Exchange City
Comments
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I will be having a revision and looking at new PS's in Richmond,VA 1.5 hrs from my home base.
Have initial consults with Nadia Blanchett and Sharline Aboutanos...anyone have any comments to share about these docs??? PM me if you would rather not share on the open board. I see one in early October the other at the very end of October, but then hope to be able to make a quick decision so as to have the revision over the holidays.
Thanks, TT
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TrmTab - I think Whippetmom keeps a list of docs from all around the country. You might PM her. Good Luck.
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@lalala1, I had a breast lift and reduction way back in 1994, before cancer. They did what is known as a "wise incision" which sort of resembles an anchor. A vertical incision from the nipple down to IMF, that connects to IMF incision. The nipple was then moved up by cutting all the way around the areola and repositioning it. But that was with healthy breast tissue and an intact blood supply. I suspect since you have had msx repositioning the nipple may not be advised as the blood supply is compromised and it may not survive. If you had the wise incision typically used in breast lifts, your breast would be more of a cone shape on that side so it wouldn't match the other side which is why they want to do the diagonal incision for symmetry. I'm sorry, I know it isn't what you wanted to hear. I hated hearing my nipples had to go only to be told by a new ps after they were gone she could have saved them. If you are adamant about keeping the nipple, you could ask if they will do the wise incision for the lift and revise the scar on the left side to a wise pattern to match. That is the only thing I can come up with.
Hugs!!
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Thank you to all of you that have have contributed to these forums. Your comments have been so valuable to me since my surgery June 1. I'm now 3 + months post op bilat mastectomy and 2 weeks post final expansion. Now waiting the three months that my plastic surgeon requires before exchange surgery. I still hate these TEs. Frequent pectoral muscle spasms and the feeling that I'm wearing a bra that is two sizes too small.
My oncologist and plastic surgeon both assure me that I'll be so much more comfortable after the exchange. But, will I????
Thanks for input. Becky
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Lalala1, I have another option for incisions in a nipple sparing mastectomy. I'm not an artist, but here's my sketch of the incisions used by my Plastic Surgeon for nipple sparing mastectomy. He called them “Batman" incisions (my rendition looks more like a mustache, his really looked like Batman):
The skin in the red lined area is removed and the spared nipple moves up. The amount of skin removed varies depending on how much the nipple needs to be lifted. A skilled surgeon is required to spare the blood flow to the nipples. However, you can see that the skin can be shaped a lot through these incisions.
I had lost about 40 pounds a couple years before my mastectomy. My breast went from 38 DD to 36 B/C. These incisions removed all that extra skin.
Hope that helps,
Mominator
(Edited to crop picture
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Becky, are your expanders under the pec muscle? In which case, I can’t give any insight. My expanders were pre-pec, over the muscle. I still found them to be very uncomfortable. As you described, like a bra that’s way too small. I’m now 4 weeks post exchange surgery. The implants feel much better than the expanders, but they still feel alien. My PS says it will take several months for everything to heal and settle in.
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Hi Shoregirl,
Thank you... that explains a lot!
When I asked if I would have the normal vertical lift incisions I was told that they would use the same diagonal scar as the other side so they look the same. I thought they meant the same scars & didn’t realize they meant shape as well. But now you say it, that makes sense.
I was apprehensive because I had heard that one of the positive things about getting a nipple sparing mastectomy was that you kept your natural breast shape. So I guess I wanted to somehow keep that.
I will get a second opinion and speak to my original surgeon so I better understand the outcomes from the different incisions. And whether saving the nipple is possible in my situation using a wise incision on both sides to match. Shame I didnt have a wise incision to begin with but myoriginal incision was from the lumpectomy & it's location is where the cancer was situated.
Gosh, all these decisions and their implications. It’s a minefield out there!
