Almost a year after the TRAM Flap surgery

Its been nearly a year since I had my breast reconstructed. The TRAM Flap procedure is the method I opted for and generally speaking, I'm pleased. I ended up having a "free TRAM flap" which is a complicated and intense procedure. I chose this procedure because it used my own body tissue and because I felt that in the long-term, it would be better for me. It would have been easier and faster to have had an implant but after all of the breast cancer treatments, I was really leery about having anything foreign in my body. When I speak to other survivors who have gone through breast reconstruction, I still wonder whether I made the right choice -- or rather, was there an easier choice to make. But, its fine now and I really have few complaints.

My tummy is somewhat flat. It isn't as flat as I expected it to be. I thought it would be just ridiculously flat but a better descriptor would be smooth. I guess in order to get it to flat, I will have to do some work. (laughs)  My breast is amazing. I still don't have a nipple yet, but I will have one soon. Surprisingly, I'm actually okay without it right now. The reconstructed breast looks wonderful in my clothes. And its nice and perky (as is my other breast which was reduced to match in size). I often run around without a bra on... and that is really cool. Hmm... I didn't realize what I was missing all those years I carried those super-large breasts around.

The downsides are few... I still have limited feeling in my tummy area. The numb area is much smaller than it was immediately following the surgery. But all of the feeling has not returned to my tummy area. My abdomen muscles are stronger but still not completely strong. Every now and then I'll do something that reminds me that I had major surgery and had some of my abdominal muscles removed. But it doesn't happen often and when it does happen, the cramps don't last too long. My posture is still rather poor. It is better than it was after my mastectomy but I am truly a work-in-progress in this area. The tightness of my abdomen causes me to involuntarily curl at the shoulders to avoid pulling those muscles too hard. Hard to be sexy with rounded shoulders. (laughs) But I'm working on that too.

The additional surgery around my underarm area totally aggravated my lymphedema. It was very mild prior to the TRAM procedure... now, it is the bane of my life. I am so sick of the fat arm... ugh. But, I can still move it around and I'm just forced to constantly stretch and exercise and massage it. And wear my compression sleeve. I am hoping that as I start to lose weight (I'm changing my food habits now) and start to work out more (planning to incorporate some very light weight lifting into my exercise plan), the lymphedema will get better. I know that for the longest time doctors have been telling breast cancer patients with lymphedema risks not to over-exert the affected arm, not to lift heavy objects and all that. But that seems so off to me (and yes, I have no medical training whatsoever but so what). I'm just going to do what I think is best and hope for the best.

The other downside of the procedure is that while my new breast is nice... it doesn't actually look like a real breast. And there are times when that matters to me. Also, there's no feeling in it. I can feel around it... but I cannot feel the actual breast. If someone brushes against me, or even reaches out to grab me... I won't notice it unless I see it happen. That is not very sexy. (laughs) But, all things considered, I'm more happy with my reconstructed breast than I was without it.

The pain after the surgery is really a dim memory. I recall that it was the most painful thing I'd ever experienced in my life. And I absolutely hated the recuperation period. But, despite all of that... I am generally pretty happy. I chose the TRAM flap because implants require regular surgical maintenance and I did not want to do that. However implants are easier to get initially, take much less time in the operating room, cost significantly less and your recuperation time is far shorter. So they are truly a good option. TRAM flaps are one time options though. Once they take the flesh from your tummy, they cannot go back and do that procedure again. My plastic surgeon was trying to convince me to have both breasts removed so that she could do the TRAM flap for both breasts at the same time. I just refused to do that. I am hoping that I don't regret the decision to keep my natural breast.

I don't particularly like my scars (on either breast) but they don't make me as crazy as they used to when I look at them. I am becoming more and more comfortable wearing low-cut things that show off my cleavage and my scars. I am less concerned with people noticing my scars and asking me crazy questions. The scars on my hips and across my lower belly have healed well. They haven't disappeared which is what I had hoped for but they are okay. It really looks a lot like a cesarean scar except it stretches from hip to hip. Now that I think about it though, I have slacked off with my vitamin E oil/shea butter massages on my scars. Hmm... need to get back on that. It was definitely helping the scars to look better, my skin to look better and also to soften up the tissue underneath the scars.

