Following my third general anaesthetic in seven months I was getting used to that moment when you start to ‘come round’ with that fuzzy and slightly bewildering feeling and it takes a little while to adjust. This time was very different though. I was in a high dependancy ward surrounded by all sorts of paraphernalia – tubes, wires, machines, bleeps….
The main difference between intensive care and high dependency care is the nurse to patient ratio. Usually an ICU patient requires one to one nursing care, whilst a high dependancy patient requires one nurse to every two patients. I had my own room and bathroom which felt like quite a privilege.
The surgery had lasted just under nine hours but had all gone very well. There was a device around both my lower legs called an intermittent pneumatic compression (IPC) device. These are inflatable sleeves that are worn on your lower legs while recovering from surgery to keep your blood flowing, helping to prevent such problems as blood clots and deep vein thrombosis (DVT). So basically, every few minutes I had an automatic leg massage!
I had an oxygen tube for the first few hours (attached through my nose) but I wasn’t bothered by it as I slept for most of the duration of it being there.
I was covered in a forced-air warming blanket, sometimes known as a ‘Bair Hugger’ and its purpose is to prevent perioperative hypothermia. The best way I can describe it is a giant sheet of bubble wrap! It consists of two primary components, a warming unit and a disposable blanket. The warming unit is connected by a flexible hose to the single-use blanket. Warm air from the warming unit passes through the flexible hose and into the blanket. Once the warmed air reaches the blanket it exits through a series of micro-perforations on the underside of the blanket, warming the patient’s skin in an area that is not a surgical site. It was very warm and very loud! At the same time there was a free standing (pedestal) fan blowing cool air into the room.
I suffer from tinnitus in my left ear. It is a loud ‘white noise’ (continuous whooshing sound) and never goes away. This inevitably affects my hearing and when I had to keep asking the nursing staff to repeat what they had said to me I just naturally assumed that was why. However, the next day when the hose was disconnected and the blanket removed I realised how loud all the equipment had been and it wasn’t surprising that I’d had trouble hearing!
I had been fitted with a Foley catheter at the beginning of the operation, after I had been anaesthetised. I was relieved that I was unaware while it was being inserted! I had been very nervous about that.
Foley catheters are primarily used to keep the bladder empty during and after surgery. One reason is pretty obvious – that the patient is unconscious and unaware of the need to urinate. The anaesthetist had also explained to me that it’s not safe for the bladder to be kept full for such a long period. The catheter helps make sure the bladder does not fill up during surgery as having a full bladder can interfere with the surgery and cause potential problems. However, they are also used as standard practice for any procedure that is expected to last longer than one hour, where the patient is required to go to ICU (or HDU in my case) after surgery. It also means that for up to 24 hours or so the patient is not expected to get out of bed to go to the bathroom.
I also had two surgical drains, one inserted into my breast and the other in my abdomen. A surgical drain is a small plastic tube that is sometimes used after an operation. It is put inside you during the surgery and will stick out of your body until it is removed. It connects to a small plastic bag that collects any fluid or air that has drained away from where you had the surgery. The drains may also include blood, pus or other fluids from the operative site. Without them the fluid might gather up and cause infection. The surgical drain allows extra fluid to drain off harmlessly.
I was given a goodie bag from a charity called ‘RESTORE’ (Breast Cancer Reconstruction) who provide information, inspiration and support. It contained an eye mask, lip salve, a pack of mints, ear plugs, wet wipes and a few other bits. Once emptied out, the lightweight fabric bag also doubled up as a holder for my drains! Once I was mobile I had to remember that the drains had to go everywhere with me!
I was also given another heart shaped cushion which helps to get comfortable and provide some protection for the breast. The cushions are lovingly made by staff and friends of the hospital. I had been given one when I was discharged from the Conquest Hospital following my initial lumpectomy a few months earlier too. They are made with very pretty colourful fabric and definitely help with getting comfortable.
“No act of kindness, no matter how small, is ever wasted” – Aesop.
I had chosen to have the DIEP (deep inferior epigastric perforator) flap reconstruction as opposed to implants. This means that I had the breast tissue replaced with skin and fat from my abdomen. Consequently I had been cut from one hip right over to the other hip. The cut was similar to a a Caesarian but a little higher up and a much wider incision. The top of my underwear sits slightly below my scar. It measures 20 inches across.
