Topic: Surgery

Personal Drescription:

I am a 29 year old female who has spent the majority of my life battling weight issues (At my highest weight in my early 20’s I reached a plateau of 225 lbs).  Since that particular moment, I have been committed to living a much healthier lifestyle through which I have been able to achieve a healthy weight range of 145 – 150lbs and a healthy BMI. During those years I also got married experienced two successful full term pregnancies. I am now a married mother of two young happy children. Between the two pregnancies, the initial weight gain and some yo-yo dieting over the last 8 years I was not at all happy with the way my stomach looked after all that I had achieved through diet and exercise.

My stomach has always been an area where I stored fat when I gained weight, and it seems that no matter what I did for exercise or how I healthy my diet, that trouble area never seemed to disappear in its entirety.  I was proud of my achievements physically, pleased with my jean size and most of my body, however the one thing that had always eluded me was a flat tummy. After all those hours in the gym and making healthier choices as the pizza called out to me still hadn’t yielded that one result and it was disappointing. As selfish and silly as it may seem I wanted to wear a bikini and be happy in it and it was that and a desire to finally be happy with my body that led me to consider surgery as an option.

I have to admit, at first I was nervous about the consultation. However, after having done extensive research there were little surprises and I started to feel comfortable with the idea of really going through with this. One particular thing that really made me feel comfortable with my decision was that Dr. Macadam confirmed with me after examining my midsection that some of my abdomen muscles had significantly separated (likely from pregnancies) and there was really only loose skin covering my abdomen. At this point I felt that I truly had “done the work” and that the ability for me to tone by midsection with diet and exercise any further was basically zero.

In the months leading up to surgery there wasn’t a day I didn’t think about it and didn’t start to think maybe I was a little crazy for doing this. Ultimately I knew that it was either a few months of recovery or a lifetime of torturing myself with diets and exercise that wouldn’t give me what I wanted.  This surgery would allow me to move on from weight-loss mindset into a healthy weight maintenance mode while giving me the tone I so desperately wanted

Surgery:

Planning my surgery a few weeks after Christmas helped keep my mind off it just a little, and before I knew it the day of my surgery had arrived. After a quiet and somewhat surreal drive into the surgery centre, we parked in the underground lot and I headed up to the surgery centre both extremely excited and nervous about the upcoming procedure. We got up to the 10th floor, knocked on the door and it all began.

I have to say, from the moment I stepped off that elevator I didn’t need to be nervous at all. The pre-op procedure was a very calming experience and the amazing staff at Dr Macadam’s who went through everything patiently and slowly for me, honestly made me feel right at home. My husband went off to the local Starbucks to catch up on work while I was in the procedure, with his cell handy when I was ready for a visitor. I was still scared and nervous but I felt comfortable. Walking into the OR and getting up on the table was probably the hardest part of the whole pre-op procedure but they kept me focused on other issues and kept me talking to distract me (I’m guessing this works with a lot of female patients!). Within minutes I was out and the next thing I recall was I was waking up after the surgery.

Post op was also good despite the grogginess and heaviness I felt in my abs. The pain wasn’t nearly as much as I had expected. I was uncomfortable for sure but not in pain. I’m sure the freezing and the drugs were helping with that. Within a couple of hours I was heading home and ready to start recovery on my own.

Recovery  Weeks 1 to 2 – Back to Basics

I learned very early on in recovery that the following motto really helps…be patient, focus on small victories, and keep a sense of humour. Within a matter of hours I had gone from a fully functioning adult to walking like a hunchback, getting dressed by others, crawling up my stairs, and having my husband do every little thing for me including emptying  my drains. There are many parts of this surgery and recovery that are not what I would consider to be glamorous in any way so being able to find the humour in it all really helped (Warning: this is a fine line because laughing actually hurts for the first few weeks).

The first 24 hrs was filled mostly with rest, medication-taking, drain changing and attempting to find comfortable positions and ways to move that weren’t hard on the incision. There were bouts of nausea, periods of extreme fatigue and periods of insomnia but every day things seemed to get a little easier, at least on most days.

