10 Months - Another Scar Post

I just saw the dermatologist because I am hoping he can help me with my scar. They really don't prepare you for the scar healing. 

So if you have been reading my other posts, you know that I am concerned that the scar seems to be widening. I have been told that this does happen with women because the breasts pull on the skin. They make you wear a bra 24/7 for the first 2-3 months to prevent the incision itself from being pulled.

While this was a pain, I did have a special bra I wore and I got used to it. I wish I knew about the scar wideing issue because I would have worn the bra for a few more months. (YMMV.)

So here is a photo of my scar at 10 months after surgery. My dermatologist looked at it and said "Marvelous! It looks great!" When I told him I was concerned it was too red and looked wider he said a couple of things I wanted to share with everyone:

1.) He said he gives my scar a B+ (this one you see here)
2.) He said the scar will contract in time
3.) The visiting doctor who happened to be with him that day said scars remodel for 1-2 years and suggested I do light massage on the scar tissue to help.
4.) He said in a few months if it is still red, we can do an easy laser treatment to take care of it.
5.) He said silicone gel or strips, or moisturizer on the scare every day helps too.

So there you have it. I still had hoped it would be a tiny white line by now.

Scar update 6 months later

205 days since my surgery (6.5 months)

Well, I saw the dermatologist today to have him look at my scar.  He said "it's looking great!" Which I was so glad to hear, because I look at it and think that it looks too red and that it is 'widening' over time. When I got a little emotional telling him I had to get all new clothes and can't wear any of my pretty things anymore, he assured me that I will be wearing them again! 

Before he came into the room his assistant told me that anywhere on the body where there is tension a scar can stretch and widen. Certainly the sternum is an area -- for women -- that has tension on it. Men don't typically have breasts that can pull on the skin.  When lying on your back (they make you sleep on your back for 2-3 months after surgery) the weight of your breasts, especially if you have larger breasts like me, pulls the skin on the center of your sternum quite a bit.  This is never a problem until you have a 6-8" scar between the middle of your breasts.

I wore a bra 24 hours a day for the first 3 months, and I was so glad to not have to wear it anymore, but I am now thinking maybe I should have worn it longer because I DO have larger breasts. So you may want to discuss that with your doctor ahead of time if you have large breasts. 

The surgeon's office was pretty non-chalant about it before surgery, and the NP there told me that with "my skin" I would probably barely notice any scar there in a year or two. We shall see if she is right.

My dermatologist happens to be the best derm in the world. Maybe everyone thinks theirs is the best, but mine really is. :-D  He told me that the silicone scar tape is great and I can wear it all the time if I want, and it should help.  He also said I can use the tape or the gel, and that some people find silicone gel easier to use. I might look into that. The tape package said to wear it 12-22 hours, but he said just take it off before bathing and then put it back on. 

I secretly believe that wearing the tape to bed might help the scar widen less, but that is complete fantasy on my part to be sure. 

It is also next to impossible to find photos of a sternotomy scar healing over time. I have Googled everywhere and you can see new scars and old scars. So I am going to keep sharing my scar over time so anyone else out there who needs to know can hopefully see this and get some helpful info. Hopefully my pain can be your gain! :-D 


**WARNING - SCAR PHOTO BELOW. STOP HERE IF YOU DO NOT WANT TO SEE A SCAR.**

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You can see what I mean by it looks like it "widened" and there is a little lumpiness at the top, which the dermatologist said we can "fix" if it is still there in a year. That is where the suture knot was, and he told me sometimes they have to remove those suture knots a year after surgery. He even mentioned having to "dig in to find them" or something, which sounded gross. So I am glad mine came out, even though at the time it freaked me out a bit.

He thought it looked great -- which was surprising to me. I really thought it looked awful. But that is why we have dermatologists.

You can see at the bottom my two drain scars. And the impressions on my skin there are from my bra. The bra band hits right where the drain scars are so you can see why it was such an issue when they were healing. Ugh, what a memory that triggered. LOL!

I wonder if silicone scar tape would make those drain scars go away? Hmm I might try that.

Here is a pic of three stages of scar progression for reference: (Please note the middle photo was taken at a different distance which is why you don't see the drain scars at the bottom.)

