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.

Eyebrows (Fill in and Feather touch technique), lips and eyeliner can be done. Lip colour tattoing is great for someone with thin or no lips at all. We also do colour correction for permanent makeup that has faded to colours like blue or orange.

Before

Immediately After Feather Touch Technique

Lips Before

Lips Immediately after tattooing

Dry Needling is also available. This is a technique that works wonders on very deep lines, wrinkles, acne pits and scars. It stimulates collagen and elastacity without damaging healthy epidermis.

Permanent Makeup and dry needling will be 15% off for the months of October and November!

Call us today to book!

Tattooing or Micropigmentation is a simple, fast procedure done in our office as the finishing touch in a patient’s breast reconstruction.  It is usually done 3 months post nipple reconstruction. Areola tattooing involves implanting hypoallergenic pigments (color) into the very top layers of your skin with a tattoo gun or pen. Depending on unilateral or bilateral, the tattooing process can take 45 to 90 minutes.

Tattooing is performed by Andrea Rheaume. Dr. Macadam is present to administer freezing and discuss size and shape. Colours are chosen based on your pre-mastectomy pictures or by matching your native areola. If pre-mastectomy photos are not available, we can work together to find a colour that works for you and suits your skin tone. If this is something you have been waiting to have done, call our office to schedule your appointment.

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!

I am 33 years old and the mother of two children aged 2 and 4 years.  I was 32 years old when I was diagnosed with breast cancer in March 2010.  With ultrasounds, I had been tracking a few lumps in my left breast for a full year before I was finally diagnosed.  When they did the biopsy in March, I had 8 lesions and 3 nodes involved.  I immediately met with my oncologist and surgeon and they recommended starting with chemotherapy to shrink the tumors.  The cancer I had was Estrogen and Progesterone receptor negative and Her2 positive.  I also did genetic testing and my results were negative for both BRCA 1 and BRCA 2.  My surgeon recommended a unilateral mastectomy with reconstruction with the chance to remove my right breast if I wanted later on.  She also suggested getting an implant so that my recovery time would be shorter and I could get back to being active with my kids.  I met with Dr. Macadam right after my first chemo treatment and she told me I was a candidate for either implants or tissue reconstruction.  Depending on which one I chose, it would affect the timing of my radiation: With implants I would have radiation after surgery, with tissue reconstruction I would have radiation before surgery.

Why did I choose DIEP reconstruction?

At first I wanted to get back to my daily routine with my kids as soon after my surgery as possible.  I had decided on only doing a unilateral mastectomy with an implant for the shortest amount of recovery time.  The main issue I had with a double-mastectomy was that I still want to have kids and wanted to breastfeed.  After a lot of discussion with other women who have been through the surgery, I decided that because I did not know the cause of my cancer that I would be safer to have a double-mastectomy and that this would allow me more peace of mind than a unilateral mastectomy.  I then had to decide about the reconstruction.  My husband asked me, “If the recovery time was the exact same for both procedures (implants or DIEP) which would I choose?” This was easy: DIEP.  I would use my own tissue, not have to be replaced ever, would grow and shrink with my body size, DIEP breasts were natural looking, I would get a tummy-tuck at the same time, I get to keep my tummy muscles, and it was a one-time only procedure (no pumping or expanders).  My husband pointed out that really, in the long run (the rest of my life), a month and half of recovery was not a lot. 

I totally understand that the experience is different for every woman, and that not everyone can do the DIEP reconstruction, but for me it was the right choice. 

Prior to the surgery:

I only had two meetings with Dr. Macadam prior to surgery.  The first meeting she showed me photos of the procedures and talked about the pros and possible cons of each of the procedures.  She also did some measurements and gave me some handouts.  I was totally overwhelmed.  By the second meeting I had a lot of questions for Dr. Macadam and she spent a lot of time with me addressing my concerns and answering all of my questions.  Andrea gave me a form for a blood test and told me that she would contact me to get a CT scan on my abdomen.  I completed chemotherapy and radiation and continued Herceptin treatments before surgery. 

I got my CT scan the week before the surgery.  Two days before the surgery I went in to VGH for a pre-admission clinic.  I was able to talk to a nurse and an anesthetist. 

