What IS the point of a belly button anyway ?

My husband asked me this while we were bandaging up my new belly button. I thought about it and there really is no need for a belly button after you are born, is there other than for looks alone.

After surgery, a new belly button is formed by your surgeon. This surgery is called Umbilicoplasty. My husband is grossed out by the belly button because you can see into the hole before it closes up. He said that he can see my insides. Ok. Whatever.

My doctor suggested putting Bacitracin or Triple Antibiotic Ointment just inside the new belly button. Then, cover it with a Band-Aid. Please check with your doctor for specific instructions.

Do not "poke around", as you might cause the belly button to bleed. If you begin to bleed or have puss coming from the belly button, call your doctor immediately.

A drain, a drain...... What's in a drain ?

Ahhhhhh........ The JP Drain. Loved by some, hated by most. These little buggers can make recovery and life in general difficult. Generally, you will have drains placed during surgery. You may be lucky enough to have one or more removed before you leave the hospital. You will most likely leave the hospital with at least one. Here;s a little bit about drains and how to care for them.

The Jackson Pratt Drain (JP Drain) is a common drain that is used for TRAM Flap or other reconstruction procedures. One is pictured below:

The white tube will be inside the body, up to the tapered end, which will be stitched in place during surgery.

Before you head to the hospital, you might want to consider a camisole that has pockets to place drains. These camis are not the most attractive things on earth, but trust me, if you forget to attach the bulb once or twice and feel the pull on your tube, you will be wishing you had one. Here is an example of what they look like. They run about $45-70 each. Your insurance may cover the cost. You also may be able to buy one at a medical supply store.

If you are good with a sewing machine, check out this pattern using a T-shirt. You could probably even make one with an over-sized tank top and some Velcro. The important thing is to make sure that it is easy to open and close from the front. My doctor suggested bringing a few sizes of sports bras to the hospital, but I felt much more comfortable in the cami. Due to the swelling, you may not even want to wear a bra for a few weeks, unless you are leaving the house. I was more comfortable wearing an over-sized shirt or a tank with a built-in bra (Confession- it was a maternity one, so the extra space was nice).

Another option is to wear jackets with pockets inside. Pants can be tricky if you have a drain in the groin area. You should wear pants that are loose enough so that they do not put pressure on the drain. You also need to be able to pin the "grenade" to your pants or tuck it into a pocket. Underwear is the next issue. I solved this problem by taking an old pair of underwear and cutting out a circle large enough that would allow me to move the bulb through the underwear. Just be careful when you remove the underwear. It is easy to forget that the drain is still attached and you may pull on it by accident.

When you are at the hospital, your nurse will care for your drains. She will show you how to strip your drains and measure the fluid. You will want to record these amounts and show them to your doctor when you go for your appointments. The amount that you are draining will help your surgeon to decide when to remove your drains. Usually, they will not remove the drain until you are draining 30mL or less per day.

Here is a video on how to strip drains and measure your drainage. 




The video shows a purple-colored liquid, but obviously, you can expect your fluid to be in the yellow-orange-reddish-pink range. If your drainage is any other color or if you drain blood or puss, call your doctor immediately. If you see any small, stringy "worm-like" tissue particles, don't worry. That is normal.

This is NOT normal:

I woke up one morning and was like "What ?" After a quick call to the doctor's office, I was told to not worry about it, a piece from the connection between the bulb and tube had come out. This piece allows the drainage to come out of the tube, but keeps anything from going back in. At my next visit, the nurse switched out the bulb for a new one and I was good to go. I joked that she gave me a shiny new bulb for Christmas, but she wasn't amused.

When you are ready to have a drain removed, be prepared. It may be a little painful, but it is over quickly. It is over within seconds, but it is a bit uncomfortable. So, hang in there and think about how great it will be once that thing is removed.

Drains are usually removed once the amount that you are draining has decreased to a certain level. As I was told by my nurse, it is not "normal" to be draining a large amount at 4,5,6 weeks after surgery, but some people do. There is no explanation or anything that can be done. However, the JP needs to come out.

