Areolar Tattoo Results…Just for Now.

Nice to be back on here!  As the saying goes, “the road to hell is paved with good intentions”.  Every day I think about various things I want to write on my blog and intend to do so every night.  But the sun rises, sets, and I haven’t made time to sit down and commit anything to post.  So here I am two weeks after having my areolar tattoos done and this backlog of thoughts, feelings, and ramblings about my tattooing process.  So I’ll start from the day of the tattoos.

 

I went into the reconstructive surgery clinic nervous as hell.  It wasn’t nervousness about pain – because I still have almost no sensation in my Noobs.  Also, I’ve been through dozen of tattoo sittings and have a pretty well established pain threshold for the whole thing.  I was nervous because I was feeling pretty damn good about the aesthetic of my reconstructed breasts and nipples as they were, and I didn’t want to mess with a good thing.  So, here they are pre-tattoos:

 

Reconstructed nipples before areolar tattoos.

You can see (hopefully) from the photos that the reconstructed nipples alone look pretty convincing as “complete nipples” – or whatever the correct way is to convey, “looks a lot like natural knockers”.  They healed really well, my scars aren’t very pronounced, and I ended up with a good protrusion for the nipple.  The best part was I could wear a tank top (with built in bra) without concern of pigment or protrusion showing through:

Healed, reconstructed nipple

 

Healed nipple displaying protusion

Healed, pre areolar tattoos, not showing through a white tank top.

 

But this was just another step on the road to completion, and here I am forging on and on and on and on!  My reconstructive surgeon did not do my tattoos, which was expected.  I was told well in advance that either a resident or a P.A. would do them.  I totally forget the name of the resident that did my tattoos.  I DO recall that she is Canadian, blonde, sweet, has light hands, good pigment matching skills, and she likes to listen to music during the tattooing hour.  We got acquainted and then moved on with the show.  First she started by finding a circular outline ring that had a circumference large enough to cover my nipple reconstruction scars.  She put removable ink on the bases of them, and then sort of twisted them on for an outline:

Outlines for areolar tattoos, placed with enough circumference to cover scars.

She brought out the pigment trays and started mixing.

Pigment tray post mixing

When she thought she had a good match, she put a little schmear on the Noobie and we gave it a test photo op:

 

Pigment test for color match before tattooing begins.

We were pleased with the color match up, so we moved on with the tattooing.  At my last appointment with him, Dr. Louie gave me a prescription for topical lidocaine but I didn’t use it because I don’t have much sensation where my tattoos were being done.  I do have some returning sensation on the perimeters of the Noobs, but not anywhere near the areolar sites.  So other than some lively discussion and the usual impatience on my part, the tattooing was really a non-event.  That is until I saw the results, with which I was really pleased:

Right areolar tattoo complete

 

Left areolar tattoo complete

They looked good, right?  So I got all bandaged up and was sent on my merry way with some Radia Gel to apply in the healing days, non-stick gauze pads, and Tegaderm strips (to adhere the gauze pads and cover the Radia Gel).

Day 1 post tattooing, all bandaged up, ready for the 1st wash.

Here is where I think things went astray:  the after care.  During my tattoo session, we were discussing what I historically used on my run-of-the mill tattoos during healing and how I cared for them.  After getting my “normal” tattoos, I was lightly bandaged and told to leave my tattoo covered for the rest of the day, wash with luke warm water and gentle soap the following day, and apply a very light layer of Eucerin or Aquaphor for the next 5 days, then lotion as needed for dryness over however long it takes the itching/healing to be complete.  No scratching, scraping, Neosporin, etc.

So when my tattoos were done, I was bandaged up with Radia Gel, gauze, and Tegaderm strips.  The Tegaderm strips did not let my skin breathe at all.  I know that you need to keep an “open wound” covered to prevent infection, but I mean nothing was getting into those bad boys.  Not even oxygen.  I was instructed to leave the bandages on for a day, then remove them, gently cleanse, and reapply.  When I took my bandages off the next day, pools of liquid poured out of my bandages.  It looked to be comprised of the Radia Gel and 80% of the pigment from my tattoos.   I hopped into the shower, used an indirect spray and let the water run over my Noobs, patted dry, and went through the dressing ritual.

Day 1 post tattoos, Left areola, bandages off.

Day 1 post tattoos, Right areola, bandages off.

