Autologous Fat Transfer a.k.a. fat grafting

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Post-op, Comforted by Stabby the Unicorn

It’s been a while since I posted.  My last procedure was in September 2015, fat was transferred to fill the indentations around my implants, and to try to create a natural slope above the implants.

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Example of one of the indentations to fill.

The fat grafting was painful, surprising and disappointing.  It was a fairly simple procedure. While you are under general anesthesia, the surgeon makes a couple incisions in your abdomen and inserts a cannula to suck out fat (liposuction).  The cannula is moved around and a few cups of fat are harvested.  The fat is centrifuged to separate out the blood and whatever else got in there, so that they can inject just the fat back into you.  Using a large gauge needle, the surgeon injects the fat back around the implants, in the hopes that approximately 80% or more is retained by the body.

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Day of surgery

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Day of surgery

Bruising and injection sites, day of surgery.  Every day after surgery, the bruising and swelling continued to progress, despite wearing a medical girdle to compress the area.  What they don’t tell you, is that blood will pool, down, to your lady business, and even thighs.  Ouch.  Ew.

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Blood pooling after liposuction.

This procedure was far more painful than placing the implants.  And disappointing.  Most of the fat that was transferred seemed like it was going to take, but over time, it’s been sinking down as my body has been burning it off.  I am now scheduled for an implant exchange and more fat transfer to try to make my boobs, boob-shaped, as they should be.

 

A few milestones from the end of post-op week two.

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Today marks two weeks since I had my prophylactic bilateral mastectomy.  I had a few milestones or maybe tips worth sharing over the weekend, at the end of post-op week two.

First, I took my own bath, saran wrapping myself.  It was a bit more difficult than I anticipated, but it worked.  I pulled off sheets that I thought would fit around me, using about 3 long pieces.  Pull the wrap from the back on both sides and stick it together in the front.  Tuck all the loose stuff up and use the stickiness to tighten and try to make it all tight to your skin to water-proof.  viola!

First self-saran wrapping for bath.

First self-saran wrapping for bath.

Second milestone.  Bra!  Not that a bra is needed, but it made a nice base under some clothing to make sure nothing weird was showing.  This is a nursing bra, easy to step into, and was comfortable enough that I slept in it that night.

First bra experience, post-op.  A bit awkward, but comfortable and easy to put on by stepping into it.

First bra experience, post-op. A bit awkward, but comfortable and easy to put on by stepping into it.

Two more milestones, dressing myself, not in pajamas!!!!!!!  Dress one, wrap dress, freshly washed hair, ready to go to work for a few hours.  I worked for a few hours Friday and Saturday night.  Running the ticket booth involves sitting on a chair in a box, collecting cash and making change, nothing to difficult or strenuous, though after Friday I determined a pillow was necessary to alternate between leaning against and leaning forward onto.

This first one is almost cheating, wrap dress, ties in the front, has enough material in the front to hide the drain bulbs.

This first one is almost cheating, wrap dress, ties in the front, has enough material in the front to hide the drain bulbs.

Dress two, a bit more complicated, had a zipper in the back.  I needed assistance to zip, but ended up being just fine unzipping at the end of the day.  This dress hid the drains perfectly, as the waist was high and tight and the rest of the dress was open.

This dress hid the drain bulbs very well.  End of week two post-op.

This dress hid the drain bulbs very well. End of week two post-op.

My last milestone will be discussed in another post to come.  I had my first major outing to the Mall of America with friends.  I spent the time in a wheelchair, to conserve energy and deal with wooziness, but had a blast.

First Bath!

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I was told at my first post-op appointment that it was now okay to take a bath in water up to my waist.  The solution was to have my drains, bulbs and incisions covered in saran wrap, just in case.

Ridiculous saran wrap bath covering.

Ridiculous saran wrap bath covering.

Who knew how amazing a few inches of warm water could feel compared to a sponge bath.

First Bath!  10 days post-op.

