Starting again on Day 28

Having already started this blog, I was no longer shy about taking photos of myself, so these were taken in hospital the day after BB's haematoma was drained.
The surgeon removed 600mls of old blood from that breast, which is a greater volume than the tissue he removed at the original operation! No wonder it had been so tense and swollen, and no wonder I had been feeling so tired and miserable during the last couple of weeks. That's a lot of blood to "lose" from the circulation, and then to then have to carry around in one poor breast.
So it was definitely worth doing, and you can see how dramatically the swelling has been reduced in comparison to the previous photos.

Of course there is always the risk that the same thing will happen again, so during the operation two drains were inserted, to try to prevent a similar build-up. This photo shows the drains doing their job.

 

Unfortunately they stopped draining during the first day after surgery, and although the surgeon seemed pleased with this, I became very worried that the haematoma would re-develop in the space left behind by the removal.

Adding to my worries, the surgeon explained that when he removed the haematoma he found a couple of areas of fat necrosis, which is yet another uncommon complication of breast reduction.

It seems rather unfair that I should experience not just one but two complications, and I can only hope that the rest of my recovery is uneventful.

Biting the bullet

The following photos were taken just 5 days after the previous ones, and you can see that not only has the swelling not gone down, but BB is looking decidedly the worse for wear. The skin is taut and shiny after nearly 4 weeks of being stretched by the hematoma, and there is an unpleasant pink/purple hue which is partly due to the lighting, but also indicates the build-up of old blood and possible early infection.

Something definitely needed to be done, so I was re-admitted to hospital for another general anaesthetic, 4 weeks to the day after the initial operation.
Having spent the previous 4 weeks in a state of discomfort, uncertainty and anxiety, I felt I was not in nearly such good shape for surgery as I had been the first time, so I was very relieved to learn that it would be a much shorter operation (about one hour rather than almost five). 

Still, it was very hard not to be depressed by the whole repeat experience, which wasn't helped by being given the wrong time to arrive at the hospital, and therefore having to wait 6 hours before being seen.

Misplaced optimism

Unfortunately, BB stubbornly refused to settle down, and although the superficial bruising had almost disappeared by Day 20, the hematoma was still obviously causing a lot of swelling and pressure.

So the surgeon tried again to drain some of it through a needle, and although he was able to remove another 20 mls or so, this made very little difference.

We agreed to wait just a few more days, and then make a decision about re-operating.

I continued with my gym programme and normal work, desperately hoping that I would wake up one morning and BB would have deflated to match GB. But it didn't happen, so I had to accept that further surgery was now inevitable. This would naturally mean re-opening the almost-healed scar, and starting all over again, which was a very depressing thought.

Week 3 - Feeling better

I was so relieved to learn that I had not brought all this on myself that I barely minded the fact that fluid continued to leak from the puncture site at a considerable rate over the next few days. I spent a small fortune on sterile gauze, dressings and tape, before realising that Super-Strength panty shields would do the same job at much less cost.

I even felt confident enough to return to work for one day, although it completely exhausted me. I was once again able to consider the overall effect of the operation, rather than being obsessed only with BB, so this photo shows both breasts at Day 18 post-op.

BB is still noticeably more swollen and shiny, and there is a new (darker) area of deep bruising around the puncture hole, but I felt that we were on the home run at last and that it was now just a matter of time until the haematoma slowly dissolved and/or drained out of this small hole.

Day 17 - Review and action by surgeon

By the time of my weekly visit to the surgeon, I was feeling very despondent indeed, and completely unable to make a decision on the choices he offered me, which were to

1. do nothing and wait another week or so to see what happened
   
2. go back to hospital and have the hematoma removed in surgery (which would mean opening up most of the scar)
   
3. trying to drain some of the hematoma with a needle, to relieve the pressure.

To his great credit, he allowed me to have a bit of a cry, and assured me that all of this was absolutely NOT my fault, and that it was completely unrelated to any activity (or lack of it) on my part. He explained that the haematoma had been created the first night after surgery, and that unfortunately the drain had not removed enough of it before it clotted. He made it sound like I had been a little too efficient in healing, rather than deficient, and this was a great comfort to me. 

I agreed to let him try to drain some of it, so he inserted a thick needle (fortunately in the numb part of my breast), and to our great satisfaction he removed about 60mls of old blood. He explained that this was only a small fraction of what remained, but already BB felt happier and less swollen and sore.

I took this photo when I returned home, and it shows the small dressing over the puncture wound, as well as the new skin growing over the triangular raw area where the dressing had been removed too hastily in hospital.