In the first week each day was a new accomplishment…going to the bathroom by myself, getting up the stairs without holding the railing, even making my own snack was an achievement. Early on I decided I needed to focus on achieving many things I take for granted in everyday life. Focusing on doing one thing each day I couldn’t the day before gave me a small goal to achieve and something to celebrate so I didn’t feel so useless. Surprisingly the pain never ended up being what I expected at all, I am sure the Tylenol 3′s helped this and I took them as directed. Overall the area felt more heavy than painful and while getting comfortable was at times tricky the first week was easier than I imagined. The most painful part was actually my back from having to walk hunched over so I didn’t tear anything open. By mid-week I was also growing tired of changing my drains and not being able to sleep on my side because of them so it was a huge highlight for me when after 6 days I was ok to have them removed by Dr. Macadam in one of my post op appointments.

In the second week I again tried to focus on progress but there wasn’t as much day to day improvements as there was in week one so it became frustrating at times. My husband was great at keeping me focusing on progress and noticed things I was getting better at that I didn’t however it was still hard not being fully involved in family life. Yet, I must admit getting to relax and watch TV, read and taking afternoon naps was a rather appealing part of the whole process.  Pain-wise, in the second week,  there was still much less than I had imagined; I was sore for sure and spent most of the week working towards being able to stand up straight (which took longer than I had anticipated), but from an overall pain and discomfort level I didn’t find it that painful. As I got more active however, I realized quickly that my endurance had disappeared as I found myself getting tired just from climbing the stairs or walking through a grocery store. As the weeks go on I know that will get better, but being a fairly active person and fit person I admit that it’s a bit of a blow to ego!

Recovery  Weeks 3 to 6 – The road back to normal 

The third week ushered in a new chapter of recovery…the real world. This week I went back to work. I work in an office setting and had been doing some work from home so knew that I could handle at least some of it, but was concerned about the lack of freedom to rest if needed. Thankfully my work is very understanding and flexible so I survived. It was hard at first getting back into the routine especially with me not as mobile as I had been. I took it easy at night and had a lot of help from my husband and daycare provider with the kid (things like getting my son in and out of his car seat when I wasn’t allowed to pick him up were a challenge). The hardest part of this week was the lack of energy and not being able to stand up straight yet. With all the muscle repair I was still hunched by the end of the day and quite exhausted. This was one of those weeks where patience was important (something I’m not always good at!)

In the fourth week things got easier. I was able to sleep normally on my side again, my energy levels were coming back up, I was able to help more around the house. On the other side I still couldn’t pick up my son and still couldn’t do everything I wanted to, so it was in many ways a week of total frustration.  Recovery however was going great with everything looking good and I was without any pain medication for most of the week. I was getting more and more comfortable with the results and despite all the swelling that still remained I must admit my tummy looked quite good. The break from the exercise did set the rest of my body back, so I couldn’t wait to start working out again. As I write this I truly realize that the overweight 225lb girl in her early 20′s sure had come far, working out used to bother me and now not being able to work out bothers me more!

The fifth week is when I started feeling close to normal again. It also marked the week where I got to go binder free during the day and actually pick up my son! Those first cuddles were the best feeling ever. Having no compression binder on was a very weird sensation for the first few days as I had been wearing it for 4 weeks straight and had really gotten used to having the support there . My stomach area especially around the belly button was still quite numb and will be for sometime but it doesn’t bother me as much as it did at first. I’m starting to notice a difference this week in how my clothes are fitting. My jeans are still tight around my legs but the muffin top is gone! Shirts are fitting better too as there is less stomach to cover.

Life after a Tummy Tuck – some final thoughts and advice

In weeks six through eight the swelling has started to decrease and I have been able to start working out again. I’m a very goal orientated, progress driven person so the first work out was rather disappointing, but I knew I had to take it easy so I didn’t hurt myself (every subsequent work out now I feel that I am getting stronger and returning to my former fit self). The numbness is reducing and/or I might just be getting more used to it and either way I’m starting to feel like my old self again. I still have some days where I feel tightness and some soreness, and days where the swelling is bad and makes me feel bigger, but I know in time that will all take care of itself as long as I take care of myself. After going through all of this I want to be sure I don’t erase the good work I have done mentally and physically in my life and health so this journey has given me a renewed focus on keeping healthy.