First Bath! 10 days post-op.

The surgeon also said that I could wash my hair in the tub.  This did not actually work.  Despite leaning back in the tub, holding onto my boyfriend, so he could rinse my hair, water still poured down the back of my saran wrap and leaked around to the front.  Luckily, I came home with just two extra pads to replace the now soaked antimicrobial pads that are to be placed around the area where drains enter my body.  Phew.  No more hair washing attempts in the tub.

First Post-Op Appointment

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Ten days after surgery I had my first post-operative appointment with the reconstructive surgeon.  He examined his work, something where he can envision the end result and say how great it will look.  I cannot envision the end result, as with the swelling down, my boobs are now deflated, and misshapen, emphasizing the incisions, with buckling skin.  I’m still covered in surgical glue and tape that I cannot remove, and I still have been taking sponge baths up until now.

The surgeon said that everything looked great, but that we can’t begin to fill the expanders until the skin has had more time to heal.  So much for some boob-shaped boobs.  He and his associate cut out some of the sutures around the drains and replaced the antimicrobial pads.  The drains will stay for 7 more days.  I can now lift my arms up, but only to start stretches which involve placing my hands on my forehead and pushing my elbows backward.  That is what increased my pain later that night, and made me beg for assistance in getting back up out of my sleeping chair this morning.

The last part of the appointment, I was told I may now go into the bathtub with just a few inches of water.  I can’t get any of the surgical site of drains wet, but I can wash my butt!  Yay for real water that stays warm, yay for a warm sponge bath, yay for being able to wash my hair and have it rinsed over the tub!

Milestones During Week 1 Post-Op (GRAPHIC)

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It got really cold the other night.  Some might have described it as a tit bit nipply.  Strangely, it felt so to me.  Especially on my left boob.  *poke* *poke* *poke* Nope.  I did not spontaneously generate new nipples.  I now have phantom nipple feelings.  How goth.

In other news.  I ran out of marcaine in my pump, right on time, 5 days post-op.  Note my Buddha belly, not sure where that came from without eating very much actual food this week.

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Empty marcaine bag, lines still intact.

These lines are removed by myself.  I have to pull all of the sticky tape, ouch!

Tape all over the place.

Tape all over the place.

'soaker hose' lines that were distributing marcaine into my breast area.

‘soaker hose’ lines that were distributing marcaine into my breast area.

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Completely empty, deflated marcaine bag and handy-dandy fanny pack for hauling it around.

Pulling the lines would have been quick, but I could feel it inside moving through and that was a little gag worthy.  There was also a bit of tension every so often.  Without all the bulk of this, I can move a bit more freely, however, I still have the two drain lines coming down to contend with.  The size and shape of my temporary boobs continues to change every day too.  My dad tells me that the surgeon told them all that the expanders are filled about 2/3 full, I imagine about 500mL each then?  Either way, here’s how it’s starting to look, you can tell the swelling is subsiding.

5 Days Post-op, prophylactic bilateral mastectomies and stage 1 of reconstruction.

6 Days Post-op, prophylactic bilateral mastectomies and stage 1 of reconstruction.

Post-Op Day Two (GRAPHIC)

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This day started with a little bit more rest and lots of visits from doctors, interns, and whomever else felt the need to wander into my room.  The bitch nurse was still bound and determined to kick me out as soon as possible, though she couldn’t give me a time or any other information.  She told me I could put my pants on, but keep the gown on.  She asked me to take another walk, this time it was really fun because I was alone, and dizzy.  Nobody seemed at all concerned to see the girl with the ‘fall precautions’ bracelet shuffling down the hallway carrying her fanny-pack of marcaine.

Catheters for the marcaine infusion.

Catheters for the marcaine infusion.

Black bag filled with approximately 5 days of marcaine anesthetic to bathe the inside of my chest, two  (Jackson-Pratt) drain bulbs with a small amount of fluid.