Day of surgery:

I checked in and was taken to the admission room.  My husband came with me.  The nurse came and took all my information and then Dr. Macadam came into the cubicle.  She asked how I was doing and then took a Bic marker to my breasts and tummy to mark all the incision areas and where my veins were on my CT scan.  Then my general surgeon came in and some students and fellows who would be observing the surgery.  The anesthetist came and set up my IV and said he would be with me for the whole procedure.  At 7:45 am I said goodbye to my husband and the nurse wheeled me to the OR on a bed.  The procedure took 13 hours in total.  Dr. Macadam called my husband and told him that everything went according to plan, things looked great, and it was a lot of work.  I woke up in the recovery room to complete chaos.  There were lights, people, and noise.  They let my husband into the recovery room at about 10:00pm. They were checking my dressings and working on my drains when things started to get a little queasy for my husband who had to take some air while they moved me to the Burns, Plastics and Trauma Unit.  I was put into my own super-heated room so that my tissue would take.    I was so hot and sweaty and puffy that I stayed naked under the paper sheet.  They also put leg compression sleeves on to reduce the risk of blood clots.  I visited a bit more with my husband, who had to wear a gown and gloves every time he came into the room.  The nurses explained the Patient Controlled morphine drip and that I would still wear oxygen for the night.  Then everyone left me to sleep, but I could only get 5-10 minutes of sleep at a time because of the hallucinations and dreams from the morphine.  Also the nurses would come and check on me every hour to check the flow to my breasts with a Doppler. As the night went on I started to feel some soreness and bruising.  I was super sweaty and itchy from the morphine, but one of the nurses was excellent and took the leg pumps off and gave me a cool sponge bath and leg massage and powdered my legs before putting the pumps back on. 

Day after surgery

Dr. Macadam came to see me.  She told me that everything went smoothly and that the procedure was long because it was basically 3 in 1 operations (mastectomy, reconstruction, tummy tuck and breast reduction). She pushed on the sides of my breasts and I was very sore and swollen on the left side where they took the lymph nodes.  Apparently this is normal.  My stomach incision was also sore and tender. Dr. Macadam says everything looked great and was doing really well. She Okayed me to start a liquid diet.  The program for the day was bed rest and it was decided that tomorrow I would try to get up and walk to a chair. 

All day I had regular visits from the nurses for checking my blood flow.  I did not have much bandaging just a tensor under my breasts to hold them up and bandaging on my stomach and new belly button.  I had 5 drains: two on the right side and 3 on the left side.

I am mostly sore around the stomach incision.  It feels like muscle pain on my sides and bruising on my hips. My breasts are quite bruised on top and vey swollen.

Dr. Macadam came by again and said that everything looked good and that her fellow would be by the next day to check up on me.

I was able to eat a bit of soup and tea and drink cold water and juice.

Day 2 post-surgery

My general surgeon, Dr. Cheifetz came for a visit.  She said her part of the surgery went well and she was able to take everything out as close to the skin as possible. 

Dr. Macadam’s fellow visited.  He said everything looks good.  The plan for today is to sit up, stand and rest in a chair for a bit.  I have to get moving a bit.  I also have a breathing tool to encourage full, deep breaths. 

I got my catheter and IV removed today. 

Today was the worst day for pain.  Lying down and cold sponge baths help.  Eating is good.  I am able to eat yogurt and an apple.   

They are still checking my blood flow with the Doppler every hour.

Day 3

The physiotherapist came by today and went through some exercises I can do: neck bends.

Dr. Macadam came by again and says: “It looks perfect, looks like it is all surviving.”  She said she would bring me a special bra to hold everything in.  She dopplered my flaps and said it was good to hear some flow after day 3.  She told me day 3 is usually the turning point.

I still have pain in my underarm area from where the nerve was taken.

I was told that I MUST get up and walk today so that I reduce my risk of blood clots. 

I had a couple of visitors and then the physiotherapist came to help me walk. I sat up and barfed.  I moved to the commode and barfed.  I peed and barfed.  They gave me 4mg of Ondansetron by IV and I barfed.  A cool cloth helped a bit but resting lying down is the best.  I did not eat a lot today: some yogurt and an apple.

Day 4

I had a rough morning.  The fellow came to visit me and said that I HAVE to get up and walk to the toilet or I can’t go home tomorrow.  I am so nauseas I can’t function.  It feels like chemo again and I hate it.  I can’t eat anything they bring me even though I can have solids now.  None of the nausea meds seem to be working.  The even tried 8mg  of Ondansteron. 

