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Category Archives: Excise

Excise Necrosis

I have been re-reading comments from my Breast Necrosis Photos article and I realized that I have to address this topic in MUCH more depth. I gave this article such a vague title because a couple commenters on the aforementioned article used the term “excise” for the non-surgical removal of necrotic breast tissue.

Excise means “to remove by cutting”. That is the least common use of the word “excise”. It also means to erase or remove by crossing out. I’m not sure how many surgeons are actually using the word “excise” in relation to the actual removal of necrotic tissue.

My experience was different. The nurses always used the term “Debridement” when talking about removing my necrotic tissue.  Debridement is defined as : surgical removal of foreign material and dead tissue from a wound.

So I suppose you could say they mean the same thing. The definition of debridement, in my opinion, sounds much less violent and painful. I’m guessing that’s why more medical professionals use it instead of excising. No one wants to have things cut off of us. It conjures up really frightening imagery.

I know it sounds downright terrifying to be told that your surgeon is going to remove the necrotic tissue. I know this because I was terrified beyond belief, myself. I want to reassure you, dear reader, that it does NOT hurt. It is in NO WAY painful. And while the entire situation is horrendous beyond my ability to describe, you will not feel anything beyond a tugging or pulling sensation while it is being done.

My advice: Don’t look while it’s being done. Bring your MP3 player and listen to something that will keep your focus off the process. Focus on breathing deeply and slowly. Think about something that makes you feel calm and at ease…a favorite vacation spot or a happy memory. Put all your focus on that.

The Procedure: The day I had my debridement done I came in to the exam room and they had me sit in the big chair with the surgical-style light over it. It looks kind of like a dentists chair but more comfortable.

To my right was a tray with a few instruments: Forceps, surgical scissors, a kidney-shaped tray, gauze, a scalpel and a few other things. The scalpel scared the hell out of me because I was anticipating pain already.

When the scalell was unpackaged from it’s sterile holder, I closed my eyes and started breathing deeply, focusing on trying not to cry or panic. Then they turned on the very bright surgical light above me. The nurse told me very softly that they were starting and all I was going to feel was some tugging. She urged me to try to relax and reassured me that it would be over with soon.

She was right. Since the tissue they removed was dead, there was nothing (no nerves) to transmit pain signals. I heard the occasional metallic snip of surgical scissors and felt some tugging and pulling, but there was NO PAIN.

As terrifying as debridement or excise sounds, as horrifying as having dead tissue removed from my body was, it wasn’t nearly as bad as it sounded. When it was all over there was a bed of healthy tissue so that I could start healing properly without the interference of the necrotic tissue.

 

The 200th Post

As the title says, this is the 200th installment of BoobCast. Today I am writing about you, dear reader. Today’s installment is all about the support and the stories that people have shared with me since I first started this blog on Oct. 11, 2008.

When I first started writing this, I was also fairly active on a website called All About Plastic Surgery (http://www.allaboutplasticsurgery.com). When I posted what had happened to me it didn’t take long before I was inundated by questions about various aspects of the surgery. You can find that entry here: http://boobcast.net/2008/10/14/questions/ People expressed a great deal of concern about how well I had checked out the surgeon, what indications I might have had and what legal recourse I might have taken. During that period so many people gave their support and I am grateful for it. So my thanks goes out to the women of the All About Plastic Surgery forum. They were the ones who inspired the idea for BoobCast.

Now you’re probably asking yourself, “Gee Maria, why do you call it BoobCast? Were they wrapped in plaster or something at one point?”

No, dear reader. There are reasons this site is called BoobCast.  In 2007 the podcasting community lost a precious member by the name of Joe Murphy. He died of a vicious type of cancer that took him quickly. During his medical treatments he talked in vivid detail about what was going on, the testing and all of it. His strength inspired me. I wanted to be as strong and as brave as Joe Murphy. So I planned to podcast what was going on with my breast necrosis. The name of that podcast was going to be BoobCast.

I never met Joe but his life inspired me. It just turns out that I’m not that strong or that brave. To honor that bravery I have kept the name.

I also owe thanks to a very dear friend, Tee Morris. When I was trying to find the strength to create BoobCast, He was there for me. He gave me mental and emotional support by letting me know that I *could* do it. I’m sorry I disapointed you Tee but want to thank you for being a friend when I needed one.