This is referred to as "Converting to a Penrose Drain". Basically, the bulb and tube are removed, but the white tube is kept in place. You will continue to drain, but you will be unable to collect the fluid and measure it. It is quite a bit messier than the JP Drain, but it does get rid of the tube, which is a plus. Each week, the doctor will "back out" the drain, meaning, he will remove the stitches and pull on the tube, removing a section. He will then restitch the tube. The area may become a bit irritated. Call the doctor if it is hot, red or if any puss come out. It is important to try and keep the area clean and dry, which can be difficult. It is not ideal to go through this, but it does buy you some time if you are still draining heavily. If the doctor removes the drain too early, the area may close up and the fluid may build up under the skin and cause a seroma.

A Christmas Miracle ! (Almost)

May be TMI- Don't read ahead if you are offended by fluid, maxi-pads and underwear talk. ;)

So, it is Christmas Eve and I have an appointment. Weird, but I was looking forward to this one because I still have my last ab drain in (5 weeks post-op) and I was really hoping that the draining would slow down and I could have it removed. My doc told me the week before that we could probably remove it if the draining slowed down. He also prescribed me an anti-biotic, in case there was an infection that was causing the fluid. Unfortunately, nothing changed during the week.

When I got into the room, I chatted with the nurse and we discussed the drainage. I asked her if it was normal to still be draining so much fluid. She said that it was not "normal", but it did happen to some people. I asked "Why ?" and she really had no explanation. Yeah, me. Once again, I am abnormal. :)

When the doctor came in, he looked over my drainage chart and asked a few questions and told me that we would "back the drain out" weekly. I didn't get it at first, but he numbed the lower area with a series of shots, then he cut the bulb and tube off. All that is left is the plastic tube that has taken residency in my body (Penrose Drain - The long white tube with the holes in it pictured below).

Each week, I will return and the doctor will remove another section of tubing, hopefully buying some time for the fluid to get out. The nurse put a pad on the area to collect the fluid and told me the best way to deal with it is to buy maxi-pads and tape them on or attach them to my underwear. Sounded easy enough.

When I got home, I put a new pad in my underwear and hoped for the best. We were having company over, so I really didn't want to leak everywhere. Thank goodness, I was good for a few hours, then I went to change the pad and it was 100% soaked. Gross.

This drain is continuous. Even when I sit down to go to the bathroom, I have to put gauze or toilet paper near it to catch the flow. The maxi-pad shifts and doesn't always catch the fluid, leading to soggy pants. Sleeping is interesting. I want to lay on my back because I am still having some breast pain, but I am afraid that the pad won't catch everything that comes out at night. I tried to wrap an Ace bandage around myself, to keep it in place, but it is in such an odd spot, it is hard to keep it from moving.

In the big scheme of things, this is no big deal. Things could be much worse. It is just another uncomfortable part of recovery that I get to experience. On the positive side, I can wear pants again and not have to worry about the tube hanging out or getting caught on something.

I am worried about the area getting infected or something getting into the tube and back into my body, but the doc said that there was nothing different that I should do to clean it, so I guess I will just keep a close eye on things and hope for the best !

The Dummies Guide to TRAM-Flap Surgery

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. 

What do you need to buy ? Well, you don't need to buy all of this if you don't have them, but these things help !

• 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 ! 

 One point that I can not emphasize enough that having a strong care-giver or team is sooooo important. You are going to want to do a lot on your own, but you just can't. You shouldn't and you physically can't do a lot on your own for at least two weeks. My husband was AMAZING ! Kept the kids away so I could sleep, kept me comfortable ran out to get me a snack that just "sounded good", took over all of the household chores so that I didn't have to worry about them getting done. I can never thank him enough.

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.

And then you wake up......

• 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 !!!! 

 During your hospital stay.....

• 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.

•  You will most likely have surgical drains in place after surgery. How many and how long these drain will be in depends on several factors: Your body, the depth of the wound and your surgeon.
• 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.

