Two Weeks After Mastectomy

It’s two weeks today since I had both of my breasts surgically removed.

It’s around a year and a month since I was initially diagnosed with triple negative breast cancer. Since then I’ve had neo-adjuvant chemotherapy (which killed three of my four tumours), surgery to remove the remaining tumour and then radiotherapy to my left breast and the middle of my chest. At the one year mark my mammogram showed some suspicious looking cells trailing away from the marker clip I had inserted into the tumour site. A second breast conserving surgery in July of this year revealed active, invasive cancer so on the 8th of August 2014 I had both of my 14F breasts removed.

I’m at home now and still healing.

Following surgery I had four drains leading from my chest, under my skin and exiting my body about a hand’s width above my waist. The drains help to prevent a build up of fluid (serum) under the skin at the wound site. Mine stayed in until the volume dropped below 30mls. For two of the drains this only took a few days but the other two were in for the better part of a week. The final one came out last Sunday.

It’s a fairly unpleasant feeling having a long tube of plastic extracted from under the skin but it’s not as painful as you would think. The nurses removing the drains asked me to take three deep breaths and pulled the drain out on the third exhalation. Two weeks since surgery and what’s interesting is that the places where they came out of my body are probably the most uncomfortable part of this procedure. I suppose it’s because any sideways movement aggravates them.

The final drain also developed a small blister under the tube where it exited my body. I was a bit squeamish about the drains and didn’t have a good look at them. When I spoke to the nurses the assumption was that I was describing nerve pain, which is common following mastectomy. It turns out the pain was a mundane blister which could have been avoided if only I’d thought to look. Worth keeping in mind if you’re having a similar operation.

My chest has three wounds. There are two long ones where each of my breasts was removed and a smaller one, high up on my left……oh wait, nearly typed ‘breast’! There’s a smaller on high up on the left side of my chest from the surgery in July. It’s surprising how much smaller this is now that there’s no breast tissue under it.

The right side is healing well. The left side is fragile thanks to the damage caused by radiation. It will take longer to heal but it’s looking okay. In the last week I’ve developed some nasty purple bruising (normal) and some more hard lumpy areas where my skin is starting to stick to my chest (also normal). My surgeon tells me that this adhesion to the chest wall is a good thing because it will prevent the collection of fluid under the skin. I don’t know if my skin will stay stuck to my chest wall. I’ll put that on my running list of things to ask my surgeon.

I have seromas (fluid collection) on each side but it’s not excessive and not making me nauseas. The breast care nurse from Gosford told me that nausea is a problem with seromas which explains why the rather large one I had following breast conserving surgery was spoiling my appetite. One of the breast care nurses at the Mater drained 30mls from the right side of my chest and just under 30mls from the left side of my chest on Monday. The breast care nurse at Gosford told me she wouldn’t usually drain such a small amount because of the risk of infection but I wanted them drained before I came home.

Draining a seroma is at least as awful as it sounds. It involves very large syringes attached to hollow needles. The first time my surgeon did it I couldn’t even look. On Monday I had no trouble watching and helping by holding the side of the seroma and pushing gently towards the location of the needle. It’s interesting what you can get used to when you don’t have a choice. But yuck!

I was taught how to gently massage each side of my body to help the seromas drain. At the two week mark there’s still some fluid on either side but it’s not excessive and, most importantly, it’s not stretching or distorting the skin. While I was still in hospital I figured out that I could use the hand held shower to massage my skin and this worked really well to reduce the build up of fluid. Now that I’m home I’m moving my body under the fixed shower which doesn’t seem to be as effective, but it’s still beneficial. I wonder how my beautiful husband would feel about an urgent bathroom renovation.

I’m covered in what’s known as ‘steri strips’ which are like a reinforced tape. When my wounds are a bit better healed I’ll replace these with micropore tape which will help to flatten out the scars. My chest feels like I’ve got a bad dose of sunburn. Depending on how I move it feels like its being stretched and pulled.  I’m focusing on keeping my shoulders back and standing tall. I used to call this throwing my chest out. Hilarious. There’s also a joke in there somewhere about taking a weight off my shoulders.

I’m doing my exercises each day and I managed about fifteen minutes of gentle yoga yesterday. Bliss.

