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.

healing well... time to start thinking about the next surgery

Saw the doctor today and I'm healing quite well. It is a good thing that my recuperation is coming along well and with no complications or infections. I am fortunate that I don't have keloid skin and generally speaking, my skin rebounds well from trauma. So, the scarring across my belly is looking very good and is already looking like it will fade nicely. The scars around my breast aren't healing quite as quickly but still seem to be doing alright. The skin around my breast is more traumatized though from the radiation treatment. I think that it will be some time before that area looks "normal" but that's okay.

The surgeon mentioned that I would need to come back in 2-3 months to check my healing again but also to start the planning for the next phase of my reconstruction. To be honest, while it seems that plastic surgery isn't quite as horrible as I'd imagined, it isn't a cakewalk. And I'm not that certain that I want to keep nitpicking for perfection. My plastic surgeon seems to really enjoy what she does. She gets rather excited when its time to discuss procedures and such. I am not so amused by the prospect.

Right now, my new breast is what I call a "Barbie boob"... its round and nipple-less much like a Barbie doll. It isn't (to me) shaped exactly as I envisioned. I am still swollen and tender in the area above the breast and in the area on the side of the breast. But, its tolerable and fine to me. My surgeon mentioned that if the swelling above the breast didn't go down, then she could go back and do a little liposuction to flatten that area.

Blink. Blank stare.

(more after the jump... click on the READ MORE link)

Really now? Um... I don't know about that. I have seen other breast cancer survivors after reconstruction and they have holes/indentations in their chest area where the fat shifted (or whatever). As you can guess... it is NOT a good look. So... I don't know about liposuctioning anything out of my chest. (That just sounds disgusting to me)

Another way that I was reminded today that I'm really not a huge fan of plastic surgery was when my surgeon was examining me and she noticed what I've been calling "my pinches"... areas on each of my hips where the end of the surgical incision was stitched up and caused a "pinched" area. It looks a lot like a hem that has had the thread pulled too tight. But to me, while its not perfect, its tolerable.

Oh no... not to my plastic surgeon. She wants to go in and smooth that out. (gas face) Are you counting? We're up to two procedures now -- the recontouring of my breast and the smoothing out of my pinches.  That's just a lot going on to me. I mean, I understand her perspective I think. She can fix it, all I have to do is say the word. But to me, the question is -- is this necessary? And I don't know that smoothing out my pinches is really necessary.

Keep in mind that the real reason for the next procedure should be to reduce and to lift my remaining breast. I KNOW that procedure will be a doozy. She's got a lot of tissue to manipulate and to remove. I'm not particularly looking forward to losing my girl but I can admit that right now I'm a little lopsided and crazy looking. One breast is sitting up so high that when I lay down, my chin rests on it. The other breast hangs so low... if I'm not careful it will roll completely off my chest and hang down my arm. (laughs) Okay, I'm exaggerating a little bit -- but not much. If you look closely... its a bit of a mish-mash over here.

But my fear and concern about more surgery has begun to cloud my vision and with all those areas that could use some refining, when I look into the mirror, I'm fine with the reflection I see. Really fine. I can't forget the week immediately following the surgery in the hospital. The pain... the pain was really bad. The morphin drip was my friend for a few days.  And I'm in no hurry to go through that again.

However, if she's able to do the nipple work at the same time... I may consider going back under the knife in about 6 months or so. Right now, the memory of the surgery is still fresh like my scars and the pain is still a big portion of my existence. But in 6 months, who knows? I'll probably be chomping at the bit to get back in the hospital to tighten everything up and make it all look nice.

I had a dream the other night that I went to the beach and had on a bikini. (laughs) So... more surgery just may be in my future.

a week after surgery...recuperating just fine.

Its been about a week or so since my surgery. I have to say... I am very surprised at my recuperation. I expected to be really down and out of it for weeks on end. But I'm up and moving around -- a little slowly -- and I am not in excruciating pain. There is pain... but its not as bad as I had anticipated.