Home Sweet Home !!!

• 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. 

Going to the doctor.....

• 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. 

How you may feel over the first few weeks....

• 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

You may feel all of none of these symptoms. These sensations will lessen over time. The first 3-4 weeks are the hardest. After week 4, you should be feeling a little more like yourself. The extreme tightness was much less by Week 4 for me. Over time, you will begin to regain some feeling in the "numb" areas. You may never fully have sensation in some areas. You can reduce the amount of pain meds that you take and eventually, you will be done. Don't toss them just yet, you may have a bad day and need something to help you get by.

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.

The Big Reveal

Yesterday was a milestone- I left the house, not to go to the doctor but a luncheon for work. It was my first time out of the house other than the doctors for anything and ....wait for it..... I was in a DRESS! Kind of a big deal, since I have nothing but elastic (or a bra) for the past 4 weeks. I really wanted to wear pants, but I have one last bulb in the lower area, so it was very uncomfortable when I tried them on. That in and of itself was a production.

I have been so excited to see what size I might be now and if any of my clothes fit (secretly hoping the answer was "no" so I could buy a new wardrobe). Well, it was 50/50. I dug deep, back into my closet where my clothes go to "retire". You know, we all have that section of clothes that we hang on to "just in case I lose a few pounds". I pulled out a few blouses and honestly, I was a bit disappointed. Other than the fact that they now fit more correctly in the chest area, they pretty much fit the same. After I thought about, it makes sense. I don't know why I was expecting my ribs and their "cushion" to magically shrink after the surgery. I have always been broader across the top, so everything basically fit the same.

I was pleasantly surprised when pants that I haven't worn in probably 6 or 7 years fit (and looked GOOD) !! Only problem was that darn JP drain. It hurt like a mother because the pants kept pushing it back "inside" and my body was like "Um. No. I don't want that back in here". I can't wait to try them on again next week, without pain involved. Bottom line, I dropped probably 3-4 pants sizes !!!! I looked at myself in the mirror and was amazed by my profile. I haven't looked that "slim" since before I had kids !! Bye-Bye "Mom-gut" !

However, it was a reminder that I need to work on my upper body. I am not sure how, but I need to do that. I think that I need to start easy, do some walking and eventually get into a more active routine. My goal is to get back into running. I used to "run" (ok, jog) back in the day and would love to get back into the habit. I always had some excuse why I couldn't exercise or make time, but now that the kids are almost at the age where they can stay home alone for 30 minutes or so I am kind of excited to get out on my own and have some "thinking time". So, I am putting it out there. Since I have been given this chance to 1. Save my life and protect me from future bad stuff and 2. Give me my figure back, I need to grab it and not get all chubby again. I have only lost a few pounds from the surgery since the surgeon basically played "Musical Fat" and just rearranged my tissue. The way that I am eating has also changed.

I am not a "big" eater. I am more of a snacker. Since the surgery, I am slowly getting my appetite back. However, the skin and my stomach are very tight feeling and when I am feeling full, I literally feel like I am going to burst. Everything feels really "jam packed" into my abdominal area. I am sure that the tightness will ease with time, but for now, It is borderline painful to eat or sneeze !

OK, focus Kelly. Lunch. Christmas Party. Work friends. I was really hoping to wear pants because they had the most dramatic effect, but I just couldn't do it. It was really uncomfortable. So, I chose a  flowy dress that I hadn't worn in about 2 years. I had never worn it to work, so it would look new to them :) I could tell the difference in the fit immediately and could see it in the mirror. Even my husband who is such a "man" commented and said I looked "great and beautiful" without being prompted ;) I have to admit, I was hoping for more of a reaction from my co-workers about how I looked. They all came over, sub-consciously looked at my boobs, gave me a hug, told me that I looked great, and asked how I was feeling. I guess I was hoping for "Oh my goodness, you look amazing" or " Look how thin you are !", but I have to just keep in mind that I really only showed off my top half and not the real difference-maker, so maybe when I wear pants, it will be more obvious. Next challenge- Family Christmas party. By that time, I will have my last drain out and I am wearing pants no matter what !!!!!

