My reconstruction, Phase II surgery, was pretty non-traumatic, compared to the Phase I surgery. Phase II was a little fat grafting, and a tiny bit of reduction, so no drains necessary.
What I didn’t know, is that approximately 10% of patients have drainage issues in what is known as the T junction. The sort of lollipop shaped incision that encompasses the areola in a circle, and a straight line or lollipop stick that goes down the middle of the breast under the areola. This part of the incision, under the areola, sometimes separates a little, and blood and fluid drain out. Not uncommon, but not so common that the possibility was included in my aftercare packet. When it first started happening to me, it was like a clot or a scab had fallen out, not really bleeding, but it smudged up my clothes. Still, I freaked out and called the resident on call, since it was after clinic hours, and left word for him or her to call me back. Reading my aftercare packet again in the 4 minutes it took to for him (for it was a him), I noticed the literature does say some oozing or drainage may occur. So I felt a little silly by the time the resident called back, but told him what I was seeing anyway. He asked me the standard questions to determine if any infection was present – temperature of 100 or more, does the tissue seem hot, is the tissue red at all – then told me to cover it with a dressing to keep it from ruining my clothes, otherwise there was nothing to worry about. Okay, fine. So I taped a maxi pad to my chest (it’s in the literature, I’m not kidding) since I didn’t have any surgical gauze, and went back to watching “Castle” with my husband.
Everything is all fine and well, until the next night. Whoa! What the hell is this? We’ve gone from a slight ooze to a full-on drip. The fluid is so dark, it almost looks purple. Hmm. Consulting my aftercare packet again, I see a phrase that goes something like “during the healing process, bruises may liquefy, and the fluid may seek a way out through the surgical site” or something to that effect. Still, I called the resident on call, for it was again after clinic hours. We again went through infection detection questions – no fever, redness, etc. Then he told me that sometimes, not often, but maybe about 10% of patients, something comes loose, and while it’s nothing to worry about, he suggested I wear a bra to support the breast, in order to ease the tension on the surgical site, and call the clinic in the morning, to find out if they’d like to see me before my regularly scheduled appointment on Thursday.
So I again was mostly reassured, and went to bed able to sleep that night, not worrying about major surgical malfunctions.
The next morning I called my clinic, and spoke to my surgeon’s primary nurse. I told her what was happening, and what the previous night’s on-call resident had to say about the tension on my incision, and how something may have come loose. She poured scorn on that idea, and told me how she felt this was all normal. She told me to continue keeping the dressing on the site, and they would see me at my regularly scheduled appointment, which was the next day anyway.
At the appointment with the surgeon, her primary resident, and a student, they packed gauze strip wound dressing into the hole in my breast, and taught my husband how to do it at home. No big deal, he’s used to getting the gross aftercare jobs whenever I have surgery, so obviously he’s the man for the job.
Well, Thursday night we removed the dressing and tape from the site, and pulled the packing gauze out of the wound. I’m not looking – because there’s $hit coming out of a big, gaping hole in my boob! Yuck!
First we tried standing in the bathroom to change the dressing. That didn’t work, so we decided that the best thing to do was for me to lay down, as I had done at the doctor’s office. No dice, we still couldn’t find where the gauze strip packing was supposed to go in (the doctor made it look SO easy). So we gave up that night, just covered it with surgical dressing, and went to bed. My husband was ready to try again in the morning, but I vetoed that idea. He was so tentative when he’d tried it the first night that I didn’t allow him to try again.
Back to the doctor we go the following week, and we have to make our confession – or I did, anyway – that we never did do the packing of the wound as we had been instructed. I was adamant that if anyone was going to do the packing, it was going to be me. I don’t often dig my heels in, but when I do, you’d best just stand aside and let me have my way. Fortunately, Ken is a bright man, and apparently so are my doctor and the doctor’s resident. So Dr. Colohan’s clinic nurse came in to give me the tutorial on packing a wound, and a new bottle of gauze strip tape. After the first few days, I have to say I’m getting better at it. The first couple of times, I think it took five attempts to reach success, and I still don’t believe I was packing as much tape into the wound.
Now, several days later, I’m packing like a champ. And packing more and more into the wound, it seems. And still soaking the maxi pads I’ve been taping to my chest. Plus it smells like old blood, and I’m passing clots. Ugh. I was joking with Ken last night, and said it’s like my boob is having a period. He laughed out loud, and said “If you haven’t used it already, that’s a great title for a blog post.” Which I didn’t use, but still, here we are talking about it.
Last night I had said that at least I wasn’t having cramps with my boob-period, but this morning I’m getting these twinges, that I am assuming are the clots passing, so in a way my boob is having cramps to go along with its period. And it’s the Mother of all periods, because it’s a rather heavy flow, and it never seems to end. And it’s all normal. Awesome.
I was doing some research last night, and based on what I’m reading about other patient’s experience, it seems like it gets worse before it gets a lot better, which is where I seem to be. And totally normal for the exudate (ha! That’s a medical type word, it means the stuff that comes out of a wound) to smell kind of yucky. Not completely foul, as that along with a higher than normal temperature and redness of the breast, means infection. But it’s totally normal for a wound to smell rusty, musty, or like old blood, which is how mine smells. Ew. As unpleasant as that sounds, I found that rather reassuring. I was worried that something was going horribly wrong, but it turns out this is all normal, and possibly even a sign that soon things will get better.
Lord, have mercy, I certainly hope that is true.