Exchange City
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Hi all
I don't know if I really belong in this thread - I started reading this thread because I thought it was about having multiple surgeries between BLMx and implants. I had BLMx with TE for DCIS in 8/08. Incisions didn't fully close so both TEs were replaced 9/08. Next, left TE was out of place and thinning the skin threatening to poke through so both were replaced 11/08. Inadvertant puncture of left TE led to its replacement 1/09. Reached TE capacity 4/09 but felt they were too small, so replaced both with higher capacity TEs (I started off with DD and wanted smaller than that but protruding more than my fat belly - otherwise I felt like I looked pregnant, which is something I never got to be, so that look just torturesme on a daily basis). Anyway, I had exchange surgery in 8/09, but as was typical for me, incisions didn't heal and implants were removed and TEs put back in 10/09 and TEs swapped again 1 week later when incision totally opened. (Every time I had surgery there'd be a few spots along the incision that would reopen/not close, and seroma would leak out. First time was Labor Day weekend a few weeks after initial surgery. All of a sudden, fluid just came pouring out - scared the crap out of hubby and me, sopping it up with first tissues, then TP then sanitary napkins and went to ER with a roll of paper towel. 9 hrs later everything had leaked out and they sent me home and I saw PS and we scheduled the 9/08 swap. When leakage occorred after subsequent surgeries, I thought it was typical, or at least status quo for me. The holes all eventually closed/leakage stopped except for post implant, where the hole was getting larger.) So where am I now? We used drains on the second 10/09 TE swap and did nothing for weeks to ensure no leakage and no holes. Fillups would be quicker because skin had already been expanded. Right TE has about 700ccs. Left TE was accidentally punctured and is flat. However, I'm now in a lopsided holding pattern because I felt a hard spot where the drain had been. BS said it felt like scar tissue but he took a sample anyway, and it was cancer.
Surgery 12/ 7 to remove lymph nodes under right arm. I start chemo 1/7/10.Sorry if this is repetitious for you vets, but I can't go through 305 pages of posts and I have a few questions from the few pages I read :
Texas 357 - why did you have so many surgeries?
BigApple09 - what happened with the heating pad? How are you doing now?
Anyone - what does CC stand for? What is meant by implants fluffing and dropping? What is the cream that helps heal incisions? What massaging/exercising should be done and how long after surgery?
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Hi CherylinSI
Wow you have been through a great deal.
A cc metric unit of volume equal to one thousandth of a liter.The fill volume of implants/expanders with liquid are measured by the volume of the fluid not the weight and the cc gives the most accurate as it is a smaller measure. For 410 gummy they go by weight as they are more like a solid than a substance.I think that they use gram which is equal to one thousandth of a kilogram .
I don't know that any cream other than an antibiotic is recommended on an open incision, and I would check with the doc before applying anything to an open area,most products say not to use on open/broken skin,mainly because of infection risk as the contents of the container are contaminated each time you touch it.
Fluffing and dropping is when the implant seems to fall into a more natural position than the expander as the muscles adapt to the new device.The fluffying is likewise as the area relaxes and accepts the new devise the swelling recedes and the implant is less constricted and appears somewhat fuller and more natural.
Massage and exercise is dependent on your body,your implant and what your doctor says. I have been told no exercises that can build chest muscle as it might displace my implant or actually push them out of the pocket in the muscle. This may be because I have a small frame and a narrow chest so there is no room to play. I did do PT and was shown stretching exercises with 5 lb weights, but again not to build muscle. I was told yes to massage my gummy implants because I had so much muscle tightness and pain,but others have been told no massage on a gummy..I think there is no general rule as all of us have different medical histories and our bodies heal and do things differently.
The heating pad is a tale of woe.Fell asleep with it on my abdomen,a corner appears to have had contact with the radiated skin on the bottom of one breast and burned it.I was healing fine,using silverdene cream, I went to the Dr on 12/11 and woke up on 12/16 with a raging infection was admitted to the hospital and lost the implant due to the infection. .
