Exchange City
Comments
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packergirl: I have Alloderm grafts and my lower pole was lifted at the time of exchange surgery. It is diffcult to know exactly what you are describing without a picture - so if you could post one on the picture's forum we could help you further. From a technical standpoint, I have read it is easier to correct an expanded pocket which is placed too high at the time of exchange than one placed too low. This picture [scroll down to see photo] should give you an idea of how the Alloderm is placed. You can see that there is significant muscle space lying below the Alloderm which can be modified/lifted if necessary. WARNING: GRAPHIC...this is an intraoperative surgery photo:
http://asps.confex.com/asps/2006am/techprogram/paper_10256.htm
Deborah
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ps... the link Deborah posted above is graphic.. ( shows surgery)... just in case anyone is squeamish....:).. I used to be.. this is why I bring it up.... LOL
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Laura,
My DH plays trumpet....not as cool as drums but great for the lips!
Candi
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~wink~
Only a musicians wife understands what you mean Candi!!!!!
~wink~
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Thanks Laura: I just added a "warning" to the link....
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Anyone else still getting a lot of muscle spasms? Its been 2 months since my exchange and I'm still getting a lot of pec muscle spasms. Not painful anymore like they were when I was getting expanded, but definitely noticeable. Of course, I'm thinking the worst and thinking great capsule contraction is just a spasm away...
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Yes...it has been 3 months for me since exchange and I still get contractions. When I wake up in the morning the underside of my foob is so hard that I have been thinking capsule contraction too.
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Whipettmom- THANK YOU. I would be happy to post a picture to get further help from you ladies! Where does one post the photo? I think your surgery photo was very helpful to understand where it is placed. Just looking at the picture, one would think it would be easier to fix something too low by taking away some alloderm verses something to high where you would need to add more allodern to get the length. My logic is odviously wrong tho since I have heard it is hard if not impossible to fix something placed too low. Any idea what I am misunderstanding. I am also relieved to know you had yours fixed during the exchange surgery.
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packermom: The pictures forum is an entirely separate forum which was set up by one of the breastcancer.org members. It is a very private site and protected as such so that women feel confident about posting their photos. You need to PM Timtam and obtain the password to get into the pictures forum. Here is the link to PM Timtam: Just ask permission to enter the forum - I don't mind if you tell her whippetmom referred you.
http://community.breastcancer.org/member/11047/message
Referable to the Alloderm: Well, the Alloderm has been grafted into your tissue and so none would be taken away. In some respects, your logic is correct referable to malposition of the expander. It is reportedly "more predictable" [I think this means better outcome] to raise the lower pole contour and the IMF [inframammary fold] level [this is all extracted from "Reoperative Plastic Surgery of the Breast" by Shestak] than it is to lower the IMF, which may result in a tendency for the implant to continue to descend with time - e.g., "bottoming out". However, Shestak states "it is EASIER to correct superior malposition" - an implant which is too high. I need to read this through again.... I need to just break down and buy this medical book - it is too hard for me to read it online.
Deborah
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QUESTION:
Do any of you who have had your exchange to silicone implants have itemized billing from your insurance company which lists the cost of either a set of or one silicone implant? You could PM me the information. Thanks so much!
Deborah
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Just an interesting thought:
Plastic surgeons tell their patients that they are taking various sizes of implants into the OR and trying them out and will give their patient what they feel looks best. Recently, two women received implants and were somewhat saddened to hear that the doctor tried an implant 25 cc's larger and it just did not look right. I have to say that this just seems so odd to me. 25 cc's is the equivalent of 5 teaspoons... I cannot imagine really much difference at all - surely not enough for a doctor to say, "it just did not look right." I hope that there is integrity in the OR. But it makes me just have this itty bitty question: Did they really try that other size?
Well, for one thing, they do NOT try out various sizes of saline or silicone implants in us at all. These are all registered medical devices - very expensive medical devices and they have a one time use. They use what is called an Implant Sizer. The Implant Sizer can be a one time use device or it can be a "reusable" device, which can be resterilized and used again up to ten times. The Implant Sizers are also expensive.
