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One step implant procedure with Alloderm - Anyone?

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YearoftheHat
YearoftheHat Member Posts: 66
edited September 2019 in Breast Reconstruction

I had a bilateral mastectomy on December 1, not long after my dx.  I had to decide quickly about reconstruction and I think I've been lucky.  I was surprised to find a doctor in the middle of Nebraska who performs the one-step procedure with Alloderm. 

Has anyone else had this?  Have you completed revsion surgery?  I have not had revision yet and my breasts are well-positioned but lumpy.  My PS says all the shaping is done during revision.  I am wondering what other women have experienced.

My PS is very bright and seems perfectly capable.  He's even really nice, but it's so difficult to put my foobs in anyone's hands!  I am really counting on him to do a knock-out job with the revision.

I 'd love to hear what others have experienced.

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Comments

  • carolehalston
    carolehalston Member Posts: 7,876
    edited July 2009
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    That's the surgery I've elected--bilateral mx with one-step immediate reconstruction with silicone implants and Alloderm.  Nothing was said to me about revision or shaping.  ???

  • fortunate1
    fortunate1 Member Posts: 467
    edited July 2009
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    Hi YearoftheHat, I also had the one step procedure. I am very curious about the revision. Mine was only on one side, also beautifully positioned, but flatter. The PS and I are trying to figure out the next move, if any. I'd like it to be better, but am afraid to risk what I have. I do have a little "corner" I'd like to be rid of that I understand is easy to do.

    There is a discussion starting at ...."simple mastectomy, can I get immediate implants?".... with a few others who have had the same procedure. And I'm very glad to have you two to talk to if you'd like. Different is sometimes confusing.

  • Meg9
    Meg9 Member Posts: 306
    edited July 2009
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     I had one-step reconstruction in May "09. The reason I chose one-step was because there wasn't a second surgery. If there was I would not have done it.  At my last visit to the PS, the nurse said sometimes you have to go back to do a little "tweaking."  I'm not sure what that means because she also said that it was too soon to tell. There is still some swelling. What does the revision include? Will you have drains again?  Recovery time?  Right now mine are uneven in size and shape. I was thinking that was because of the swelling. I ave an appt with PS this wednesday. I will ask, but would like to know what your PS says. Thanks
    Dx 3/29/2009, DCIS, 4cm, Grade 3, /0 nodes, ER+/PR-, HER2-

  • YearoftheHat
    YearoftheHat Member Posts: 66
    edited July 2009
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    Carol, Fortunate, Meg - Wow!  I didn't see any responses at first.  I didn't realize anyone had posted here until today! I'm so glad I am not alone with the one-step.  It's not so common yet apparently.  

    I saw my PS just after I first posted this.  He said that all he really did with the first procedure was create the pocket and place the implant.  He did not do any 'trimming' of the outer tissues at all.  He said with healing sometimes those tissues will remold and take shape, and that if they do not it can be taken care of afterward.

    I do not know how to link this but there are 5 of my mastectomy photos on photobucket.  If you search "mastectomy" you'll get only about 30 photos total.  You can see who posted them by letting your cursor rest over the image.  Mine are all by 'coeurquibat' and you can double click to see my comments.  One is of my very large natural breasts after my lumpectomy but  pre-mastectomy. 

    My left breast has sunken down a little and he's going to create a better and higher fold on that side to lift it up.  That should help make the scars more symmetrical too.

    I'm also having him go with 600ccs.  I have 450ccs now and I feel flat.  I know it's tacky but I'm used to having more size.  He assures me that my insurance will cover that.  

    Otherwise, there is a lot of extra tissue along the sides which he will remove.

    He'll also sit me up partially and will use Alloderm to create the nipple and areola.  He will tattoo there during the same procedure.

    He said my recovery will be about two weeks and he is not sure if I'll need drians.  There will likely be an overnight stay but he does not have to do this in the hospital.  There is a facility at the medical center where he's located where I'll have this done.  

    I'm so happy I didn't have the expander hassle but I'll feel better when the final results are in, assuming they are good!  Losing your breasts makes you happy just to have your life but I'm glad I opted for reconstruction.  I'm very wary of flap procedures.  Muscles do very important jobs and shouldn't be taken out of commission, especially muscles that support the spine! 

    Thanks for the responses!  I didn't think anyone would ever answer!

    Nancy

     

  • okiegal
    okiegal Member Posts: 333
    edited July 2009
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    I had the one-step procedure with Alloderm on May 29, 2009. I didn't realize it was so "uncommon". I live in Oklahoma and have a forward thinking surgeon and plastic surgeon. I orginally was about a size B or small C. Didn't want to be any bigger. At 49, my skin was loose enough that I had enough skin to perform a one step procedure eventhough they removed my nipples.The surgery went great. I was in the hospital one day and went home with an "On-Q" pain pump which I wore for 4 days. Had drains for 2 weeks on one side and 3 weeks on the other (sentinal node biopsy). Glad to be rid of them.

