In my mission to avoid surgery, I have gathered the opinions of many doctors, peers, and experts over the last 3 weeks. After talking with Dr. Tjoe, my surgical oncologist, I decided that I wanted a chance to meet with the other plastic surgeon that she had consulted with about my situation. I felt the need to get a second opinion and hear about the other muscle sparing options that were mentioned. I also consulted with my Dermatologist to get a non-surgical perspective.
I got in for my second opinion on February 2nd. The appointment went really well. Surgeon #2 spent nearly an hour and a half with me discussing my options and answering my questions. He took the time to show me pictures of procedures I might be facing so I could see the outcomes I might expect. We ruled out the TRAM Flap (abdominal) since I just had fat grafting from my abdomen. He explained that the tissue could be damaged and blood supply compromised. By the end of the appointment, his recommendation was for me to undergo not one, but three additional surgeries. First, remove the implant and damaged skin and allow at least 3 months for my skin to heal. Then he would do a LAT Flap, using muscle, tissue and skin from my back to replace the skin that was removed in the previous surgery, and put in a tissue expander to stretch the area to the desired size. Finally, I would have one more surgery to exchange the expander for the final implant.
Not thrilled, because, going into the appointment, I had hope that there would be a non-surgical way to heal, and coming out of the appointment, I was facing three more surgeries. He was also willing to let me try to heal a little longer, and prescribe a cream that is used with burns and difficult to heal wounds. He also suggested that I continue with the antibiotic for up to six weeks. I did learn a lot at the consultation with the second surgeon, and I took that information and continued to read and learn more.
Yesterday, I returned for my follow up with surgeon #1. We discussed the other surgeon’s strategy as compared with his. He feels that it would be overly conservative to spread it out over 3 surgeries. He believes that the cellulitis is confined to the skin, thus making it possible to replace the damaged skin with the LAT Flap and keep the implant in place. I like the idea of only one more surgery, but I’m not entirely comfortable with this option either. The last thing I want is to go through the surgery only to have the infection continue, forcing me to have another surgery to remove the new implant. Then I’d have to start all over again, and would have sustained damage to my back in the process. It seems to me that the infection goes beyond the skin, because I have pain in my side, chest, back and arm. My arm is very swollen. He said I could have an ultrasound guided aspiration and a culture to test if the infection is deeper into my tissue. Otherwise, he could make that determination during the surgery by taking the implant out and testing for signs of infection before deciding whether to continue with the reconstruction or not.
My first thought upon leaving that appointment was to let surgeon #1 attempt to do the reconstruction in one surgery, with the understanding that, if there was any sign of infection, I would want to simply remove the implant and heal before attempting reconstruction. Leaving the surgeon’s office, I made my way over to my medical oncologist for a follow up appointment.
Being early, I decided to detour upstairs to pick my physical therapist’s brain and ask her about a compression sleeve to deal with the lymphedema in my arm. When I showed her my arm and explained the pain I had, she assured me that the swelling was a reaction to the ongoing infection rather than lymphedema. Her explanation was that lymphedema does not cause pain or limit range of motion. She also told me that compression sleeves are not the most effective way to reduce the swelling, since “one size fits all” doesn’t take into account the fluctuating levels of swelling. Instead, she gave me a wrap (like an ace bandage, but not so stretchy), and instructed me on how to use it.
On to the oncologist, I got blood work done, which showed that my white blood cell count was still low, not helping me fight the infection. I decided to withdraw from the study drug since that was most likely the cause. I also asked the oncologists and her nurses their opinions on the surgical decision I was facing. It was a long day of appointments and a lot of information to process. I didn’t feel ready to make any decisions until I had a chance to sleep on it.
Today, I feel ready to move forward with my decision. I have spoken with 3 surgeons, an oncologist, a physical therapist, peers in my support group, and on and on. I know that I’ve exhausted all other options, and surgery needs to happen soon. The incision wound is getting worse, not better, after a month of trying to save the skin and heal. The pain and swelling in my arm is affecting my day to day existence.
My gut feeling is that I need to get the implant out as soon as possible and heal fully before attempting another reconstruction. Then when I am sure that my skin is better and the infection is handled, I will do the LAT flap procedure straight to the new implant. So, 2 surgeries rather than aggressively doing one surgery or conservatively doing 3. Seems like a good compromise. I’m ready.