give you much of an option to do otherwise.
I'm posting photos below as I look at this stage of healing. When comparing to photos taken right after surgery, you'll see I have some bloating and swelling in my abdomen. My doctor warned me on Tuesday to expect this, so this doesn't surprise me. This is part of the normal healing process. My doctor also told me I was a very tight closure on my stomach and that they had to put my OR bed in a v position to close my stomach, so this explains the extreme tightness I feel in my stomach. I'm able to stand up almost completely straight now although I cannot do it for long periods of time. My lower back hurts something awful if I try to stand for too long. I've also found I have to get up about once an hour for a few moments or I begin to tighten back up in my stomach, which leads to losing what ground I've gained in being able to stand up straight.
April 2, 2017
I am a bit behind updating my blog as I just realized I haven't updated this since before my last drain came out. I got my last drain out on March 20, which was two weeks after my surgery. Needless to say, I was very happy to get it out. As you likely know by now, I absolutely hate drains. It was barely putting any fluid out anyway, so it was not doing much of anything. My appointment was very fast as he removed my drain, checked my incisions, and said he would see me again in a month. I think I was in and out of the office in less than 15 minutes.
As you can see in the last photos I posted, I still had tape and glue on my incisions, which has slowly come off during the two weeks that's passed since then. Most of it came off each time I showered plus I use a q-tip with a little alcohol after each shower to clean up residual glue. As of today, I still have two small spots on my stomach incision that still have a scab, and there is one small area on my breast with a scab that hasn't fallen off yet. I resist the urge to pick as I tend to want to do that, but I'm scared to death of causing healing issues for myself, so I don't do it.
It's been almost a month since my surgery, and I'm feeling very good. I'm able to get up and down easily now, and standing up straight is no longer an issue. It's not painful anymore, but it does still feel very tight. I am finding I feel very swollen and bloated now, which is odd to me. I feel more bloated and swollen now than I did right after surgery. It seems like I would have been more swollen then than now, but from what I've read it's very normal for the swelling to kick in at this point. Since the day my drain was removed, I've been using compression on my stomach incision, which is recommended to keep swelling down in the abdominal area. I purchased spanx prior to surgery in anticipation of this, but I hate wearing them. They are fine on my stomach, but they are extremely tight on my legs and butt, and to be quite honest, they drive me insane because they cause wedgies. I have a bit of a big bootie (and it feels bigger than normal since I haven't been able to exercise and have spent more time on my butt than being active), and what helps with compression in my stomach is too tight for my butt. Also, having to wiggle out of spanx each time I needed to pee is extremely annoying, so I used a wide ace bandage around my stomach. I kept it wrapped tightly to ensure the same compression I would receive with spanx. For me, this has worked great.
I'm still off work as I don't return util April 17, but I do feel very good. Personally, I feel I could go back to work now, but my doctor is afraid I'll overdo it and cause a setback; however, I also know he's likely right. While I feel great, I fear a 9 hour shift would cause me some pain. I've ventured out here and there such as wedding dress shopping for my older daughter, getting my hair colored, and getting my nails done. Last night, I event enjoyed some time with my youngest daughter at Ohio University for Mom's Weekend, but I'm also careful not to overdo it and let myself sit down as needed. I try to stand up straighter each day and not get comfortable so I can get my flexibility back. I am a bit numb around my stomach incision (about 1/2 inch from incision on each side), which I've read gets better over time. My other scars have faded with time to a thin white line, and I hope my stomach incision does the same. For now, I've purchased a cute Michael Kors Tankini to wear and cove my stomaching incision. I don't want to gross anyone out, and the incision is currently quite obvious. At some point I have no doubt I'll be fine with it, but until it doesn't scare small children, I'll be covering it up. Finally, I haven't taken any pain medication for over two weeks, so I feel I'm doing very well! Below are some photos to catch you up on my healing process!
The following photos were taken about one and a half weeks ago:
The photos below were taken tonight. As you can see, much of the scabs are gone. The incision areas are still red and raised, but there has certainly been much improvement. As you will notice, my hip area at the end of the incisions on my abdomen have resulted in some pretty serious muffin top that I didn't have before. I now have a very flat stomach with a muffin top on the sides, which is frustrating, but I've been assured this will be corrected during the phase 2 surgery and is fairly common with this surgery. I'll be glad when I don't look like a busted can of biscuits!
Finally, the photos below show me doing some dress shopping with my daughter three weeks after surgery, and then enjoying Mom's weekend with my daughter last night (one month after surgery).
May 4, 2017
Only after logging in did I realize it's been a month since I have updated this. Time seems to slip away from me without realizing it when I'm not confined to a couch for healing. I'll do my best to update everyone on what's been going on since my last update and how I'm doing.