So, what do Angelina Jolie and I have in common ?

Well, aside from long, dark hair, a couple of kids, our moms both had cancer, we both have BRCA+ diagnoses.We are a bit different in the fact that she has a BRCA1+ and I am a BRCA2+.

I have to admit. I have never been a big fan of Ang. The whole Billy Bob, blood in a vial.... She just always seemed weird to me. When the whole "Brad/Jen" split happened, I was totally on Jen's side and made me like her even less (Like anyone cares). Didn't like her. Didn't like her movies. Thought she was fake. Adopting kids from all corners of the earth- I thought she was just trying to change the public opinion of herself. Then the article came out that changed my mind. Angelina Jolie's op ed- Please read

I read the article and I felt sad for her. She had lost her mom and grandma at very early ages. I am proud of her for being tested so that she could be there for her kids. No matter if they are her's biologically or adopted, no one deserves to grow up with out a mom. My Mom was diagnosed with breast cancer in 2012. When she called me, I cried. I'm 34, but I didn't want my Mom to die ! Thank God, she caught it very early and is clear today, a year and a half later. She also gave us a gift- The ability to be tested for the BRCA mutation. Of the 5 girls in our family tested, 3 of us were positive.

When I was going back and forth about the surgery, THAT was the reason that made my decision. How silly if I decided not to have surgery and then eventually get cancer. Why would I take the risk of leaving my kids without a mom when there was something that I could do to prevent it ? Now, near the end of the surgical process, I can't believe that I even hesitated.

So, although I may not have millions in my bank account like Angie, we both do have our kid's best interest at heart. <3

Do's/Don'ts and everything that I wish that I had known......

Ok. Here's a crash course on what to do before/during and after your surgery:

Before:

• Make sure that you have arrangements for yourself. You can not do this alone. I don't care if you are Wonder Woman. You can't do it. Be sure to have a ride home and someone to stay with you for a week or two. You will also need someone to drive you to and from weekly doctor's appointments. 
• Make arrangements for kids and/or husband. Who's going to get the kids from school ? Can they stay with Grandma and Grandpa for a few days ? Maybe make a few meals and freeze for Dad to toss in the oven. Let school know that maybe the kids might miss a day of school or maybe their homework won't be on par because mom is going to be away for a few days. You don't have to be specific.
• Get laundry done and put away and get things set up for when you return home. If you are like me and see something out of place, you want to fix it. But you can't. Let it go !!!! It will be ok. I promise !!! 
• Pack your bag for the hospital. I thought "I'll bring books, my Kindle, phone, paper, extra clothes, socks, etc. ". Guess what I used. My Kindle and my phone. I checked Facebook occasionally and email and called home a few times. other than that. I slept. The hospital gives you the gown to wear and socks, so just wear home what you wore to the hospital. 
• I went grocery shopping before and bought everything you might need for a month. I also made sure to get some bland things that I like to eat, just in case you are not feeling great when you get home. The hospital has most of this stuff, so don't bother bringing your own.
• Graham Crackers
• Saltines
• Lorna Doones
• Pringles
• Bagel Chips
• Jell-o
• Pudding

• Make sure your husband or caregiver can do a multiple text or phone call to all those who are worried about you. 

During: Not much YOU can do DURING surgery, but as I said, get as much rest  as you can. Sometimes it can be hard when the nurses come in every two hours to check your vitals, but you can make up for that sleep during the day.

