Wednesday, November 2, 2022

Breast Cancer Fight: Skin Discolouration and Tiny Lump After Surgery

My first appointment with Dr Jane after being discharged from the hospital was supposed to be on Fri 4 Nov 2022. However, as I noticed some skin discolouration {faint blue-black} and tiny lump {0.5cm?} below my nipple on Tue 1 Nov 2022, I emailed Dr Jane and Nurse Jessica from the Aesthetics Plastic Surgery Clinic with a picture to ask if it was ok.

I wasn't too worried over it that I wanted to go in for an emergency visit, but just disturbed enough that I had to ask. 

I had kind of noticed the lump in the hospital but it seemed a bit more obvious at home maybe because I changed out of my clothes and looked at my wounds more. In the hospital usually the doctors or nurses would check my wounds. Plus the lights are usually dimmer. 

Dr Jane had previously mentioned that because my skin was thin after the mastectomy, there was a possibility that the implant would show through as a blue-ish or grey tinge. 

Even though I had an under-the-muscle breast implant for reconstruction, Dr Mikael had cut away the lower part of my chest muscle as the some of the cancerous breast lumps was resting on it. Thus, not all of the implant can be covered by muscle and was actually directly under my thin skin. 

Anyway, that skin discolouration might just be the implant showing through... but I was also worried that it might be post-surgery skin necrosis. 

After a mastectomy with immediate breast reconstruction, sometimes the breast skin doesn’t heal properly because the network of blood vessels that supply blood to the tissue were damaged. The skin may have been thinned too much when tissue was removed during the mastectomy, like mine. When there isn’t enough blood flow to the skin, portions of the skin can wither and scab. This is a significant problem after mastectomy. 

I did not experience common early signs of skin necrosis like swelling, redness, pain, warmth at the surgery site or a fever that day though.  

Later that afternoon, Nurse Jessica called to tell me that she checked with Dr Jane who said that the lump could be from the drainage tube. However, Dr Jane asked me to come in earlier on Wed 3 Nov 2022 to have a better look. I agreed and Nurse Jessica helped me to reschedule my appointment. Dr Jane also replied my email that she couldn't really tell for sure from the picture what was happening and also asked me to come in the next day.  

On Wed 2 Nov, I registered about 9.30am to see Dr Jane even though my appointment was at 10.30am since there wasn't much to do. Luckily, Dr Jane was free and saw me earlier.

She was relieved to see that the skin discolouration was just the faint blue-black and not purplish or red as that would mean that it might be skin necrosis. It was just the implant showing through as I had thought as well. In the future, I could add on fat as another layer to "pad" my left breast up if the discolouration bothered me or if I wanted "extra protection"... but that would be another day surgery at least a year later. 

As 5 days had already passed since the surgeries, Dr Jane said that it was fine for her to open and change the dressing. 

That day was the first time I saw the long incision across my left breast that was used for the mastectomy and breast reconstruction surgeries. Other than some dead black skin at the end of the incision and on my nipple that Dr Jane said would scab away, the wound was healing well with no infection and my nipple was saved. Hurray! 

Dr Jane took off the dressing completely for the cut that they made under my armpits to take out my lymph nodes as that one has closed already and the dressing was causing a small blister. She gave me a small tube of Chlortralim ointment which is an antibiotic that works by stopping the growth of bacteria to apply at the wound and blister twice a day... forgot I already had a tube at home from the big bag of medicine prescribed when I was discharged.  

The nurse assisting her also helped to change my drainage bottle and Dr Jane issued me another 3 extra bottles to use at home, just in case. She had checked the wound where my drainage tube came out and said that there was no leakage there, and couldn't tell for sure why the suction cap popped so fast the day after I left the hospital.  

I like Dr Jane as she is very friendly and has a cheeky sense of humour, even though she is obviously a very experienced and knowledgeable doctor. No air of arrogance or rudeness around her. I joked with her that the drainage bottle was like my pet Tamagotchi - I had to bring it around everywhere and "feed it" with me... and she just laughed. 

At first, she thought that perhaps the small lump was from the drainage tube inside my body or a marker from the implant. However, she realised that the implant marker was somewhere else and she didn't know what that small lump was. Dr Jane will talk to Dr Mikael to see what it could be. 

Case in point of her cheekiness? She drew a tiny smiley face over the small lump to mark it out for Dr Mikael to see during my appointment with him on Tue 8 Nov 2022 hahaha. 

As she was going away for a conference 6-15 Nov, my next appointment with Dr Jane is on Wed 16 Nov 2022. She didn't think that my wound dressing needed any changing until then but if something happened and I needed to see a doctor while she was away, her colleague, Dr Yap Yan Lin, would be around on Mon 8 Nov or Wed 10 Nov. 

Dr Jane also gave me a copy of my Surgical Pathological Report to have a look before my meeting with Dr Mikael, who will go through it with me. 

Dr Jane 3rd visit cost {including consumables & medicine}: S$193.38

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Before mastectomy and breast reconstruction surgeries

After mastectomy and breast reconstruction surgeries

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