Gravol works, but totally knocks me out.  I took a short walk across my room, barfed and then ate a bit of food. The fellow thinks it is the pain meds that are making me sick so he is going to change them today. 

Dr. Macadam came by and brought me a new bra. It  is a compression bra that does up in the front.  It is supposed to keep the swelling contained and the breasts in place.  I have to wear it at night too.  It looks nicer than the tensor and makes me a feel a bit normal again. 

I took  Dilaudid and Gravol and had a great nap.  When I woke up I actually felt hungry and ate some food and had a milkshake.  With the help of the physiotherapist I walked around the ward with a pillow clutched to my stomach.  Later I walked to the nursing station by myself.  They let me have breaks from the leg compressors and then finally just took them off.  They also finally turned the heat down to a normal level.  Things are looking up!

These are the drugs that they have me on:

Regular Tylenol

Dilaudid (4-6mg every 4 hours)

Vitamin C

Multivitamin

Aspirin

Heparin shots (in right arm-which is totally bruised now)

They always asked me what level my pain was at on a scale of 10 and I would say it varies from 4-6 every day. Not bad considering the major surgery I had.   

Day 5

Time to go home!  After checking with Dr. Macadam, the nurses finally redid my dressings and removed drain #4 on the left side.  They showed me and my husband how to empty the drains.  I feel fairly good, but a bit sweaty and light headed from the pain meds. 

My husband went and picked up my medications from the pharmacy and I got washed up and dressed.  I had made sure to wear really easy clothes to put on to the hospital (yoga pants, really loose-necked shirt and slip on shoes).  The ride in the wheelchair made me really nauseas and dizzy after not having moved around a lot over the past 5 days. 

I took a Gravol and then we drove home.  The fresh air was amazing.  . I made it up to bed and had a gravol and a nap.  While I was sleeping, my husband went and got me a commode from the Red Cross.  Our bedroom is on the top floor and I would have to go downstairs to go to the bathroom, so this will be easier.

My husband emptied my drains every 12 hours and recorded how much liquid came out and the times I took my meds.  I can eat normally now, but not very much. 

I stayed in bed all the time.  I did get up to pee in the commode a couple of times.  As I was sleeping flat on my back at night (with pillows under my knees and arms) I woke up with a crushing pain n my chest and not breathing  I had to get my husband to help me up and prop me up with pillows.  I gasped for breath for about 10 minutes until I felt better.  It was very scary, so now I am sleeping sitting up. 

Day 6

I feel well-rested after the incident with the breathing.  My goal today is to have a bowel movement.  I have been taking sodium ducosate twice a day to try and get things moving.  I sat on the commode for a good half hour and was able, with difficulty, able to have a bowel movement.  While I was on the commode the home nurse came by.  She could not take out my drains because she needs a full 24 hours of data before she can do anything.  She said she will come back tomorrow. 

I was able to walk downstairs and sit in the living room and visit with my friends today. 

Physically, it is still hard to manage the stairs and do lots of talking as I get winded.  I had a sponge bath today, with help, which made me feel so much better. 

Day 7

I had a terrible sleep last night.  It is hard to get comfortable with all the drains in.  I had to transfer to a lounger chair to sleep, which was way more comfortable, but I still had to use 5 pillows to support my back and arms. 

The nurse came today and took out three drains.  She said everything looks god and dry under my dressings.  It was such a relief to have them out!  She bandaged me back up and left the one drain under my left arm (which was at 30 every time).  She will call tomorrow to see if she should remove it. 

I made it downstairs again and sat on the couch for a while.  It feels good to get moving.  My days are mainly spent laying in bed and looking at the computer.

The pain is really not as bad as I thought it would be. 

I still have someone here every day to help me with day to day tasks and getting out of bed. 

Day 8

My appetite is slowly returning.

I was able to get up and have dinner with my family for Christmas Eve.  I ate more than I have eaten in a long time

Day 9

I had another poor sleep, but stayed in my bed all night.  I didn’t take any pain meds last night but I took 2 Emtec this morning before the Christmas rush. 

I was able to stay sitting or lying down in the living room all day.  I took one break to rest upstairs but I didn’t nap.  I find it hard to get comfortable and I don’t want to compromise my sleep at night.