• How does it feel ? It is hard to get into a seated position from a reclining position. It is hard to twist and turn. Ask for help and you life will be so much easier !!!
• It may be hard to breathe. It feels very tight in your chest. You may feel like you are able to walk around for a bit, don't overdo it !!!
• Follow the exercises that the nurses give you about flexing your feet and be sure to get your heparin shots ! These will help keep you from getting blood clots.
• Listen to what the doctors and nurses say. If you don't feel like you will remember, ask them to write the instruction down or have your caregiver listen for you. 
• If you have ANY questions, ask them ! Doctors and nurses have heard/seen it all. You are better off being embarrassed and having a direct answer than going home wondering.
• One thing that I did not know when I was going to have the TRAM surgery was that there would be drains in my pubic area. ACK ! Embarrassment city !!! I almost asked my doctor's assistant at my last appointment, but I was too embarrassed. They at least waited for me to pass out before they trimmed the hedges, but they also have 2 drains in that area, where they are constantly stripping, checking and showing to students. So basically, I am no longer ashamed about my body, since just about every single person on the earth has seen it by now. So, just be prepared.

After: Don't be a hero !!!! Just because you think you can, you shouldn't ! You may be feeling great, but it is going to eventually come back to bite you in the butt.

•  How does it feel ?  The tightness has moved down more from my chest into my waist area. remember, the doc pulled all of that skin down and the area where the two areas come together is pretty tight. By staying on top of meds, you can avoid some discomfort. I also feel a lack of appetite or just a smaller appetite (not that I am complaining...) I am not sure if this is temporary, but I'll take advantage of it. 
• The first time I looked at the mirror to see the "new me" I kind of freaked out. I looked like a penguin. I was really puffed up on top (rib-area) and I was super hollowed out in the waist area. I almost wanted to cry. I told my PS and he said that the swelling would go down and it would look better (P.S. It did go down and it does look better :).
• It has been almost two weeks and I still have both drains in the groin area and I can not wear underwear because it tugs on the drains. I just change pants everyday :)
• Just a warning- When the drains come out, they don't feel good. It is not horrible, but a very quick, sharp pain. Literally, it its over in a second. Nothing to stress over, but just a warning.
• Sleep when you can. Sleep when you can. Sleep when you can.
• If you have any questions, don't hesitate to call your doctor if you have a question or if something doesn't seem/look right. Any leakage, seepage, discoloration.....Call. Trust me. I have sent cell phone pics of a rash on my breast "just to be sure". (BTW- One and only time I have taken naked pics of myself with the phone). You will feel much better for them to say "Don't worry" rather than sit and stress about it.
•  Some of your drains will produce different amounts of "stuff". It may be clear, cloudy, chunky, wormy, dark, light, just about anything. The color may be different too. One of mine is rosy colored, while the other one looks like it could be used on CSI for blood splatter. No joke. Just keep track of how much and what color the discharge is and this will help the doctor decide when to take out the drain.
•  This is a long-distance race, not a sprint. Be prepared that things are not going to happen over night. Every morning you will wake up, you will be better than the day before. I asked my doc's assistant this week (day 8) when I would start feeling better or at least more like myself. She said that by next Friday (day 18), you will feel more like your regular self. Looking forward to that day !!!!

Upkeep

Whew. Life is rough. Sleeping and eating. LOL Of course, there is a lot more going on daily in order to care for everything. First, there are the "granades" or "JP Drains". Here's how to strip and empty your drains Your doctor or nurse will show you how to do this, but this is a good refresher (We never had gloves, we just used the alcohol wipes). For the first few days, I had my husband doing this, but at about a week later, I am doing it myself. (Go me !)

Showering: I invested in a hand-held shower before, so that seems to be the easiest for me to clean off. I can wash my hair quickly and quickly clean off all of the necessary areas with soap and water by sitting on the edge of the tub. I had a bad experience with staples and showers with one of my pregnancies, so I prefer to keep it is as dry as possible. I know that I don't have staples, but I am weird, ok ?

I did have a blister when I left the hospital and they did not really explain what to do with it. We finally called the doctor today and they instructed that we clean it well, use Silvadene cream and a loose fitting pad. After a few hours, repeat. Of course, if you have any issues, call your doctor immediately and follow their instructions.

Sleep: Sleep whenever you are able to ! Visitors will understand. Tell them to drop the Tupperware on the counter and you'll call them later. :) If they don't get it, just start nodding off and maybe they will start cleaning up for you. If all else fails, just come out and say it. "I'm really tired. Would you mind coming back next week when we can chat more ?"

