Surgical Pre-Op

February was a flurry of workouts, gymnastics meets, work, and enjoying life.  I had my pre-op appointment on March 8^th, so I was looking forward to that.  I asked Jeff to attend with me uncase I forgot something and, let’s be honest, I wanted the support.

Now, let me explain what I thought was going to happen.

Here is a little information from Wikipedia:

“A DIEP flap is a type of breast reconstruction in which blood vessels called deep inferior epigastric perforators (DIEP), as well as the skin and fat connected to them, are removed from the lower abdomen and transferred to the chest to reconstruct a breast after mastectomy without the sacrifice of any of the abdominal muscles.”

So, why was I pushing for this type of surgery?  Well, I had been doing a lot of research on breast implant illness.  I was hoping there was enough of me to be able to nix my current implants and be able to use the all natural chubby belly I’ve been toting around.  Luckily, I have had friends with DIEP (pronounced deep) Flap and have been very happy with results.  Plus, I knew if I was all natural, I would not have to ever deal with implant exchanging.  Implants have a “life span” of about 10 years.  Therefore, every 10 years, I’d need to flip out the old ones for some new ones.  My implants always got cold, especially on cold weather runs.  I would constantly ask Jeff, “Does this feel cold to you? Or just me?”  Yep, implants get cold, like cold enough I even researched the freezing point of silicone implants.  [Silicone freezes at like -67 Fahrenheit, so, maybe my concerns were a little over the top].  But, those guys do in fact get cold, and it’s noticeable.  Nothing like going, “Wow, my Foobs are freezing!” As if I was gonna ask someone to warm them for me?! And I digress…. Back to Kim’s Big Plan…

My plan was easy: remove the implants, remove the nipples! Dr. Chin stated she could fix my chest, so, chest muscle back to normal…Move my belly up to my chest, and apparently a “small” implant needed that will never get cold again (since it will be properly nestled in my belly-fat foob).  Piece of cake in the head of Kim….

Then there was the reality.

Waiting in the office for Dr. Chin, I was given two release forms to sign.  One release was regarding the DIEP, completely expected.  Then the second, regarding a tissue expander….. Whaaa?! We didn’t discuss that initially.  But, as Dr. Chin so bluntly explained, I don’t have much “real estate” for my belly.  I.E. I’m short. Mental face palm, I kind of never considered that.  So, if she uses what she has, we might need to make more space for a proper implant later, hence the tissue expander.  Nuts. I had been able to skip these devil devices.  But, now it’s a possibility. 

Let’s explain a tissue expander:

They sew those little tabs into the chest wall, then little by little fill the expander (think empty balloon) with silicone until the proper size is achieved.  Then the expander is exchanged for an implant of similar size.  The fill then every two weeks with the silicone, and I hear it’s tolerable, but just not all that comfortable. 

Jeff and I left the office with a good idea of what to expect.  I was very nervous, and she explained, that this is VOLUNTARY.  She was right, but as Jeff said, “You’re not getting any younger.”  They both has points.  I was tired of the pain, and I just want to feel normal-ish.  Remember I AM worth it, so here we go. The tentative plan (my laymen’s understanding):

1. 1.      Remove the current implants
2. 2.      Put my chest muscle back to where it belongs
3. 3.      Remove the nipples
4. 4.      Somehow “harvest” the Ab Flab for foobs.
5. 5.      Save some Ab skin to cover the “holes” left by my excised nipples – think pepperoni size, not salami.
6. 6.      The incision used would be the “lollipop.” Straight up and around the nipple.
7. 7.      Add tissue expander?

We had 8 days until surgery.  In those 8 days, lots of things happened.  Oncologist appoint (my 6 month check up), a CT scan, MRI, GYN appointment, pre-op blood work and covid test, and a pre-op appointment with my Primary care. I was seen by more people in 8 days, than I had seen in a year.  I had so much blood drawn and IV contract, my poor left arm was battered and bruised.

By Monday, March 14^th I was all checked out and approved for surgery.  One more sleep and it was off to be a new me!

Scheduling Surgery

I received a call around late December 2021, early January 2022 to schedule my surgery date.  In my brain this was going to be a quick in, quick out...maybe week recovery. 

Of course, the tentative date was in February, smack dab in the middle of gymnastics season for High School and CC.  Naïvely, I looked at the day, and figured it would be a good week so, we penciled it in... Then I started asking more questions...