I am about 11 months from the surgery and its been a good recuperation. I am confident that I will continue to make progress and feel sexier every day. I do not regret making this choice at all.

I think I miss my fat belly

I'm still getting accustomed to my new boobies. I have been reminiscing and recollecting a lot about this journey the past couple of days. Realizing just how much I've been through, how much change I'm endured and how emotional this trip has been in its entirety. While I do like my new boobies and I am finding them to be quite satisfactory at this point, I do think about my body before breast cancer and I miss it.

Including my fat belly. I really miss that soft, squishy part of myself. When I opted for the TRAM-flap reconstruction, the largest selling point for me was that my breast would be constructed from my own tissue and I would not have to endure an implant. I know that many women opt for implants and are happy with their decisions. I think that its great that there are options for all of us to consider actually. For me, the thought of going from a natural H cup to any type of implant seemed just above and beyond what I could fathom for myself. I just didn't want any other foreign object in my body.

The fact that the TRAM-flap would also give me what amounted to a nice little tummy tuck was a bonus. I figured that it was a pretty good trade-off for the 12+ hour surgery and the 2-3 months recuperation time that I needed afterwards. I had hoped that the new breast and the flat tummy would propel me farther down the lane of recapturing my sexiness. It hasn't exactly done that though.

My tummy, while flatter, is not FLAT. And even all these months later, there is still a significant area that is numb. I have a belly button but I forget about it a lot because I can't feel it. (Although the numbness is making me consider getting it pierced actually.) I guess I didn't really think about what I would look like after the surgery. I assumed that I would be slim and trim with perky new boobies. When the truth is that while flatter, my tummy isn't flat and in order to get my body to look the way that I picture it in my head... I'm going to have to work out and eat better.

Gag. (laughs) I'm starting with yoga and running a couple of days a week. I'll tell you how it goes.

All in all, while I miss my belly a bit I am growing increasingly happy with my breasts. I can only hope that soon I will be happy with everything I see in the mirror and I won't keep having these "remember when" flashbacks.

Preparing for more surgery

I met with my plastic surgeon the other day. It was my 3 month follow-up appointment after my TRAM-flap procedure. All things considered -- 12 hours under anesthesia being operated on; 6 days in the ICU recuperating from the procedure; 6/7 weeks at home further recuperating; a loss of muscle strength in one arm; reduced energy; pain in my abdomen area following surgery -- I'm doing okay. My scars are healing well. My energy levels are slowly inching back up. My tummy doesn't feel as tight as it did before. (I used to feel like someone tightened me up so much that I couldn't stand up straight)

She was quite pleased with my progress. However, I take that with a grain of salt. (laughs)  I have learned that what the medical community sees as impressive is not always perfectly correlated to what the rest of the world sees as progress or improvement. Neither view is wrong, just different.

To my doctors and their staff... the fact that nothing is sticking out (hernia), I'm back at work, I didn't have to go back to the hospital for any complications... that means I'm doing well and progressing marvelously. Now, to the rest of the world who has no clue that I have been going through my own personal hell for the past 2 years... I look like a chick who might be a little lazy or a little overworked. I walk too slow, don't move so fast and refuse to lift anything that looks heavy. (laughs)

Its all about perspective.

I noticed that I am growing more comfortable with choosing whether or not to discuss my breast cancer status with people. I no longer feel as though I have Tourette's and can't control what comes out of my mouth. I went out last night to celebrate a friend's birthday. (had a blast too!) When I checked my coat and my bag, I got into a conversation with the guy working coat check and eventually shared with him that I was working on a blog and a book about breast cancer. Later that same evening, I ran into an acquaintance and when he inquired why he hadn't seen me in a few years... I simply said that I had been sick. Didn't go any further.

That would not have happened 6 months ago. (laughs) Thank God for growth and continued progress.