Wendy
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Hi Ladies;
I just had a revision surgery 48 hrs ago, after my first exchange resulted in a ruptured incision and pectoralis muscle tear. Seroma fluid was the culprit (just 6 days after the original surgery-Nov.24). It was a lovely mess when it ruptured at work (second day at a new job, to boot). The implant was partially exposed for 23 days and we staved off infection with 4 courses of anti biotics. Finally, repair!!!! The implant and pocket were washed, and the necrotic skin incised off. The implant went back in, as well as a drain this time(but just for 72 hrs). The output of drainage the first 18 hrs post surgery was 200cc's.It has dramatically reduced now - which i hope is a great sign.
My surgeon was shocked at the fact that i developed SO much B/L swelling and seroma fluid at the first exchage, but said some people just do. During the 23 days waiting for surgery(long story), the incision continued to drain seroma fluid and the skin failed to close and heal. On suggestion from Whippetmom, I experimented with increasing my protein levels to reduce the production level of seroma fluid. Amazingly, it seemed to help. The first night I increased by 50 g of protein and the seroma fluid reduced in half overnight.
Needless to say, I am supplementing now (2x's 28g / day). My output of fluid today is only 45cc. THATS amazing! Coincidence? .... I don't know or care, but it makes sense to me. I tended to only consume fruit and vegetables as i recovered from surgeries and neglected the obvious protein foods (eggs, meat, nuts, dairy etc).
Thought i would contribute that info.... at the risk of scaring anyone from what should be a staightforward, happy tjime of exchange.
Thank God for the opportunity to learn from posting here!!!!!!!!!!!!!!
Hugs to all,xoxoxooxoox
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Hello Ladies
WOW - I missed a lot today!
intrasite gel - is the gel that you have to get from the pharmacist (not prescription - just behind the counter) that my PS instructed me to use on my open nipple incisions when the sutures were removed and had a hard time healing. I still use it daily on the incisions so that they keep healing nicely.
I definitely need to do the mani / pedi thing this week! I am having a hard time reaching my own feet!
cherylinSI this is the perfect place for you - OMG you have been through so much!
CC might also mean capsular contraction if it is used in a different context than a unit of measure.
I have now started with Aleve for pain relief... Advil yesterday and the day before made me queasy and I know I took more than the allowed dosage. I might have to resort to wine & lortab to get through the night. I am driving home tomorrow and being home will help with the comfort level. I can not tell you how happy I am to have this week off from a fill.
Geena - How are you doing today?
Wendy - You are such a source of information and compassion. I wish you a speedy recovery! My friend who was the victem of a heating pad will have her TE removed on 12-31. I think she will get a second opinion before starting over.
Have a good evening everyone!
p.s. Sherlock Holmes was a good movie - I think there was so much going on that it is one to watch on DVD a few times.
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Thanks Wendy and musiclovermom for your info. I knew cc as a measure but not Capsular Contraction. What is that and how often does it happen?
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Wendy ~
I beat you to it on that mani/pedi!!
! I went this morning! I also had my hair colored & cut!! It was SOOO nice! Got a gift certificate for my favorite salon from DH...he's sweetheart!!!CherylinSI ~
Welcome!!! We are here to "listen" so bring it on when you please! Repetitous? We all tend to go back & forth on all issues...eventually everything gets addressed by someone. We are all here for each other!!!
NAE
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Cherylin -- Capsular Contraction is when the capsule surrounding a breast implant tightens or thickens, causing excessive firmness and distortion of the breast shape. As I understand from reading here, everyone has a small degree of this but it becomes a cause for concern when it becomes too tight or thick. I'm sure there are others who have had this condition (and fixed it) who can give you more details.
Sorry you've had such an ordeal! I am wondering: did you not have an SNB (Sentinel Node Biopsy) when you had your BMX? I thought that was standard procedure... anyway so sorry for the additional cancer diagnosis.
Lilah
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I got in on the pedicure craze today, courtesy of a sweet niece! My nail color of choice..."Wild Thing"..roarrrr!
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Mmmm yes! Ditto on the kudos for the mani-pedi idea -- I haven't had one since before I started chemo! I'm thinking it is getting to be time
Cheers,
Lilah
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Lilah -
I did have SNB - 2 nodes were taken at that time and both were clean. I'm wondering where they were physically in relation to the one I felt. Was it there all along and the dye/tracer just didn't go there? Was it right next to the 2 that were taken and if BS had taken 3 they would've found it initially? Or is this something new ? I had multiple checkups along the way from BS, who poked and prodded lymph area each tim, most recently in July, and this showed in Nov. How bad i that fo growh rate?