Thank you so much for your help
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Thanks, Maggie. Mine are sub pec. I've been following the pre pec forum intensely. That group seems much more comfortable in general. I'm wondering if that's the way most future TEs will be done. I see that it may be an option to change from sub pec to pre pec at the time of the exchange. I will consider that, but it would mean changing plastic surgeons and having to travel quite a ways. Hoping that these will just get more comfortable. Can't wait to have this all behind me.
Thanks for your support.
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Hi Mominator,
Thank you so much for your info on the ‘batman’ incision option. I think your sketch is great! It explains it really well... thank you!
I guess not having to cut all the way around the nipple would help the nipple keep blood flow and be more likely to live.
Is the scar hidden in the aeriola line?
It’s good to know that it can remove a considerable about of skin with this method as there is a bit to remove.
I will definately sk about this option for me. Thanks again
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Hi Lalala1,
A lot of skin can be removed and the nipple brought upwards. A skilled surgeon needs to do this as the blood supply to the nipple is underneath.
I had a Breast surgeon and a Plastic surgeon working together.
A small section of both of my aerioles became necrotic and had to be removed.
The scar is hidden in the aeriola line.
My reconstructed breasts look like this. I am very happy with them.
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hi everyone, I'm trying to go back a bit on this thread but apologize if I miss understand a few things. First, mominator are you an art professor??? AWESOME drawings. Maybe hallmark should contact you.
I will share a tip but not sure this applies but maybe it's worth bring up to your PS. I had nipple sparing mastectomy, inframmary incisions. 5 weeks post final exchange. They do feel alien still but we are getting used to each other. Not sure this applies to revisions after initial mastectomy or not but....The PS put on an inch of nitropaste covered with tegaderm on my nipples at end of surgery. It is a vasodilator which helps with blood flow to the nipple. Genious! However I still got the systemic side effects for about a day ( lower BP, headache) but it wore off the 2nd day. I removed the tegaderm on day 3. Just thought I would throw that out there. Just not sure if it is done maybe only at initial surgery but if you are trying to save a nipple I would think anything that improves blood flow would help. The surgeon doing the mastectomy is responsible for maintaining blood flow so they must be skilled. Of course we all bring our individual conditions too. Ready..if you are out there..cant remember which thread..maybe you can ask you NP neighbor if she has heard of this.
Becky, I'm still getting used to the implants. They just feel a bit heavier which I'm trying to get used to but yes it is better. I am pre pec also so the TEs were not too bad. It does seem like pre pec is definitely becoming more common
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Pre pectoral exchange yesterday with new PS. He was so trustworthy and I had near no fear going in in comparison to mastectomies. It's painful where he had to do some revision work on the right but really manageable so far. I know what to expect this time so I'm not afraid of every little twinge. The new incisions feel the same but not as raw all over as with the mastectomies. Had a long drive home, medicated up and just was so happy to be going home with maybe my final set for awhile. I can move my arms around far more than after the mastectomy. Have to sleep on my back till the drains come out but he expects that will be in less than five days.
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Bcbc, my TE's were also under the muscle. Towards the end of the fills they were soooo uncomfortable. Yes, you will feel so much better after the exchange. It will take a while because of the surgery and getting used to things but they are much softer and less constricting. I had lots of spasms after the last fills. I got Valium for those which helped a lot. I think I also regularly took ibuprofen those last couple weeks.
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Thank you DebAL. I think I'll be able to tolerate heavier. Just really tired of this constricting feeling and muscle spasms.
Nursepatient, I so appreciate hearing how much better it typically is post exchange. I was often miserable during the first 8 weeks post op. I, too, am a nurse but had no idea how difficult this surgery would be. Gabapentin is my friend. It's made a huge difference in my comfort. No additional pain meds needed for the last four fills. I still hate the TEs, but I can live with them until exchange. (As long as I'm much more comfortable then. 😊
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DebAL, you're too kind. I am a musician, not an art professor.
BS/PS also used about an inch of nitropaste on my nipples at end of surgery. Yes, it is a vasodilator, and it probably helped with blood flow. My nipples and aeriolas were questionable during surgery.