My main piece of advice: Even if you think that you can do it, you shouldn't ! Your pain meds will give you false confidence. Yes, you will be able to do things like laundry and lift children, but it is not a good idea. This is your time to take it easy and let someone else have a turn.

The aftermath

I woke up in my room, so I must have been on some good drugs ! I remember lots of ice chips and that I had a pump for meds, which I used as often as I could. :) So, other that that, the first day is a blur. I think that I actually felt like eating and ordered a sandwich, but when I smelled it, I pushed it away. I tried a little Jell-o, but that didn't turn out so well, either. I think that I just called it a night at that point.

Day 2  I can't believe how well I felt ! Of course, I am not going to do cartwheels, but, I was able to move a little bit. I was still hooked up to a catheter (YES !) so that saved me from having to have to go to the bathroom and I could just relax and sleep.

The nurse made me get up and walk with a walker to the end of the hallway. I thought. "No freaking way !", but being a good little patient, I flipped my legs around and miraculously, my legs worked ! I did my lap and did not die. It was a little tight breathing, but I did it.

Day 3  Today, she wanted me to walk longer and a few times, which I did. I even did it without the walker. I was off of my IV, and on some pain meds orally, so I was able to use the bathroom, brush my teeth, walk around the room. Still pretty tired, the meds made me sleepy and it is important to get the sleep when you are tired.

Day 4 Go Home Day !!!!! The kids and hubby came to get me to go home. I had an extra pillow to go between my tummy and the seat belt. I got home and headed straight for my recliner. My trusty recliner has been through a tough pregnancy, numerous surgeries and now this. We bought a cover and my husband put some nice, cushy blankets over the top, so we could wash them if something gross made its way on to the blankets (We're practical, OK  ?).

Day 5,6,7....... Nothing really stands out other than taking my meds, sleeping, waking up, eating, going back to sleep. As the days go on, the amount of sleeping decreases. I can walk around just fine. Going to the bathroom is fine, until, well, you know, #2. It is hard to bend in the way to clean properly. Either ask for help or use a wet wipe or cloth.

This is IT !!!!!

Finally. I was within a week of the surgery. I had let school know, made plans for the kids, packed my bag. Filled all of my prescriptions. I thought that I was ready. Maybe. I have to admit, I did have a moment (or two) where I thought about the "what-ifs". Do I need to make out a will ? Should I write out a list of songs and readings that I liked for my funeral? I knew that it was silly, I just remember hearing about people my age who die from blood clots after surgery or something weird and I didn't want to be unprepared. But then I just said to myself  "Self, you are being silly. There is nothing that you can do about surgery. You are going to knocked out. You aren't doing any of the cutting, stitching or anything. The only thing that you CAN do is follow the directions from the docs and nurses after". And that is is exactly what I am doing. BTW- I didn't die, just in case you were wondering ;)

Ok. Let me back up a bit and go over the surgery, hospital, blah, blah, blah......


The day has arrived. All of the planning, waiting, hoping, dreading, crying, worrying has come to an end.
I was scheduled to be at the hospital at 6am. Since I live an hour away, I was pretty darn tired. I knew that I would sleep most of the day anyway, but my husband was going to be exhausted ! I checked in, they called me right back and I got all dressed up in my beautiful gown. Met with the anesthesiologist, my breast surgeon came in a reassured me. Then my plastic surgeon came in. another awkward artist session, at least this time, I was a little numb in the breast area. :)

So, after my IV went in, off to sleep I went. I don't even remember going into the Operating Room like I usually do. So, for the next 5-5 1/2 hours, I was sleeping soundly without a care in the world. And then I woke up.

The "S" Word

Ok....... It's been long enough. I have been waiting it seemed like forever to get this surgery over and move on with my life. My doctor and I had discussed two possibilities: Mastectomy with implants and a TRAM Flap surgery. (Here's some more information about the TRAM FLAP surgery).