I just wonder how many plastic surgeons maintain a arsenal of all sizes of Implant Sizers and how many various sizes and styles of implants they keep on hand. Most of them order the implants from the Allergan or Mentor [or other mfr's] distributor as they are needed. I hate to be such a skeptic, but are they REALLY ordering all of these different sizes for us? They have to pay for all of the implants they do not use- they are not returnable to the mfr.
I don't know quite how we would ever be certain if there are truly two different styles and/or sizes of implants in the OR....or whether there are various sizers being used - or any sizers at all. It might be worth it to ask the PS to show you what the Implant Sizers look like and ask him if he keeps various styles and sizes of implants on hand in his offices or if he orders them "as needed".
Okay so this was just a "musing" on my part. I might be completely off base about this. I just feel that a great many breast reconstruction patients have so little control and so little input over this area of implant selection, as opposed to breast augmentation patients who rarely wake up from surgery to find they have smaller [or larger] implants than ever was agreed upon or understood prior to surgery. The surgeon would have to refund the patient's fees, if this were the case - or do the surgery over again at his own cost. Not so with breast reconstruction patients.
Okay....off my soapbox now.
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Wouldn't the surgical notes from the hospital say if they tried different sizes? I would think so. Everything must be documented. Of course, that doesn't help us before we go into surgery.
I do know my PS told me after the surgery that he had planned to use 375 cc's but the 400's looked better. I'm assuming he did try them both. The sad part is, I thought he was going to take in 400, 425 and 450. He never mentioned 375 to me before the surgery. Maybe he didn't try any other sizes. Maybe he just told me he was going to go with 375 so I wouldn't be disappointed with the 400's. I guess I'll request the surgical notes on Tues. and see what he did.
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Thank you mhm
Whippetmom, in my case I saw my OR booking and Operative note. They did order the implants of different sizes (OR booking and clinic notes), and used a sizer in the OR to decide which one to use. I was under the impression they could return the unused and unopened implants, perhaps I'm wrong.
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Deborah,
My experience is pretty much like kmmd's. At my preop I asked for the sheet of what my PS ordered for implants and the nurse photocopied it for me. He had quite a few ordered in different profiles. The morning of my surgery he did say that he uses a sizer to determine which one would look best. I don't know what he does with the unused ones. I can't imagine that they don't have some sort of program worked out with the mfr. for returns, or if there is a "shelf life" for the extra implants where they can use them for other surgeries....interesting question though.
Today is my unveiling so I will be doing that pretty soon. I'm nervous....this is what we all wait for and hope that it's a good ending to all the BC stuff we have gone through....wish me luck!
Candi
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Me again.....well....from what I can tell my PS did a great job....my only disappointment is my size. I am fuller, but I don't feel much bigger. I was pretty small before. I don't mean to sound ungrateful, but for us less endowed women, the one silver lining in having this "opportunity" forced upon us was the chance to feel a little more Marilyn Monroe(ish)
As usual, my DH said the "right" thing. He said if they had gone any bigger it would have started to look less natural on me. I guess I was just hoping to "reward" him a little more for all he has gone through!
I have read about women feeling better about the results after the "fluffing." Can anyone share a little about their experiencing this? Does fluffing happen in all cases or is it just in certain circumstances?
Un-voluptuously yours,
Candi
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Candi, sorry you're a little disappointed. Your DH sounds like a keeper. Mine has dropped a bit in the last couple of months, but don't think its fluffed much. I was disappointed with the projection at first, but got looking at it more, and realized that the "base", cleavage, slope etc. of the new foob matched exactly the other side, the "tip" isn't there. Figured PS can't do much about the fact that the nipple and surrounding skin that make that tip and projection look the same. Sounds like some others got more of a natural shape and less of a hamburger bun look with time, maybe they will weigh in.
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((Deborah) I don't know for sure if my PS took several implants in to the surgery. I do know that I was replaced with a 500cc implant (Mentor moderate profile), the exact replacement of the 500cc filled TE. He placed a 275cc implant on the other side which was the volume taken out at the time of the mastectomy. I am smaller on the mastectomy side, but I don't know if that is texture difference and/or the missing nipple, I will ask him when I see him in 2 weeks. Deborah, I have a friend that was the IT manager for Mentor in Santa Barbara up until a year ago. Tony may know or can possibly find out what the reimbursement rates for the implants are to Mentor from different insurance companies.
