Timeline, Radiation And Necrosis
The first phase of reconstruction is the tissue expanders. They are implants that have a port on them to keep filling over a period of time to stretch the skin so it can accommodate permanent implants. They are terribly uncomfortable, but necessary. I had “immediate reconstruction” which meant the expanders were placed in the same surgery as my mastectomy instead of another surgery at a later date.
The expanders were placed then started with a small amount of air to allow healing of the incisions before adding the weight of saline.
We started off replacing the air in the expanders with saline, but keeping the same volume. This was actually the most uncomfortable part of getting the expansions. Sucking all the air out before refilling with saline was really awkward and uncomfortable. It was over soon, thankfully. It was a weird sort of pressure, but a suction from the inside instead of a pushing from the outside. Not a natural feeling.
We didn’t get far before we learned radiation therapy was indeed going to happen. At first we were on the fence.
With tissue expanders and needing radiation things got a little complicated. My plastic surgeon and radiation oncologist needed to create a plan around each other because generally expansions have to be done before radiation. Radiation effects the tissues, tightening and shrinking it so expansion needed to happen first for the best outcome instead of trying to expand radiated tissue.
I had necrosis that needed to heal before any stretching of the skin. I had radiation on the books that needed to happen “soon.” One needed more time before expansions and one needed to happen now, but after expansions.
My radiation oncologist wanted to get started and gave my plastic surgeon 30 days until he took over. My necrosis needed a couple months to heal.
So what did we do?
My cancer was on the right side, my necrosis was on my left side. Yup! We expanded the right to get ready for radiation and not the left so the necrosis could heal. So I was pretty lopsided for a couple months. Fun! Not!
Expansions
My right side happened pretty quickly. We did more at once than originally planned so I could be ready for radiation. Then I took a break until radiation was done and my necrosis was healed.
Each visit for expansions my plastic surgeon held a little device over my skin that had a swinging magnet in it. The port on my expanders was magnetic but completely under the skin and can’t be seen. When the magnets lined up he knew he was in the right spot. He put pressure on my skin with his magnetic device that left a small “x” indent. This is where he inserted the needle. He would inject 50cc’s at a time. Sometimes only once per visit sometimes a couple at a time depending on how I felt about it and how much time we had to finish. We were only on a timeline in the beginning because of the radiation.
The expanders were pretty awful. They were tight and hard, sewn to my muscles restricting movement, uncomfortable to sleep at night and definitely awkward to give someone a hug. But they were necessary and over all, worth the trouble. The expansions themselves weren’t bad. I hardly felt anything, just slight pressure for a day and I didn’t feel the needle at all because I have no sensation in my skin.
And Now We Wait
Once we were done expanding we had to wait. I couldn’t get another surgery replacing the expanders until 6 months passed after my radiation was complete. So for a few more months I watched the days go by until finally it was time, again. Back to the OR.