Back to the surgery... As I said, the surgeon was very pleased with my progress and wanted to start discussing the next step in the journey. (sigh) I am beginning to understand how some people get addicted/hooked on plastic surgery. It seems impossible to get everything you want done at one time. So, there is always another procedure waiting in the wings. At any rate, its time for me to start thinking about the next step to getting things back to "normal".

The next step for me is to have my natural breast reduced so that it matches the size of my reconstructed breast. Also, a little bit of additional contouring to my reconstructed breast so that it looks better. I'm going to have a little liposuction! (gasp) But its not what you think. (laughs) This will be some really small areas of fat removed around my reconstructed breast. Just to make things look prettier. (smile)

The beauty of this next step is that I won't be in the hospital for a week. The surgeon said that she can do it all in one day. (Sweet!) And that my recuperation will be about 2 weeks. (Even better!)  I definitely want it done and would like to have it done as soon as I can schedule it. But I have to coordinate with my manager (that sort of blows) and also keep in mind my travel schedule for the year. Right now, I'm aiming for early June but we'll see what works.

I am a bit scared but not overwhelmingly so because this procedure is far less dangerous, far less involved than the procedure I went through in November (TRAM flap). And afterwards... I will have CLEAVAGE and perky new boobies!

Fantastic!! My swagger will be at 1 million after its all said and done. (at least I hope so)

>>> Yay... cleavage!

Still fatigued after the surgery

I am healing very well after my TRAM flap surgery. My plastic surgeon is quite pleased. However, I have to admit that I am really quite tired. My energy level has not returned and according to my doctor, it may be weeks before I'm feeling like myself. I'm beginning to wonder if that is even possible. (laughs)

I did receive the green light to return to work in a week -- though I believe she was reluctant to do so. But since I'm healing so well and looking pretty wonderful (her words but I agree) she agreed that I can return to work.

I'm beginning to feel like a prisoner again...which is why I asked to be released for work. And its this feeling that has me really wondering about the future surgical procedures I have to look forward to. We discussed briefly the procedure to reduce and lift my other breast and my nipple reconstruction as well. (First, let me say.. yuck. The conversation was not fun...but I digress.)  I am a little tired of being out of work for weeks at a time. It sounds nice in theory but really, I feel like a hostage or a prisoner. I'm too weak to go out, or travel and take advantage of the downtime. But my body requires the time to heal and needs the rest to make things better. I just don't know how to find a balance.

If I can make it 6 to 9 months (or longer) before I have to have another surgical procedure, I think I will be pleased. But... since it may not be possible (I don't know what God has in store for me actually) I will just hope that the next time I will be just as responsive in my healing as I have been this time.

well, i am home and i am in pain

I have to thank my sister, Michal for updating the blog in my absence. Her post was really quite lovely and she's absolutely right... I have been graciously and wonderfully supported during this lastest stop on the journey.

Since I just got into bed and it seems that finding a comfortable resting place is going to be difficult... I may have to keep this initial post short.

Few notes:

• the surgery was far too long
• the way my stomach feels right now,  I'm not sure iI made the right decision
• I really expected to wake up and feel "all good"...but I don't.
• All of the love and kindness is truly appreciated
• I'm really feeling very sad.

There are a few side effects that the sugery kicked off; like the lymphedema in my left arm is SERIOUS right now. Which means, more doctors, more appointments and more time/money. Right now I have three drains hanging out of my body -- and its gross as hell. I'm swollen like a balloon and it is NOT CUTE at all.

But I'm here and a few days ago, I really wasn't sure that I would be. I'm tired, I'm scared and I'm without any percocet to get through the night.

But I'm here. Details will come soon... and they will be more entertaining than this post. I promise. Its just been a long few days.

One step forward, two breasts back

A few weeks ago, Nic wrote about her pending TRAM flap surgery and her uncertainty about going through with it.  Well, I'm here to say that even with up-to-the-last-minute doubts, Nicole underwent the twelve hour reconstructive surgery on Wednesday and is faring very well.  When I spoke with her today she was experiencing some pain but had a great sister-friend and an awesome cousin visiting and making her laugh.  I can't begin to describe the feelings and emotions that she's experienced (just over the last five days) with the raw eloquence that she does, so I won't even try.  Anticipating her return to the blog, to describe the latest stop on her journey, will give us all something to look forward to.

