I wish that I had done a better job recounting this recovery week-by-week, so that it might be more helpful for someone one day, but honestly, pretty much the first 3 weeks I did nothing but take meds on cue and sleep. I don't think that I even picked the laptop up until last week. I still have it kind of resting on my knees, because I don't want any extra pressure in the belly area.
I will try to recall basic details, so if you are thinking of having a TRAM-Flap or preparing for one, you will know what to expect. This is going to be an unfinished epic. I am going to keep adding to it when all of the warm, fuzzy memories return. :)
Deciding between the surgeries can be difficult (or simple). Your Plastic Surgeon will be able to let you know right away if you are a candidate for the TRAM-Flap or what size you can expect to be after the surgery. Some plastic surgeons don't even do this surgery, so make sure to check with the office when setting up your appointment. My surgeon said that I had a "good harvest" (his words) which made both my husband and I laugh. I have never thought of a fat stomach that way. I have always been larger-chested, especially since I have had kids. I didn't have a problem going smaller. We decided that it would be a good option for me. I liked the idea of the tummy tuck (DUH !) and using my own tissue as opposed to implants. My sisters and Mom all got implants, but I just wanted to try to avoid it, if I could. If that were going to be the route that I was going to take, I would have just done more research and it would have been fine as well. It just worked out for me to go this way.
One important thing to keep in mind when going in for surgery is to be realistic with your expectations. The surgeon is going to remove lower belly fat, not ALL fat. You may be larger on top of the incision than you thought. Unless you have no upper fat, you are not going to come out of this looking like a supermodel. The good thing is that through diet and exercise, you can change this. If you are concerned, ask your doc what he thinks the results will be.
OK. Surgery Date's been set. What do you need to do ?
I'm a planner and a little OCD. Not sure if I have revealed that fact yet. I am a list maker. I make lists for my lists. I made up a list of EVERYTHING that I wanted to get done about 2 weeks before surgery and just ticked things off, one by one. Everyone will be different. For me, having 3 kids was the biggest thing to plan for. My list was basically:
- ALL laundry done and put away
- Clean sheets on all beds
- FULL grocery shopping done- Anything that you and your family might eat or need (toilet paper, dish soap, comfort food, things that you will want to eat- even treats for yourself :)
- Pack your bag. I mentioned this before, but you really don't need much. You wear hospital gowns and won't eat or do much while you are there, so basically, bring a toothbrush and you're good.
- Plan for your kids- Babysitters, picking up from school and day care. It sucks, but it needs to be done. My surgery was first thing and an hour away. We dropped the kids off at my parents the night before. My husband ended up staying the first night at the hospital, so Grandma and Papa had them both nights and had to get them to and from school. My husband also just planned hospital visits around school times, so it worked out. If you have pets obviously, you need to plan for them and also have a Back-up, just in case something doesn't go as planned.
- Tell as many (or as few) people about the surgery. Obviously, if you are an open person and tell people about it, they are going to offer to help out. TAKE THEM UP ON IT !! Even if they get your mail or make a meal, it is one less thing for you or you care giver to do.
- I wrote my kid's teachers a note that I would be having surgery and would be down for a bit and we were going to to try to keep things as normal as possible and that Grandpa would be picking them up some days. I hope that this also helped them understand if homework was done a little more "creatively" with Dad or if they were missing something.
- Finally, (and most importantly), I loaded up my DVR with a bunch of everything. Surprisingly, I have made my way (or slept) through most of what was recorded. I am glad that I did. It kept me occupied while I was relaxing, but not really ready to read or do much else.
- Recliner. I was lucky enough to already own a big, cushy leather-blend recliner, so I don't know what people who don't have one use to get comfy, but I spent 23 1/2 hours of each day in the recliner (30 minutes going to the bathroom and showering), so if you are thinking of adding a piece of furniture, consider a nice recliner. I bought a washable cover, so every few days, it got a wash. I am on week 4 and still in the recliner for most of the day and sleep the best in the recliner. It takes the pressure off of your belly and it is easier to get out of than a flat bed. We'll discuss this later.
- Pillows, pillows and more pillows. You can use them however you need to to get comfortable. You can never have too many, and all sizes and shapes work.
- I had a detachable shower head already, but I recommend this for "showering". I preferred sitting on the edge of the tub and using the sprayer to clean myself. I have a few areas with wounds that are slowly healing more slowly that freak me out, so I can make sure to keep them dry this way. I also have a shower with a seat in it, which would work to if I was not worried about the spots. You can stand up in the shower, like any other time, but you will feel weak at first and it will be hard to stand for any long period of time. You may want to rent/borrow/buy a shower chair.
- You will probably need some medical supplies, but I would wait to see what they give you from the hospital and what your doc says that you need. You may not need anything. Lucky you !
