Back to the Grill Again

I am more than slightly mortified sitting back at my desk and realizing it’s been so long since I’ve updated my blog.  But, to be honest, there really hasn’t been much to write about these Noobs, which is so fantastic.

Yesterday I went back to my old stomping grounds of the Plastic and Reconstructive Surgery Center at the University of Washington Medical Center so that they could take a second crack at my areolar tattoos.  To briefly revisit, the first time I went in for my tattoos was this past fall.  The procedure was simple, quick, and straightforward, and the Noobs looked so great upon completion.  They had a really nice aesthetic and I left the UWMC feeling like I went from having some nice “Noobs” to “titties”.  It’s amazing what a little color can do to really sell these reconstructed boobies.

Sadly, my skin rejected the pigment and I went from being so pumped about my Noobs to taking a small step back.  As I previously wrote, if something were going to fail in this process, I was more than happy with the tattooing to be the place of the failure.  I’ve been ridiculously fortunate throughout my process to have no complications.   So after enough time for my skin to heal, the holidays to pass, and both of our kids to get through this year’s flu – I was back with Dr. Louie and his lovely staff.

Anne, the PA-C who did my tattoos last time, was there again at the helm with me.  We went through the same set up for sizing the tattoos, she mixed the colors, but before we got started on the tattoos this go-round, she injected my reconstructed nipple sites with lidocaine and epinephrine so that I would bleed less and, hopefully, my skin would be less reactive and take the pigment.  During my last tattooing session, I had no pain or discomfort.  This session was the same, but I suspect that the lidocaine injections masked some of the discomfort I would’ve felt without them.  When I got home, my chest was tender.  I still do not have a lot of sensation in my Noobs.  I have full sensation over my sternum, some on the outsides of the Noobs, but little to none in the center (at the nipple sites).  If I run my hands over the nipple sites, I can feel pressure but no sensation beyond that.  So, it was with great surprise that I had some tenderness after the lidocaine wore off.; it means some of my nerve connections are reestablishing themselves.

I was directed stay bandaged up for 48 hours per my after-care instructions and will unwrap myself tomorrow to see how this round went.  I took pictures of myself before my tattooing and again today.  I needed to update my photos anyway since the last one I posted was in October.  My scars have settled a bit more and lightened.  Unfortunately my reconstructed nipples have flattened out a bit, but that was to be expected.  Dr. Louie and his staff were very clear about the nipple protrusions flattening out.  I still have a bit of a protrusion on my right side, but none at all on my left side.  You’ll see the difference in my photos (below).

My abdominal scar is still just as noticeable and I’ve been asking around about having it covered up with a tattoo.  I don’t hate the abdominal scar; I can definitely live with it.  But the asymmetry of it bothers me every time I look at it.  So I figured if there is something to be done about it, I might as well do it.  But it turns out that tattoo artists aren’t really keen on putting their work over scars because scar tissue is more likely to reject the ink and react (i.e. keloid).  I sent out a Tweet asking for recommendations for Seattle area tattoo artists and only received two.  I have a few more chambered that I wanted to check out as well, so I’ll hopefully have a couple of consults and see if the consensus is that no one wants to tattoo over that big ass scar.

So now I will leave you with my photo updates until the big reveal.  Wish us luck!

Noobs and abdomen (333 days post-op)

02/11/13 – Abd scar, R side

02/11/13 – Abd Scar, L Side

02/11/13 – Areolar tattoos, just home

02/12/13 – Areolar tattoos, Round 2, Healing (24 hours later)

I absolutely had to reblog this post.

The World of Special Olympics

The following is a guest post in the form of an open letter from Special Olympics athlete and global messenger John Franklin Stephens to Ann Coulter after this tweet during last night’s Presidential debate.

Dear Ann Coulter,

Come on Ms. Coulter, you aren’t dumb and you aren’t shallow.  So why are you continually using a word like the R-word as an insult?