The doctor was pleased with my healing progress so far and I'm moving on to the next phase... trying to figure out how to minimize these scars and do all I can do to heal my skin and my abdomen. I'm ready to get back into my life again.

From an emotional standpoint, I'm not quite sure where I stand really. I'm up and down... still quite emotional from the past few weeks. Can't really put my finger on what's bothering me -- I think its that I'm chasing a feeling that keeps eluding me. I feel like I'm "chasing normal". The feeling came down on me really hard while I was in the hospital and it hung around for quite a few days.

I'm trying to get back to a certain feeling, a certain place in my mind where I'll be normal again. Where I'll feel like myself again. And everything that I do to get there, disappoints me because when I get there, I still feel like the cancer-girl. I am sick of it.

I woke up from surgery feeling tired, in pain and so deeply sad that it really took me by surprise. I was grateful for the visits from family and friends during those few days because it really helped to lift my spirits. Now that I'm home, I feel less sad but still I'm struggling with depressing thoughts. I expected this surgery to be a quick fix, I think. I thought that I would wake up, look down and smile when I saw my changed body.

Truthfully, I almost cried.

I was not prepared for the bruising, the pain the stitches. I was not prepared for the inability to walk, sit up, or stand. But, even with that... I am grateful that I'm healing well and feeling a bit better.

I'm down to just one drain. Had four when I was in the hospital. The doctor believes that I'm healing well and she asked me if I was happy with the size breast that she gave me. I am. It is a nice size -- I'm guessing a DD -- but there is still swelling and all that. So it may shrink some before its all said and done. It will require some mental adjustment because it is not the same size as my natural breast and when (if) I decide to take the next step in this journey and have my other breast reduced and lifted so that it matches -- I'm still going to have to see myself in a different way.


Today, I am plotting the rest of the year and making plans for next year. From a medical perspective, there are several surgeries in my future and while I am not really excited about them, I will do what I need to do to keep this train moving forward. It just may take some time. I've been moving pretty fast in getting things done. I will probably slow down and take more time between procedures. The costs are adding up in ways that I had not imagined previously.

I thought that the quicker/sooner I did "the next thing", the better my mental outlook would be. But that's not exactly what's been happening. Each new step has created a new whirlwind of confusion, sadness, and all kinds of emotions that I was really trying to avoid. Concerns about everything from my health, my survival, impact on my family, impact on my job, impact on my finances, and my dating prospects have swirled around my head and my heart with each step I've taken. 

I am mentally and emotionally tired now.  So, I'm going to give myself some time to just get comfortable where I am. The one thing I learned from this experience -- moreso than the other steps on this journey -- is that moving forward when you're not sure, really isn't the best thing to do.

I'm happy that its over but in hindsight, as much as I didn't think I could wait longer...I believe I should have waited a few months longer. I think that I was so hesitant because the truth was that I probably needed to get comfortable with my body in its altered state. This body with all its scars and discolorations (and aches and pains) is my new normal. This is it.

This is it. Realizing that is like letting go of a big breath of air. Exhale...

I'm focusing now on this moment, this perspective, learning to love and accept this life that I have -- which isn't the life I had before and that requires a different out look on life. But this is what I have, this is what I fought for. This is why I cried through chemotherapy for four months. This is why it was worth losing my tastebuds and my fingernails. This is why it was necessary to go through 2 months of radiation. To watch my skin blacken and peel away from my body. This is it. This is why I had to miss the inauguration of the first black president of the US to have my mastectomy. This ... is it. This life, right now, at this moment -- scarred, battered and bruised -- has to become my joy. Its not some thing out there... its right here, within me.

I've been asking myself (every day)... what's next Nicole? What do you appreciate about your life? Where do you want to go with your future? I don't have any answers yet, but I'm working on it. I do, however, have a flat tummy. (smile) Haven't seen one of those in a long time.