At 4 months the top of the incision still had a little hump there, which absolutely went away like they said it would.  But now I do (sometimes) have that little lump of skin at the top.  It seems to go away after wearing the silicone scar tape overnight, but then appears again by the end of the day. I am guessing it is related to laying in bed versus being upright all day. Who knows.

4 months after surgery

122 days since my surgery (4 months)

Four months ago today I went into the hospital and had open heart surgery. It seems like a distant memory and also feels like it never even happened. Unless I look at my incision scar.

My scar is actually getting much better - I have been using sicilone strips to help it heal flatter and smoother.

My niece is a cardiac surgical nurse at a children's hospital, and also has had some hip surgery in her past. She recommended these, and she showed me her scars --which you can barely see - that she used these on.  So I am hopeful they will help my scar get flatter.  Really the only part not flat is the top where the suture knot was.  Sometimes it is a little raised and then if I wear the silicone strips it goes down flatter. 

I am still waiting for my spot in the cardiac rehab program.  My friends on the AHA support group highly recommend I do it, so I want to. But it's been FOUR MONTHS! I can't believe how backed up they are!

Day 64

64 days since my surgery (2 months)

The scabs where the drains were are still really hard and crusty. The one on the right side actually started looking wet and stuck to my gauze and came off. I called the nurse at the Cardiac office and went in today to see her to make sure it’s OK. 

She said they’ll take a long time to heal, but they’re OK. She also looked at the top of my incision where the suture knot had come out. 

I asked her if that’s gonna heal nice like the rest of the incision and she said it might not. Which is not great because now it’s like a little round hole at the top of my incision. (Sigh) She did say I could start using the silicone strips but not on the top of the incision because it’s still closing. She said it should eventually close and she checked it to make sure it’s not “tunneling.“ It’s not - and she said it’s healing fine.

She gave me some hydrogel to put on the scabs to make sure they stay soft and moist. When I took the Band-Aids off at the end of the day, it was really gross. It also smelled really funky, so I don’t know how much I want to use that hydrogel.

Now that the right scab is falling off, the left one which is larger and grosser looking is still there protecting what’s underneath, but you can tell it’s coming off. I’m not looking forward to that, but I’m hopeful that that means it’s healing better.

I have a lump at the bottom of my incision and one in the middle, she told me that it is scar tissue. I had googled it and was worried it was a seroma. She said no it’s just scar tissue and it may or may not go away.  It feels like a hard bony lump when I press down there. 

The lump at the top of the scar is going down, but I could still feel something when I rub my hand from left to right it’s like there’s a hill in the middle of my chest. She said it’ll go away, but may never go away all the way. It’s certainly better than it was when I left the hospital. But that lump was more tissue, and this feels like bone.

A lot of this is stuff they just don’t tell you, and the only reason I went to see her is because I kept asking her about it. I’m really surprised they don’t do wound checks. I saw the Cardiac surgeons two weeks after surgery and haven’t really seen them since.

Surgical Incision

 **WARNING** I am sharing photos of my incision and scar for people who want to know that to expect. These are not great photos, and they are personally awkward to share. But I want to help people.

So please do not proceed unless you want to see surgery scars that are not fun to look at. 

But they also aren't really that bad. 

Scroll down to see.

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Stop now if you do not want to see a big incision scar.

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So what you see at the very top is a lump that you have after surgery that will go down over time. It does, and they tell you this. But it is weird when you see it. 

The top of the incision is where they tie-off the stitches with a "suture knot." More on this in a later post. They actually sew you up from the bottom to the top. 

Woman have to wear a bra 24/7 for a month or so because the weight of the breasts will pull on the incision. The incision itself is about 6" long for women. Below the incision you see 2 scabs - these are from where the drain tubes were removed. These scab up and are there for quite awhile. 

There are so many tubes and lines and monitor patches they put on you, that your skin takes quite a beating. The adhesive is also almost impossible to remove. What looks like gray glue on my skin is all of the adhesive.

Honestly, this was not as bad as I had thought it would be. I was far more aggravated by the dang surgical glue. After 4 showers it was still there. I finally got some adhesive removal wipes from the nurse at my follow up visit.  Ask for those before you leave the hospital - you will need them.