I was able to get a new shirt on today.  The best type are ones that button up the front or are very loose around the neck.  I also wear yoga pants or PJ bottoms to protect my stomach incision

Day 10

I had a great sleep last night, probably because I was able to lie flatter on my back and because the incision on my stomach is feeling a bit better. 

I am now able to go downstairs to the washroom and stay there all day.  I have to remind myself not to pick up the kids or to do any housework. 

I am eating full-sized meals now. 

I felt really good all day but had a swollen, sore arm on my left side by the night.  I had to lie down and raise the arm and take one Emtec.

Day 11

I had my first shower today, which felt amazing.  I took off all my dressings before.  They were all dry but there had been a lot of drainage on the left side. 

After my shower I lay in bed without a bra for a couple of hours.  I called the homecare nurse to see if they would come re-dress me.  She finally got back and said that I could do the dressing myself

I only took one Emtec at night again because I was swollen and sore. 

Day 12

Today was my first time out of the house since surgery.  It felt good to get fresh air and stretch my back.  Walking feels fine, but I am still really tight in my tummy, especially along the right side of my pubic bone (it feels like a string pulling through there). 

I had my first follow-up appointment with Dr. Macadam.  She and the fellow took off my steri-strips and a lot of my skin came with them.  I didn’t feel it at all except for when they removed some of the bandages.  They said there was quite a bit of blistering, but they had seen worse and mine wasn’t too bad.  This type of blistering is to be expected with this type of surgery (a reduction pattern mastectomy).  They also said that it wasn’t too good to have the blisters on my tummy so I need to keep them moist with Polysporin.  They redressed all my wounds with Telfa and paper tape and some steri-strips along the incision on my tummy.  Dr. Macadam said that everything should heal in ten days and that I should get the nurse to change my dressings every day until then.  She also said that everything looks good and that my breasts are a good shape.  This was reassuring to hear. 

I have to really take it easy: no cleaning, making the bed, or lifting the kids.  If I have to get up I have to roll onto my side and swing my legs over the side of the bed and push up.

Week 3

I made sure to take it really easy for a couple of days so that my tummy wouldn’t pooch.  My sleeps still are terrible, even though I can sleep on my side now.  I always wake up for a couple of hours with a really sore back and then I wake up really early. 

I am still walking hunched over a bit.  I had to walk back to the car a couple of blocks, so I was a bit winded.  The hardest part about walking is the tummy incision is so tight.  I have to walk bent over which hurts my back.

My muscles ache to move and I stretch out more.  I want to do things and have to keep reminding myself to slow down.  If I do too much I find I get light-headed and have to rest.  I went for my first walk at the park.  I still have to go slow and had to sit for a awhile so I wasn’t straining my back.  I was really tired after this. 

Week 4

My tummy incision feels a lot better and I want to keep flexing and stretching my muscles.  I am able to sleep flat and on my right side now, but still wake up with back pain. 

I saw my general surgeon for the first time since surgery.  The clinic nurse and fellow came in to check me out because I am “unique case.” They don’t get to see many DIEP patients.  She was not surprised to see the skin necrosis because with reduction incisions the blood has to flow all the way from the top of my breast to the bottom and the blood flow is cut off for so long.  She said that everything looks good and that I have really nice shaped breasts. 

I had 2 sleeps without back pain!  I am only taking Tylenol at night.  It also helps that I can walk a lot straighter.  There is  A LOT less pain on my left side and just a bit of sensitivity on the right side under my breast.  I am still numb on my left side under my armpit and against the breast. 

Week 5

I am able to move around and do everything now, just not pick up heavy things.  My tummy incision feels a lot better, not as tight but numb. I no longer have dressings on my tummy. 

I had a follow-up appointment with my radiation oncologist.  He said that everything looks good.  He said my pathology report was good.  He is happy with how things went with radiation and that I seem to have breezed through the process.  I only have to follow-up with him if I have rib or chest pain or skin problems over the next few months.  He reassured me that there is no sign of cancer anywhere else in my body and that, like anyone else, I could get cancer again but I need to move on and live my life.  Because  I have tissue reconstruction he explained that I will no longer get mammograms or scans, but I will just get manual tests. 

I have almost no pain anymore, just a numbness and tightness on my left side.  I can only lift my left arm to my shoulder and then it pulls in my armpit and across my chest. 