This was Day 17, and if you compare it to the previous photo (Day 12), you can see that the drainage has indeed reduced the swelling, which had increased even more during the intervening week.

Week 2 was a low point

After devoting several days to healing activities such as I mentioned above, I was keen to see what improvements I had achieved, so it was deeply depressing to find when I took this photo on Day 12 and compared it to the ones taken 4 days earlier, only to find that BB was actually looking more swollen and discoloured, rather than less.

This was the start of a very bad week for me, emotionally, and it was definitely the low point of the whole experience. I was sleeping very badly, because of needing to be propped up on pillows and unable to lie on either side, and I was finding it very difficult to manage on my own with such a swollen and tender breast. It seemed to complicate even simple things like cooking or hanging out the washing, and I was becoming more and more apprehensive about the consequences of this stubbornly persistent haematoma.

I felt I had somehow failed in all my attempts to encourage it to heal, and my guilt was increased by the very kind and well-meaning comments from friends that I was probably “overdoing things” like the gym, driving and looking after myself at home. So I felt the situation was “all my own fault”.

Day 7 - Review by surgeon

A week after surgery I had to go back to see the surgeon, so he told me to shower and remove all the dressings before I left home. This gave me my first proper look at the wounds, and I was amazed at how extensive they were, in view of the minimal pain I had experienced. Again, please skip these photos if you think the sight of fresh scarring will distress you.


The remaining dressings cover the areas of rawness I mentioned earlier, where the surgical dressings were removed a bit roughly in hospital. You can see how far the scar extends around under the arm, because in fact the breast does go that far, so breast reduction can involve removing tissue anywhere between the sternum and the armpit.
As before, you can see how the clearance of the bruising is inhibited by the surgery. The scar marks the dividing line between bruised tissue and non-bruised tissue, whereas outside the breast the bruising gradually moves down the body and away.

The photo below also shows the “T-junction” in the scar at the base of each breast, which is likely to be the last area to heal. It is very common for this part of the wound to take several months to heal properly, even if the rest has healed perfectly within weeks. The reason is that 3 different parts of the breast and skin have been brought together at this point, so they have to make completely new connections of blood vessels, nerves etc. This is also the lowest point of the breast, so blood and other fluid is more likely to collect there, increasing the pressure and slowing the healing process.

At this post-op consultation with the surgeon, he felt there was a 50% chance that the haematoma would gradually dissolve. To my great relief, he also gave me permission to return to driving, and even said that I could return to the gym the following week, although of course I had to avoid upper body work and anything involving bouncing.

I immediately decided to do everything I could to help my body deal with this problem, so I went 3 times a week for a session of Manual Lymphatic Drainage. This is a specialised and very light form of massage which aims to stimulate the fragile lymphatic vessels just under the skin, to encourage drainage of the area. It is used successfully after mastectomies, when all the lymph nodes are often removed entirely, and the patient often has great trouble with fluid retention and a very swollen arm. I also tried to follow the same technique at home at least twice a day, for 15-20 minutes at a time.

I also drank copious amounts of water to help the body liquefy the blood clot, and as soon as I was able to return to the gym for some lower body exercise, I did so. Not only was this essential for my mental well-being, but by raising my heart rate with careful exercise I hoped to increase the flow of fresh blood to my breast and hasten the removal of the old blood.

Day 6 post-op

After a few days at home, things were looking much less gruesome, and I was starting to recover from the lingering effects of the long anaesthetic. This photo was taken 6 days after the operation, and shows that the superficial bruising is starting to fade to yellow, a good sign. Of course I didn’t know what was happening deeper inside the left breast, but I was becoming more optimistic that after a slight delay, BB would soon catch up to GB.

Back home

After 4 days in hospital the drains were removed and I was allowed home. I was a gruesome sight, so skip the next few entries if you have a sensitive stomach.

It was already apparent that my breasts were playing their own version of Good Cop Bad Cop. In my case it was Good Boob (GB) on the right, and Bad Boob (BB) on the left. Right from the start, GB was an exemplary patient, healing quickly, quietly and without fuss. As you can see, it was barely bruised, and I was thrilled at the small size that the surgeon had achieved.
I had not expected such a dramatic size reduction, and it is the first time since I was about ten years old that I have not been able to hold a pencil under my breast (this was our childhood gauge for whether or not a bra was necessary).