1. Will I be able to coach the weekend after surgery... No

2. How about a week after.... No

3. Will I be ready in a couple weeks to start training for a 1/2 Marathon... No

I think it was around the third question when I was flat out reminded, "Hey dumb-dumb, this is like a MAJOR thing.  You WILL be down... This is not just a "little" thing."  

SIX WEEKS RECOVERY... every question I had, all answered with SIX WEEKS.

In my head it was easy, peasy.  I'd had my implants exchanged before, with a bit of lipo... I was down about a week.  

This was not the same surgery. Not by a long shot.  

I tried to do some research, on a Hybrid-DIEP flat procedure.  I never really found what I was looking for.  There used to be blogs, message boards, websites....Now, it's all Instagram and Tik-Tok.  I spoke with fellow friends to gain their insight on the surgery.  But there just was limited information on true first-hand accounts of what to anticipate.

I decided to push off the February date and was offered one in March.  This date would occur after our High School Gymnastics Season and this date felt right.  It gave me plenty of time to prepare.  Then I came down with COVID... like many folks in January 2022... It was a blessing that I pushed off that surgery.

During my Covid recovery and working with my TU group...I decided what I needed was a game plan. The beautiful month of January was getting ready to end, and the shortest, yet longest month of the year was upon us.... February. 

I was off tamoxifen for four months, I felt great!! I had been working out, mentally in a good place.  February would mark my 6th month of finding a better mental space, doing my "AM" and "PM" routines.  I discovered things like, drinking Sprite Zero at night instead of multiple beers was OK...Having a nice cup of tea was OK... Slowly, converting my questionable habits, into better habits.  Be accountable was still a mantra, but so was "Consistency is more important than perfection." Being such a Type A person, I was always doubting the perfection of things, so it was easy to simply NOT do them.  But, working to understand being more consistent and trying.... was better than nothing at all. 

I asked myself, “What could I control before surgery?”  The answer was simple... ME. 

Drawing from my last breast surgery with lipo (which- that HURTS), I remembered I could use my arms pretty well, my abs were blobs but my legs and quads--- THOSE were my saving grace.  Since I had already survived the double mastectomy - you know the hard part- I assumed my arms would be basically OK.  I figured my abs would be trashed again, but my legs... again, would be my saving grace. 

January 30th, I started my preparation to go into this surgery as strong and as healthy as I possibly could. Surgery date set for March 15th. My goal, workout EVERYDAY of February.  I was coming off Covid, so I did start a little slow.  

Every week, I journaled my workout schedule for the week, and our meal plans.  I set out to do at least 3-4 Miranda workouts a week, plus 50 minute cardio workouts (my goal was typically 4 or 5).  I had a plan, now the only person that could either find a way to get it done or find an excuse was me.  See, here I am still being accountable for me.  Miranda and the TUs knew my goal and helped me stay motivated and accountable.  

Twice in February, I adjusted my definition of workout...one day things went completely sideways and all I was able to fit in was a 12 minute ab circuit.  The other "not perfect workout" day, I was at an all day meet moving mats, coaching, cheering...and I was simply exhausted at the end of the day. I moved that entire day, I closed my stand and calorie circles- I counted it a win.

And then I exited February about 30 pounds lighter and a lean warrior princess!!!!

HA. NOT.  Not even close. 

However, I did exit February in a great mind space, great cardio endurance, and strong.  Looking at me, I was still me. But, I was stronger, healthier, and happy.  I was a damn JOY to be around! Ok, maybe not everyone thought I was a joy, but I felt like I was nicer.  

Recap: February...Prepare for surgery by being as strong as possible.  Schedule March appointments, pre-op with Dr. Chin, pre-op with primary care, and 6 months oncologist appointment.  Oh, and that work stuff get paperwork in order for that 6 week leave.  Yikes.

I Am Worth It

There is a long back story to how I've gotten here, in this moment.  I'm going to do a quick Reader’s Digest version. I’ll begin with the downward spiral.  Well, it wasn't quite that dramatic, but it makes for good reading when you can make it seem the protagonist, has had some dramatic back story.  However, in this, I am the protagonist and the back story, well that is my life.  

More likely than not, if you are reading, you know me. Many of you really know me, a few of you know my more perfect Facebook version of me, a few may know me as a coach of your child, a few of you are in that close inner circle that truly know that crazy that is Kim.  Disclaimer time here:  This is me, likely my filter is off, and all the stories and opinions are my own. If you are squeamish or become twitterpated with four letter words, you may want to stop here.  I am here to type my truth as I know it.  Every few years, I turn these blogs into a book.  A little personal history so my kids can explain to their kids, who I was.  Let us begin....