Spring has arrived, and that means sunshine, warm weather, and one of my favorite activities--gardening! Over the past few weeks, I've planted a garden with a few tomato and cucumber plants as well as work on my multiple flower beds. I add to my flower beds each spring, and this year I created a flower bed around a tree in my front yard. While I love the look of my flower beds, it's really about making it easier to mow around objects--the beauty is an added benefit. I absolutely love digging in the dirt and planting flowers though. There's something about it that just makes me feel like everything is perfect and right in the world. Some may ask how I'm able to do all of this after such a large surgery. I say with all honesty that it's really not that bad, and I feel like it's been very good for me. Without overdoing it, the more active I am, the less stiff and sore I feel in my abdomen area. I'm slowly beginning to feel like my normal self again. I still wear a compression garment on my stomach each day. I've tried to go without it a couple times, and after a couple hours, I can feel my stomach bloating up. Until that goes away, I'll just continue to wear it. My body will let me know when it doesn't need it anymore.
In previous photos, you'll notice a small area in my tummy incision line just below and to the right of my belly button that had a scab area. This area held onto this scab longer than all the other areas even when everything else was healed and the scabs had fallen off. Two weeks ago, I had my one month checkup, and Maggie scrapped the top layer of skin off the area, which was a little gooey (that sounds gross--sorry). Once she scrapped the top layer off, she discovered I had some tunneling going on. This means the skin healed on the surface over a hole, or "tunnel", that had not healed from the inside. The hole was about 1/2 deep but not very wide. She said it was normal and happens to many people and it wasn't necessarily anything I did. I have been placing packing in the hole since my appointment per her instructions, which are to change it every morning and evening. The purpose of the packing, which looks like seam tape (for the sewers out there), is to keep bodily fluid from sitting in the tunnel area and forcing the body to heal from the inside out. When I remove the packing, it's always damp, and it's kind of cool how it pulls the fluid out. To answer the questions in your mind, it doesn't hurt at all when I push the packing in. The incision line across my stomach is numb, so I can't even feel it. I can feel slight pressure when I push on it, but I don't feel anything else. Since the tunnel is very narrow, it's not easy to get the packing in, but I have got it down to a science now. I cut the packing strip at an angle so there's a point on the end. I insert the point into the top of the tunnel, and I use a sterilized bobby pin that I've straightened out to push the packing into the tunnel. I simply keep pushing it in until I can feel the resistance, which means it's reached the end of the tunnel. Over the past two weeks, the tunnel is getting smaller, so I know it's healing. I've included some photos below.
While at my appointment two weeks ago, I also discussed phase 2 of my surgery. I confirmed my expectations and my ultimate goal/outcome, which is to have an implant placed on the left side and even out my breasts now that I have healthy tissue on the left side. Also, I want the dog ears (or muffin top) that I have been left with from the surgery removed. We were on the same page, and she said I would receive a phone call to schedule my surgery once my insurance had approved and preauthorized it. I received the phone call yesterday, and my surgery is scheduled for June 1, which is exactly three months from my DIEP flap surgery. Three months is the minimum time frame one must wait after having the DIEP before moving on to phase 2. I feel very fortunate to have had no major issues or setbacks and I can look forward to moving on to the next phase. I have another checkup tomorrow to see how my wound is healing in my tummy. I'm not too concerned about it, but it will be good to receive confirmation that I'm healing well.
Below are some photos for those who like to watch the photo progress. The top row of pictures was taken about two weeks ago and shows how the wound looked before my doctor scrapped off the gooey layer. The bottom layer was taken this evening. Obviously, tonight's photos show the packing sticking out of the tunnel. Also, I would like to point out that I've begun running again, and it feels great. If you can't tell, I've lost a little weight. While I would like to lose a few more, I'm thrilled to be running again and to simply feel like myself again. So for those wondering if this surgery totally puts your life on hold, the answer is no. In fact, I'm probably more active now than I was all summer last summer!
June 8, 2017--PHASE 2 SURGERY
Hello Everyone! Here I am post phase 2 already, and I can hardly believe it. When I began this journey, it felt like it would likely be forever before I was able to see results I was happy with in the mirror, but I have to be very honest, and the truth is this truly hasn't been that bad, and time has went by very quickly. For those that may not know the details of how the DIEP flap surgery works, the results and surgeries are broken into phases. The first phase is the main surgery, which I've explained above. The sole purpose is to simply obtain healthy skin and tissue to build a healthy breast mound. Cosmetic appearance isn't necessarily a priority of this phase while I believe my doctors certainly did their best to keep this in mind. The second phase is what I just had done, and the purpose is to make adjustments from a cosmetic perspective for symmetry, appearance, and tweak any abdominal issues leftover from the incision obtained in phase 1. Some people get implants at this point if needed, and others do not. Some people do not need an implant as their donor tissue is enough to build a breast mound that's normal in appearance on its own. I, however, didn't have enough donor tissue and skin for this option, so I required an implant. They do not place the implant when they do phase 1 in order to ensure the blood supply isn't damaged and the transplanted skin and tissue heals. Phase two typically isn't done until at least three months after phase one. Some have to wait longer depending on any issues they may have faced after phase one.
