A Breast Reconstruction Patient's Journey

Pamela’s Story: Part 5

The following is the final chapter in a 5-part series by Pamela K. She shares her experience with breast cancer diagnosis and breast reconstruction surgery with Dr. Christopher Hess in Fairfax, Virginia. Click here to see all chapters from Pamela’s story.

After Surgery: Drains, Drains, Go Away!

“Health is like money. We never have a true idea of its value until we lose it.”  Josh Billings

My First, Dizzy Days Out of the Hospital

Thank the Lord I am married to a big and tall man who rarely prunes things from his closet. Why? Because my post-surgery wardrobe consisted of some of his oldest and biggest button-down shirts. The swelling in my chest, together with the fanny pack I wore around my waist under my clothes to hold my four drains, plus room for the drain tubes coming out under my left arm and on the left side of my back, gave me a broad silhouette that none of my clothes, even the roomiest of them, could comfortably accommodate. So, in the days and weeks after surgery, I was dressing from his closet, at least from the waist up.

My spirits were good the first few days out of the hospital, but I wasn’t feeling the best physically — very nauseous and kind of dizzy with a case of the chills. I think part of this was the hangover you get from a lot of anesthesia and part of it was all the medication I was taking for pain, to avoid infection, to relieve the itchiness I get from the pain meds, etc.

I also wasn’t sleeping well, even though I was bone tired by night time. There was just one position I could sleep in – on a slanted wedge pillow, on my back, but leaning a bit to the right to avoid direct pressure on the incision on the left side of my back. After a few hours, I’d wake up with the urge to change positions, but there wasn’t much I could do, except lean a little more to the right or move my legs. So I’d get out of bed, sit in a chair for a few hours, then go back to bed. I’d get eight hours, but in roughly four-hour shifts.

One Drain Out, Three More to Go

On my fourth day out of the hospital, I visited Dr. Hess at his office and he yanked one of my drains, exactly one week and two days after my surgery. It was a big OUCH followed by a much bigger HOORAY! You don’t realize how deep inside of you those drains are until they’re pulled out. It feels like a snake slithering along inside your body while the doctor is pulling on them. A very strange sensation.

I was happy to have even one less drain in me because drains, while certainly necessary, are a pain. They slow you down. It takes longer to shower because you have to put Neosporin around where the drain tubes come out of your body before and after you bathe, and I couldn’t reach some of mine, so I always needed help with this. And it takes longer to dress because you have to make sure the tubes don’t catch on anything. I caught a tube on a door handle coming out of my bathroom one morning and nearly fainted out of fear that I’d pulled the thing out….though it was fine. Plus you have to empty them twice a day and keep track of how much fluid is coming out. I also found it harder to get in and out of a car, drive, and sleep with the drains.

That first drain Dr. Hess pulled was one of the ones under my left arm that was collecting fluid from my left breast area. He told me on this visit that he might be able to pull out the other drain that’s under my arm in about another week. Since these two drains were the most annoying of the four (the other two being attached to my back, on its left side, at the top of the incision there), I was very happy about this.

“I Know it Doesn’t Look Good…We’ll Fix it Later”

On this first visit out of the hospital, Dr. Hess also found the hard lumps and folds of tissue that were my left breast after surgery to be in good condition. “At this point, it’s all about keeping the tissue and the muscle we moved alive. I know it doesn’t look very good, but we’ll fix that later.” Easy for him to say. He explained that this part of the process is just about getting the tissue through this trauma and keeping it in good condition and getting my body to build a pocket of tissue around the thick plastic, saline-filled, football-shaped balloon called an expander that’s in there under the lumps and folds (and that reaches almost up to my collarbone, in fact). If this part of the process goes well, then the next part — actually shaping all this material into a breast and replacing the expander with a silicone or saline implant, will yield great results. OK, I’m in. Too late to turn back now.

More good news was that I was able to exercise on my stationary bike in my first few days out of the hospital — just a short 30 minutes and I didn’t let my heart rate get above 120 — but it felt great. And the doctor said I could continue this level of exercise, even kick it up a notch if I wanted to, so long as I continued to get a lot of rest.

I want to be completely honest here. So I’m going to tell you that I sometimes found the doing and viewing that started by days post-surgery made me a tad sick to my stomach. It was tough waking up to emptying and recording the fluid in each drain, and the sight of my left side in its current state, and then needing my husband’s help every day to shower. In fact, I found myself hoping that one of the mornings I’d wake up and discover that this had all been an incredibly vivid, bad dream, and, “surprise!,” my life would be back to what it was before I developed cancer. Don’t get me wrong: I always believed I was (and am) a very lucky woman. I kept counting my many blessings as I marched forward, knowing that this was just a part of the process. And I reminded myself often to keep my eye on the finish line and not focus on the few rocks in the road along the way. But the truth is, there were moments when this all just really sucked, and there was no point in pretending otherwise.

