Tuesday, November 8, 2022

Breast Cancer Fight: Fat Necrosis and Prolonged Skin Discolouration Due to Dye?


I met Dr Mikael about 1.5 weeks after I was discharged for my mastectomy and breast reconstruction surgeries {read about part 1 and part 2} on Tue 8 Nov 2022 at NUH Breast Care Centre.

Registered via the OneNUHS app early about 8.30am, but still saw him around the appointment time at 9.50am. He was assisted by Nurse Zhenna today. 

He started off by telling me briefly that the Surgical Pathological Report shows that the cancer has not spread beyond the breast area into my sentinel lymph nodes, so that is good and it is likely pathological Stage 1 cancer

Even then, as my breast cancer type is aggressive, I would still need to do chemotherapy. It's ok, I understood that from the beginning and have come to terms with it.  

Then we talked briefly about the tiny lump and skin discolouration and what Dr Jane told me about them before he examined my surgery wounds and left breast. 

He cannot confirm without further testing, but thinks that the tiny lump may be due to fat necrosis. Fat necrosis is a benign condition that most commonly develops after an injury or trauma to the breast tissue. A lump can form if an area of the fatty breast tissue is damaged, for example like when I went for my surgeries. It could be a round, firm lump... but as mine is round but soft, I think it might also be an oil cyst due to the fat necrosis?

Dr Mikael didn't seem worried about it and said we can monitor and see how it goes. At my next appointment with him, he can also arrange for an ultrasound to check it out further. He is not sure if it will disappear on its own, although it might. 

For my skin discolouration, he said it might also be bruising or caused by the injected dye used to locate the sentinel nodes. By right the dye leaves the body on its own 24-48 hours after the surgery, however sometimes there may be blue dye staining of the skin on the breast which may last even up to 3 years, I've read. Again, it is harmless and since it is not causing me any pain or discomfort, Dr Mikael is not too concerned over it.


After that, I told him about having to change the drainage bottle every 2 days and he said that it's a fine balance between keeping the drainage tube in until the fluid output is at a low enough level, and taking it out early to prevent infection or complications from having an open wound and a foreign object {the drainage tube} in the body. Most drains come out 1-3 weeks after surgery. 

I sense that he thinks the tube can/ should? come out this week but as Dr Jane isn't around and my appointment with her is next Wed, I should leave it in as she planned. Nurse Zhenna also said that the Aesthetics Clinic prefer to leave the tubes in until the output is very low.

Later when I went back to Aesthetics Clinic to get 4 more bottles to last me through the week the nurse there also said they would usually take the tube out when the output is about 10-20ml for a few days. Oh, the nurse there also said that they prefer patients not wipe the tube and bottle tips with alcohol wipes, unlike what the ward teaches. 

Currently for the last 2 days, my drainage fluid output is about 30ml/day. 

I checked with Dr Mikael to see if increased activity would cause an increase in fluid output. He said it's hard to say as it has a "life of its own" but doing activities is good as it aids recovery. 

He even said I can cycle now if I want! Just that it is impractical with my drainage tube and bottle, and that if I do I should take it easy.


I asked him about a scar cream for lightening my scars as I think my scar for the sentinel lymph node dissection incision looks like it is forming a keloid. He recommended Dermatix but said I should ask Dr Jane about it at my next appointment with her. 

Hmmm.. I think regarding anything about my wounds or scars, since Dr Jane is the care doctor as she did the last surgery after him and "closed me up", he doesn't want to overstep and leave all the surgery wound healing after-care decisions to her. Fair enough. If I just did the mastectomy, he would take control of the decisions I feel. 

Anyway, he also said that I can start massaging my scar tissue gently next week. Scarring is part of the body's natural healing process after tissue is damaged. When the skin is wounded, the tissues break, which causes a protein called collagen to be released. Collagen builds up where the tissue is damaged, helping to heal and strengthen the wound. 

However, unlike healthy tissue, scar tissue forms in random, criss-crossing patterns. It is not as flexible or as functional as the tissue that it is replacing. It has poor circulation, which limits the supply of fresh oxygen and nutrients. Scar tissue also is more sensitive to pain because it has more pain receptors than the original tissues, and it tightens up when you sleep. 

Sooo.. it not only can cause more pain, but also limit the normal function of the muscle or area. Already I feel a bit stiff and tight when I lift my arms due to the scar tissue forming where the sentinel lymph node dissection occurred, and a bit at my chest area..  

In other words, scar tissue is helpful when the wound is healing. However, too much left after the wound has healed isn't good as it can cause you to be stiffer and lose your range of motion. 

In regards to lymphoedema due to my sentinel lymph node dissection, he said the risk is very low and I can treat my arm as per normal. He even said I can still tattoo my left arm more if I want in the future hahaha 

Overall, my wounds are healing and I barely feel any pain or even soreness nowadays. I think in part this is due to the severing of the nerves that provide feeling to my breast and nipple. When nerves are severed, nerve signals are disrupted. This can result in numbness and permanent loss of sensation to the breast area... 

Maybe just some heaviness when I wake up due to some fluid build-up when I sleep. More discomfort from not being to exercise/ bathe properly, and slight irritation from having to drag a drainage tube and bottle everywhere.  

Sometimes, I do feel rather sad when I look at my body and see all the scars and wounds, and how different my boobs look and feel from one another... but I try to stay positive and just focus on the good.

There is still a long, hard way to go with the second part of my treatment - chemotherapy.  

Dr Mikael 3rd visit cost: S$108.05

*****
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Before mastectomy and breast reconstruction surgeries

After mastectomy and breast reconstruction surgeries
   

1 comment:

Estee said...

Prayers with u always! Thank you for sharing everything