I was fortunate enough to get to do phase two exactly three months after my phase one surgery, and I was absolutely thrilled. Items that were addressed for my phase two surgery were:
- Implant placement--left breast
- 350 cc implant placed in left breast beneath mound created in phase 1.
- Abdominal incision revision below belly button
- Approximately a 2.5 inch area beneath my belly button of my abdominal incision had begun to show a "pooch". My physician informed me this is done on purpose to ensure there isn't too much tension on the abdominal incision during healing, and they always correct it during phase two. This correction flattened out the skin and incision on my abdomen.
- Removal of dog ears on each side
- The incision across my stomach goes from hip to hip. The area where it ends at my hip left a very obvious bulge on each hip where all the skin and fat was removed from my abdomen but not on my sides. These bulges are nicknamed "dog ears". The manner in which is is corrected is by extending the incision on each side slightly and removing extra skin. Additionally, the liposuction on that area is performed from this incision.
- Muffin top liposuction for fat grafting
- Since so much fat was removed from the abdomen, this causes a very disproportionate look around the middle as there isn't a natural slope any longer. The liposuction is used to make this slope more natural, but the most important factor is to remove fat that can be harvested for fat grafting, which is needed to fill in areas around the implant and beneath my arm that were damaged severely during the mastectomy.
- Fat grafting around left implant and beneath left arm
- A mastectomy is an aggressive surgery where all breast tissue is removed. For me, my doctor was extremely aggressive and left me with paper thin skin, and all my lymph nodes including the fat pockets it sat in were removed from beneath my left arm. I had a very large cavern beneath my left arm and along my left chest wall where this tissue was removed and essentially scraped down to the bone. This was quite painful as tissue and fat is more useful than one may think. Fat grafting is useful to fill in areas such as this and put fat to good use where it's needed.
Yes, that's quite a list, but it really wasn't too awful. I will admit I woke up in a little more pain than I was expecting. I suppose I was so excited to be getting my implant after three months that I truly didn't care or think about the pain. While my left breast was definitely sore (especially beneath my breast and right in the center along my sternum), nothing was as painful as my sides, hips and flank area. Liposuction is some real aggressive stuff, and you certainly feel it. Imagine the most sore you've ever been from a hard workout--one of those times where simply getting out of bed or walking hurts. It felt like that. And I was bruised so badly on my hips. I took one look at my hips and laughed saying "Well, take that muffin top--you didn't listen when I did those crunches and asked nicely".
Headed back for surgery. I've lost count at this point!
On the top right with the grey PINK panties, is a photo taken the night before phase 1 in April. I didn't realize how much weight I had gained before this surgery (I had to fatten up as much as possible). I must say as much as I dislike the scar on my stomach, I hate looking like that more! There were a lot of cheeseburgers, ice cream cones, lattes, and other junk food items sacrificed to create that fat.
On the bottom right in the green panties is me the night before phase two surgery. So this is what I looked like without an implant on my left side. I was about a small B cup on the left and a C cup on the right. Was it annoying? Sure! But I managed! This photo doesn't show the dog ears too well, but previous pictures on my blog show the bulges I had going on.
This is the same two photos as shown in the collage above, but just two full body shots side by side for those who would like to compare. The green panties was the night before my phase two surgery and the left photo was taken about a week after my surgery. 
Oh, the bruising after liposuction! The top photos show my sides the day of my phase two surgery after liposuction, and the bottom two photos were taken today, which was exactly one week after surgery. I'm not quite sure how the bruising disappeared so fact since it was so ridiculously bad, but these photos are not retouched, and there's not a bruise in site!
I had a check-up yesterday, and I saw Dr. K. He said everything is healing fabulously, and I'm "amazing" (that's really what he said--I wouldn't say that about myself). I did ask about symmetry as I was concerned that my left breast is now bigger than my right, but he assured me time would resolve that. The fat grafting that was done around my implant causes the breast to appear larger, and they "over fill" the fat around the implant knowing my body will absorb some of the fat that was injected. The idea is to over fill so what sticks leaves me looking symmetrical. I go back in six weeks for a checkup unless I have an issue, which I don't foresee; and I was released to go back to work on Monday. For those wondering, I was off work for one week for this surgery.
Finally, here I am at my appointment not even one week from my surgery. What can I say--I'm a pro at surgery at this point!
Much Love--Teresa