I also got the systemic side effects, very low BP, about 40/** for me. That's not a typo, they couldn't detect the lower number. (I usually run between 90/60 and 120/80.) They kept me in recovery room for several hours, pumping me with IV fluids. They eventually sent me to the cardio unit instead of the surgical unit so they could monitor my BP.
Lalala1, and DebAL, best wishes on your exchanges.
rachelcarter, congratulations on coming over to the squishy side. Did you drive yourself home from your exchange??
Mominator
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chiming in here with a question about sub vs pre pectoral implants. My PS said that my skin was too thin (presumably due to a pre cancer breast reduction) to consider pre pec. I’m not really sure why my skin would be thinner because of that but I’m no doctor. Also, I’ve read that sub pectoral is better for mastectomy because there’s no breast tissue between the implant and the skin? I guess it’s a moot point for me because my expanders are already in place, but I wondered if anyone could help me understand.
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I don't know a ton about this but my PS told me that there is always at least a thin layer of fat under your skin, so there is something there, but may not be deemed an optimal amount. Obviously, the less fat, the more “visible" the implant. With pre-pecs, the PS will use something like Alloderm to create the implant pocket. I think the choice between pre- and sub-pectoral implants is at least partly based on what your surgeon is used to doing, how much distortion might occur with sub-pecs based on your lifestyle when you lift your arms, and how a pre- or sub-pec placement works with your body type. If you really want pre-pec placement, find a Dr who will talk it over with you instead of dismissing it out of hand. Pretty sure you can change placement at your stage if your Dr is willing. Depending on how yourTEs were placed you may need some muscle repair.
Fat grafting can add more fat/padding to the chest if needed.
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Three days out from implant exchange. Pocket revision area hurts the most. OUCH! Arm range of motion much better than after mastectomy.
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I had my exchange from under the muscle to over the muscle last Friday. My PS said my pocket was way too big clear around towards my back so he had to make the pocket smaller with lots of reinforcement stitching on the sides. Now I have a big dent on each side right under the armpit and pushing into the implants. My ps said we could maybe release some of the stitching or do fat grafting after the new pocket heals, maybe 6 months from now. Anyone else had this experience, it's like the outer third of the breast is dented in.
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Thanks for the info Lanne. My doctor does to pre pec as well, but said I wasn't a good candidate. I'm going to proceed with his advice for now.
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Crawfish,
My PS was going to do direct-to-implant prepectoral reconstruction (his suggestion, I knew nothing about any of it) but said he wouldn't know for sure until the surgery if he could do the direct to implant. He wasn't able to do the direct to implant so put expanders pre-pec. Went into my exchange surgery with the understanding I would have prepectoral implant, get more alloderm and have fat grafting done at same time. When I woke up from exchange my implants were subpectoral. It ended up, the way my skin stretched on the cancer side it was just too thin for pre pectoral. While it wasn't what I expected I definitely trust my PS. Just letting you know, it does happen, skin can be too thin for prepec.
I see you from NC too.🙋
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Thanks for sharing, Sitti. My surgeon said the same thing about deciding at time of surgery, although he was pretty sure he'd be going the sub pec route beforehand. If you're in NC too, I wonder if we have the same surgeon?
How did you weather the storm? We came out unscathed, thankfully.0 -
ANYONE GET IMPLANTS AFTER RADIATION MANY YEARS BEFORE, WITHOUT A FLAP?
I'm ready to start thinking about my future exchange surgery. It will be in January, no sooner. I just finished chemo last week, and I have some family obligations in November and December. So, by January I'll be well recovered, and ready to face the swap surgery.