If you are a single gal, please try to line up someone to stay with you or cover shifts. You will be taking meds and even getting up to go to the bathroom can be dangerous. If you don't have someone with you 24/7, have a neighbor or friend who lives close on speed dial so that if you need help at 2 in the morning, they can be there in minutes.
It's here, it's here ! It's finally here !!! The big day !
I know that most people would dread this day, but I had been waiting for so long, I was ready to get it on. I have had my mind made up for over a year, I knew this was what I wanted to do. No second thoughts. Let's just get moving. What to do:
- Follow you doctor's or hospital's instructions- Usually no eating or drinking for 12 hours before the surgery.
- Only take into the hospital what you need immediately. Insurance cards, Driver's License, cell phone. Leave your bag, lap tops, chargers, etc in the car. Your care giver can grab this stuff later. You won't want to have to lug this around into the pre-op room.
- Be prepared that even if your surgery is scheduled at 8, you will probably be set to arrive 2 hours ahead. It might seem like a lot of time, but you will check-in, be called back to pre-op, get changed into a gown, take a medical history, talk to a few nurses, get an IV going, talk to the anesthesiologist, talk to your surgeon, talk to plastic surgeon. Maybe a few more people. Before you know it. Its showtime !
- One more thing to be prepared for (this has happened a few times, so I know from experience) is that you might get bumped. Not physically, but other surgeries might run behind or longer than planned. I know how nervous/excited you might be, but try to stay calm and just know that it will be done. Just ask the nurses to keep you posted and they will.
- When the time comes, the nurse will start a drip of meds that will make you groggy, but still awake. I usually remember clearly kissing my husband, saying "I love you" and being wheeled into the OR. At that point, sometimes, I remember getting on to the operating bed, other times, I have been out before that point.
- You may or may not remember recovery. Usually you will wake up and a nurse will say "Hello" and explain what is going on and ask you if you need anything like water or ice. Yum. Ice chips. They just aren't the same at home.
- You may be feeling sick, tired, in pain, anything. Just tell the nurse, and they will adjust your meds, get you water or a bed pan. They are your go-to at this point. If your nurse isn't cutting it, have your care-giver grab one of the others. You need to get comfortable and that won't happen if your needs aren't being met. Most of these nurses are really helpful, but my Mom had to go after one guy I had after one surgery because I was in so much pain and he was kind of blowing me off.
- Bottom line- this is about you and it is ok to ask for things. I always felt awkward asking for some crackers or a cup of ice chips. Now I realize that YOU are the one having surgery. They won't think twice about you an hour after you leave, so who cares how many times you ask for something ? You are not putting the nurse out. It is their job to help you ! Oh, and if you throw up on them, it won't be the first time and I am sure that they have seen it all before, so if you are an apologizer like me, DON'T WORRY
!!!!
REST. I can't say this enough. Sleep whenever you feel like it. It doesn't matter what time it is, sleep if you want to. Visitors will understand if you nod off and will either be there when you wake up or leave you a little note. If you have a pump for pain meds, DO NOT be afraid to use it. You will have some pain and discomfort. Don't be a hero. Your doctor ok'd the use of the meds and they are set to only disperse after a set amount of time. You are not going to OD. LOL The meds will allow you to relax and be comfortable. If you don't have a pump, don't be afraid to ask for something if you are feeling uncomfortable. If the nurse asks if you want something, take it ! They can tell by how you look and your body language how you are feeling. They won't think that you are an addict ! They will only give you what you need. The longer you wait to take something, the longer it will take to kick in. Be proactive and hit the pain head on. You may have a catheter in after surgery and that will make things easy on you for the first day or so. Once it is out, you will have to get up and use the bathroom. Your nurse or caregiver can help you at first, but after a few times, you may feel more comfortable doing this on your own. The nurse may collect your urine in a "hat"- a container that fits over the toilet that catches the urine and allows the nurse to measure your "output". This will help in determining how much of the IV is going through your body and exiting the system. Getting out of bed- The nurse will encourage you to try and get out of bed, possibly the day after your surgery. You might think that it is impossible and you might feel tired, but just moving a little more everyday will make your recovery easier. You might start off by walking around your room or down the hall of the hospital. Each time, set a further point to try and walk to. You will be so proud of yourself when you reach those goals ! A Respiratory Therapist may visit you and leave behind an Incentive Spirometer (below) for you to work on breathing. Listen to their instructions or have them write down the goals for you. You may not reach them right away, but keep trying a few times an hour. This will help to increase your lung function. It will be hard at first, but keep trying ! It is very important and will help how you feel in the long run.
- The most common drains are "JP Drains" - Jackson Pratt Drains. For the first few days, your nurse will strip the drains and measure your fluid output. Before you leave, if you have still have drains, your nurse will show you how to care for them.
