Almost 2 months since top surgery, but mostly about "Cording"

I am healing well and am able to lift normal amounts of weight so doing some carpentry wasn't an issue. The skin on my chest feels a little tight, but not nearly as much as it did a month ago. I recommend doing the exercises that the doctor tells you to do and as frequently as you are supposed to do them if you don't want to be all bent inward!
However, the thing I wanted to discuss in this post is a condition called "cording". Cording is the short and easy name for Axillary Web Syndrome. The weird thing is that no one really knows how or why it happens, but it happens to about 20% of people who have mastectomies, including transgender patients and women being treated for breast cancer.  What happens is connective tissue grows in "cords" from the incision sites in the armpit or on the trunk and forms long strands of stretchy, (but not stretchy enough) "cords" that appear under the skin. They can run all the way from the armpit to the wrist or from the chest incision site to..who knows where. As soon as I heard it doesn't happen to most people I knew that it would happen to me because I'm special. Great...and it DID happen to me. I have cording in my left armpit down to my forearm and from a part of the incision on my chest. The left arm one happened first and I could feel a weird pulling sensation before I could see it under my skin. The cording on my chest happened a few weeks later and was raised under the skin and visible when I raised my arms up over my head. somewhat like in the image below. I pushed on it while it was taut under my skin and I actually felt it tear away from whatever it was adhering to. Ouch, but not incredibly painful. My wife was far more affected than I was. Anyway, I brought it to my surgeon's attention and she referred me to a physical therapist, who I start seeing next week. Since I tore mine I have no images to share but from the web there are some available:



http://www.mylymphedemalife.com/axillary-web-syndrome-aws-also-known-as-cording/


Axillary Web Syndrome
**Photo taken by Elisabeth Josenhans, Hamburg, Germany
elisabeth-josenhans@hamburg.de

1. Cording is rarely discussed as a complication by the surgeon; My surgeon didn't mention it.
2. Some forms of cording may be difficult to see and feel; If you do feel it, you probably won't know what you are experiencing.
3. Some women do not want to complain to their surgeon; (many people feel that doctors are gods)
4. There is no recognized comprehensive physical assessment of Cording; Yep
5. Cording assessment may not be a standard practice in the breast cancer clinic; and
6. There is very limited research into treatment protocols. I find much disagreement about what it is and why it happens. Treatment?  Not much.

Note: More research and conversations with specialists lead me to believe that cording originates where there are damaged lymph nodes.

Scar strips get itchy

I have been somewhat regularly using the silicone scar-strips on the front part of my chest (the part that is the most visible) and so far I think it has evened out some of the higher parts of the scar tissue. However, wear time is supposed to be pretty much, as long as you can stand it. My skin likes to breathe and after about 12-16 hours it itches and makes me want to rip and tear at it. So I take it off. Then it isn't supposed to be put on until your skin is dry and clean so if you are into bathing a lot, this product is for you! I like to give my skin a break from soap occasionally as well so right now I've gone almost a day without the scar strips. Ugh. That defeats the purpose. Oh well, I will pout them back on in an hour or 2. In other news, most of the skin glue has finally fallen off. what I see is just me.

All about scar tissue and how to deal with it

It's a month and 2 days since my top surgery. I am healing really well, but I have some concerns about the condition and extent of the scarring on my chest. There are some obvious things to avoid, like the SUN. I am aware of many Youtube videos where the transguy is relatively healed up and can't wait to take that shirt off and sunbathe. Do not do this unless you think scars are sexy. If you want your scars to be minimally visible, shun the sun! My doctor recommends an entire year out of the sun. I'm afraid of skin cancer so that probably won't be an issue for me. I am excited about wearing my suits and looking good in them :) Another thing I wanted to mention is scar treatment. I am using adhesive silicone strips to cover the scar tissue. What this does is flatten out the scar and relieve pressure from bending and stretching the scar tissue. Check out the pic from today below. As you can see, I have applied the scar strips to the front scars because I am most concerned with how they look. I haven't applied the strips anywhere else as I am almost certain to have revisions under my arms due to loose skin from weight loss.

4.5 weeks since my top surgery

OK, this post is mostly to upload a picture since I got my stitches out and apparently nothing is going to fall off. The surgeon gave my right nipple 2 thumbs up as far as being ahead of the curve on healing, and a C grade for my left nipple. Since my top surgery I no longer see myself as awesome so every time I look at a picture I think "OMG you are sooo fat", but I know I am in a lot better shape than I was a couple months ago!