I’m a 30 year old man with Down syndrome who has struggled with the public’s perception that an intellectual disability means that I am dumb and shallow.  I am not either of those things, but I do process information more slowly than the rest of you.  In fact it has taken me all day to figure out how to respond to your use of the R-word last night.

I thought first of asking whether you meant to describe the President as someone who was bullied as a child…

View original post 260 more words

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:

 

BRA Day

Today is National Breast Reconstruction Awareness Day.  There is a lot I could say about today.  In the interest of brevity:

I am a 31 year old mother of 2.  I am BRCA1 positive.

3/15/2012:

Bilateral skin sparing mastectomy, immediately followed by DIEP flap reconstruction.

6/22/2012:

Nipple reconstruction and abdominal scar revision.

10/01/2012:

First round of areolar tattooing.

There are many options available should you choose to have reconstruction after mastectomy.  I chose DIEP flap reconstruction; this is my result.  I hope that this helps you decide, regardless of what your decision is.

DIEP Flap reconstruction

Areolar Tattoos

I meant to post an update before today, but here it is…TODAY! I’m currently sitting in the waiting room getting ready to have my areolar tattoos. Dr. Louie gave me a prescription for topical lidocaine but I didn’t use it because I don’t have any sensation in these Noobs. So, here we go! As always, I’ll post some photos so you can all see how things went.

Stitch & Bitch Free (day 142 overall!; day 43 post newpples)

Good morning sunshine!

I’m up and blogging because trying to get this done at night never works as of late!  I am now 43 days past my nipple reconstruction and 142 days since my Stage 1 bilateral prophylactic mastectomy and DIEP flap breast reconstruction!  It’s hard to believe that 5 months ago I was a nervous and emotional wreck worried about the outcome of all of this.  And here I sit, just peachy keen (well, a  little sleepy with messy hair, but otherwise peachy).

So I have had to doctor’s appointments since my last blog post.  The first was with my breast oncologist, Dr. Larissa Korde of Seattle Cancer Care Alliance.  I met with her for ONE LAST TIME! just as a follow up and baseline assessment post bilateral prophylactic mastectomy and DIEP flap breast reconstruction.  Just as I was with my last visit with Dr. Sarah Javid, I felt very fortunate to have Dr. Korde taking care of me and screening me while I waited for a decision about what to do with my BRCA1 mutation and those damned boobs.  I saw Dr. Korde every six months for screening, either in the form of a mammogram or a breast MRI.  Now that I no longer have my natural breasts, I do not need a breast oncologist or breast cancer screenings!  What a relief!  As I’ve written before, there was such a  lingering feeling of doom every time I went in for my screenings. I just knew that that appointment would be the one at which I found out that I had dilly-dallied too long and this genetic mutation had manifested in breast cancer.  I would go through so many emotions waiting for my screening appointment and be upset with myself for not having our lives together and situated well enough to have the bilateral prophylactic mastectomy and DIEP flap reconstruction.  I knew that this process was going to ask so much of my husband, our family, loving friends, and our two little girls.  With the benefit of hindsight, I know that I didn’t misjudge the level of upheaveal my surgery would cause in our lives.  We needed a lot of help with the girls, and I can’t thank our family and friends enough for helping us.  Everyone was so supportive and wonderful; I was (and still am) stunned at how genuinely concerned, caring, and helpful everyone has been.  And, here I am, on the outcome end of all of this and feeling great about my choices and my surgeries.