I saw Dr. Macadam again.  She looked at everything and says my tummy incision looks amazing and the blisters are gone.  She was hoping that the incisions on my breasts would have healed more.  She is mostly worried about the bottom of the right side.  She has seen wounds like mine heal before, so she will give me another week and then will consider a skin graft if I haven’t healed.  She would take the tissue from my side, where it bulges over my tummy incision.  She wants me to change the dressings every day and use Flamazine to clean up the dead tissue.  She also checked the lump on my left side and is pretty sure it is fluid buildup because it has some “give”.  She wants me to massage it with pressure a couple of times a day.  I asked if I could start driving and she said I could if I felt like it, but really it has to do with how I could react in an emergency situation.  She also confirmed that on Thursday it will have been 4 weeks since surgery and I can eat chocolate and have caffeine and red wine again. 

3-month update

I have been head down trying to heal and get on with life. I am back to cooking, driving, parenting and all of the other fun life adventures. I started driving again at 5 ½ weeks post surgery.  I am finally getting back to being able to walk more than a block at a time and can do long walks and run after my kids, but am not very good at heavy exercise. I did a study at UBC, and they tested my lung and heart function with exercise: Apparently, I am at 88% of normal, which isn’t too bad as I am so soon after treatment.

There is a lot of healing still to do.  I am still getting Herceptin injections every 3 weeks. I only have 4 more treatments to go and will be done at the end of May.  My left breast is totally healed and I just have a red, indented scar there now. The wound on my right breast is about 1/8 of the size it was. The nurse is guessing another week and it will be all healed. It had actually all healed, but then the skin is so sensitive that it tore again while I was toweling off after a shower, so I have to wait for it to close again.  I am really looking forward to being bandage-free and being able to bathe and swim again. I did not get skin grafts, as Dr. M thought my breasts were healing okay, just very slowly.  She will work on the scar on my right side when she does the follow-up surgery. Once I am healed and done all of my Herceptin treatments I will have the second phase of reconstructive surgery: It will be a day surgery and I will have some liposuction done on my left breast and on my sides and have a bit of tightening done on my right breast. Dr. M has decided not to do my nipples at the same time because she doesn’t want them to collapse. It will be another couple of months before I get my nipples made.

Some days it is really hard because I still have nipple-less, bandaged breasts that every medical person I see wants to look at.  I know that the reconstruction is secondary to the actual surgery being successful at removing my cancer, and I know I will get there, but it has been a long journey.

I have also been working very hard at getting the mobility and strength back into my arm and my core. I found out that I had auxillary web syndrome.  Basically this is when the lymphatic channel in the arm chords and pulls through the entire arm and armpit. My physio has been massaging and stretching it out and it is almost gone.   I have a had a really sore back and tailbone from how I have been sitting and standing and protecting my incisions so I have been working on that with my physio.

Would I still recommend DIEP surgery?

After reading my experience after the DIEP surgery, and seeing all the healing that I have done, people ask me if I would still recommend the DIEP surgery, and I would answer: Absolutely. 

My breasts look real and are a great shape. They fit my body (they are the right size and shape).  I know that the scars and wounds will go away with time and once I have my nipples, they will look complete.  I am glad that aside from the wound healing, I had no complications with infection or anything.  I am so happy that I was able to wake up from surgery and wear a bra and clothes and not have to look different from other women.  I am also happy with my breast reduction: my breasts look perkier and rounder, and I hope will help me heal from the back problems I have always had.  I am also very happy with my tummy-reduction: I look skinnier, but still have my stomach muscles.  I am looking forward to being able to build my core up again. 

When I compare this surgery to the other options I had, I know I made the right decision: I do not have to wait for my second surgery as with implants.  I do not have to maintain the breasts in any way (well, other than the wound dressings).  I look and feel real and do not have to have any follow-up surgeries after my initial ones.  I still have my stomach muscle, as compared to the TRAM flap.  Overall, the recovery was fine considering the surgery.  I was up and about as soon as I got home, I felt a LOT better after 4 weeks, and was back to normal activity by 6 weeks post-surgery.  As a young woman, being able to get back to life and work as soon as possible has been important, but so has having a body shape that I like and feels real.

Dr. Macadam has been great to work with:  She answers all my questions, she has been very accessible by appointment and email, and she has done a great job on my breasts.  She takes pride in her work and is able to balance her professionalism with a genuine caring attitude for her patient.  Over and over, everyone I have seen has told me that Dr Macadam is very qualified.