KMMD! You put a word to it, Hamburger buns! I was hoping for more projection,but they are full, but somewhat flatter than what I was hoping for. Maybe when/if they settle and drop they will pop out a little more. I think when they add a nipple that will balance the look a little.
Happy exchanges for jrgolomb, Lisa810, snoopygirls, and DV80 next week, can't wait to see how it went for you all. Jan
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Candi: I am so glad for your words about what a great job your PS did for you. Referable to "fluffing" - it occurs more with complete submuscular placements - to a lesser degree with most partial submusculars. If I recall, yours was partial? Mine are partials and they do look a lot better than they did in the photos a week after surgery. But the key question is: Do you have good symmetry? Are you happy with that? Would love to see pictures!
Firni: I suppose that is the crux of it...a patient is under the impression, based on conversations with the PS, that certain sizes will be brought into the OR and then after surgery it is learned that entirely different sizes were attempted instead. How to address that...we need to figure this one out....
Re: Returning unused/unopened implants: My PS said they stocked plenty of the Allergan Style 20's, and if I wanted the Allergan Style 45's, she would have to order them. She said, "I want you to be sure, because if I order them and we don't use them, we are stuck with them." I think it is b/c it is a registered medical device and that device has been recorded as having gone to this physician. I doubt they can be returned.
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Jan: That would be fantastic - if you could get that information re: Mentor's pricing for silicone implants.
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Deborah, I just got off the phone with friend, he stated that he didn't have actual cost information as he was the computer guru, but did know that the wholesale cost was about $500.00 for saline implants and $1000.00 for the silicone implants as of July last year. Mentor was purchased by Johnson and Johnson about 10 months ago, but he doesn't think that the prices went up dramatically. He stated the only way to find out what was reimbursed rate is, if the hospital billing could provide it. Most insurances pay by the procedure factoring in all of the usual costs and it is up to the hospital to negotiate their costs with providers and those costs vary widely. In theory, my hospital billed my insurance co. $2080.00 for each implant, and if the wholesale cost is $1000.00 (silicone) then the hospital made $1080.00 per breast. I doubt that Aetna paid $2080.00 each, but it would be interesting if I could find out. Jan
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Jan: Amazing! Simply amazing. So for a set of implants, it would have been $4,160.00. In Oregon, it would have been $7,000.00 - Karen....is your jaw dropping? But Mentor was purchased by J&J? How interesting that they are getting into the breast implant business.
Thank you so much for investigating this for us!!!
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Deborah, quick question, how do you know if you have complete sub-musculars or paritial sub-musculars? In reading my surgical report it states that the subpectoral pocket was created. It sounds like I had full "unders" so mayby I will "fluff" some. I did ask the PS after the exchange and I thought he said they were full unders. Thanks again! Jan
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Jan, a completely submuscular placement is partially under the pectorals and in the lower 1/3, completely under the fascia or connective tissue and upper rectus abdominal muscle. In partial submuscular, the implant is partially under the pectorals in the upper pole but the remainder is under the skin only or under the skin and Alloderm. Typically, if you have Alloderm grafts, you have partial unders, as Alloderm would really not be needed for complete submuscular placement, unless there is some skin integrity issue which needs addressing.
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BREAST AUGMENTATION COSTS:
This link will show you that surgeons in various parts of the U.S. are charging between $4,465.00 and $6,200.00 [I just checked the first page of this link - some might be lower or higher] for breast augmentation. This includes the cost of the implants, the surgeon's fee for placement of the implants, the facility cost and the anesthesia costs. Now hospital charges would be much higher than outpatient "facility" costs, but we can gather some idea of the difference between the actual implant cost alone as billed for breast reconstruction vs. all that is covered in breast augmentation. It does not appear that the PS is marking up the implant cost for the augmentation patients. Why this incredibly elevated charge for breast implants to insurance companies for the reconstruction patients? This is perplexing.
http://www.realself.com/question/breast-implants-how-much-should-they-cost
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Deborah, that is very interesting. My exchange surgery bill says:
Ambulatory Surgery $4,157.00
Ambulatory Surgery $4,157.00
Ambulatory Surgery $3,353.00
Ambulatory Surgery $3,353.00
Supplies-Implants $5850.00
Total cost for ambulatory surgery at a surgery center, not hospital is $20,870.00. (Still fighting insurance to pay it.)