I will say-as her friend, her sister, her prayer partner, her ace-thank you for all of your love, support, and prayers.  Being the modest woman that she is, she may remove this blog entry later but since I have the floor now...Nicole is such an amazing, inspirational sister with a story that many don't even know the half of.  The strength that this woman has shown (even in her weaker moments) during her journey with breast cancer has been admirable, to say the least.  I am so proud and blessed to have her friendship and I look forward to growing old together.  Interestingly, while I'll be old and saggy, Nic will be oldER and perky.  Hey, you've gotta try to find the bright spots wherever you can!

Nic, I love ya, girl! And thank you for trusting me with your baby (blog).  And for those who may think that my usage of the term 'raw eloquence' is an oxymoron, you must not have read this sistah's writing.

-Michal

Embarrassment preparing for the TRAM flap surgery

Today was my pre-op appointment with my plastic surgeon for my upcoming breast reconstruction surgery. I am having the TRAM flap done. I wanted to have the DIEP flap procedure done – less down time and no muscle cut -- but there is only one doctor in DC who does that procedure and I could not get onto his calendar. I also did not want to travel out of the state/region to have it done because I thought that it would be too difficult to navigate the return trip home afterwards. Going through the airport is already a pain in the butt...imagine after you've had hours of surgery and have been in the hospital for a few days. Yikes. No thank you.

So, after a detailed conversation with my plastic surgeon, I opted for the TRAM flap a few months ago. And promptly put my mind on other things.

This morning, I completely FORGOT that I had this appointment. I was on my way to work, thinking about cupcakes and then the reminder notice pinged on my blackberry. I was stunned. Between me and you, I think that I’m in denial about having this procedure done. I feel like I’m on a runaway train and I can’t find the brakes. And that is really not how it’s supposed to feel.

George Washington University Hospital is a teaching hospital so it is not unusual for student doctors to be with a member of my medical team when I have an appointment. I think that I have a reputation as being a relatively easy patient because it seems that many of my appointments are ones where students are in the room with me and my doctor. Normally, it doesn’t bother me. Today…the two students were guys and it bothered me. Deeply.

After all that I’ve been through; all of the doctors and nurses who have seen my body in various states of dress…I was not prepared to be so embarrassed when the plastic surgeon asked me to drop my pants while she examined my belly area. It felt very invasive. Not cool.

Considering that normally I only get undressed from the waist up…I had not considered dropping my pants. I had not thought about her touching me, in front of two strangers and examining me so intently. Yet, there I was, face burning hot…trying not to look at these two young men too directly because I felt…so exposed and really embarrassed.

I was relieved when she asked them to leave only to be further embarrassed when she pulled out a camera to take pictures of me.

Before my mastectomy and my chemotherapy, I took a picture of myself naked so that I could remember what I looked like before my treatments. However, since my mastectomy, I have refused to take a picture of my body in its current state of disfigurement. I did not want to keep a picture of this crazy radiation scar (hyper-pigmentation) and I did not want to see a picture of my mastectomy scar. Its difficult enough looking at it when I’m in the bathroom alone. I didn’t want proof that breast cancer had changed me so much.

But today…proof does exist. And it’s proof that I won’t even be able to control or hold in my hands because its part of my medical files now. I am so embarrassed and I’m not completely sure why. I am unhappy today. There is so much to do before the surgery and I am still seriously contemplating cancelling it completely and just pretending that I’m okay just the way that I am.

So many things can possibly go wrong. The surgery scares me, to be honest. And while I want to feel like myself again, I’m starting to really accept that I’m never ever going to be that person again in my life. The normal for Nicole before breast cancer just doesn’t exist anymore. And that really hurts.

Today is a day...I could use a big ol' hug. But a cupcake from Red Velvet will have to suffice.