EXCHANGE RATE

Have you ever walked yourself into surgery? As in, walked with your own two feet from the pre-op area (where they strap the pic line onto the back of your hand) into the OR? Neither had I. 

The hospital where I had my exchange surgery last week is "trying something new." Instead of being wheeled in on a gurney, I had the pleasure of walking (with a nurse) in my faded gown and anything-but-sassy, mustard-yellow, hospital-issued socks down an icy corridor — straight into the operating room. 

Once inside, they untied my gown and asked me to climb onto the surgical table. I was pleasantly surprised — it felt so soft, like a pillow-top mattress covered in warm flannel. (Turns out they just got new table pads. Score one for me.) As for the "trying something new," I reckon that just means less gurney guys in the wee small hours of the hospital morning.

Prior to my stroll into the OR, while waiting for the day to commence with my husband, we spoke to the very pleasant anesthesiologist about my vomiting tendencies. She assured us she would minimize the chance of this happening.

And so, after 19 long months, I finally, finally have the final surgery to remove my tissue expanders and replace them with permanent implants...
My plastic surgeon, Dr. C., did a lot of "pocket work" on both chest cavities, removing built-up scar tissue and refining and preparing the areas for the implants. They were then slipped under my chest muscle and secured with an array of stitches.

Given my trouble with healing over the past year and a half, Dr. C. also places AlloDerm, a biological matrix, between my right implant and my chest muscle to enhance circulation. (He used AlloDerm during my BMX too.) He cuts through my old incision scars, though only 2 1/2 inches on either side, in the area closest to my underarms.

After the three-hour surgery, when I come to, I don't know where I am. I seem to have forgotten that I was even in the hospital. But then it hits. (Pass the plastic pink bin, please.) Thankfully I had a dedicated nurse for the three hours I was in recovery — she was very gentle and kind and never left my side.

My husband spoke to Dr. C. after surgery was completed, and was told all went well, so while I was in recovery, Husband went to the cafeteria for an early lunch and ran into the anesthesiologist. So he asked how things went. She tells him I am experiencing some nausea. (Yeah, an understatement.)

Two hours later, he is finally allowed in to see me. I remember him walking towards me; I recognized him but couldn't focus my eyes — he was just a big blur. He took one look at me and said to the nurse, "OH. I've seen this look before." Meaning he knew how nauseous I was. He hung with me for another hour, after which my tummy was sort of under control. A short while later, I was in a wheelchair heading for the front door, heading home.

To be honest, I was expecting to "feel" differently when I awoke from this surgery. Trading in tortoise shell-like tissue expanders for soft, round implants seems like a no-brainer; the majority of women I have been in contact with who have been through reconstruction talk up the softness factor they experience immediately upon exchange. (In the inner circle of breast cancer patients, the procedure is referred to as "exchange to squishies.") 

But I feel no such relief. Quite the opposite; I have a lot of pain (mostly on the left side, where Dr. C. did more pocket work) and still feel a tightness overall. I'm bandaged and zipped tight into a compression vest. There ain't nothin' soft about any of this. 

I also have two surgical drains, which I hate! These are my 7th and 8th drains (not that anyone but me is counting). I knew I would have one, and possibly two. They hurt like the dickens, must be emptied twice a day (very gross) and I have to track how many cc's they excrete. My husband was kind enough to handle emptying my first four drains post-mastectomy (mainly because it hurt too much for me to reach around to do it), but since then, I have handled it on my own. 

Having drains reminds me of going through my mastectomy all over again. It's a very raw place to be. 

All these months of waiting while being lopsided, one-sided, and everything inbetween, and I am surprisingly uninterested in how "they" came out. I know from talking to other women that how they look now will differ vastly from how they end up; everything is swollen and misshapen at the moment. I don't want to be disappointed. Best not to get an image stuck in my head. So I don't even bother to look.

I am, however, quite curious as to what size implant Dr. C. ended up using. 