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I don't know the answers Cherylin but am bummed out for you that it happened. These all seem like excellent questions for your Oncologist. I see you are HER2+ ... I was put on chemo for being HER2+ (I did have one node but was told I would have chemo regardless due to the HER2+)... so I'm wondering why you weren't. Or am I misinformed? (All I know is that the day of my second lumpectomy, also the day of my SNB, my BS said that I would have chemo whether I had nodes affected or not because of the HER2+). I did chemo immediately after second lumpectomy and just had a UMx (right breast). SO sorry that this happened to you. Hang in there.
Lilah
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Cherylin, so sorry about all of the problems you've had! At this point, after treatment, you just want to get this done and get back to your life, right? What's going on with the accidental punctures?
You asked, so here's the list of my surgeries since 10/08:
Oct 08: Left mastectomy/SNB, Tissue Expander implanted
Nov 08: Chemo port installed
May 09: Chemo port removed
June 09: Bilateral surgery on tear ducts, which scarred shut due to chemo. (Didn't work, my eyes still water all the time.)
Aug 09. Prophylactic mastectomy and TE on right side (ALH found -- good call to get the surgery!)
Aug 09. Rushed back into surgery later that evening due to heavy bleeding.
Nov 09. Exchange surgery with bilateral silicone implants
Dec 09 Implants replaced with smaller ones after left breast (radiated) incision opened, Necrotic and scar tissue removed.
I'm about 1-1/2 weeks post surgery, and my left breast already feels tight again. I'm terrified that the implant-only route won't work for me and I'll need the LD Flap.
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Texas -- What's the reason you decided to get the prophy on the right side 10 months later? And what is ALH?
Thanks,
Lilah
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All this talk about intrasite gel, thought calmaseptine should also be mentioned. It's great for using around your drain site. It protects the skin and keeps down bacteria. I work in home health care and all of our nurses call it the "miracle cream". They use it on stoma's all the time. You have to ask the pharmacist for it but do not need a prescription.
Cherylin, Wow, what a story. Have you asked your BS all the questions about possibly missing it the before? It won't make much difference to know now but still something you need for peace of mind.
Geneskirt, Thank you, thank you, thank you for the protein advice. My BMX was in September and swelling was never ending in the beginning and still when I go in for expansion I always have some seroma leak through the needle hole for a few hours after. I will definitely make sure I up my protein intake before exchange next month!
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Lilah,
I had ILC and multi-focal ALH in my left breast ... which gave me a better than average chance of it showing up on the right side. I decided I couldn't live with the anxiety and worry, nor did I want to go through the chemo/radiation again if I could lower the odds even a few percentage points.
Also, I have a mild case of lymphedema on my left side which limits the use of my left arm. The prophylactic removal of my right breast meant I'd never risk needing the SNB on the right side so I'd never risk losing full use of my dominant arm.
What's truly ironic about my decision is my oncologist's reaction. He'd been adament that the 2% risk reduction of AIs vs. tamoxifen was significant. But he blew off the 98% risk reduction of contralateral breast cancer as not being all that much.
As it turns out, the ALH and ADH they discovered in my right breast would have meant more monitoring and more worries at the very least. I'm thrilled with my decision.
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Wow! This site jams with the speed of light...
CherilynSI - Yes, sounds like you have many questions to ask your doctors. I always bring in a list, put it down on the exam table, wait to sit on said table until the doc comes in, then when going to sit on the table tell her "oh! I have these questions I need to ask you before you go..." What a rigorous journey you've had!
Geneskirt - Yes, I too am making note of the protein advice. It is something Deborah mentioned to me once too, and as a vegetarian it is something I need to stay more mindful of myself.
Texas357 - I think I've decided if the implant route doesn't work for me, I'm done. I know my other choice (and my PS's preferred choice) was the LD Flap - and I just don't want that. Of course I say that now. I always said if the surgeries for implant reconstruction became too many I would quit. Now, not so sure. I guess you never really know what you'll do until you're in those shoes.