I have TE's, below pecs. Skin too thin because of radiation scarring on right side to be a pre-pec candidate. My right side has scarring and therefore a compromised blood supply from 2003 radiation. After my BMX in May 2018, it took 8 weeks for right side (horizontal, NNS) incision to heal, and left side took just 2.5 weeks. NO INFECTION, just slow. Of course, right side now has had its lumpectomy in 2003, then radiation, then the 2018 MX, and both times there was lymph node excision. In 2018, that was via the same breast incision, and in 2003 it was a separate axillary incision. Radiation causes scar tissue in the whole breast. The right pec won't stretch happily--it's also scarred. So, my right pec feels much tighter than the left one. Left side: skin expands happily. Right side: skin and pec complain and do not like stretching over TE.
I've gone slowly on TE fills. 200 ccs were put in right away at surgery, on each side, and eventually in August I had 2 more 50cc fills. I might just stop.
The incision for Exchange-to-implant surgery will certainly, again, have slow healing, because the blood supply is compromised. And, now I worry: the more saline we add, the more the blood supply is likely to be compromised. At least, that's my own logic. I'm wondering whether scarred / irradiated tissue can add vascularization--I will continue to try to get my PS to weigh in on that. Seems like a relevant fact to know. So far, he's been vague, which might mean that it's different for everyone, of course, or that he doesn't think it will change how we proceed.
Has anyone had this type of implant / swap experience, with a long-ago (15 years) previous radiation affecting the reconstruction decisions and healing?
My concern is wondering whether having now stretched the skin a bit (300 ccs in TE's that can hold more than 500) and might end up A/B cups at this point....should I stop? PS wants me to be "happy with how I look in clothes." I want to have the size implants that my skin can manage to heal over, so I'm perhaps done with tissue fills. I was 36DD before BMX, but I'm completely fine being smaller. To me, not healing well is a worse worry than small foobs.
My PS also pointed out something hearteningly positive to remember. I started chemo 4 weeks after my BMX, which certainly slowed that surgery's healing. So, since exchange surgery is less traumatizing, and I won't be also having chemo while trying to heal, he predicts that my healing will go better after the implant-swap surgery than it did in May.
If anyone's had similar experience, I'd love your stories. There's a high "complication" rate with cases like mine, and some PS's go straight to flap / donor site skin reconstruction and prefer to do that instead of trying to do implants without them, if there's been radiation. The high complication rate is up to 40%, depending on what gets counted. My PS hopes all will go well with our plan, and Plan B would be a revision surgery with a flap, if a simple swap to implant has healing issues, such as infection or failure to heal. Also, there's research that my PS refers to, which shows a reduced risk for all of this after more than 5-10 years have passed since the radiation, and that's in my favor.
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My doctor planned on doing a pre pectoral but then when I woke up they told me I didn't have enough skin or something along those lines so had to go under the muscle. I was so sore but don't know if it would've been better the other way. When I had my implant exchange they still put alloderm in. Now that I'm all healed up I have no complaints.
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HikingLady, I can't answer your main question, but if you do experience problems with healing, ask your Dr about hyperbaric oxygen therapy (HBOT). Also, load up on vitamin C!
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HikingLady - Here is some info on HBOT. A few ladies on the board below have just posted about their experiences
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Hiking Lady - you may want to read this thread about fat grafting the the radiated breast. I have no personal experience but have sort of followed this treatment.
https://community.breastcancer.org/forum/70/topics...
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Crawfish, I wondered the same thing about having the same PS. Like Nursepatient I'm pretty sure my PS also used more alloderm during exchange although I never asked. We are weathering the storm okay also, just lots of rain for the next couple of days. We are in the Charlotte area. Glad to hear you faired well!
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Nurse patient and Sitti, I really appreciate you sharing your experiences. It makes me feel so much better about my own. I'm going to look back through this thread to find more info about each of your exchanges (so I'm not that person who asks the same questions that have already been answered) as I'm curious about others who are in similar circumstances to my own.
Sitti, I'm in the Triangle, so I doubt we had the same surgeon after all.
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Drains are coming out tomorrow. I'm just leaving the ace bandage from surgery in place until the doctor removes it tomorrow. So the big reveal will be then. I'm trying to keep my expectations down because I know they will need to settle in and shouldn't be judged at least for a month or two.
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