We are a little over two weeks past the most recent reconstructive surgery which included a fat graft and reduction…
As I stated, I went out of order about my original cancer journey. I should have discussed my plastic surgery consult prior to the mastectomy. I met with Dr. Rhemtulla while I was still newly into my chemotherapy. What was especially of note is that the nurse brought me back and did the usual intake prep before the doctor came in and said, “oh, don’t worry about changing yet, he wants to consult first and then he’ll worry about an exam.” It was an interesting concept and I appreciated it.
Dr. Rhemtulla ran me through the various options I had, which included:
- No reconstruction whatsoever.
- Saline Implants – which would require a replacement after so many years.
- DIEP Flap – Deep Inferior Epigastric Perforator Flap – my tissue.
- LD Flap – Latissimus Dorsi Flap – my tissue.
Let’s just say I knew about the first two options, neither of which I was interested in. However, when he advised me of options to use my own body tissues to recreate a breast peaked my interest immediately. The DIEP meant removing a flap of skin, fat, and blood vessels from my lower abdomen and implanting in my breast. This requires two surgeons, one to prep the blood vessels, microsurgery, in the breast and one to remove the tissues from stomach. On average, this is approximately an 8-hour surgery. The alternate, but similar without the microsurgery was the LD Flap that the muscle just below your shoulder blade and behind the armpit.
As we discussed the options, the DIEP appealed to me the most. Though the rougher surgery, the idea of getting what was basically a tummy tuck and a new boob from my own tissue, I was all for it. Now remember, I had to clear chemotherapy and radiation. I had to be at least six months post radiation to be able to have the surgery, because the irradiated area could kill the tissue being moved there without that rest period. Once chemo was done, I had to wait about sixty days before the mastectomy could happen and that was the end of January 2024. When the mastectomy was completed, I had a tissue expander implanted. The expander is a place holder so to speak, it is gradually filled with saline in order to keep the skin pliable and ready for the next step in the process and ready for your implant.
My reconstruction was delayed a little bit because of the additional chemotherapy I had after the mastectomy and radiation. I finished with the next chemo in November 2024, which meant another 60 day wait for my reconstruction. I went into this completely excited and nervous at the same time. However, Dr. Rhemtulla appointments were something I looked forward to. We didn’t just talk procedures or my progress, it was also sports, things going on in the world, travel, etc. I genuinely enjoy my visits with him and his staff. Dr. Rhemtulla’s demeanor felt more like talking with a friend than a care provider and I appreciated that.
The day of the surgery came and I was stoked. Again, I was expecting at least an 8-hour surgery. My surgery took 13 hours. He and Dr. Caterson were my surgeons. They found the tiniest clot in a blood vessel and worked that before closing. Things I didn’t expect, waking in my room unable to move my arms. I was in a T position for 13 hours, even at rest that was a strain and when I wanted to adjust in the bed that night, it wasn’t happening. I couldn’t believe how sore I was. I was constantly checked, and Johnny, the surgical nurse for plastic surgery was in and out. He was monitoring a machine that was monitoring how well the blood vessels were taking. They did a doppler check every hour, but the machine that was attached wouldn’t read correctly was supposed to give them remote readings. Most of the flap took, but there was an area where they couldn’t get a good read, which lead them to giving me a topical medicine to open the blood vessels more to encourage them to attach appropriately. What was a little unnerving was the day after surgery, both surgeons, Johnny and a couple of their other colleagues came in to check some things out. The concern with the blood flow in one part of the reconstructed breast was causing them concern and I had the brain trust discussing what I needed to have done to encourage the blood vessels to work. I received a topical cream that opens the blood vessels and to see if it would encourage acceptance of the transplanted vessels.
The plan was a three-day stay in the hospital, but on the outside, it would be a five-day stay. Of course, I was the five-day stay person. The nurses on the floor were great. My mom was there for the surgery day and the day after, my aunt there the rest of the week and took me home. The day after I left the hospital, I received a home health visit for wound care.
Dr. Rhemtulla believes on erring on the side of caution. I was back in for a visit a week and a day after surgery. Ultimately, he wasn’t happy with the graft. He suggested we remove the piece that just was giving them fits. It was cool to touch, which wasn’t a good sign, but the rest of the flap took just fine. So we decided to get me into surgery ASAP after that, which was less than a week later.