BB, however, seemed determined to experience every possible problem, with continued wound seepage, extensive bruising, and, most importantly of all, a persistent haematoma. This is one of the most common post-op complications in this sort of surgery, due to the intense vascularity of the breast and the fact that the escaped blood is more or less trapped in a confined space. As you can see from the photo, the blood (bruising) in the breast is unable to travel down the body with gravity, whereas the bruising between the breasts can and does move down. This is because the normal drainage system of lymphatic vessels and tiny blood vessels in the lower part of the breast have all been destroyed or interrupted by the removal of the breast tissue during the operation.

The body is amazing, and it works hard to remove the blood from the breast by dissolving the clot and gradually transporting it away using different channels higher up. This all worked perfectly in GB, but unfortunately the back-up system was unable to cope with the excessive bleeding in the left breast, so the haematoma remained. It wasn’t painful, exactly, just uncomfortable, because the skin was stretched very tightly, which pulled on all the hundreds of tiny stitches along the wound. Also, there is a constant risk of infection with such a large collection of old blood (which bugs love best of all), so I had to stay on high doses of antibiotics.

In hospital

I can't say much about the actual operation because I was (thankfully) completely unconscious, but I later learned that it took about 5 hours and involved the removal of about 400g of tissue from my right breast and 500g from my left breast.
I found this animated video to be very helpful in preparing me for the operation, and this simple diagram of the procedure is also worth studying.

The anaesthetist arranged for a PCA pump (patient-controlled analgesia), so I could just press a button if I was in pain and the pump would deliver a measured dose of intravenous pain control. In fact I only used this a couple of times and at no time was my "pain score" any higher than 5.

The morning after my surgery, the first thing the surgeon checked was my nipples. Because the procedure involves cutting all the way around them and lifting them to a new position higher up the breast, there is a risk that the blood and nerve supply will be damaged, leading to loss of sensation or even “death” of the nipple due to lack of blood. This is one of the most serious complications of a breast reduction, and patients are always warned very clearly that there is a (hopefully very slight) chance of losing one or both nipples.
Fortunately mine were still pink and perky, so that was one hurdle passed.

While in hospital I had a tube in each breast, draining blood and fluid that collected after the surgery, and I was on intravenous antibiotics for 3 days as well. So although I could get up and walk around without too much discomfort, I had bottles and tubes to manage as well.
On day 3 I was allowed to have a shower, which was blissful, but unfortunately the nurses were a little over-enthusiastic in removing some of my dressings, and took off a large piece of skin on the side of one breast. This was to give me more trouble than the actual wound, because it was initially very painful then intensely itchy, and remained so for several weeks as it gradually healed.
To my great relief and astonishment, the wound itself was almost pain-free, mainly because the bottom half of both breasts was completely numb due to nerve damage. This is very common, and usually sensation returns over several months. But with wounds totalling over 20 inches in length, the numbness is a blessing, and by the 3rd day I was taking only simple paracetamol, without needing codeine or anything stronger except when the drains were removed or the dressings changed.

The "Before" photos

It has taken a lot of courage for me to publish these photos, but I hope I have managed to hide my true identity from all but the most determinedly curious reader.

I have never liked my body, and certainly I have never before had any photos taken unclothed, but these are the ones taken by the surgeon at my first visit. I didn't dream that I would ever want to see myself like this, so I didn't take any of my own pre-op photos, and had to ask for a printout of these at one of my post-op visits.

Why?

It's been a rocky road, but here I am, 3 weeks after my breast reduction, and finally ready to share my experiences.

I'd read quite a few blogs and personal accounts before the operation, and they were very helpful indeed, but I didn't see any with a similar post-op course to my own, so I thought I'd add my own contribution to the blogosphere.

Firstly, why did I decide to have this done?

Well, over the last 2 years I have lost about 45kg (100lbs), mainly through an intensive exercise programme, and I noticed that while the rest of my body gradually adapted to my lower weight, my breasts stayed about the same size. True, they were a lot "emptier" than before, but they still took up as much room in a bra, and they hung flat against my abdomen when not supported.

The idea of cosmetic surgery had never occurred to me, but my GP (family doctor) asked if I would consider having a "tummy tuck", as there was a lot of loose skin there as well. I answered that my floppy tummy didn't bother me as much as my dangly boobs, so she referred me to a plastic surgeon for review.

At her suggestion, I went to 2 different surgeons, to compare their manner, costs, plans etc. 

Surgeon 1: quiet, thoughtful, but expensive.

Surgeon 2: brash, confident, but a lot cheaper.

I spent many months trying to decide between the two, and also to plan my life so that I could be out of action for several weeks, but eventually I made the big phone call ... to Surgeon 1, because I knew this would be an emotional journey, and he had by far the best bedside manner. 

As it turned out, this was just as well.