Men with body hair might have an even harder time with the adhesives. I am not sure.

Below is a picture after almost four months.

The incision is all healed but is still a bit red and raised. Based on what the nurse told me before surgery, it will take about a year or so for the scar to heal into a less visible state. 

This photo doesn't show the drain scars but they are all healed up as well. They were big scabs for a very long time.  But once they fell off it was all soft new skin underneath.

The top of this scar is where the suture knot was, and it is more raised than the rest of the scar. This is where the silicone scar tape should help me. But again, this will take time.

I will take more photos in the coming months so I can share how the scar progresses.

Day Two. Wednesday.

Today I saw my incision scar.

They removed the incision bandage this morning and I got my first look at my scar. It actually wasn't that bad. I have photos elsewhere on the blog of the incision if you want to see it. But they use internal glue or something so the scar wasn't anywhere near as bad as what I was expecting.  

I had very little feeling in my chest, and across my chest. They told me it will take months to get some of the feeling back as nerves are cut when they open the chest for the sternotomy. It takes months for those nerves to grow back and some never will.  It was a strange sensation but not bad.

A word on pain killers.

They were giving me oxycodone 10 every few hours, along with Tylenol. I did not like how the drugs were making me feel and I asked them to stop giving them to me. I felt like I was in a woozy dream state, and I also had terrible dreams the night before.  I was taking the Tylenol and they gave me something else that was not an opiod.  But I was also not able to get comfortable, and the head NP on the floor came in to talk to me.

The NP explained that they felt it was necessary for me to be on them to ensure I was not in pain, and that without them I might feel pain that would hinder my recovery. They assured me that in-hospital use of opiods was safe and even necessary. We agreed I would go on the oxycodone 5 instead of the 10, and that I would let them know if I was feeling any breakthrough pain and needed more.

Shifting around in bed, or in the chair, was uncomfortable, and my back was sore from lying flat on it for so long.  (News flash: you will be sleeping flat on your back for a couple of months, so get used to it.) None of this was unbearable pain, but when the physical therapists came for me to take a walk, getting up out of bed and standing was uncomfortable - but I think it was mostly pain originating from the drains under the incision. 

Catheter out - able to go to the bathroom!

They took the catheter out today and I was able to go to the bathroom.  The physical therapy team came by and had me walk a little bit to show them I was able to do it. 

The nurses cleaned me off today with some wipes, but I felt damp and gross. Luckily I had brought my powder with me, so when I went to the bathroom I was able to powder up a bit and feel a little more dry and less gross. Hard to explain, but I wasn't able to shower yet.  And those wet wipes they use smell medicinal, and really leave you feeling wet and damp down in your nether area. (I say this as politely as I can.)

They took the saphenous vein from my left leg, and today I was able to really get a good look at my leg. Here are a few photos. My legs were both swollen, this one more so than the right leg because of the surgery they did to remove the vein.

So on the left is my inner thigh, and there are steri-strips covering the top incision. This was a small incision at the top of the saphenous vein. These have to stay on until they fall off. It took about 2 weeks for that to happen. 

The middle photo is the incision near the crease of my leg where they did the big incision. You can also kinda see a line that goes down my leg, following where the vein used to be that they used. 

The photo on the right shows the small incision at the bottom of the saphenous vein where they made a small incision there, also covered by a steri-strip. These didn't hurt, but I did not have a lot of feeling on my leg near the big incision. This is because some of the nerves were cut and I was told this would take time.

You will be getting up a lot to go to the bathroom.

They had me on a diuretic to remove the water from my system, and you can tell you are holding water by how swollen your legs are.  This means a lot of trips to the bathroom.  From the time I entered surgery to the time I was weighed the next day, I had gained 20 pounds. This is mostly fluid and it is from the blood and other "products" they give you in surgery. 

They also removed the drains today.

The drains from your chest are also removing fluids and blood and you see it in the bag next to your bed. I wish I had taken a photo of the drains, but I didn't. 

They have you hold your breath when they remove these, but it does not hurt. It feels a little strange, but there wasn't really any pain.  But I was very glad to have them removed and found that some of the discomfort I was feeling was gone when they were removed.