I also had a dressing on my belly button and I wasn’t expecting that. I asked why and it all made sense when it was explained to me. I have also since discovered that this is a question that is typically not discussed with a surgeon priory to surgery which was the case for me. If you are particularly squeamish you might want to skip the explanation!
“It’s actually not a “new” belly button. It’s the same one you always had, it may just look a little different. Your belly button was formed from scar tissue left over from the umbilical chord after you were born. The belly button you have today is still permanently connected internally to your liver and therefore cannot be moved.
During DIEP flap breast reconstruction, two incisions are made over the lower abdomen: a football-shaped incision around the tissue that will be used to reconstruct the breast(s) and another around the belly button. The tissue is removed and transplanted to the chest to reconstruct the breast(s) and the belly button is left in its original location.
The abdominal surgical site is closed by pulling the upper abdominal tissue down to the lower abdominal incision, over the belly button. Since the upper abdominal tissue is now covering the belly button, a new hole must be created to expose the belly button.
Once the abdominal incision is closed, the surgeon identifies the location of the belly button under the skin and cuts the new hole for the belly button to pop through.” – prma-enhance.com
So I now have a pretty pattern from the stitches around my belly button which I’m sure will fade in time. Otherwise it doesn’t look a lot different to before.
“Opinions are like belly buttons; everybody has one. I never knock a man for his opinion.” – Shaquille O’Neal (professional basketball player)
I’ve always known that I have a high pain threshold (four labours with only gas and air) but this was an invasive procedure and unlike anything else I had ever encountered in my life. It would be unrealistic to not expect pain but I have to say, I managed it well. As I was being settled back on the ward a nurse put a handset close to me which was connected to an electronic pump and administered by a drip. This is called patient-controlled analgesia and allows a patient to manage their own pain relief. The infusion is pre-programmed and controlled by the nursing staff. The machine has a special safety feature which means it switches off for five minutes after giving a dose of morphine. This prevents you getting an overdose, so you can press the button as much as you need. However, I never actually needed to use the Morphine pump and, with my permission, a nurse disconnected it the next day. I was given regular doses of paracetamol, ibuprofen or dihydrocodeine at the appropriate intervals.
“Although the world is full of suffering, it is full also of the overcoming of it.” – Helen Keller
The steps of recovery happened steadily throughout my hospital stay. I had to demonstrate that I could walk a few steps in order for the catheter to be removed. Although I was lucky enough to have my own bathroom attached to my room I needed to be strong enough to get off the bed and make my own way to the toilet before they were satisfied the catheter was no longer required. So the day after surgery I was assisted to walk up and down the corridor (with my little friends in my shoulder bag!) and the nurse was convinced that I was ready to independently get myself to the toilet. Removal of the catheter was entirely painless so that was good.
The day after the surgery I was advised to put on my bra and control underwear. I wore the same bra which I had worn after my lumpectomy. However, when the plastic surgeon came to check me, she wasn’t happy with the shape of the bra. I said it was a post-surgery bra and she asked if it was from ‘M&S’. It was. She said that lately they had not been getting it quite right in this respect. Fortunately they held a stock of bras at the hospital which are donated by charities and they found me a suitable one. It was a crop top with a zipper front and I must admit it was a much more snug fit and cupped my ‘new’ breast perfectly. When I left hospital I gave a donation to the charity. The nurse had looked at ‘Amazon’ with me to find the exact same item so I could order a second one. They were very cheap considering the quality. I duly ordered one but it never arrived and I ended up getting a refund. Typical! The surgeon was happy with my high-waisted pants so thankfully I had got that right. From that point forward I would be wearing both garments, as well as the compression stockings, for 23 hours every day for six weeks, only removing them to shower.
I was on 15 minute observations for the first 36 hours then half hourly. With each observation they checked that my breast was warm as this is very important. They also did a Doppler test during every check. The first time this happened I asked what it was for and the nurse jokingly said “I’m just checking for the baby’s heartbeat!” and I replied “I hope not!” This made me laugh! In actual fact, although commonly used for that purpose during pregnancy, a Doppler test can also be used to check if there is adequate blood flow following operations or injuries. A Doppler ultrasound records sound waves reflecting off moving objects, such as blood cells, to measure their speed and other aspects of how they flow.