Candi, I posted pictures the day after my exchange. I think they're on page 4 now. I was really disappointed too. I actually was a cup size smaller than my TEs. That was 3 months ago. I have fluffed and dropped some and gained a little in size again. But 60cc's in volume and 1cm in projection is a huge difference. ( the difference between TE and implants and the difference between my being satisfied and wistful ) I do still have that flat spot on the cancer side where the nipple is gone. And the scar gives me a kind of boxy look at times. The right side has some issues and PS wants to do some revisions on that side. He wants to open up the pocket a bit on the outside and below so the implant can settle and look more like the other side. He's also going to remove the nipple on the right side. Unknown to me, BS decided during surgery that nipple sparing would be good on the prophy side but he took the bottom of the aureola off during the MX. Trying to move and repair it will most likely cause me to lose it anyway. Besides, the whole idea of the bi-lat was to get rid of the breast tissue, not leave some behind. Anyway, I did drop and fluff and there is a big difference between the day after exchange and today. I am happier. I'll post some new pictures in a few days when DH goes back to work. Don't give up hope.
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Ladies,
How long after exchange were you allowed to get back to exercise? Beyond just walking.
Thank you! Happy Sunday to all!
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Firni,
Thanks for the info. It's nice to hear of others experiences and that time is needed for final results. I'm sure mine need some "settling in" time. You're current pictures look great. I'll look forward to seeing you future posts.
Candi
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Deborah, I PMd you again. Yes, my jaw is dropping.
Laura, I was released by both the PS and Onc/gyn at 8 weeks. My PS made me wait 12 weeks after MX! Back on the elliptical, stair-master (not back to rowing machine yet) back to weights--get this in October I military pressed on a bad day 70 pounds, now I can only do 15, but I'm back at it. I added the pool on Friday and think it is a great idea for me. I do water running for about 20 minutes, then kick-board until I can't do it anymore, then breast stroke, and some stretching. I can feel that my chest is tight doing this, but my range of motion as improved in just a couple of days, and I feel my whole body getting engaged--remember my abs are messed up from the hyster, so engaging everything in the water is GREAT. I want to get back to yoga, but can't because of the trial I'm in, I cannot participate in yoga until August.
My PS gave me one caveat, try not to do things that engage the pecs too much. So, there is a lot of weight training I won't be doing, or will modify.
I hope this helps.
Elaine--I hope you are healing well.
I can't remember if I posted this, but this is what I'll be doing at work this week http://www.stccmop.org/education/K12/oceanobservatoriescamp
This is my little corner of the Center http://www.stccmop.org/education/K12
If I've shared this stuff already, sorry, exhaustobrain, and I'm happy about all that is going on at work, just need less stress while getting it done, and a 4 day work week at the same pay rate would be really nice.
Ladies of the week, thoughts and prayers with you
7/8 - jrgolomb - Exchange surgery
7/8 - Lisa810 - Exchange to silicone implants
7/10 - snoopygirls - Exchange surgery
7/10 - DV8Q - Exchange surgery
My PS gave me one caveat, try not to do things that engage the pecs too much. So, there is a lot of weight training I won't be doing, or will modify.
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hey Laura I hope u had a great 4th
My ps usually wanted me to wait 4-6 weeks
I do think I may have started biking after 2 weeks (just road bike no crazy single track riding) than I saw her and she said she would rather I wait even 4 weeks for biking if I remember right
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Oh my.. if I have to wait 6 weeks to work out... it will set me back so much... BROTHER.. it seems like it is ONE STEP FORWARD TWO BACK ladies... no wonder we have had times staying supper positive all the time...grrrrrrrrrrrrrrrrrrrrrrrrrrrrr
Anyone able to work out in a few weeks????LOL Linda.. Sandy.... Tracey. ..ANYONE...hehe
Also... I was told to bring my zip front sports bra to surgery, as He will put me in this after, and he wants me in it 24/7 for a WEEK. Just a week. I asked him if he meant a few strong weeks.. and He said no.. it is not needed. ANYONE want to comment on this?
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