My Dad passed away in December of 2019, before the word COVID was even a thing.  That hit me a lot harder than I expected.  I loved him, he loved me, Jeff, the kids.  All in all, he was a good Paw-Paw.  He instilled his love of fishing with us all.  Of course, there is more to that story, but I'm not ready for a full dive into that.  

As we all know in 2020...that was COVID...a very weird time.  Periodically, I would run/walk and do some online lifting with my trainer friend, Miranda.  I was as committed as any semi-committed person could be.  I was unable to visit my Mom in her facility, due to stupid COVID.  In 2020, we lost my Aunt Georgeann, that December her husband, my Uncle Paul.... and I lost the ability to see my Mom for fear I'd introduce COVID into the facility. We would talk on the phone, then one day the phone stopped ringing. Mom had COVID, but survived.  I would do window visits, and eventually in person. But the person I saw was not my Mom.  I would go visit, and she would just stare into space.  In the year of COVID, I lost my Mom. She was alive, but not living, or really interacting.  Literally, a shell of herself.  Out of the blue in July 2021, a guardian angel called me to say, there has been a change, something is not right.  Mom and I had two moments in the end of July when I knew she knew me.  The next weeks were a blur with hospice, having family visit... I just cannot type everything, yet. Mom passed in August 2021.  I was at the lowest of my low. I wallowed in the low for a bit. [Aside here, Mom now resides on my bookcase.  We talk daily.  It’s a HUGE comfort she is with me. I teased she was gonna be “Mom on a Mantel” like Elf on a Shelf.  Likely she hated my humor, with that comparison (I also considered “Nana on the Nightstand”) but I know I like her just being here.]  

By mid-August, I had two decisions, wallow in the shit or get my act together.  Right at this turning point, I received an email from my friend and trainer, Miranda.  FYI- this is not some push for M or her services, but this is my story and she (and my group) play a huge role.  Miranda was explaining to me this new program she was starting, a very personal group with mental training, physical training, check-ins, bi-weekly member meetings, one-on-one check in and accountability.  Not just "fitness" but the WHOLE person.  It's called Transform U.  

At this point in my life, I was pushing 200 pounds, eating junk, drinking more than I should, and just low.  The stereotypical drown the pain with food and alcohol.  I was still on tamoxifen, still fighting the effects of that stupid drug.  And I was just in a funk.  I reached out to M, the program was what I needed, but the price tag was my challenge.  I was dealing with all my personal stuff, an atrocious boss at work, everything was just a clusterfuck, and I was simply trying to hold it together and survive.  I'm sure on Facebook we still looked like a delightful family and perfect.  That was exactly what I was ready to portray, only Jeff really knew the truth behind the curtain. 

The more I considered that "price tag" which was holding me from committing to TU, the more I realized I pissed that amount away on amazon purchases, target trips, etc.  It was time to put that money to good use.   Finally, it was time to transform. I decided I was worth the investment, my health needed to be primary.  If I invested in me, to be a better Kim, I could be a better Kim all around.  This was for me.  Just me.  This change had the ability to impact everyone I love in the best way possible.   I had to.  My first journal entry...

August 18, 2021....Step 1- Be accountable.

So, I began.  I signed up for a 1/2 Marathon, and wrote out my training program.  I followed my TU group mental challenges, our daily gratitude journaling, nightly wins, and the very cathartic "write and burns."  I learned quickly that finding gratitude daily was easy but forgiving yourself for mistakes in the day or negative thoughts was difficult. Looking yourself in the eye, and telling yourself, "I love you" - much harder than I anticipated.   I worked the program.  I wrote myself a letter on why I decided to do this.  My big AH-HA of my letter is this statement, "Be the example." I want to be the example of what a strong, healthy, smart woman is.  I want my kids to look up to me, I want to be a good example for the kids I coach.  I want to live that life honesty and integrity.

I decided I was worth it and I needed to fight to be the best Kim I could be.  Step 1- Be Accountable.  I started with the 1/2 marathon training, added in some online lifting classes with M.  I began making a weekly plan and making it happen. I was accountable. Just a little progress each day.  The fitness portion was the easier part for me.  The other portion was, be a grown-up. Go to your 6month Oncologist appointment and call a plastic surgeon and discuss the foob issues.  YOU ARE WORTH IT, now pick up the phone.