How was I feeling? Disappointed that it didn’t take as easily as I would have liked. Disappointed that I wouldn’t get the full B/C cup I was shooting for, but I was thankful for Dr. Rhemtulla. He’s a great doctor and one that I now call my friend, because he gave me the hard truths, but he also showed a great deal of care, period. I was ok with what had to happen as long as I was going on my milestone birthday trip March. Dr. Rhemtulla was doing his best to make that happen.
The redaction surgery didn’t take nearly as long and I did have an overnight stay. Unfortunately, not in the unit I was in for the larger DIEP surgery. Not that the nurses weren’t good, they just weren’t the caliber of the ones on the floor I was on previously. I contended with some guy screaming most of the night, I assume in pain. My earbuds barely drowned him out. My old room, I heard nothing but the nurses chatting here and there and a food services worker oversharing his woes of his love life.
A wound vac, a machine that actively applies negative pressure to the wound (suction), pulling the edges together while removing excess fluid and helping tissue healing/promotion, was applied during surgery. And this is where it went off the rails. So, there was a change in vendors, and the plastic surgery team was not made aware of this. The connectors of the wound vac that was placed on me did not match anything in the recovery unit. The wound vac placed on after surgery was the appropriate size for the wound. The supply company came to provide me with my take home wound vac. The connectors did not match. Rather than the nurse saying, “hold up, let’s reach out to the doctor, she just accepted the package and kept it moving. When she tried to apply the new wound vac, she still failed to reach out to my surgical team to let them know of the issue. So, she scavenged a wound vac that was meant to be on say a small cut on your hand vs the size of a breast. She used it because the hoses matched. I repeat, SHE DID NOT REACH OUT TO DR. RHEMTULLA’S OFFICE.
I left on Friday afternoon. By Saturday morning, there was a tiny leak in the wound vac. The home health nurse’s eyebrow went up and suggested I reach out to Dr. Rhemtulla’s office to see if they could have an emergency appointment for me. I left a message for the office first thing Sunday morning because I had an absolute mess from leakage on my bed. Johnny called me back within half an hour. I took photos of the wound vac, the application area, etc. and text him. Johnny went from zero to 100 in anger. He double checked my chart and the portal for messages from the nurse. He found nothing. He had me request an emergency appointment with home health (they weren’t due in until Monday) to apply the wound vac that wasn’t applied, but I was sent home with. He also asked me to call him when they arrived because he wanted to have a very thorough discussion. He was able to give her additional orders and walk her through everything. My follow up appointment with Dr. Rhemtulla was already set for Monday, but Johnny made sure it was moved to Tuesday (a non-surgery day) so that they could both be in attendance.
By the time Tuesday rolled around, I was just tired. Johnny was still on a war path and Dr. Rhemtulla was disappointed that the nurses in the recovery unit did such a piss poor job in dealing with me. I have to say, of all the treatment I received, this was probably the worst and it wasn’t terrible, just ham-handed. By the end that ordeal, all was well and I was healing just fine.
So, what was next, now that the flap wasn’t fully what we wanted? I opted for fat grafting. I’ve had two sessions so far, one pulling from my sides and one pulling from my thighs, that gave me an ok volume. I’m not going to be a larger B or C cup but I will likely achieve a smaller B by the last graft. Which leads us to where we are now.
The goal in late August was to complete the last fat graft and reduce my right breast, to match as closely as possible. This required me to get a mammogram to clear the breast. Due to timing, it actually worked out I was due for my normal mammogram anyway. Unfortunately/fortunately, this mammogram picked up the smallest of tumors (1 cm) toward the right chest wall (very high up in the breast). Subsequent testing showed no lymph node involvement, which meant, I was miles ahead of what I was with my first diagnosis. Again, I was pissed, but grateful we found it so quickly. I think the look on Dr. Rhemtulla’s face hurt me more than the diagnosis. He is so invested and he was so disappointed on my behalf that we are starting over, he was quiet for the first part of the consult. But the plan is set, I could still have the reduction and reconstruction done two weeks after the tumor is removed as long as the margins are clear.
So onward…
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