Upon reflection, the other hard part of the recovery was the mental aspect especially regarding the taking time for myself. Watching my kids play and not being able to join and not being  able to pick up and hold my 18 month old was very difficult.  I could see the confusion in his eyes when I wasn’t picking him up and the disappointment in my daughter’s face when I couldn’t play with her. I like to think though, one day, they will understand and down the road I believe this will make me a better parent as I become more happy with myself.

I tried to enjoy the downtime and at times accomplished that, but the mommy guilt is a hard emotion to eliminate. There were also other mental aspects I hadn’t really considered that were taking effect. The first time I took a good look at the results and incision I almost blacked out. It was strange seeing all the loose skin gone. With the gradual weight loss I had before I don’t think my mind had really ever caught up to that so this drastic change so quickly was a little hard to process. Overall I would say that I benefitted from doing a lot of research and coming to terms with my decision before signing up to do this. I had a good support structure available and I relied on it  in order to get through this procedure.

While they say it takes a year to realize the full results, I would say that in two months in I can really see and feel the difference and am truly happy that I decided to do this for myself. I would like to thank Dr Macadam and her staff for making this experience a great one, the care I receive pre and post operation was excellent, the people were friendly and knowledgeable and I felt confident after each consultation, appointment and procedure.

Personal Description:

In 2010 I was diagnosed with metaplastic carcinoma of the left breast, locally advanced to the left axillary lymph nodes.  I had just turned 59.  The good news is that the CT scan revealed no spread to liver or lungs!

After chemo, I had surgery consisting of Bilateral Mastectomies and Left Axillay Node Dissection (6 nodes removed) with Dr. Rona Cheitfetz, then Right Alloderm implant insertion and Left tissue expander insertion with Dr. Macadam. After surgery I received radiation therapy for 5.5 weeks ending in October 2010.  I had also started physiotherapy for my left arm.

By the end of radiation, the skin on the left and the right of my chest was damaged and very thin causing the incisions to break open in places.  Physiotherapy was put on hold

After a series of attempts at “re-stitching” the incisions and an additional surgery Jan. 7, 2011, it was evident by February that the skin was just not going to cooperate.

Fortunately for me, Dr. Macadam had another option to spare me the fate of a flat-chested future.

To avoid risk of infection, Latissimus Dorsi Flap surgery to the left breast with a smaller implant and revisional surgery to the right breast was quickly confirmed for the end of March at UBC hospital.

Pre surgery:

I’m feeling like a seasoned veteran – get blood test, ECG, pre admission telephone call, orchestrate transportation to and from the hospital and someone to stay with me after I come home. (If you’re an obsessive type, making sure the house is tidy and the bathroom is clean for the Homecare nurse and visitors).

Still, there is apprehension – compared to my first surgery, a longer stay of 2, possibly 3 nights in the hospital plus the unknown level of discomfort incurred from an additional incision on my back and those niggling “what if” worries given my track record with skin, or some other complication.

Tips:

Use Dr. Macadam’s website.  It’s an excellent resource that addresses most of the common questions and concerns for your surgical procedure. Learning about the procedure also helps one articulate specific questions at consultation appointments.

Get prescriptions for antibiotics and painkillers filled prior and in house so one less thing to do en route home from the hospital

I  purchased Senokot (or generic brand) to have on hand for the first few days as the anesthetic and painkillers play havoc with your “plumbing” and who needs that discomfort along with everything else?

Confirm homecare arrangements are in place prior to leaving hospital.

Have a pillow in the car to place in the small of your back to absorb bumps during the drive home.

Day of Surgery:

6 AM front and centre at UBC hospital to check in. Process paperwork and get wristband (sadly, this one doesn’t guarantee little umbrella drinks like the all-inclusive resort). Proceed to waiting room, my name called and a double check that my info and name matches what’s on file. Proceed to change room to swap my clothes for the hospital issue gown, attempt a last nervous piddle and then proceed to pre-op area.

Pre-op:

Nursing staff review my information, insert IV lead, and help wrestle on long white compression stockings. Dr. Macadam appears accompanied by resident surgeon, and a medical student– it’s amazing to listen as Dr. Macadam, black marker in hand, maps out and explains the game plan. Next the Anesthetist comes by, introduces himself, reviews my information, pain medication and explains that post surgery I will be given a self medicating button to push for pain management.