For the uninitiated, it is impossible to determine exactly what "bra size" you will end up being after reconstruction. You cannot go into this process thinking you'll end up being a 36B or C or whatever. It doesn't work that way. Because all the breast tissue is removed during a mastectomy, and the chest cavity is left somewhat deformed, the size of the implant is selected based not just on what the patient wants, but on what her body can handle (inside and outside). In my case, given my skin integrity issues on my right side, we were limited; Dr. C brought six different implant sizes into the OR. 

Fortunately I had instructed my husband to be sure he received the card with my implant info on it after surgery. I was surprised to read that lefty got a 500cc, and righty a 450cc. Hmmm. I'm confused. Since more tissue was taken from my right (cancer) side, so it would seem that there would be more room for a bigger implant, but due to my skin issues Dr. C. couldn't push the envelope. So righty got the smaller implant; lefty, which always had good skin, got the larger. This should be interesting, how I end up looking!

The stinging pain I feel after surgery overshadows any feelings regarding the fact that this long-awaited surgery has finally come to pass. I don't know about you, but my emotions don't work that quickly. I don't immediately go to a "happy" place. I am ever cautious. I was like this pre-BC, but post BC I am even more so. 

A day after I am home, I am taking Vicodin every 4 hours to calm the pain and decide to take a peek. I look down the top of my surgical vest and things appear the same as when I had my tissue expanders. Righty is more swollen. But I'm not fretting. I'm not really focused on them. I really just want to heal and deal. 

I'm sleeping on an incline pillow with pillows on top of that; this is to discourage swelling and assist the body in getting rid of excess fluid. I also have to sleep flat on my back so that my implants stay where Dr. C. put them. (If you sleep on your side or stomach, you can dislodge the implant.) I am a side sleeper, so this incline not only hurts my back but prevents me from getting more than three hours of sleep a night. 

The evening of the day after surgery, I develop a low-grade fever, which decided to present itself after the Vicodin wore off. In addition to being sore, I now feel hot and achy. I'm looking for a break here.

I decide it's time to take a real look. I unzip my surgical vest and am disturbed to see that my dressings are not in place! The big, puffy gauze pads have slipped off the surgical tape that is covering my incisions. No harm done, but good thing I decided to check things out. I tell myself not to be alarmed by anything I see, that my chest will continue to change as the days, weeks and months go on. 

I don't look much larger than I was with the tissue expanders. I'm not sure if this is good or bad. I grab my camera and start taking pictures.

A variety of people are calling the house to see how I am; my husband hands me the phone each time, even when I'm eating or taking a nap. I eventually break him of this habit, but for awhile I am talking to people and pretending that everything is OK (because that's what my husband tells them and I guess from his vantage point, things are OK: I survived!). People just want to know that you are OK. Even though surgery went well, I feel like hell. Do I say that? Well, sometimes I do. But when I do, I'm then faced with folks trying to cheer me up. I don't want to put on the "happy face." I stop accepting calls.

Several friends who have had augmentation surgeries in the past share with me the pain they remember feeling post-surgery in an attempt to connect with what I'm going through. Make no mistake: This is not augmentation surgery. There is nothing pretty about what I have had done to me over the course of 19 months. I feel mutilated. And all I really want is to be able to wear regular clothes again.

So I find myself in a precarious emotional position. Yes, my (hopefully) last big surgery is behind me and am grateful that all went according to plan. But I can't relax. Not yet. Because I know I'm not out of the woods.

Two days ago, I saw Dr. C. and had my drains removed (I have eight drains over the course of this recon, and eight really IS enough!) The good news: I no longer feel like an invalid! But later that day, with my body now absorbing the excess fluid I am producing in response to my surgery, I hear a swishing sound in my right side. It's fluid moving around my implant. My low-grade temperature returns.

I take pictures of myself (something I am doing every other day to document my progress) and email them to Dr. C. I know to look for redness, which can indicate infection (or, God forbid, implant rejection — it is a foreign object, after all) but so far I just have the fever. Dr. C. said a low-grade temp is normal, that the buildup of fluid and the swishing is normal, and if I go above 100 to let him know.

Just took my temperature — 99.9.

PS: For more of my story, see "Solo Sojourn."