Try not to be too discouraged if you leave the hospital with drains. This is very normal. Yes, they are a pain, but they will most likely be removed with a week or two. - After a few days of resting, walking and lots of doctors and nurses "checking you out", it will be time to go home. This may be exciting and/or scary, but as long as you have someone there to help you, things will be fine. You can do it !
- Your doctor will prescribe some pain meds to take home. Try to have them filled at the hospital or have your caregiver have the Rx filled before you leave. The nurse may be able to call some of the prescriptions in to your pharmacy ahead of time, if necessary.
- You may want to have a pillow in the car to put over your tummy area. Your seatbelt will be tight and the pillow will keep it from hitting you where it hurts.
- Ready or not, you are back at home. Time to move on to the next stage of your recovery. My main advice is to take it easy. You may feel useless for a few weeks, but in the end, it is the only thing that will speed up recovery. You may feel as if you can do things, but bending, stretching and turning will prolong your body's recovery. Here's a link with some tips on going home.
- Your doctor may prescribe a stool softener that will help you "go" without having to strain. Once the magic moment happens, you may want to have someone help you clean the area or use wet wipes. It is difficult to turn like usual, so for the first few days, you just have to do what you have to do.
- Sleep when you can, take the med on schedule and try to relax as much as possible. Be sure to chart when you take your meds and any drainage from your drains. Also, write down any questions for your doctor. Bring all of this information to your follow up appointment. Your doctor will want to see you a few days after you leave the hospital and then weekly, to check your progress.
- Be sure not to use a heating pad on your breast area. You will not be able to feel how hot it is and there is a possibility for burns. Check with your doctor about using ice.
- You may not feel much like eating, especially the first few days home, but it is important to eat when taking your meds. This will keep you from getting nauseous. It is also important to eat foods that contain protein in order to promote healing. I know that it is tempting to eat junk food, and it is ok to eat that in moderation, but you don't want to undo what you just did !
- Drink lots of water. This will keep you hydrated and also keep your body healthy. Drinking several glasses of water is a good habit to get into, especially if you are not a water drinker.
- If you are in severe pain, running a fever, vomiting, there is excessive bleeding or something just doesn't seem "right", call your doctor immediately or head to the Emergency Room. Don't feel bad about calling after hours, that doctor is on call for a reason. The doctor will instruct you on what to do.
- Your surgeon will want to see you a few days after you are released from the hospital. You may already have an appointment set up or you may call the office when you leave.
- When going to see the doctor, be sure to bring any charts about drainage or your schedule of meds with you. Bring anything else that the doctor has asked you to keep track of.
- At your first visit, you nurse or medical assistant will bring you back to a room and may check your blood pressure and/or weight. She will ask some questions about your recovery and how you are feeling. Don't diminish how you are feeling or if something hurts, let the nurse know. Ask any questions that you may have. The nurse may answer them or let the doctor know and he can address them when he comes in.
- When the doctor comes in, he will check your stitches and look at your incisions. He will ask how you are feeling and if you have any questions. If he has any concerns, he will let you know and if there is something that you need to keep track of or tend to, the doctor will tell you and instruct you on how to tend to these areas. Be sure to ask questions that you may have. You will schedule your next appointment to see the doctor within the next few days or weeks.
- He may feel the breasts and check for hard spots. These areas may require some massage to make them soft. Your doctor will let you know if this is necessary.
- He will check any open wounds and instruct you on how to care for them.
- You may also have a breast surgeon who is independent from the plastic surgeon. The surgeon will also want to see you and check your progress.
- You may feel extremely tight in the stomach area
- You may have a hard time taking deep breaths
- You may feel gas bubbles or the feeling of air moving around your belly
- You may have a hard time having a bowel movement
- You may have pain and/or discomfort in the areas where you have stitches
- You may have numbness or tingling sensation in the surgical areas
- You may feel hard areas in the reconstructed breast or in your belly area
- You may have a hard time sitting up straight for a period of time
- You may have pain/discomfort in the drain areas
- You may feel weak, tired and have a hard time doing everyday activities
- You may have a hard time standing for a period of time
- You may have a hard time walking for a period of time or going up/down stairs
- You may feel like your stomach area is rock hard to the touch
- You may feel a lack of appetite or like a "stuffed turkey" after eating
Your doctor will give you the OK to start driving once you have stopping taking pain meds and your stitches are out. Your muscles may feel tight or weak, so be careful to make the trips short until you feel more comfortable. Try not to brake hard and be careful making turns. You would be surprised how much making a turn can hurt !
Follow all of your doctor's instructions over the next few weeks and continue your appointments so that he can keep track of your progress.
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