My doc said I was just on the edge of the weight recommended for the TRAM surgery, so, unless I could lose a little weight, we would probably go with the straight implant surgery. I thought that I would do what I can and see what happens. I tried to watch what I ate a little bit and started walks around the neighborhood, But I just couldn't lose any weight. I figured that I was destined to go implants.

My Mom and both sisters went with the implants and were happy to choose what breast size they would ultimately be. My Mom and one sister went straight to implants, while my other sister did expanders. She said that it was uncomfortable, but not horrible. I wasn't really looking forward to going in every few weeks or month and tweaking it (Bad memories from braces !).

At my next appointment, my doc did the measurements, head tilt and grabbed at my fat again. He said no problem, we can do the TRAM and I could be C, just like I was after the reduction. YEAH !!! I knew that it was going to be a tougher surgery, but I would be happy with the results after it was over. Even if I was slightly slimmer, I would be happy. I couldn't get any fatter, right ?

Subtraction before addition

So. The reduction. I have had several surgeries throughout my life, so I wasn't too worried about the surgery. This surgery should only take an hour or hour and a half, so no big deal. I have to say, the most embarrassing part of the whole thing was when my ps came in to the pre-op room and drew all over my body with a sharpie. My husband was watching and I am soooooo ticklish !!! OMG My body probably looked like a drawing that my 3 year old did. I felt like I was on Nip/Tuck, but I'm not hot. LMAO.

After surgery, I elected to stay for the evening, and went home the next day. At first, my boobs were ROCK hard ! They were really hard for quite a while. They felt like I was breast feeding again. I actually followed my doctor's orders and took it easy for about 6 weeks, then went back to work. I would say that I was feeling like myself after 3 weeks or so, but I enjoyed the "free" time anyway, just to be sure.

Can I tell you how exciting it was to actually fit into my clothes again ? You know, those ones that have a place in the back of the closet for when "You lose a little weight" although that have occupied that corner for 3 years ? I pulled those out and they fit ! They FREAKING fit !!!

Ok. I am 5'2 and I have been wearing DD+ bras since having my kids. Just because I could wear a medium shirt because it fit my waist, my giant boobs would make me have to buy an XL blouse. Then, the shirt hangs off of my and I look like I am wearing a garbage bag.

So I could finally bring back clothes into my rotation and everyone compliments me "Is that a new sweater ? Did you lose weight?" It's awesome !!! 

Surgery Scheduled. Just Kidding !!

***Attention*** This is not for everyone and not every surgeon will suggest this, just my personal experience :)
After a few consultations with my plastic surgeon, we discussed options about surgery. I have had 3 kids and had "National Geographic" boobs. AKA "Fruit Roll Up" boobs. Basically, you gather them up and shove them in a giant bra. They contort and somehow come out in a round-ish shape. So, since they were "sizeable", my nipples hung down quite a bit and wouldn't look right if they were to clear out the tissue and reconstruct them to a smaller size. If I wanted to save my nipples, I would have to have them removed during surgery, placed elsewhere on my body (under arm, stomach area)and then have it reattached once things had healed a bit. This could go off with out a hitch (worked for my Mom and one other sister). However, there were some things that could happen.
1. The skin could reject it and it could die.
2. There could be a lack of blood supply and it could die.
3. I would be a "Barbie" for a time until the nipples were reattached, not to mention, I would also have udders. LOL
We scheduled the surgery for the "Nipple-Sparing Mastectomy" and I started to prepare for that (mentally and physically)...
Then my doctor had an idea. What if we did a reduction first ? It would give me an idea of the "end product" size, They could put the nipples in the final position, so we could avoid that procedure later, it was also give me a little more time to get myself into shape since my boobs were going to be smaller, they couldn't hide my my "mommy gut" as much anymore. One of the biggest advantage if that it gets rid of excess tissue, making the final surgery shorter and the blood flow is increased, which will help in the tissue healing and less chance of necrosis (tissue loss).
Well, at first I was like. "Really ?" I had already told my boss I needed time off, got the kids arrangements all squared away, now this ? AND, if I did do the reduction, that means another surgery and having to wait another 3 months until I could through with the "BIG" surgery.
What to do, what to do..... As much as I really wanted this OVER with, I called my breast doc and asked her opinion. She said flat out, it was my decision, but if it were her, she would do it this way. OK, so I decided that this makes sense and I would suck it up and have the second surgery because it would look the best in the long run.
So, I called my Mom and my sisters and...... they hated the idea. I bawled my eyes out. It was so hard to make this decision, and I felt like I was on my own. I tried to remember all of the positives that the doctors had said and I thought for sure that by telling my Mom that Dr. K had recommended it that she would support me. I was feeling really down, but I figured "This is my body and I don't have to do what everyone else wants me to do". I do highly value what others have to say, but when did they go to medical school ? So, I went along with the scheduled date and had the reduction, as planned.