The Radia Gel is a pretty light/thin feeling product.  The instructions state that it should be applied to the area 3 – 5 times a day.  This is a problem when used in conjunction with the Tegaderm strips.  The strips completely adhere to the gauze and skin and create a seal.  So whenever the gel needed to be reapplied I would have to start all over again with the dressings.  I think that the strips are also too confining, if that’s the appropriate word.  I felt like my tattoos would have healed better and retained some of the pigment had the dressing been more breathable and allowed some ventilation instead of being completely sealed in.  But I wanted to follow the instructions I was given and see how things went.  Turns out, poorly – at best.  I now have very little pigment left in my skin and will have to start, just about, from scratch when I go back in.

Day 3 post tattoos, healing

Day 7 post tattoos, Left

Day 7 post tattoos, Right

Out of all the steps in this journey for things to go a little wrong, I feel like the tattooing was the best place for it to happen.  Had I had some failure at the portion of my breast or nipple reconstruction (like my seemingly endless fear of necrotic tissue), I would’ve probably gone to pieces.  This, fortunately, is an easy fix.  So, I will go marching back into the fray to give areolar tattoos another shot in about two months. Until then, this is what we’re looking like just for now:

 

Don’t Call It a Comeback (Day 44)

What a day!  Today I went back to the torture chamber with Paul.  It was hard work, harder than it was when I started working out with him.  I spoke with my physical therapist the other day after leaving her a message asking if I was clear to go back to the gym.  She had to make a few additional phone calls herself, but then got back to me.  We discussed things that I could do, what I might be able to do, and things that I should avoid.  Yesterday I was super excited to get back into the gym.  When I was walking into the doors, I was excited.  When I was done working out, I was totally exhausted.

My range of motion is so much more limited than I anticipated.  I think it’s from, in part, how much I have been guarded about fully using my arms.  Even though I’ve been keeping up with  my physical therapy stretches and exercises, I didn’t think I’d struggle so much with the simple things.  Despite having a few dashes of cardio in my workout, the things that got me sweating the most involved me trying to raise my arms.  It doesn’t hurt to raise them, I just have a lot of tightness in certain areas that prohibit me moving them freely and without worry.  It’s a slow and steady work in progress, but you may have guessed I am not a creature of patience.

It was also surprising to find that doing certain motions with my legs (like raising my knees up high and attempting pistol squats) really caused a tugging, strange sensation along my abdominal scar.  We did a few things that included trunk rotations in which I expected to feel a tugging or pulling sensation along that scar, but I didn’t anticipate so much of it while doing leg exercises.  Everything was a challenge, but it’s good to be back at the gym.  I worked so hard to be in tip-top shape prior to my surgery in hopes that it would decrease my recovery time.  I don’t know if it did or had no impact at all, but I’m glad I did it.  Since I feel like the time before my next stage of surgery is quickly approaching, I’m hoping to be in better shape before I have to ease off again (albeit for a much shorter recovery).

Another surprise today:  a little unexpected oozing.  My dreams, like yours probably, are sometimes only loosely tied to my actual, awake life events.  Sometimes, they’re spot on.  This morning, before I got out of bed for the day, I kept dreaming that my abdominal scar was ripping open at different points during my workout with Paul.  In my dream my skin would split open neatly along my incision, but only little drops of blood would come out.  No doubt this had more to do with my fear about getting back into a regular workout and my limitations, but when I finally crawled out of bed I noticed a little bit of blood over my right hip.  I pulled up my pajama top and I have a very small spot (I think where my last drain was pulled) that has opened up a little bit.  There is a small bit of puss coming out of it and it is slightly tender, but it is not like a raging infection.  I was able to send a message to Dr. Liu on Twitter asking him about it.  I wasn’t overly concerned due to its small size, but I also didn’t want to risk leaving a potential hazard for the whole weekend.  Amazingly, on a Friday night after anyone’s normal office hours, he immediately responded.  It sounds like this is just an irritation from a dissolving stitch and should be watched to see if redness developes around it.  If so, then I can call for some antibiotics.  But basically “NBD”, as the young people Tweet it.