For the first few hours post-op my temperature and blood pressure were also checked as part of the obs, then less frequently as time went on.
The drains were also closely monitored for their output. The fluid that drains from the body after a mastectomy is called serous fluid. Serous fluid is the result of raw tissue and will slow its development inside the body when the tissue begins growing back together. Serous fluid is a natural part of the healing process and wants to come out and that is why drains are used to aid in that process.
Until the fluid output reaches a low level, the drain should be left in. For two consecutive days, this is usually less than 30cc per day. The level for both of my drains to be removed had been set at 20cc.
The drain in my abdomen came out first, two days after the operation. I wasn’t feeling particularly nervous about it as I’d had a drain removed in a previous surgery a few years earlier and I barely remember anything about it. When the nurse said to me “Take a deep breath” I replied “Is it going to hurt then?!” She just repeated “take a breath” and suddenly my relaxed demeanour switched to an ominous feeling. So I took a deep breath and thank goodness I did because, oh my word, the pain was excruciating! I almost left the bed as my body reacted! Even my high pain threshold could not have failed to feel that pain level. However, it was immediately fine again once the tube was out. It was just the process of removal that was horrendous. The tube was quite thick, about the diameter of a large drinking straw, and it went from my hip to my belly button so roughly ten inches in length. The nurse explained to me that this, combined with the fact that all the time the tube is in the more settled it becomes with your insides naturally starting to attach and grow around it, meant it felt like my insides were being ripped out! That sounds a tad dramatic to be fair but the best way for me to demonstrate why it hurt so much.
“Great things never came from comfort zones” – Neil Strauss (American author/journalist)’
The breast drain didn’t empty out at quite the same rate and ultimately it was the only thing holding up my discharge from hospital. By the Sunday I was getting bored and desperate to see everyone. I was initially told that I would not be allowed any visitors due to the Covid restrictions but on my third day in the hospital my husband had been given permission to come in and see me. It wasn’t so bad when I was very sleepy but it felt quite isolating once I was more alert. On the evening of the operation, just a few hours after I came round, my husband and children did a group video call. Two of my sons are incredibly alike and had the same hairstyle at the time. I asked why one of them was on the screen in two places and they all cracked up as they were both on there and I had just thought I was seeing double!
Although it’s better to be in a calm, quiet environment than too noisy and busy, it was a bit disconcerting over the weekend period. There didn’t seem to be many patients and you could go a long time without seeing a member of staff. Don’t get me wrong, I didn’t feel neglected as my needs were not as great by then as others might be but it was like the ‘Mary Celeste’! I literally could have been the only person in the ward, tucked away in my little side room, and I wouldn’t have known!
The debate around my breast drain was also due to the fact it was a weekend and the plastic surgeon was not working. Ultimately, although measuring a little above the required level, she agreed over the phone that it would be safe to remove it. It was completely painless this time, a much smaller and shorter tube, and I didn’t feel a thing.
A nurse came to talk to me with a big folder in her hand. It contained examples of realistic looking prosthetic silicone nipples. The nipples are attached to the body by using a medical adhesive which is strong enough for any day-to-day activity and is waterproof. We looked at the variety of samples to get the one that most closely resembled my remaining nipple. I wasn’t rushed into the decision and, once satisfied with my choice, she brought me the little set to take home.
I was finally ready to be discharged and the process was very straightforward with instructions around pain relief, dressings, leaflets about exercise and self-care. It was ok to shower, just not for too long. The dressings would dry off or I could use a hairdryer on them if necessary. I would be given an appointment in one week to return for the dressings to be changed and the wounds checked.
I was eventually ready to leave late afternoon on the Sunday. Considering the magnitude of the surgery I think three nights is pretty amazing! I was told at my pre-op that they don’t keep you in hospital for any longer than necessary as recovery is generally quicker at home.
I love my house but it’s not the place that matters, it’s the people, and I was so happy to be back safe and sound with my family.
“Home is a shelter from storms – all sorts of storms.”-William J. Bennett
Hoping for a Happy Ever After 