Black bag filled with approximately 5 days of marcaine anesthetic to bathe the inside of my chest, two
(Jackson-Pratt) drain bulbs with a small amount of fluid.

After returning from the walk, I decided to empty my drains.  This consists of stripping the blood and clots from the tube into the bulb and then dumping out the bulb and measuring and recording the output.

I slowly gathered my belongings in anticipation of leaving, and I’m glad I did.  The nurse arranged for someone to transport me to the pharmacy in a wheel chair, and then to the entrance to be picked up.  Meanwhile, the surgeons each came to take one last look.  Both were very proud of their work.  Um.  I would hate to see the work they aren’t proud of, because all I see is crooked, lumpy frankenstein boobs.

Results, approximately 24 hours post-op for prophylactic bilateral mastectomies with stage one reconstruction with expanders.

Results, approximately 24 hours post-op for prophylactic bilateral mastectomies with stage one of reconstruction, expanders placed.

Pointing to the ridge of the edge of the expander.

Pointing to the ridge of the edge of the expander.

So according to the surgeons, this looks great, the skin looks good, incisions look good, everything is draining properly and there are no signs of infection.  Time to go home.

I sat in a wheel chair and a woman helped carry my bags while wheeling me down first to the pharmacy, then to the entrance.  Each bump, threshold, rug, concrete floor junction shot a sharp pain through my body.  It’s okay, because before I knew it, I was being helped into a warm car, nestled in with a pillow,ready for the short ride home.  I was looking forward to my new recliner,my own food and drinks, my own schedule.  That was quickly overshadowed by the excruciatingly painful experience of feeling every single bump, patch of snow or ice, every pot hole.  Every muscle in my chest was being jostled and tensed up and all I could do was bury my face in my pillow and hope that I got home soon.  The whole way to the house I was sobbing in pain, and I could barely get out of the car.  I think this is a sign that perhaps I was not adequately controlling my pain and perhaps another day in the hospital to work out the proper regimen would have been appropriate.  It was too late.  No way in hell was I going anywhere in that state, with that amount of pain. Time to take some drugs and try out the new recliner.

Post-op Day One

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Due to the initial error of my surgery being flagged as an outpatient procedure, most of the people I encountered on day one post-op seemed to be snarky, trying to rush me to get better and out the door.  I was upgraded to solid foods almost instantly upon waking, despite my severe nausea and dysphasia.  If I can’t get liquids down, how am I supposed to get solids down?

I also made the mistake of asking one of the nurses if she could send her nurse assistant over to help me comb my hair, and her snarky reply was first to say they she was too busy, and they really don’t do that sort of thing, and then to say, and could you please tell me exactly why it is that you think you can’t do that yourself.  GRRRRRRRRRRRR!  Um, because I was told that I can’t lift my arms, duh.  And my lack of sleep gave me a serious rat’s nest to contend with, so I wasn’t about to back down on this nonsense.  It’s their job to help you with activities of daily living, I don’t think combing out my hair is really too demanding.

About and hour later that nurse skulked back into the room and asked where my brush was.  She said she had confirmed that my arms couldn’t be raised above my head, so she sat and combed out every snarl in my hair.  Heh, heh, heh.  Bitch.

That was the highlight of my morning, as the rest of the day consisted of me trying to find the right combination of pain meds, me fighting the nausea and food that was being forced on me, and me being forced to get up and move out of the bed.  Standing, ok, that’s cool, but remember I have a catheter still from surgery, two drain tubes and bulbs hanging from my chest, and this giant fanny pack of marcaine hooked to tubes hanging from my chest.  You try untangling that mess while, dizzy, light-headed, hungry, nauseous and exhausted.

I managed one small walk, and since that was a success, I could have the catheter removed, as I was now trusted to use the bathroom on my own.

I had a few nice visitors too, that were kind enough to keep me company, take me for a walk around my unit, bring me my favorite candy and some super soft pajamas, and loan me their favorite bear to watch over me.

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