Tuesday, May 12, 2009

5/12/2008: DIEP Procedure

“If I am not allowed a Frappuccino I will surely die,” I said dramatically to my surgeon, Dr. Maurice Nahabedian, while I covered my face and let the warm tears of frustration run down my cheeks. “I haven’t been able to eat or drink anything for over 36 hours and I am losing it.”
Dr. Nahabedian smiled, looked at my mother and said, “Go across the street and get this girl Starbuck’s.”

I don’t think I had fully prepared myself for the severity of this surgery, nor had I realized how big of a deal it is in the medical field. My surgery is called the Superior Gluteal Artery Perforator Breast Reconstruction more commonly called the S-GAP. S-GAP reconstruction uses tissue from the top of the buttock, which contains the upper gluteal artery. During this surgery, a rounded section of skin and fat (and occasionally muscle) is removed from the top of the buttock. After being transferred to the breast, the tissue is shaped to create the breast mound and is attached to the remaining breast tissue. Using complex microsurgical techniques, the blood vessels are reconnected to existing vessels in the area. Only two surgeons on the east coast perform this type of operation, and Dr. Nahabedian is one of them. A modest man with a strong handshake and a compassionate tone to his voice – he is one of the best plastic surgeons in the United States and he is right here at Georgetown University Hospital. How lucky am I!? I know, weird thing to say coming from the girl diagnosed with cancer at the age of 27.

I was prepped for surgery by three eager medical residents who looked at me like a medical miracle. They asked me all sorts of questions, each taking notes in their notepads and studying “my case.” I felt like I was on an episode of ‘House.’ They explained that all the medical students were excited about my procedure and said, “A lot of people are going to see you naked today.” Hilarious! My assistant surgeon was named Michael Cohen and was one of the chattiest doctors I have ever met. He genuinely enjoyed talking to me and was quite concerned that I remain calm.

My surgeon met with me prior to surgery and drew out the plans with a black marker along my body. I shook from the sterile nature of the room and cold air. Cohen reassured me that it would all be OK. Dr. Nahabedian finished prepping me by drawing the blue prints along my butt. Cohen asked questions about the artery Dr. Nahabedian would be removing and what would be landmarks internally when he opened me up. I turned my head around and asked, “Will you be able to reach into the right butt cheek and pull some fat over to fluff my left cheek?” Cohen thought very seriously about the question while Dr. Nahabedian laughed knowing that I was breaking the serious tension and explained that the right side would not be touched in case it ever needs to be used in the future.

So, I was rolled into an 8-hour surgery with my surgeon, assistant surgeon, three medical residents, two anesthesiologists, oh, and just the rest of Georgetown University.
I woke up very quickly and realized I was in the ICU. My Mom was crying asking the nurse to please let her stay (which she did the entire duration of my recovery), the residents and Cohen were in my room rubbing a wand across my breast, and the only thing that hurt was the catheter which no one warned me about! There was so much activity and all I wanted was to eat and sleep -- neither happened for a long time. (I didn’t know until several days later, but Cohen slept next door that night on the ICU floor incase I needed him.) The nurses had to use this tiny machine called a Doppler Radar (I though that was only for weather!) and rub it across the new section of my breast every 15 minutes. You could hear the blood pulsing through the blood vessel they had sewn together.

Dr. Nahabedian explained to my parents after my surgery that they removed the skin, tissue, artery and fat from my left butt cheek and it took three tries to finally get the bypass created in my left breast. The arteries and blood vessels were not the same size so it took some magic from “the plastics” (Georgetown University Plastic Surgery) to make it all work. The first 48 hours are the most critical and you can usually tell whether or not the transferred area will take.

Between visits from my dad, brother, Uncle Chuck, co-workers, friends and boyfriend I was in pretty good spirits. They had to keep reminding me that it was only one to two visitors at a time. I even had an old girlfriend from high school come surprise me who works at Georgetown University Hospital as an oncologist RN. I was enveloped in love and compassion that I felt incredibly strong. My nurse Jenna even sat at the end of my bed at 3am and talked to me for hours about becoming a nurse and how she’s never seen a surgery like mine. Eileen was my other nurse who spent too much time in my room chatting about dogs, so she was moved to the other side of the floor the next day to care for another patient. She would still stop by to chat though. I believe that these young nurses truly connected with me and my journey. They saw themselves or their friends and sisters in me and it made the 1 in 8 statistic all more real. And quite frankly, I was the most fun person on the floor! One of the technicians on my floor was huge like a football player with a deep, soulful voice. His station was right outside of my tiny private room and he would sing me love songs anytime my door would open or he would bring in a tray of food. It was like something out of a movie. When I took a lap around the ICU floor (part of my physical therapy) with my friend Laurie, the technician yelled, “if you run by the pool I’ll kick you out” followed by a loud outbursts of laughs from the whole unit. I think they appreciated my spirit and survivor mentality.

Tuesday I was able to have the catheter removed which I HATED, then the physical therapist started working with me on walking and learning how to use my leg again. This was something else I had NOT prepared for in advance. I choked back tears as I reached for her hand and drug my limp leg as I tried desperately to walk again. I felt humiliated and defeated. My physical therapist was patient and my mother was strong while watching me struggle. I know it could not have been easy for her. I gritted my teeth, pulled my dark locks behind my ears, took a deep breath and pushed myself. It is going to take a hell of a lot more to keep me down.

The medical residents came by each morning at 5:30am with their notebooks to do their checkup. When Wednesday came around “the plastics” still wouldn’t let me eat or drink anything in case I had to go back into surgery quickly. I officially lost it -- I started crying. They must have notified Dr. Nahabedian, because he came in and told me that he had heard how great I was doing and that he would let me have coffee and food. Additionally, he said he heard that I was doing really well with physical therapy, even doing stairs without help, and if I chose to go home Wednesday night he would let me. I stayed until Thursday enjoying my coffee and hospital meals (with my boyfriend sneaking in some funnel cake) and made a pillow nest for the bumpy ride home.

It wasn’t until I got home to my parents that I got to really look at my incisions. I was disgusted with myself (as I always am initially) and even got close to fainting while taking my first shower. The pain goes beyond physical and challenges me psychologically. It took seven days for me to finally look at myself in the mirror and make peace with my new body. (Although now I am back to hating my hair and calling myself Keanu Reeves and pretending to dodge bullets like in the ‘Matrix.’) Despite my family and my boyfriend reassuring me that my butt doesn’t look lopsided and that the lines of my new breast incision were done so incredibly well – I needed to believe it myself.

Tomorrow I see Dr. Nahabedian for my post-op appointment where he will remove the drainage tubes from my armpit and hip that are irritating me and we will discuss my “touch-up” surgery planned for 3 months (August). He believes that he can make my breasts more symmetrical, but

I am operating on little victories for now …