Picture from 5/10/17

Warning, if closeups of stitches being removed makes you queasy, do not watch. Stitch removal on my nipple grafts including close-ups of the nipple grafts are available in a video here:

https://youtu.be/_TQVoiv-6WY

4 weeks since top surgery

There are a lot of things that I read about, but couldn't know about since it has to be experienced. One of those things is "dog-ears". In my case, I was quite a bit over weight and lost 20 lbs right before surgery and I continue to lose weight. The incisions under my arms, (in my lower arm pits), are now the only part of my body that actually jiggles if I jump up and down. I don't like this, it is not a good thing. There is a bunch of loose flesh there and immediately after surgery it was mostly numb. After a couple weeks the nerves woke up and it was just painful..all of the time. It hurt when I raised my arms, it hurt when I lowered my arms. It hurt when I was laying down, it hurt when I was standing up. It was maddening because there was no position that I could be in that would make that low level pain go away. As a sleep aid I took CBD/THC pills rather than than the opioids that I was prescribed. An addiction to pain meds is not something that I wanted to deal with on top of having to wear a really uncomfortable compression vest and nagging pain and itching, healing flesh.

I want to mention the compression vest. It was cleverly designed to be able to hook the drain reservoirs to, but it was so tight that it bruised me in areas that I didn't already have bruising from the surgery. Yes, bruising is a result of the surgery. I imagine that when the skin is pulled together it has already been roughed up when it is moved from its original position to a new one. The reasoning for the compression is to keep the skin and nipples in close contact with the blood vessels so they will grow into the grafts, and the skin that was moved is almost like a graft. The nipples take about 3 weeks to be out of danger of being easily "sheared" off by normal activities like putting on a shirt or washing. I am past that milestone and I am very happy to report that my nipples stayed where they were sewn. My wife was their guardian, making sure that I didn't brush them off, scratch them, or do any damage to them accidentally.

My pain levels are at about 0-1 unless I stretch something that hasn't healed up quite yet. The places where the drain tubes went into my chest seem to be pretty deep and are healing inside slower than the outside. My biggest irritation is the tightness I feel in the areas of the incisions. My upper chest is very tight and if I try to stretch it feels like something might split. I don't know if that is actually true but I don't want to find out. I stretch until it feels uncomfortable, then I stop. I had thought originally that there would be a little slack because I was losing weight but the surgeon cut all of the excess skin off. It's strange, (more like ridiculous), because my chest is muscular from the 5 weeks of upper body building I did before surgery, but I have a big belly below it. Sigh..eventually I can lift weight again. In the meantime I go for walks, but I get tired easily. Healing takes a lot of energy.

Day 11 after top surgery

It's been 11 days since my top surgery and I finally have no drains or tubes hanging out! The drain on my right side was removed yesterday as the PA made me "cross my heart and swear that there had been less than 30 CCs of fluid daily for the last 3 days. The last time they talked to me about it the requirement was <25 cc per day for 2 days, anyway, I didn't know how to do the cross my heart thing and he removed the drain. Sweet! Showering is much easier and the only concern I have is keeping water from the shower head from spraying directly onto my nipples. Apparently new blood vessels grow into the grafts in 3-4 days, but the cells that attach them to the existing skin takes a few weeks to get strong. Shearing force (side to side movement) can rip a nipple graft right off so I am very careful when changing shirts.
I am super happy with the incisions on my chest and unhappy with what is going on in my arm pits. Most of that skin is either numb, or screaming about being touched. "Dog ears" is what the surgical result is called, but I had no idea how uncomfortable it would be to feel the bundle of misshapen flesh, with damaged nerves under my arms. There is no escape from it. I am told there are often revisions required, which makes me think about more drain tubes and cutting! Ugh. It would be nice to just be in the healing part of this adventure.
My wife is concerned about intimacy and heart rates. The surgeon told her that my heart rate is not supposed to go over 100 beats per minute (BPM). I am not sure why, but it could be to keep down swelling. Yes, swelling is uncomfortable, but I have no idea when this limitation is supposed to be lifted!
< 5/14 Note, I asked my doctor about the heart rate thing and it is about blood clots. Increased blood pressure could send a clot from the surgery to your heart or somewhere else terrible>

Oh, an interesting thing to mention about me. Before the top surgery I was unable to see myself as I was in a mirror. A lot of people have this issue to varying degrees. Many people see themselves as fatter, or their nose looks too big. In my case, what I saw in the mirror was always good. Now when I look in the mirror it's like some spell has been broken. I can see my wrinkles, my fat stomach, and my stretch marks. I think I see everything now. I attribute this to coping with gender dysphoria. It must have been how I was able to cope, to not see the things that were distressing. So now I know just how fat I am. This is good, and it sucks at the same time.

5 days since top surgery

It's been 5 days since my top surgery. I went to a doctor appointment to be looked over and have some tubes removed. I had a pain deliver system that involved a pressure pump and tubes that delivered a pain medication under my skin. It felt weird to have the tubes (about 4" each) under my skin removed. I am left with one drain under my right arm pit. It is painful (slightly), irritating, it itches, and I would very much like it gone. I also got the bandages off of my new (slightly used tissue) nipples. The doctor says they look great. They look like scabby prune skin and they hurt when I get out of bed or do anything to pull the skin across my chest, but pain is how you know you are alive, or that your nipples are alive.