Tissue Expander Exchange Surgery Recap

Exchange surgery = done! What a relief. It was pretty easy, not a lot of pain involved and I am happy with the results.

I am going to try to use this post to give detailed information about what to expect during tissue expander exchange surgery. When I did my own research, I could not find a ton of information about the surgery, so I want to try to help other women who might be preparing for it.

After my double mastectomy in June, the plastic surgeon inserted tissue expanders. The expanders are meant to stretch the skin to prepare the area for implants. As I have mentioned in earlier posts, the expanders were uncomfortable but not unbearable. I will admit I was excited to get them out. The expanders stay in for a couple of months, and then you have another surgery to exchange the expanders for implants.

I went back to Houston to have my exchange surgery at MD Anderson. It was a bummer that I had to travel, but it’s important to do this surgery with the same surgeon who started, as it is sort of a “Part 2” of the whole process.

I went in for my pre-op and that part was pretty similar to the mastectomy pre-op. Bloodwork, meeting with anesthesia team and consult with the plastic surgeon. You have to sign a lot of paperwork that detail the worst case scenarios. Bad scenarios would be infection, seromas, blood clots, etc. It’s hard to hear about all of the bad things that could happen, but I guess the doctors have to cover themselves.

The plastic surgeon threw me for a loop when he asked me if I wanted fat grafting. This was the first time he had mentioned it, so I did not feel prepared. Fat grafting is basically taking a little bit of fat from fatty areas of your body (could be stomach, thighs or stomach) and using the tissue to fill in the area around the implant. It is like liposuction. But from what I heard, they take such a small amount that you wouldn’t even notice you got liposuction (bummer!).

I have heard that the fat grafting is painful and was nervous about having two additional incisions that could get infected so I opted not to get it. I also really wanted to get home to my kids and was worried it could make the recovery longer. So I asked the surgeon if he thought it would be okay to skip the fat grafting.

I am a planner and I had not planned for fat grafting. So the idea of it really threw me. The surgeon said its more of a preventative measure to prevent possible rippling down the road. I guess my kind of implants (smooth, round) can ripple sometimes and the fat grafting helps. But he said about 60% of his patients opt not to do it and he thought he could still get a good result if I didn’t. So…I decided no fat grafting. I hope I made the right choice.

The good news is that if I decide I want it down the road or if I want any revisions whatsoever it will be covered by insurance. Pretty incredible, right?

My surgery was scheduled for 9:15am so I went in at 7 and they took my vitals, gave me an IV and went over the anesthesia, etc. The surgeon came in and drew some markings with a magic marker on my foobs…he was pretty detailed about it. I really love my doctor. In addition to his incredible medical training, he started out as a Fine Arts Major at Brown before he switched to med school. He is a sculptor. I think its so cool that he has artistic vision and approaches plastic surgery as an art.

When the OR was ready, they put some medicine in my IV to put me to sleep. It worked super fast! I was chatting with the nurses and I think I may have passed out mid-sentence. Next thing I knew, I was in recovery. I thought they had not done the surgery yet. The same exact thing happened with my mastectomy. I had no memory of being wheeled down to the operating room, and no memory of the OR at all.

The surgery took about 2 hours. The surgeon told my parents in the waiting room that everything went well and that he was “very pleased” with the results.

When I woke up, my eyes felt goopy from the vaseline-type stuff they put on it. I felt a little pain, but not bad. I started feeling sick, so they gave me some anti-nausea medication, which worked pretty quickly. They also prescribed an antibiotic (to prevent infection) and pain meds to take as needed.

I looked down at my chest and saw that they had put me in a surgical bra. It’s like a white sports bra that has velcro in the front. The nurse told me I need to wear the bra (or a similar type of sports bra) for two weeks. She gave me some juice and a snack and after about an hour of resting, they took out my IV, I put on my clothes and left in a wheelchair.

At MD Anderson, they have a hotel attached to the hospital called the Rotary House. It is run by Marriott and so nice. Definitely a great choice to stay here after a procedure..you don’t even have to go outside to get there. I was in the wheelchair all the way to my hotel room.

When I got back to the hotel I slept for about 3 hours. When I woke up I had a splitting headache and a little pain in my chest. I took my pain meds and had something to eat.

I took a peek at my new breasts and I was really surprised that they already look pretty good. They look similar in size to the expanders, but more rounded. There were no bandages, which freaks me out a little. All of the stitches are internal, and they used a surgical glue to close the incisions.

I am so nervous about getting an infection. That would be worse case scenario. Especially if it happens when I am home…because I probably would not be able to travel back to TX. Sometimes when you get an infection they have to take the implant out, etc. I have read many horror stories. But I am trying to keep things as clean as I can and follow all the post-op instructions (no bathing for 48 hours, no swimming for 6-8 weeks, etc). Sweating is also bad I guess..and since I live in FL I may have to limit outside activities and exercise for awhile.

Day 2

I woke up feeling really good. Nothing like after the mastectomy when I would wake up with burning pain and need to immediately reach for my pain pills. I had a little discomfort/pain but it kind of just feels like after you work out. I took the pain pill they prescribed anyway, just to stay on top of it.

A couple hours after I woke up I noticed that my face was red and flushed, so I checked my breasts and they were red, too. Ugh! I called the nurse and they had me come in to the clinic to take a look. They think I had a reaction to one of the medications, so they switched up my meds and gave me benadryl. The good news is that it was not an infection! They marked the area on my breast where the redness occurred and told me to keep an eye on it. If the redness were to spread or I developed a fever they told me to go the ER.

Day 3

Today the redness on my face and breasts was gone, but still a little rash on my stomach. I went in for my post-op and the nurse thinks it might just be a reaction to the antiseptic they used on my body for the surgery. The doctor said my incisions look great. He told me to wear a sports bra for support for a few weeks and to take it easy…no lifting or bouncy-type exercise for 4-6 weeks. So, since I am feeling really good, I decided to fly home! Excited to hug my kids.

Final Thoughts

I am simply amazed at how easy this whole “exchange” experience has been. Very positive. This surgery has such a different feel to it than the first one. Since its not really about the cancer, there is more of a celebratory feel to it. Celebrating getting the expanders out, being cancer-free and the added bonus of your new breasts hopefully looking perky and beautiful.

For more information about exchange surgery, go to the message boards at breastcancer.org. There is a section under the Reconstruction category called “Exchange City“.


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