Friday, August 25, 2023

Patient review: stacked PAP flap breast reconstruction post mastectomy

 Warning, if you don't like medical language or if breast cancer is triggering, this isn't the post for you!

But if you are recently diagnosed with breast cancer, or are a breast cancer survivor, and are considering an autologous tissue reconstruction I.E. using your own body tissues instead of an implant, and you want to know what this version is like, read on. 

I know there's maybe other BJJ ladies-- or heck, just ladies of any flavor, but particularly athletic ladies-- out there who may need to research this someday. I used to write about training and competing, but I don't feel I have very useful comments on all that. Maybe never did but certainly don't anymore. This might be a place and topic I can help people understand better, so here goes. 

By the way this is intensely personal for me, so while I welcome any questions, I really don't want to hear anything judgey or nasty. Thanks. 

So, I met with my surgeons starting about 9 months ago to discuss my options.

BACKSTORY: I had a mastectomy in 2016 and had (serially) 2 implants installed. First one had healed, but developed a horrible strep B infection and after being hospitalized without any IV antibiotics working, they took it back out, let me heal, and I got a second implant. That implant was recalled by the FDA for causing lymphoma. I don't have lymphoma, to my knowledge, but did have some horrific scarring and the implant was constricted in the scar tissue pocket, and basically glued to my pectoral. I could do crazy pet tricks by tensing up the muscle, but I couldn't do pushups or lift kettlebells and it SUCKED. Haven't trained BJJ regularly since mid 2018, either, so I'm just fat. 

Anyway, a year or so ago I decided it was time to pull the implant and fix things and I started interviewing plastics people (my original plastics guy was awesome but he only does emergent reconstructions for cancer patients and doesn't have time to eat even so... Def doesn't have time for later reconstructions. 

I ended up being extremely happy with the surgeon I picked and he brought in his med school professor/mentor who trained under the doctor who invented this procedure. If my surgeon did the procedure alone, it would take some 16 hours which is no good for doc or patient. 

Thus, teaming up took only 8ish hours and while that didn't sound bad to me, now that I've done it, I realize there's an enormous difference between waking up from 4-5 hours and from 8-8.5 hours, even if you do the superior anesthetic protocol recommended by MD Anderson's people... ****That's a topic for another post, but until I write it, suffice to say never, ever do gas inhalational general anesthesia, for any fucking reason. Do TIVA (total intravenous anesthesia.) Email me with questions and eventually I'll edit to add a link to the post I haven't written yet.****

Anyway... I felt like I understood our discussions well, so uncharacteristically for me, I did no research into the specific procedure I was going to have!! I'd done so much reading on breast cancer, mastectomies, chemo, radiation, anesthesia etc years ago that I kind of took this lightly. Well, I wish I hadn't, if only to really understand what was coming. 

If anyone wants to read what says about the PAP flap reconstruction, you can read here:

But-- I can tell you what's not quite accurate or what didn't come true for me. I had the PAP flap version, meaning they used the fat from my inner thighs and the "PAP" arteries to do the transplants. Well and good. I didn't have any fat on my stomach or back to do another kind of transplant. But apparently I didn't have enough fat in the place where the arteries go, so instead of one moderate 6-8"cut in a straight line where a bathing suit might cover the scar...noooooo, they basically made TWO 14-16" long cuts, one on each leg. 

And on mine, to get the fat plus the arteries, the cuts are L-shaped. One 8" long, following the line where your panties elastic for the leg hole goes around your inner thigh, on each side, and then a right angle, and another 8" incision straight down the back of my hamstrings. So where this article says oh yeah, scars will be hidden... That's a fat lie. Yours truly is feeling 100% pure Frankenstein here 😎

All in all I feel good, except the incisions both around the breast and on both legs are super itchy (they say that's good, a sign of healing) and they're also so tight I can't basically walk, sit, bend over, get up from sitting down, put on shoes, wash my feet etc. So, I walk like I have a stick up my butt, spend most of my time reclining in bed or on the couch, only walking as much as the surgeon told me it's okay.... wearing loose pajamas, with occasionally dirty feet, order in food, and just can't wait to go for my first check up on September 11.