1. At my routine oncology appointment, we weighed the pros and cons of staying on Tamoxifen.  For over 5 years I was on this drug and dealt with the side effects. Finally, we decided, based on the "calculations" my recurrence was low, I did my 5 years, and I stopped. The drug. The doc seemed “doubtful” all the side effects I felt were due to tamoxifen, but more due to being in my late 40s. 

2. I finally made an appointment to get my Foobs examined.  Since my last surgery (2016), I've had problems.  Everyone LOVES to tell me how nice they look.  That is great! They are pretty! But they are assholes!!! No one told me by saving my nipples, the ONLY sensation I would have is PAIN.  Imagine a spiderweb and your nipple is in the middle.  Every time I bent down to tie my shoes, the spiderweb would pull and cause pain. Turn too far one way, pull.  Constant, daily pain. I just dealt with it.  Besides the pain, the stupid nipples were always "ON."  I would tease they always were waving, "Hello" for all to see. The nipples were just an annoyance.  The real issue was my chest.

My implants were placed under my chest muscle.  This is simply how it was done in 2015/2016.  They moved my chest muscle and placed in a giant implant under it.  ANYTIME I used my chest muscle, the muscle would flex, flatten the implant and create this gross deformed chest.  This made me feel less than sexy during intimate moments.  If you watched me get out of a pool, by pushing up with my arms, you could see the massive defect.  Remember, the foobs were pretty and us cancer girls, well they just do the "Best" they can...I essentially surrendered to the fact little could be done about that, but I did know we could possibly fix the nipple issue.  I picked up the phone and made my appointment with Dr. Chin.  She was there for my previous surgeries but was still learning about the microsurgery for performing DIEP flap reconstructions.  

Dr. Chin confirmed we could fix the nipple thing, then asked about my defect animation (my chest deformity), and said, you know we can fix that. MIND BLOWN. She explained there are new techniques, and my chest muscle could go back to its intended position. Then I asked about removing the implants and using some of my belly fat to use for a DIEP Flap. Let's just say, being short, I don't have a lot of real estate between my foobs and hips.  We discussed a hybrid DIEP flap.  Some of me, and some implant help.  SIGN ME UP.  They would call me with a surgery date.

During my first three months of the “Kim is Worth It” journey... I've been working on mental and physical health, stopped a cancer drug, and decided to fix the foobs.  I cannot lie, I thought this was all a little vain, but I wanted it.

By December 2021, I had lost about 12 pounds. I worked out regularly, started cooking more at home, cut out lots of adult beverages... and felt great.  One morning I woke up, and it was the first time since 2016 I did not feel like the Tinman.  Every morning on tamoxifen, I was slow. It was hard to get up, hard to walk, hard to move.  But, that day, everything was different. And since that day, it's been different.  Again, I had no idea how shitty I felt, until that moment. Everything tamoxifen took away was back.  My joints felt so much better, I felt like a woman again...I saw a huge glimpse of Kim pre-cancer.  It was amazing. I had no idea how shitty I felt for all those years.  I was told, if I wanted to live a longer life, feeling like shit was my trade off.  Talk about quality of life. 

As a cancer survivor I was led to believe, if I wanted to live, I had to accept things. Daily pain, zero sex drive, painful intimate moments and weight gain from tamoxifen. I had to accept painful nipples, and a chest that looked pretty - but did not function properly.  I want to live, so I figured that I would deal with the shit to live. Not ONE doctor told me, this is temporary.  Medicine and technology advanced in six years.... it never dawned on me to just ask the questions. 

Once I decided I was WORTH IT, I started asking. My friend Amy, who I met in a chemo chair next to mine, told me early on to be my own advocate. I finally started advocating for myself. I AM WORTH IT, and this was how it started. 

Hello Dolly.....

I love my friends.  Apparently, I have been quite since surgery.  I thank all of you who reached out to me.  This surgery threw me for a loop.  I thought I had it all figured out; and I was wrong.

Let's go back to the day of surgery...

We dropped the kids off at school, and it was National Smile day.  So my girl was in heaven.

Jeff and I headed over to Church.  I lit a candle to pray for a successful surgery and for all my friends also on their cancer journey.  We went home and piddled around.  I asked Jeff to take me to the Zoo before surgery  I was tired of just wasting time around the house, and a walk sounded like an excellent distraction.

 Here we are near the Gorilla area.  We were almost late to surgery because those guys were putting on quite a show.  But, then it was time to go down the road to Christ.  In keeping with my photos from last year, I did my handstand, in this year's Crush Cancer shirt.