Dr. Korde discharged me from her care and referred me to the wellness clinic at Seattle Cancer Care Alliance, where I will continue to go for my CA125 marker blood draws and pelvic ultrasounds to monitor the health of my ovaries since they, too, are at risk for developing cancer.  At our last appointment together, Dr. Korde performed a brief “breast” exam.  In true compliment to Dr. Otway Louie and his team, she asked me if I had the skin sparing AND nipple sparing mastectomy.  So, kudos to Dr. Louie for giving me such realistic, reconstructed nipples that they fooled a fellow physician!  Dr. Korde asked me if I had any concerns at that time, and my only concern was this arc shaped band of thick scar tissue that’s formed underneath my left noob.  It didn’t form (or at least noticeably form) until after my stage 2 revision surgery.  It’s about the thickness of a finger and runs from the side of my noob adjacent to my armpit all the way under the flap.  I noticed it when toweling off one day and that my pectoral muscle was uncomfortable in that same area whenever I raised my arm overhead.  Dr. Korde felt it and said that it did feel “different” to her.  She said that I’d probably be able to break it up with deep tissue massage or another modality, but to first ask Dr. Louie about it.  She said that I could have additional imaging done at Seattle Cancer Care Alliance if Dr. Louie was concerned about the scar tissue.  So, that got me all riled up because I was worried that I would have to undergo yet another procedure to address this weird band of scar tissue.

I then saw Dr. Louie on Monday, July 30, for our follow up.  I told him about my scar tissue, he performed a quick physical exam, and told me that I could simply start massaging it to break it up.  Relief!  Simplicity is so amazing at times like these.  At the time of my follow up with Dr. Louie, all but about 6 of my stitches had fallen out.  His resident removed the last danglers and, alas, stitch and bitch free!!!  If I do say so myself, these reconstructed nipples are pretty convincing.  During my healing, I was really worried that I wouldn’t guard them enough and would end up with flattened out newpples.  I spent a number of weeks looking like I was wearing Madonna’s long lost cone bra from the early 90’s because I was so padded up with protection around my newpples.  But it was totally worth the numerous confused and questioning looks receieved whenever I went out in a fitting t-shirt.  I have a little bit of projection and don’t look like I’m REALLY EXCITED to see everyone.  The circular shaped scar I have from my nipple reconstruction is different enough from the surrounding skin on my noob to look like arealos that are simply the same color as my noob.  My areolar tattoo appointment is on October 1, so I have a couple of months with no noob/newpple action to enjoy with our family.

I wanted to add in this post another testament to the great work of my reconstructive surgeon.  As with every blog post, I included photos of my recovery process on my last blog update.  I have done this throughout my process.  I have always included photos of my noobs, but it wasn’t until my last post with photos of my healing newpples, that I was flagged on Facebook.  My blog feeds to my Twitter, which feeds to my Facebook.  I found it interesting that up until that point, my noobs were of no concern to whomever flagged my last post on Facebook (which was later removed from my feed).  But, my convincing, reconstructed newpples are the official point of controversy.  I was very much testing the waters to see when, if ever, someone would think that the noobs were looking too much like the real thing.  So, in the words of Billy Blanks, Tae Bo – now you know!

Again, I can’t say that you enough to all of my physicians.  Dr. Javid did an amazing job on my mastectomy; my recovery and healing went really well due, in large part, to effective yet gentle touch.  Dr. Louie’s DIEP flap reconstruction is nothing short of phenomenal; the proof is in the pictures (no pudding, please!).  And, I have to say, I miss seeing Dr. Daniel Liu, who was Dr. Louie’s plastic surgery resident.  Everytime I had an appointment with Drs. Louie and Liu, it was so great to see him.  He is a great guy and surgeon.  He took mercy on my near pulsating anxiety and started to follow my blog when we were gearing up for surgery or shortly thereafter.  All of my rambling questions, my middle of the night concerns (both founded and, sometimes, just wild), and nervous energy just sent out to the ether…Dr. Liu was kind enough to send a note here and there to address them.  I have heard that many people are paying a pretty penny to have a Concierge Physician service.  I am not one of those people, but Dr. Liu was there for me free of charge.  It was, and is, such an amazing thing to have a physician so involved.  I feel, a lot of times, that when I’m out of a doctor’s office, that’s it for my concerns until the next appointment.  I don’t know if I was a particularly anxious patient or Dr. Liu is just a super nice guy, but either way I’m entirely grateful for his extensive care and attentiveness during my surgeries and recovery.  I believe he and his family are now in Chicago enjoying more of a summer than we’re having this year.  I hope his patients realize what a gem they’ve received from our Emerald City, and I hope he’s absolutely loving his new job.  But, I just wanted to send a huge thank you out there, in case he still reads this, for all of his help.