I’m not on any heavy duty painkillers. I’m taking panadol (paracetamol) at regular intervals and at this stage I’m on six a day. I could have up to eight. My doctor explained that the idea is to keep the pain relief topped up and not to wait until I’m in pain to take it. Pain will put my body under stress and stress will have an impact on my recovery. This makes sense.

I’ve also been given enough Gabapentin to wean off it. I was having three a day in hospital and was delighted to find that my peripheral neuropathy symptoms vanished. No more sore hands waking me at two in the morning. No more ‘metal mouth’ where everything is tainted with an aluminium taste. Food tasted so good I thought I might leave hospital heavier than I went in, which, having left close to two kilos of breast tissue in the operating theatre, would have been something. I’m having one a night and sadly the neuropathy symptoms seem to be returning. I’ll need to research the long term effects of this drug and decide whether or not to ask my GP to prescribe it.

Not surprisingly, my balance feels a bit off. Remove two kilos from one side of your body and that will happen. I’m walking for at least half an hour every day and that’s helping me to feel more comfortable, or what my massage therapist would call back in my own legs. I love that phrase.

I was sent home with a binder which is a thick piece of elastic that fastens around my chest using velcro. It’s like a heavy duty girdle but worn around the chest and the edges dig in at either side. What’s the inverted version of a muffin top? Whatever it is, you get one at the base of a binder. Not attractive. I have been told variously that wearing it will either help to prevent seromas or that it won’t make any difference. Some women report that they loved wearing their binder and the sense of security it gave them. I think I’ve found a better solution.

I’ve got a couple of compression tops. If you’re not familiar with these then think of the skin tight black outfits worn by elite athletes. They exert all over pressure on your body and they are supposed to help with everything from performance to recovery. Here’s an article about them:

http://www.ausport.gov.au/sportscoachmag/sports_sciences/compression_garments_do_they_influence_athletic_performance_and_recovery

Compression garments are also used in the treatment and prevention on lymphedema, so it seemed sensible to me to try one out as part of my recovery. I’m so glad I did. They are very comfortable to sleep in and give support to my chest without feeling like an old fashioned corset. Mine have long sleeves but if you’re somewhere warm you can get short sleeved versions. Sporting goods stores will charge you a compressed arm and a leg for them but they are available cheaply from Aldi from time to time, or you could search online. Also, with a pair of matching black tights, I get to play Catwoman over breakfast.

Check with your medical team if you want to wear a compression top instead of a binder. It might not be suitable for you.

The down side of compression garments is that you probably need to be able to get your hands over your head to get them on and off. They are designed to be tight so if your movement is restricted that could be a problem. It would be possible to have a kind person help you to pull one on, but it would not be easy.

Mood wise I’ve been a bit up and down. I’m missing all the care and attention I had in hospital. I miss impressing the staff with my recovery and my sunny disposition. I miss my breakfast tray. I’m not as sad as I was before surgery and I think my ability to just make room for all of that sadness is part of the reason I’ve coped so well. I suspect the reason I feel so flat is that I’m home, but I still need to take it easy. I want to be out and digging in the garden and moving loads of mulch. I want my health and my strength back. I am impatient.

I’m having all the same weird pings and tingles through my chest that I had after breast conserving surgery. It’s good to know this is normal. I also have the occasional random pain in my left shoulder, as if someone is sticking me with a needle. What’s that about?

My pathology came back ‘cancer free’. When I told my husband he said, “That’s wonderful! Will they be putting them back on?” How would I have managed all of this without his sense of humour? He’s been doing a lot of hugging this week. I’ve had a few tears but mostly I’m like a tiger in a cage. Don’t worry. I’m not doing any heavy lifting.

I’m counting down five years from the 8th of August 2014. My chances of staying cancer free improve every day that I don’t have cancer. One day at a time. I am hopeful that the removal of both breasts and my node negative status mean that I have finally dodged this barrage of bullets, or at least emerged with survivable wounds. I’m ready to be well. I’m ready to get back to life and love and laughter. I know my mind will keep whispering ‘but what if….’ and I will recognise that very familiar thought that occurs regularly to all cancer survivors, and I will ask myself “Is this thought useful?” and I will let it go.

This is my bonus round. Every day from here on in is a gift, a day that might not have been. I know who I am and I know what I really, deeply care about. Thank you cancer.

Let’s do this.

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