8 AM it’s time to don my blue surgery party hat  and walk to the operating room, which is a hive of activity as I am assisted onto the table. It’s then “lights out” and Dr. Macadam and her team work their magic to create something out of nothing.

Post Op

4 PM (because I asked) woke up in the recovery room – very groggy, cold and thirsty, but not much pain other than sore on the left side of my breast – maybe a 3 on the pain scale of 1-10. (10 is that involuntary-yelp-out-loud pain)

Dr. Macadam came by – it went well. Moved to my room, settled in my bed – with the magic “pain button” in my right hand and the call button near my left, I slipped in and out of consciousness

In the middle of the night I awoke feeling anxious, too hot and very thirsty.  I had a feeling of tightness across my chest and discomfort in my back from the drain – let’s hear it for those buttons!

The nurse came, removed the extra blankets and got me settled – the pain level we decided was 2 for discomfort.  

Day 1

Today is get up and walk day. Pain level is about 2, soreness and discomfort category – very tender under my left arm, especially the drain site. Dilaudid drip and leg compression sleeves removed and catheter out – I’m on my own now!

Resident surgeon came by to check on me – everything OK and looking good.

Physiotherapist in – went over a few simple exercises and then up and walking arm-in-arm in the hallway – felt good to be up.

Had something to eat and then back to bed to rest although it’s tricky finding a comfortable position with all the drains.

Up and brushing my teeth when the “pain management” doctor came by. Total of 1.2 mg of hydro morphine used in the last 12 hours (not much apparently). My best buddy came to visit, brought me peanut butter sandwiches and laughter – the very best healer.

Slept intermittently – difficulty finding comfortable position with drains and cement pillows.

Day 2

6 AM up to stretch and walk around. Not much pain – mostly categorized as discomfort -very tender under left arm, sore down the middle of back and a feeling of numbness on lower back left side.

Feeling restless and ready to go home – the sun is shining!

Dr. Macadam came at noon, checked me out, and yes, I can go home today! The sore spot on my back is a “dog ear”, a piece of skin from the incision which will resolve fairly quickly – OK to lie on it.

Dressing changes, last antibiotics IV, and a “how to check the drains” briefing.

Off with the compression stockings, on with my drawstring pants and hoodie and with drains stuffed in my pockets, my buddy escorts me to the car and home I go to my own bed and puffy, soft pillows and uninterrupted sleep.

Week 1

Laying low – my niece is staying with me keeping me out of trouble and reminding me to take my antibiotics. Everything is sore, but not unmanageable. Trying to raise my left arm and getting into and out of bed is a bit challenging. I take my prescription pills for pain when I’m going to bed to guarantee sleep – maybe it’s the placebo effect, but it works for me!

The health care nurse is in each day to check that the drains and dressings are OK. On day 5, drains out on my right side.

On Day 6, I see Dr. Macadam.  My “plastic wrap” dressings come off (OUCH) and the drain on my left side is removed – what a relief!  Everything is looking good.

My lower left back feels numb.  Apparently that is normal and will remain so for about a year. The drain in the back will remain for another week, but with new dressings and 3 out of 4 drains gone, I’m beginning to feel human.

I am to start physio this week to get my left arm mobile.

Week 2

No health care nurse this week – I’m on my own.

Appointment with Dr. Macadam and the last drain is out – how liberating!  Also got a compression bra to keep everything in place and now I’m sporting cleavage.

Physio twice this week to work on arm mobility and also a sore lower back – a result of favouring my left side. I am able to drive although it’s not that comfortable for me. I’m walking to the store and trying to remember to keep it light.

I’ve taken a couple of “pajama days” where I just nap and read and take it easy and I definitely feel better for the down time. 

Week 3

I’m into week 3, going to physio and feeling much better and definitely less sore with each passing day. Hopefully I will soon be ready to go back to work, subject to Dr. Macadam’s OK.

I know that each individual’s experience will differ from mine, but it helps when you are feeling sore and frustrated to:

- Focus on the “finished product” – the worst is past.

- Avoid “well-meaning” negative people!

- Be extremely grateful you are in the care of Dr. Macadam who has the skills, dedication and compassion to ensure the very best end result possible, given one’s unique circumstances – I know I am!