So, now for the photographic evidence of all of these doctors’ great work!  My abdomen incision is also looking really great.  Because I have several scars that have kiloided over my lifetime, I asked Dr. Louie what to do about my scarring.  He gave me a reference sheet for a product I can look into that may help me prevent this on my abdominal scar.  Once I’ve bought and tried this, I’ll post progress pictures if there’s a noticeable difference.  Right now I’m just trying to keep a good SPF on my scar and am wearing a new, one piece swimsuit that is UPF 50 to try and prevent my scar from getting any darker.

Next procedure up:  Areolar tattooing – October 1, 2012.

07/31/12 – Incision

07/31/12 – Incision, L side

07/31/12 – Incision, R side

07/31/12 – Noobs!

07/31/12 – L Noob + Newpple, upclose & personal!

07/31/12 – R Noob + Newpple, upclose.  Controversial!

Prince, Controversy

Quick update! (Stage 1 – 127 days, Stage 2 – 28 days)

Like sand through the hour glass…

Never enough time in the day.  I just wanted to post a photo update here and will update the text tonight.  But in short, I’m doing great and my noobs /newpples look fantastic!

07/18/12 – Abdominal scar post revision

07/18/12 – R Side Abdominal scar post revision

07/18/12 – L Side Abdominal scar post revision

07/18/12 – The full monty

07/18/12 – Gym set 😉

07/18/12 – L Newpple healing well

07/18/12 – R Newpple healing well, too!

Hello Stranger (Day 114 (noobs) or 15 (newpples))

Hello stranger(s).  It seems so good to see you back again; how long has it been?

We have been busy!  I know I need to get back here more frequently than two week increments and be a responsible, timely blogger.  It’s just hard to make that happen these days.  Even with Pluto out of the picture and  Venus being supremely close to Earth last month, the planets just can’t align well or long enough for me to get my act together and regularly post updates.  This is odd, because I have been reading more blogs belonging to women who are either preparing for or in the midst of my same surgery path.  So, while I haven’t been a vigilant blogger, I’ve been a vigilant reader.  It seems like I can remember so well what each of those stages felt like, but then I look at this body and my progress and healing remind that it wasn’t all just yesterday.  I guess for even more accurate time keeping, I could just look at my blog posts (or lack thereof).

Truth be told, it’s nice to be able to be busy and back in the throes of regular, every day life.  I had my stitches and surgi tape removed from my newpples on Monday (July 2) with little excitement (but for a small fire alarm in the clinic).  When I got home for the big reveal and looked at myself in the mirror, I was pretty shocked.  It turns out that steri strips cover up a lot of scary looking shit.  My newpples were much more interesting to me when they still looked like ninja stars.  Revealed for what they actually were, healing surgical wounds, I was a little deflated.  Not that I was hoping to have ninja stars instead of reconstructed nipples, but they just looked a lot more presentable than my healing, slightly startling newpples.

The good news is that they don’t hurt and they’re healing quite well.  I was surprised that I was sore the day of and day after I had my stitches removed because of the absence of pain related to the reconstruction.  My abdominal scar revision was uncomfortable, particularly with the hassle of wearing pants, but my newpples didn’t and don’t hurt.  I had some discomfort along the right side of my chest, I think around the liposuction sight, and underneath each flap.  I’m not sure why the area below my flaps were sore, but it was uncomfortable wearing a bra or even a tank top with a built in shelf bra.  The discomfort passed after the first two days but certain movements bring about a twinge of “meh”. But, so far so good!  I’m feeling a little less like they’re going to turn necrotic and fall off if I bump into a wall, sneeze, take my gauze off too quickly, or all three oddly at the same time.  Dr. Louie was kind enough to assure me that this far out, they’re much less fragile. And with that, I’ll leave you with two photo updates.

The first set was taken 3 days prior to having my stitches removed.  The second set is what I looked like the day I had the stitches and steri strips removed.