In the time I’ve been writing BoobCast I have had people email me directly for advice. Of course, after reading the email, my advice was always “Contact your PS (plastic surgeon) and ask for [fill-in-the-blank]. Whether it was about bruising, skin texture or pain, I advised talking to their doctor. If they couldn’t get a decent answer from that doctor, talk to another one.

The one that really broke my heart was the husband of a woman who, a few days previous the email,  had the same procedure I had. According to her husband, the pain pills her PS had given her weren’t doing much and she was in constant pain. She couldn’t eat or sleep and she was suffering. I told her husband to call her PS immediately and insist on different pain meds and not take NO for an answer. i explained that, right now it was his job to advocate for his wife since she couldn’t do it herself.

A couple days later I got an email from him saying that her PS had changed her meds and she was doing MUCH better. It’s emails like those that made BoobCast well worth the emotional pain of writing those early posts.

I also want to thank everyone who talked to me about BoobCast at DragonCon last year. Being told in person that I’m making a difference means the world to me. Thank you for taking the time to talk to me.

Finally, my thanks to Carol Montoya, Lolly Daskal and the Woman At Denny’s. I promise that once I’ve had nipple reconstruction and recuperate from that, I WILL write the book. The foundation is in the works already.

My thanks to you all for reading, commenting and talking to me. Here’s to another 200!

 
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Posted by on January 18, 2010 in anchor breast lift, Anxiety, barter, boob job, Bra Fitting, bra sizes, Bras, breast, breast cancer, breast health, breast implants, breast lift, breast reconstruction, breast size, breast volume, Cash fees, checkup, chemotherapy chemical, clogged surgical drains, communication, complications, compression bra, compression dressing, cortisone, cosmetic surgery, cryotherapy, debreiding, debridement, deformity, dehiscence, Depression, Drain, Drugs, emotional healing, emotional scars, Excise, excise fluid, fear, Flashbacks, flourouracil, Fluid, granular tissue, granulation tissue, Healing, Hospital, Hospital fees, Hosptial Costs, implants, Incisions, Infection, Insurance, interferon, Invisibility, keloid, keloid scars, laser, Latissimus flap, latissimus flap reconstruction, malpractice, mammogram, mastopexy, Medical, Medical Insurance, memory, Nausea, necrosis, negligence, Nipple prosthetics, Nipple reconstruction, Nipples, Pain, Pain Management, plastic surgeon, plastic surgery, Plastic Surgery Disaster, podcast, Post surgical depression, Post Traumatic Stress Disorder, Prescription Drug Addiction, Prosthetics, PTSD, radiation, Reconstruction, Recovery, Scars, Seroma, serous fluid, Sex, silicone sheets, situational depression, Sleep, slow healing, suicide, Surgery, Surgical complications, Surgical drains, Surgical Fees, Ta Ta Tuesday, Uncategorized, V.A.C. machine, Vacuum assisted wound closure, wet to dry bandages, wheelchair

 

The Valium Story

One of the more mind boggling instances of the HiQ totally blowing me off is what I refer to as the Valium story. After the initial surgery I did not have surgical drains. Drains allow for serous fluid to leave the body so that it doesn’t build up and cause complications in the tissues.

Serous fluid is the yellow sticky stuff that beads up when you scrape your knee. It’s the stuff that allows a scab to form. It also occurs when there has been damage to the capillaries. Basically your body is trying to heal itself. Mine produces a metric shit ton of the stuff. Unfortunately I didn’t know that THEN.

In the evening some time early during the first two weeks after the initial surgery I began feeling pressure in my chest. It felt like a baby elephant standing on my breasts. The pressure made it difficult for me to breathe.

So I had Ken call the HiQ’s answering service. I took off the surgical bra and laid down on my back because I thought the compression from the bra may be causing problems. I felt better and it became a little easier to breathe but I still felt pressure in my chest.

When the HiQ returned the call about 15 minutes later it was still kind of difficult to breathe. The first thing he told me to do was that I needed to calm down. I explained about the pressure on my chest and he said that I needed to put the surgical bra back on. He implied that not having the surgical bra on would make the pressure worse.

So I handed the phone over to Ken and did that. While I was occupied, the HiQ suggested that Ken should get me a Valium and that there was nothing wrong.

As I have said before, when the HiQ took the implants out he also found about 300 ccs of serous fluid in each of the pockets. That is probably what caused the pressure.

A couple weeks after that incident at a checkup one of the nurses noticed a bubble on the outside of my left breast about the size of a jumbo egg cut length wise.