Again, totally amazing that I can communicate with one of my physicians about concerns after hours using social media.  AMAZING!  I also bumped into my breast surgeon, Dr. Sara Javid, who performed my prophylactic bilateral (skin sparing, but not nipple sparing) mastectomy.  Dr. Javid is so kind, sweet, and skilled.  We stood in a bakery and talked for a little over 5 minutes about my recovery and how I was feeling and doing really, really well.  She was and is so great to work with; it was really nice to see her again so I could tell her how thankful I am to have been her patient.  I know that this probably sets the bar pretty high for other women who may have upcoming surgery, and I apologize for that.  But all through this experience, I have found that all of my physicians and their staff really want nothing more than to be great at their professions and treat their patients well.  In reading about the experiences of other women who had bilateral mastectomy and DIEP flap breast reconstruction, it seemed like they were rarely able to get helpful communication OR information from their physicians or the physicians’ staff.  And thinking about those women now in contrast against my experience, my heart really goes out to them.  This process is very intimidating, emotional and complicated.  I can’t imagine going through all of this and feeling like my surgical team didn’t or couldn’t support my after care needs.  So, I am grateful to all of my physicians – but as of late Dr. Liu has been Man of Steel quality medical super hero.  So THANK YOU DR. LIU!

I discussed on one of my recent posts the possibility of ordering some prosthetic nipples to see if they would get me a little more solid on nipple reconstruction.  They should be here in 3 – 5 business days, so stay tuned for some false, detachable nipple excitement! My daily dose of medical wonders is below, as always.  Today I included a picture of the sometimes visible dip just below my abdominal scar.  I’m not sure what makes it more noticeable some days versus others, but I tried to get an aerial view so that you could see where the little dip is.  I am doing scar tissue release massages at home which were prescribed by my physical therapist.  Hopefully these will loosen this area up a bit.  Because it’s not as visible every single day, I will only post pictures of it when it seems like someone else would be able to see it.

DAILY DOSE:

 

04/27/12 - Frontal

04/27/12 - Flaps

04/27/12 - Abdomen (see the scar dip?)

04/27/12 - Scar dip just to your lower L of my belly button

04/27/12 - Suture abscess?

04/27/12 - Right

04/27/12 - Left

Day 41

Tonight’s post is short and photo free.  It’s been a tough day for a variety of reasons.

My left shoulder, clavicle and sternal area is afire with discomfort today.  The girls had parent & tot swimming lessons again this morning, and Olivia took out her unwillingness to participate on, what felt like, only my left noob and abdomen.  Being that flailing limbs are innate to swimming,  I can’t complain much that I took a few body shots.  But the after effects are massive today.

I also had a lot of wrangling to do with the girls before Mike got home from work.  They woke up feisty and just wanted to pull each other’s hair out, so there were many time outs and subsequent apologies issued this evening.  My physical therapist told me that I’m probably having so much shoulder and clavicle pain because I’m over compensating for my limited strength and ROM on the left side by using my entire shoulder girdle to do movements that usually only involve my shoulder itself.  Even after doing my prescribed stretches and a little self massage, I’m throbbing and my swelling is really uncomfortable.

Today I scheduled my nipple reconstruction for June 22.  When speaking with my reconstructive surgeon’s scheduling assistant, she wanted to bring my attention to the fact that not all of this procedure will be covered by my insurance.  That conversation led me to make about 12 other phone calls today between my insurance company and the hospital, wherein I found out that my insurance is (currently) not paying the claims submitted for my DIEP flap breast reconstruction.  There is an appeals process that we have to navigate our way through, but if my insurance denies payment we possibly have a long battle ahead of us.  I have thought and talked so much about this today that I’m just exhausted on the various issues and potential avenues that all of this could go through.  So, now I am even less interested in having my nipple reconstruction than I was before.  Mike has encouraged me to forge ahead.  I think that his position is subject to change once all of the related bills gets here.

For now, I’m hoping just to get to bed and not dream about selling my kidneys on the black market to pay for all of this.

 

P.S.  Check out the “baby bundt cakes” and “skin sombreros” here.

Bright, sunshiny day! (Day 38)

In case you hadn’t guessed by the title of this, today was a gloriously sunny and warm day; tomorrow is supposed to be the same (if they’re not lying to us)!  After having a day of less swelling on my left side noob, it’s back with a vengeance today.  I’ve been doing my physical therapy stretches and massages but I can’t tell if I’m seeing changes because I’ve started incorporating these things into my day or, again, if it’s just an amalgamation of things.  I’ve been carrying the girls, being active with them, and using my left arm more vigorously and often than I had been.  So, who knows at this point what it will do over the entirety of my recovery.