Then was asked to put on a gown....this one opened in the back :)

The goals of this surgery....
1. REMOVE LUCIFER!!!!
2. Correct my monster gap from my Foobs.
3. Graft some fat to create cleavage for my foobs to make them look more natural.

The day before surgery, I drove to Columbus for a pre-op.  Dr. Tiwari (Foob Creator), and I discussed size and such.  I learned my implants were 400cc, and he ordered 500cc, 550cc and 600cc implants to have on hand.  We discussed the 600cc implants may be too big, but, really I was open.  The initial plan was to do a larger implant, then fat graft 100-200cc of fat for the cleavage.

Best laid plans --- right?!

Like any surgery, all my fun docs came in to visit.  This time no selfies; I was ready to get this show on the road.  Doctor Miller (aka Lucifer Exorcist) and I had a lovely discussion.  My goal was to keep Lucifer; I wanted to mount that jerkface in a shadowbox as a memento of all the hell he gave me.  Well, thanks to the fact in was implanted in me, I was unable to keep him.  She promised a picture for me.  I'm still waiting for my 8x10 glossy of that asshat.

Dr. Tiwari came in and drew all over me with sharpie.  We discussed the areas that we would graft from and our goal.

Then at some point I received the happy medicine and went to sleep.  I thank the nurse who was holding my hand as that happened.  Not sure who you were; but it was comforting.

In typical Kim fashion, I came out of anesthesia horribly.  I could feel my lungs were "wet."  I woke up to someone giving me a nebulizer.  Apparently, my Oxygen sats were very low.  I felt like I was there for 45 minutes, I think Jeff said it was closer to 3 hours. Eventually, my body finally decided to cooperate, and I was allowed to change out of the gown.  As Jeff helped me get dressed, a suture pulled and I started to bleed--- a lot.  If you know Jeff, you know he does NOT do well with blood.  The nurse came in, got it all bandaged up, and finally we went home.

Things got fuzzy after that.  I slept on the couch, sitting up.  I thought that would makes things easier.  What I did not know was how horrible the pain from fat grafting my abdomen would be.  FYI- fat grafting is a kind way of saying.....liposuction then shove it in my foob cleavage.

The first two days were tough. I could not use my arms/chest to push up to sit up, and my abs were worthless.  Here are some extremely unflattering pictures of my post surgery dressings, and messy bedroom.

It's a safe bet to say I had some serious swelling going on.  How much you ask?  Enough that I dropped 7 pounds in 2 days.  WOW.

Back to the foobs.....right, so....Turns out that 700cc implants "slipped right in."  Turns out we had another issue.  I learned about this yesterday in my post op.  I asked Dr. Tiwari why he did not "harvest" more fat-- like we discussed,  Apparently, my fat is dense.  Nothing like being told, "You have the fat of a 20 year old."  I think that is a compliment, but that is a WEIRD compliment.  Unfortunately, dense fat does not lipo well.  So, he used a bigger implant to fill in the space, since we could not graft as much as anticipated.

After I escaped the post surgical dressings, I entered into the world of old lady support bras and spanx.  I was sporting this lovely ensemble under my elastic shorts and baggy t-shirts. Excuse the lovely hair- it's post surgery, give me a break.  It's real people!!!

Now, being me, I was planning on returning to work 4 days after surgery.  THAT was a mistake (hindsight is always 20/20).  I did return to work, I did go back too soon, I did get sick, and I did live.  I feel a LOT better finally, 10 days post surgery.  I can bend over to tie my shoes without thinking I may die.  For all my friend that have C-sections-- much respect.  That must have sucked to recover from.

Oh, the foobs?!  THEY ARE HUGE.  Like Dolly Parton HUGE.  Like finally, at 41 my Capannari boobs came in.  I had to make a deal with Dr. Tiwari, I am giving them 3 months to see how they settle in before making any decisions.  Also, I had to promise no running and no yoga for a month.  Apparently, I was already doing too much and I got my wrist slapped at my post op.  I need to wear my LOVELY spanx for 6 + weeks to assist with the healing from my "contouring" and I should wear 2 sports bras when I walk.  This is hysterical.  Remember, I went from a "full B" to now wearing 2 sports bra's in a year.  I figure if I lose my day job, I may have a future in topless dancing. There is always a silver lining.

So why was I quiet? I don't know.  I was tired, and I did not have much to say.... and I may have been binge watching some Netflix....

But, all in all I'm OK.  Still healing, but I'm OK!