Musiclover and all - I'm doing OK. The scab is getting thicker and the capillaries around the site are less red, more pink. I'm simply avoiding all movement at this point. I think my expanders have rotated so much, that they are stretching areas of skin just not able to stretch anymore. Calling doc today.
Wendy, Lilah - So wonderful of you to respond with so much care to our new members....
JuliemPW - I've made note of that cream. Thanks!
I'm not on for the rest of the day - taking a day to myself to do some art and to put some serious thought into "what next" for myself vocationally, money wise. Things haven't been going well on a number of fronts - just getting by financially, work is so stressful, not a huge fan of Providence, good friends here but no partner and I hate the cold - I really need to put some quality time into reassessing things. Sooooooo.... a day away. I'm sort of stuck a bit until surgery is complete - dont' want to go moving to another state right NOW, but I want my brain to start considering other options... solitude and quiet and some reflection are needed...
Wishing you all a beautiful Sunday and healing thoughts...
Peace,
Geena
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In looking at the photos on the other site, it seems that people either get hp or moderate. Has anybody had the moderate plus. I think my last expansion will be on Tuesday and I'm expecting that my PS is leaning toward MP.
So far it seems that most people are happier with hp than moderate but I'm wondering where moderate plus fits in and how hard I should argue for HP. Will it make that much difference to me in the end?
Julie
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juliempw- I have had both silicone and saline in the moderate plus. HP is typically used for women with narrow ribcages. Whippetmom (aka the breast whisper) can give you more specifics on when HP is used over Moderate or Moderate Plus. Moderate definitely wouldn't have provided enough projection for me (ribcage = 40 inches).0
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Julie: I do not know what your PS has in mind. Based on my research, the plastic surgeon should be selecting the tissue expander, based on the measured width of the natural breast - with the widest point being in the lower pole of the breast. When he selects this tissue expander, he should have a plan for the style and some range of volume for the implant he intends to use at the time of exchange. Here is a very important question. Does your PS perform primarily augmentations or is he KNOWN for performing as many reconstruction procedures on the breast as he does cosmetic procedures?
Finally: You CAN voice your concerns about style and tell him what YOU want! I would personally feel that if you have a ribcage 30 inches or less in circumference a high profile is usually preferable over the moderate plus profile. However, this is all predicated, as I stated earlier, upon the base width of your natural breast prior to mastectomy and the TE your PS has chosen for you. If you have a 13.0 cm width TE [which I believe you have] you will need HP's with a volume of at least 500 cc's to meet that width. However, your PS could use a moderate plus implant and only require 400 cc's to meet the 13.0 cm width. In some cases, if a TE which is too wide for the chest wall has been chosen, some significant pocket work can be performed to reduce the width of the pocket created by the TEs. However, most surgeons choose the TE width with a purpose, so finding out his purpose is key. Discuss all of this with him PRIOR to the pre-op appointment.
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abiwoman- I do have a question list and my sister-in-law always adds more (and sometimes better ones)
julie, mooretennis, whippetmom - can you clarify HP, MP and what site has pictures?
Has anyone else had their TE accidentally punctured during a filling? Anyone have TEs patented to resist this? Anyone have TEs where injection port is attached to the expander by a tube as opposed to being directly a part of the expander? I'm trying to find stats on the net but can't.
Cheryl (in Staten Island, New York)
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Cheryl: HP is high profile and MP is moderate profile, although most of us have either HP's or MPP's - moderate PLUS profile implants. This website has some fairly good descriptions....and for purposes of our discussion, the Style 20 and Style 15 in Allergan are the HP and MPP implants respectively.
http://www.lookingyourbest.com/breast/articles/BreastImplants/breastimplant-styles
Referable to tissue expanders - there are only four manufacturers who are used here in the states and two of them, very infrequently. Mentor and Allergan are widely used. Tissue expanders by PMT Corporation and SSP Corp [the latter TE developed by plastic surgeon - Dennis Hammond, M.D.] are rarely used. It is not that they are inferior - they serve a different purpose. All use magnetic port injection sites - which can be detected through the skin. If your PS knows what he/she is doing, they will find the injection site when it comes time for fills. Complications can occur but have a low incidence. Again...make sure your PS is experienced with breast RECONSTRUCTION - not just breast augmentation.