I’ve noticed the past couple of days how different each of my sides feel.  As of about last week, my right noob really doesn’t feel like a reconstructed breast.  Other than not having sensation on the skin where my natural breast (and nipple) used to be, it has pretty much fallen in with the rest of this body.  But, on the converse, I am acutely aware of my left noob all the time every day.  Laying down, standing up, walking, sitting, sleeping.  It is a source of constant discomfort and some worry.  When I lay down, I feel the weight of my left noob shift to either side.  When I stand up, I feel it fall.  When I’m asleep, it is bothersome because it causes me discomfort and wakes me.  I’m not sure how much of this is “normal” during recovery (to have one side more bothersome), how much is different and unexpected because of my recent increased activity (but I question that because the left side has been a pain since day 1), and how much of it is psychosomatic.

Speaking of psychosomatic, I noticed how much better I immediately felt after Drs. Louie and Liu told me that I was off of my weight bearing restrictions and could start to work my way back to my pre-surgery normal.  Even though, in the days leading up to that appointment, I had a lot of discomfort and questions about it – just them saying “you’re ok to do what you did before” alleviated some of those complaints.  I’m not sure if my excitement help me forget and everything just went back to normal after the adrenalin high went away, or if this is something else entirely different.  I just wanted to be honest about the waxing and waning improvement because I don’t want someone who is planning to have this surgery read my blog posts and think “Week 5 or 6 is the money spot!”.  I’m still having pain and discomfort on my left side but it is manageable without pain medication, and for a couple of days I didn’t take either Tylenol or Ibuprofen for it.  Today I took both (T & I).   I’ll keep commenting on my left side as long as I feel it is noticeable enough in my day(s) to discuss here.  Hopefully, that won’t be too much longer.  All that being said, I’m still happy with my surgical results thus far.

 

And now for the (almost) daily double…

 

04/21/12 - Frontal

04/21/12 - Flaps

04/21/12 - Abdomen

04/21/12 - Right side

04/21/12 - Left side

 

 

 

 

It’s Just One of Them Days (Day 31)

My apologies at the outset for the truncated, tardy update. It was one of my BFFs birthday celebration this evening, so I had to go directly from mama-time to social time, which cut out blog time.

I didn’t do much too different today but noticed this morning that I have an indentation developing around my abdominal scar. It’s between my belly button and the scar itself; I think you can tell by the photo.

I’m not sure if this is just how it’s going to be, if it’s because I’m mid-cycle and bloated like I belong in the Macy’s parade, or if I’ve finally eaten enough peanut butter to put fat around my newly trimmed mid section, but I’ll hopefully find out on Monday.

This is the only photo I’m posting tonight. I’ll be back to my endless babbling at its fullest tomorrow with regular photos. Until then, twinkle, twinkle little stars.

And Happy Birthday Drew!

And on 8th day there was fluid

Today I ended up having to take an unscheduled trip back to the hospital. Over the past 48 hours, my left “flap” was obviously swelling. This morning I awoke and my flap was probably 50% bigger than the right. The evening prior I also had a low grade fever and, because of the swelling, some very dark bruising. Just to err on the side of caution, Dr. Louie’s team wanted me to come back in and be seen. I saw Dr. Liu (different than Dr. Louie) and was told that I had some fluid pooling around a drain site. Dr. Liu used a 60 gauge needle to drain the fluid and some blood from my left flap, and I almost immediately felt better as soon as he started to drain it. It was hard to find pockets of the fluid, so he had to move the needle around quite a bit. But I have/had absolutely no pain during the exam. It’s interesting trying to get used to having no sensation at all in my chest anymore. You anticipate pain, and there’s just nothing.

I was to the doctor and back within an hour. I was told to watch for any spreading redness as a sign of infection and any tissue turning black (necrosis). My left flap is still pretty swollen but I’m relieved to know that the skin and tissue transfer aren’t failing.

After this bit of a scare, I decided that I probably need to scale back my activities. I’m going to try and do a little less on my own and see if that helps my fluid decrease. Just because I can doesn’t mean I should.

I’ll post progress pictures tomorrow. I’m already tucked in for the night and sleepy.

Endless thanks to my BFF and personal super hero, Monell, for having the unfortunate luck of always taking me on emergency medical trips. What can I say? She’s always here when I need her. And she’s always amazing. Thank you Monell! You’re the best ambulance driver in Seattle!!!

More tomorrow.