 

 

06/29/12 – Abdominal scar

06/29/12 – Abdominal scar, L side

06/29/12 – Abdominal scar, R side

06/29/12 – Safety stacked!

06/29/12 – Newpples

06/29/12 – Left newpple

06/29/12 – Right newpple

07/02/12 – Abdominal scar

07/02/12 – Abdominal scar, R side

07/02/12 – Abdominal scar, L side

Scar revision a la Sally Skellington

07/02/12 – Stitch & surgi-strip free

07/02/12 – L newpple revealed

07/02/12 – R newpple revealed

 

 

Everybody Was Kung Fu Fighting! (“Newpples” Day 5)

I am happy to report that things haven’t been any crazier, wilder, busier, or necrotic since my nipple reconstruction and scar revision on Friday.  As I previously posted, I kind of came home, hit the ground running, napped, woke up woozy, repeated.

The past few days I’ve been a little more sore along my abdominal scar.  I’m a little swollen and tender there.  Having to wear pants (because it’s still winter in Seattle) causes a lot of friction and irritation along my scar revision.  Also, the girls have been demanding that I carry them everywhere the past two days, so having 2 toddlers resting on my scar revision sites isn’t helping along Drs. Louie and Liu’s work any.  I’m hoping for the absolute best, but my scar revision, in all honesty, has taken a beating in the past 48 hours.  Bothered as it may be, my level of discomfort is easily managed with Tylenol.

I am still pretty neurotic about my reconstructed nipples (“newpples”).  I open my surgical camisole about 5 times a day to make sure one hasn’t fallen off, isn’t being compressed by a slipped wad of gauze, or something else equally dramatic.  When I was able to take off and change my dressings from the hospital, I was about 0.05 ml short on Crazy and decided I didn’t have to make the new dressings look exactly like the ones I was discharged with. And, in all honesty, I would’ve plowed through all of the supplies they sent me home with just trying to get to something even close to these:

06/25/12 – Newpple protection

 

I have 4 x 4 gauze pads with little holes cut in the middle of them for the newpple to poke through.  I stack those up until they clear the tip of the nip, and then put another (whole) gauze pad over the top and tape it to me.  Then I toss on my surgical camisole for support but not too much constricting force on the tender ninja stars (just wait; you’ll see).

 

06/25/12 – Surgical camisole

 

 

(Advanced warning to those who do not want to witness the gore…it gets pretty intimate and gorey from here onward!  Take your leave now lest your precious eyes be polluted!)

 

 

Mike helped me do the first dressing change and wanted to be there for the big reveal.

 

06/25/12 – Husbandly duties

 

 

 

We were both pleasantly surprised to find that I’d been sent home with two well crafted ninja stars to add to our home defense collection!

06/25/12 – HIYA!

 

Even with the dried blood, scabbing, wild style steri-strips, and stitches, they look like they’ll be damn convincing when all is said and done.  I am certain that until either one of my plastic surgeons say, “You can’t mess them up from here on out”, I won’t relax about them falling off or otherwise failing.  This part of the process has been so intimidating to me!  I am so worried about it because I think that without the sensation of pain (no nerves post-mastectomy), I won’t know immediately if they’re necrotic, injured, infected, et cetera.  So, it oddly is the one time through this whole process I am wishing I were able to feel more pain.  Although, I wonder if I still had some sensation in the nipple reconstructions sites I would still be panicked if I was feeling pain (too much pain?).  Who knows?  I’m a nervous nelly about these things…because they can FALL OFF.  So, I have nothing superbly interesting to post about the newpples, just that they’re coming along and hopefully healing well and never, ever necrotic, infected, or otherwise failing.  Close ups are below.  Avert your eyes if you plan on having sausage soon.

 

 

06/25/12 – Frontal

06/25/12 – Right ninja star

06/25/12 – Left ninja star

06/25/12 – Lipo’d noob

 

Recovering

I will post a full update tomorrow. Just wanted to say that I feel good, have very little to no pain, and I have decorated my Noob/Newpple home care kit accordingly.