To gain access to the pictures forum, which is a totally private and separate forum apart from bc.org, you will need to PM Timtam and request an authorization for entrance. You are very new to bc.org and so you might need to wait a couple of weeks or so for entrance. We all had to wait...
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Cheryl- I am so sorry for all of this you are going through. You are in my prayers!
I can share with you. I had a DCIS in one breast but decided to take both (2 women in my family have BC). My BS took 5 nodes on the BC side and 3 on my good side. I asked her why (I was pretty mad at her at the time due to the lymphodema risk) anyway- she said it is her policy ALWAYS to take 3 nodes as to be on the safe side. She told me just taking one didn't give her enough proof that cancer wasn't there. I don't know why that is different than what other docs do and I do feel more at risk for lymphodema especially since both arms are affected. Anyway- I just wanted to share that info with you, for what it is worth.
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Any suggestions on what to put on a rash that's developing on both my breasts. Is there anything that I can put on before it gets worse? It's located in the same areas (above and below the length of the scars) that I had the bandages on and it seems to be a reaction to the tape that was covering the gauze bandage. My PS won't be back until Jan 5th so I can't call him.
Thanks,
Terri
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Terri:
I am super phobic now about any skin changes. Maybe take an antihistamine tonight but call a doctor or even pop into the er tomorrow to have someone look and make sure its just a rash.
Wendy, the newly phobic wonder
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Hi Ladies,
I guess this board may be a help for me. I am on my third TE. First one removed for necrosis and then the second one was removed after my lat flap surgery due to the MRSA virus. Well this one seems okay. I have had my third fill and all is going well. I had my good breast lifted at the time of my lat flap surgery. The PS said he will match the new one to the size of the lifted one. I believe after three fills ( 60 cc's ) each time the breasts are almost the same size. Hopefully one more will do the trick. How do I know what shape to ask for? I believe the PS said that I will be a small C. Sounds right . Do I assume that the PS will know what is right. I do know that there are different types of implants. Any suggestions.
Ladies I don't need any sympathies .Despite having seven surgeries in a little over a year I have remained an optimist . I do believe my journey is coming to an end. Then I will have a new breast to match the other one and will only have to visit with the oncologist four times a year.
Any suggestions for size shape firmness etc would be greatly appreciated.
Hugs,
Francine
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LADIES.... I HAVE MISSED YOU !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Oh Lordy I pray you had the BEST CHRISTMAS.... POO POO Breast Cancer...
Mine was BUSYYYYYYYYYYYYYYYYYYYYYYYYYYYYYY ..
Grandkids ROCK!
I love you and miss you and look forward to being active again on the boards... as I love my sista's!!
DH is on Vacation till the 4th... sooooooooooooooooooooooooooooooo... We will be out spending WAYYYYYYYYYYYYY too much money for stuff we don't need.... ( which I HATE).. pray for me....hehe..
I will rejoin our God given EC thread soon... until then....... WAHOOOOOOOOOOOOOOOOOO
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Terri: I agree with Wendy - take a Benedryl. And use some OTC topical rash cream perhaps. And call the clinic tomorrow.
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Thanks for the advice...as luck would have it I don't have any Benadryl or the like so I'll go out tomorrow and get some. I have some Polysporin, so maybe I'll rub a bit of that on it and see what happens. If the rash doesn't go away in a day or so, I'll go back to the hospital.
Francine, welcome to our group. I'm sure someone will be able to help you. I'm by far no expert but there are some very knowledgeable ladies on this thread who can answer your questions. Best of luck to you!
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my560sel - after my first exchange I developed an allergic reaction to the tape used over my incisions. It eventually spread up my chest and down my stomach - the itching drove me crazy. My PS had me use Polysporin, he said that the 3rd ingredient in Neosporin can just add to the irritation. Hope it clears up quickly for you.0
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Cheryl, I am new to this forum and this is my 1st post. I had my rt TE accidentally punctured and I also wondered how often this happened. I had my exchange surgery on 12-14-09 and am hoping to get my drains out tomarrow. I am so sorry for all you have been through.
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