Did I mention the surgical drains? How could one forget those little leashes connecting me to the pouches of love? ALL LIES. I hope to have the 3 surgical drains removed ASAP... They are literally sewn into the skin near the incisions and def not comfortable. 

I don't mean to complain too much, I am unbelievably blessed to have survived cancer so far plus getting the equivalent of 4 quality boob jobs (2 in 2016, this surgery, and coming in November one more "alignment job") plus the equivalent of two thigh lifts and one tummy liposuction in 2017 (to smooth out the original mastectomy contours) and oh yes--thank goodness for health insurance.

And thank God for the Democrats who made sure to include a requirement in federal law saying women with breast cancer are ENTITLED to reconstruction of their breast(s) and insurance HAS TO cover it. 

And thank goodness for wonderful loving women in my family, I don't really discuss in this level of detail with many friends. I'm only blabbing here because I would've liked to know this before I had the surgery. 

I should be healed enough to have the current restriction (I'm not allowed to drive or ride in a car) lifted in about 4-8 weeks. Planning the "alignment" surgery for November so I can take advantage of having paid the whole deductible this year. And then hopefully my surgeon will clear me to train BJJ again.... And hopefully I can get back on the mats next summer.

I'll write a post about anesthesia and my research on that topic soon. 

PS-- the blog post is titled "stacked" flaps because the "flap" (not the skin, just the fat and blood vessels) for the top of the breast comes from one leg, and is stacked on top of the flap from the other leg, which comprises the bottom half of the breast.  And I will note with pleasure that my doc listened to me!!! I said, you take out all the fat you can find without making me look gross when I heal.... but don't you put it all back into me. I wanted smaller breasts as the end result. A cups are fine by me. So he did... And in November the other, OEM breast will be reduced and aligned so they look as symmetrical as possible.

If only there was a way to do liposuction on my fat derriere without the end result looking lumpy bumpy. I want the equivalent of A cup butt cheeks, but there's only one way to do that and it's called work your ass off.

Oh one more question I have heard a lot... That is, why not just do liposuction on your inner thighs or whatever and squirt the fat into the pouch created by the removal of the implant? And you know, when I had the implant put in, at the end they did lipo on my tummy and squirted the fat back into my breast to smooth things out. 

But the problem is, liposuction is really hard on the fat cells that get sucked out. It bursts a lot of them, so they die, and the ones that didn't pop still need a blood supply to live. Only when you have a mastectomy, the surgeon is trying to get you clean margins ie no cancer cells on any perimeter. So that means (at least in my case with a clean margin of only 0.48mm) that virtually all the blood vessels in your original breast tissue are gone. 

The medical profession used to try to do autologous fat transplants for breast reconstruction by liposuction and they ended up with lots of "oil cysts." That means pockets of dead and rotting fat cells instead of a boob. So this procedure, transplanting pieces of fat with all the nerves and blood vessels and stuff, and connecting those up as best they can, produces (I'm told) a real live breast made of fat that lives. And crazier still.... those reconnected nerves? They're working. I can FEEL where I couldn't feel anything for the last 8 years.

Ok, that's enough for now. Thanks and good luck. 

Wednesday, August 23, 2023

Quite the layoff....

 Geez, it's been over a year since I thought I was coming back.

Well, I've had to have surgery, and I have another surgery coming. So I kind of allowed the laziness to continue being in charge. I hope I'll be done with surgeries and done with healing by next spring, and I hope I'm allowed to come back to BJJ without risking my health. I should say, I hope coming back to BJJ won't risk my health, because that's the only reason I wouldn't come back.

Until then, I'm still here, lurking in free live streams (like the Celestino 'guard retention' Livestream hosted free from digitsu this Friday afternoon (noon central time...)

Wishing you the best....