***UPDATE***
Once I explained the advantages of doing the reconstruction, they were on board. I am soooooooooo happy that I did the reduction first. The results are wonderful ! I will not need to do any further surgeries to "touch up" any scars or to have nipples placed or tattooed. All of the nurses at the office comment on how great my breasts look. I was very surprised, but the doctors did not have to cut around the nipple during the TRAM flap surgery, they just cut along the same line as the previous surgery. It is six months later and the scars have almost faded around my nipples. I would definitely  recommend doing both surgeries if you are able to and your doctor recommends it. I am very pleased with the results !!

Plastic Surgeon..... Round 2

Soooo.... where were we ? I guess it was a bout a year ago. I just had my oophorectomy and life was pretty good. The surgery wasn't horrible and I was back to work after a few days. No one even knew (other than my boss), and I was ok with that. I am a pretty private, modest person. I like people, but I don't like them knowing my business. I really like my co-workers, but I just wasn't ready at that point to broadcast it. I knew that I was going to do the surgery, just not exactly when or how.

Shortly after the ooph, I made an appointment with my sister (another one) and my Mom's breast surgeon and plastic surgeon. My mom had not troubles, but my sister had a few issues, which made me hesitate about going with this ps. I had my appointment with the breast surgeon first. I LOVE her. Can I say that ? She was so accommodating and made me feel like a person, not just a patient. She talked to me like a friend rather that someone paying her. She answered all of my questions and didn't make me feel dumb for asking. I did ask her about the other doc. She reassured me that if I wanted to meet with another one, she would go with me and we could talk about it together or whatever made me feel the most comfortable. I asked her about the doc that my Mom and sis saw and I asked her "If it were you, what would you do ?". She said 100% she would go with him. No question about it. So, I figured if he was good enough for a top breast surgeon, he would probably be good enough for little old me ;) So, next on the checklist was meeting with the plastic surgeon. I was a bit worried because I am kind of joker and I had heard that he was kind if a dry guy. Looking back, what the heck was I thinking. I wasn't going to to go with a skilled surgeon because he didn't laugh at me jokes ? Silly.

At first it was uncomfortable, stripping down for him, his assistant. Taking pictures (really uncomfortable). I just tried to put myself in a different place. My head wasn't on any of them and they were from the waist up, but they definitely weren't flattering ! The reassuring thing was that this was the WORST that they were ever going to look. I was going to look better. Not immediately, but we would get there. By the way, although he wasn't Jokey McJokester, he was no where near as bad as I had imagined. Once again, make your own judgements based on personal experience. Others will have their opinions, but this is about YOU and your comfort level !!!

Wow. It's been a while, huh ? Time flies when you are having fun !

I don't remember if I have said this before, but I will say it again anyway because it it so true. This takes over your life. Not forever, but from the time you find out that you are positive until your surgery (and recovery), it seems like it is always on your mind. Planning school conferences, vacations, your job..... everything gets the "Do I have an appointment that day?" or "I should be out of the hospital by that time." before you can commit. The important thing to remember is that this is temporary. Five years from now, you won't even think about.