Two More Drains Out, But One Just Won’t Quit

About a week after he pulled my first drain, Dr. Hess over delivered and yanked not just the other drain in my breast area, but one from my back as well. If you’re keeping score, that’s three down, one more to go. The one that was left, toward the bottom of the incision in my back, was still prolific, though, pumping out more than 50 ml a day. So Dr. Hess said it would be another week, possibly longer, before it came out.

I wasn’t complaining, because it was much easier to manage one drain than three or four. In fact, I was able to ditch the fanny pack I’d been wearing 24/7 since I came home from the hospital in favor of just pinning this drain to the inside of my shirt. This worked everywhere but in the shower, where I still needed my fanny pack to hold the drain.

Overall, the doctor was pleased with my healing and happy to see that the tissue he’d moved around   remained alive and well. It’s was hard to believe that I was just two weeks post-surgery. It felt like I had come a long way quickly.

Bye-bye Last Drain, Hello Saroma

My body has a thing for making and holding fluid – unlike anything Dr. Hess has ever seen before, he tells me. Within a week of the last drain from my breast area being removed, my body began collecting fluid around my expander – the temporary plastic, football-shaped, saline sack that was creating the space in my body that would eventually house a permanent implant – causing my left breast to become very swollen. It had to be drained with a syringe, a process called aspiration.

And it took a month and two days from the surgery (but who’s counting, said the woman with the patience of a hummingbird) before Dr. Hess finally pulled the last drain in my back, because it just kept putting out a lot of fluid, around 80 ml a day. With the skin where the drain tube exited my body red and sore, and Dr. Hess suspecting that the presence of the drain itself had become an irritant that was causing some of the fluid production, he finally yanked it out.

Free at last, free at last! Thank God, almighty, I was free at last! I felt akin to a dog just let off the leash. No more fanny pack in the shower! Hooray!

Dr. Hess said he fully expected my body would create a saroma within a week, and had me book my next appointment accordingly. A saroma? Any relation to “my Sharonna” of Kinks’ fame? Would it be spending the night? Would I have to feed it? As I learned, a saroma is a fluid-filled sack that forms in your body. Dr. Hess said mine would likely be at the base of the incision in my back, where he extracted my lat muscle, and he said he would use a syringe to drain it. And, more great news, he said it could happen more than once! Oh, goody, because, I don’t get stuck with enough needles or see enough doctors these days — although, I have to admit, Dr. Hess is one of my favorites because he’s funny.

What Part of “No” Don’t You Understand?

When I next saw Dr. Hess, about a week later, I felt confident – cocky, even — that I had managed not to form a saroma. I was expecting this saroma thing to be easily recognizable, some big, puffy, balloon-like protrusion, and my husband and I were both on the lookout for it. Dr. Hess, however, just touched my back lightly in a couple of places and said, “Yup, you have a saroma.” I guess that’s what eight years of medical training will do for you. One needle stick later and he’d pulled out 30 mls, which he said was great, because he’d expected a lot more. He said this was a good sign that I was healing.

Well…maybe. Several weeks in a row I was back to see him for more aspirations. At one point, he was pulling 65 ml of fluid out of my back. And that’s when he uttered the dreaded words, “If this keeps up, we may have to…” I don’t think I even let him finish the sentence before I said, “No! No, no, no. You’re not putting a drain back in me.” He explained that it would be a different kind of drain, much smaller — a “pigtail,” I think he called it.

I wondered what part of “no” this kind, learned man did not understand…the “n” or the “o?” I repeated my displeasure at this idea, and he said if we didn’t reinsert a drain, he would just have to keep sticking me with a needle, and that hurts. True. It did hurt. At one point during an aspiration, Dr. Hess had to remind me to breathe. While I deeply appreciated his empathy, I pointed out to him that this was my pain and stridently restated my position that I’d take the needles over the drain. I did, in fact, stick with the needle a while longer. And eventually, my saroma went away. But this wasn’t the last time in my reconstruction process that fluid would create a problem for me and my doctor.

Resources

Fanny packs are a great way to manage drains, especially ones made of material you can get wet. I had two – one to wear in the shower and one that stayed dry for afterward. I found sturdy, inexpensive ones at Target.

Call 703.752.6608 to schedule your consultation with Dr. Hess.
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