Perhaps a little of it might have been anxiety. After all things WERE starting to go wrong. I’m still REALLY angry about being blown off like that though.

I also have a vague memory of  him telling me that even if he had known about the fluid in the pocket there was nothing he could have done about it.

Dr. Elliott and Dr. Guy excised over 500 ccs of fluid from my back between the two of them. So how is it that someone with supposedly 15 years experience couldn’t do the same thing? It still just pisses me off to no end.

 

Nip Tuck It

Since we had to be in Atlanta anyway I got an appointment with Dr. Elliott. He ended up excising about 100 ccs of fluid from the same general area on my back. No big deal. It’s common with this type of surgery. I’ve gone over that before.

Something else he mentioned after doing the medical groping to check  my progress was the revisions. He’s really good at what he does but sometimes skin doesn’t knit together quite the way you’d expect so there are little places that could be nipped and tucked to improve the overall appearance.

One of the things was smoothing out the corners. In my opinion there is a spot on the right inside next to my cleavage that looks a bit squared off. That should have smoothed out by now but it hasn’t.

Another thing he mentioned is possibly doing a lift. I sort of froze like a deer in headlights for a few moments there. The lift was one of the reasons I lost my nipples last time. Of course I know there are no nipples to lose this time, I have to wonder HOW he’d do the lift without making them smaller. I’m also not too excited about the possibility of more scars.

Time to do some research on that.

Either way I let him know that I would most definitely NOT be opting for another surgery any time soon. Right now I don’t care about the oddly shaped corner or the slight pendulous appearance. I love my new breasts and I’m happy with what I have.

Right now I’m even happy with what I DON’T have. I’m content with not having nipples. That may change again as my mood is rather changeable. Dr. Elliott told me in our first consultation that there would come a time when I would be ready and I’ll know if or when that time comes.

In the mean time I’m protective of what I have and I’ll keep the Twins just the way they are for the time being.

 

M M M My Seroma 2

I had an appointment at Dr. Guy’s office today to check on the seroma issue. Unfortunately, we got an emergency business call from Atlanta this afternoon and we’ve got to be there by tomorrow night. Because we have two orders on the table and a dog that desperately needed his shots and heart worm meds, I had to reschedule for next Wednesday. So far it doesn’t look like anything has developed again though.

It also occurred to me that since we have to make an emergency run to Atlanta tomorrow as it is, I should make an appointment with Dr. Elliott’s team for while I’m up there. So I emailed Suzanne since I didn’t get to call before 5. I’ll call again tomorrow to make sure she got the email and find out when they can fit me in.

As usual, I’ll update when I know more.

 

M M M My Seroma

I posted about my check up yesterday. This morning the troubled spot will be left to heal. No more wet to dry dressings. YAY! It’s closing up nicely finally so that’s not an issue any more.

Now since I can’t seem to do anything half-ass-ed, while Dr. Guy was poking around on my back (and I mean that literally…poke…poke…poke) she discovered that the right side had a pretty massive seroma.

A seroma is a pocket of clear serous fluid that sometimes develops in the body after surgery. When small blood vessels are ruptured, blood plasma can seep out; inflammation caused by dying injured cells also contributes to the fluid.

This isn’t a threatening or serious condition, though it could potentially cause complications down the line. The fluid is that yellowish slightly sticky stuff that bubbles up when you scrape your knee before the scab forms. A good idea of what a seroma looks like is here: http://tinyurl.com/n8ne2

It is evident the bruising is the skin is also distended and there is a large, softball sized lump where the fluid has collected. I was unable to find a photo of a seroma on the back. With a Latissimus Flap breast reconstruction, seromas are VERY common. From what Dr. Guy said, basically the pocket it causes makes the skin separate from the muscle. Until the fluid is drained or reabsorbed back into the body, the skin cannot reattach itself to the muscle. Basically the right side of my back from below the shoulder blade to my waist and in towards my spine was one gigantic seroma.

After giving me a local anesthetic, Dr. Guy excised the fluid by sucking it out with a needle the size of a harpoon. At least that’s what it seemed like. Ken says it was only an inch or two long and pretty small in diameter.

The Doc removed 455ccs of fluid. That is very nearly half a liter of fluid. She showed Ken how to tell if it builds up again. Basically he has to poke my back. If it ripples like a waterbed, there’s a buildup of fluid.

I have another check up in two weeks. I’m really hoping there will be no more fluid build up. As usual I’ll keep you all posted.


 
 
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