    Although my PS discussed everything thoroughly beforehand, I was surprised to understand after the surgery that the surgeon "releases" a small portion of the pectoral muscle at the sternum. It really worried me for a while, but I seem to be getting back to normal. I'm still taking it easy with lifting. My PS says no weight lifting or upper body exercise for a while. I'm taking Soma as a muscle relaxer and probably will for several months. I'm also taking Percocet for pain. I have stinging if I don't take it. I'm also advised that I will be taking this for a while.

    Everything is looking pretty good. A little flat in front where the nipple tissue would be on a normal breast and one side looks a little better than the other. According to my PS, it takes 8-12 weeks for everything to "develop" to it's final shape. I am doing a series of implant massages twice a day for 5 minutes per session. No one has mentioned anything about a 2nd surgery. I am guessing that it's because, for me, I had so little skin to begin with, that there wouldn't be much to revise. Typically, I think the idea is to get it all done in "one step".

     On another note, my mother (DCIS, LCIS) had the same surgery 25 years ago without Alloderm (one step bi-lateral mastectomy/silicone implant reconstruction...they left her nipples). She's healthy and happy and doesn't have any regrets. Reports that she is 90% happy with the results.

     Finally, if anyone would like to correspond, I'd be happy to be part of the group.

  • fortunate1
    fortunate1 Member Posts: 467
    edited July 2009
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    So glad to meet you all. 

    I chose the 'one step' because I didn't want to sacrifice any well used, necessary-for-work muscles to make a breast. I think I might possibly have gone for a muscle sparing tram or diep if it had been offered, but it wasn't, and I was very concerned about muscle function. The 'one step', with no moving flesh around, no expanders, fast easy recovery, seems so kind to our poor traumatized bodies.

    I have a very nice reconstruction, that could be fine just as it is, but could also be improved. My PS wants to 'finish' it with a nipple and a bit of a trim of a little corner at the end of the scar that I don't like. The problem I'm thinking about right now is the flat area in front, and the skin being too tight to make a nipple. PS says that there's not enough skin to create a nipple without making the new breast even flatter. I'm massaging the scar, hoping that it will soften and let the skin stretch a little more. We're going to wait another three months and strategize then. Nancy, I'm curious about the use of alloderm for a nipple and areola.  

    Ah, I'm rambling. Each idea brings more questions, so I'm going to stop for now.

    Okiegal, Try to relax and wait. Your new breasts will change and settle in as you heal. The only second surgery that was mentioned to me was optional, to make a nipple, and that it would be a very minor procedure. You could very well be done already.

  • shuff
    shuff Member Posts: 1
    edited July 2009
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    I am trying to decide the reconstruction route...so confusing!  I have it narrowed down (I think) to either the diep or the one step. Since I am not very pain tolerant , the one step is appealing. I don't want to regret the decision though.  If you have had the one step...do any of you regret not doing a flap? ie. do you find the implants uncomfortable?  I have read where pople go back and after have the flap done in order to remove the implants ..which means more surgery..yuck.  But maybe these people have had large implants and tissue expanders?   Thanks for any advice!

  • YearoftheHat
    YearoftheHat Member Posts: 66
    edited July 2009
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    okiegal - It sounds like you have a good doctor.  It's wonderful to have medical people that you like and trust.  My revision is totally optional and I do want the nipple/areola reconstruction.   Like fortunate, I have corners at the end of either scar that I would like trimmed.  I think all surgeons are so different.  In my case, I know they wanted to minimize my time on the operating table which may be why he did so little at that point.

    I'm the only one on the Jan. chemo board whose had this procedure which is why I thought it was unusual but maybe it isn't so much as I thought - thank goodness.  I am happy to have you all to talk with about it!

    Fortunate - I didn't know there were muscle sparing flap procedures!  I had such a crash course in all of this after my dx, then my focus shifted quickly to managing chemo treatments.  Just like you, I was concerned about compromising muscle function and wanted to heal as quickly as possible.  When I first consulted with my PS I had no idea he did a one-step procedure.  I lucked into that one.     

    Shuff - this is such a difficult decision to face.  Personally, I do feel some discomfort with the implants but it has improved since my surgery seven months ago and it does not really bother me.  Really, I do not know if that is from the implants or just a result of having the mastectomy itself.  I've heard women say they feel like they have rocks on their chests with implants.  I don't feel that but it's like a general stiffness.  I met face-to-face with three plastic surgeons before I decided.  I really do recommend shopping around for one that you like, if you have time to do that.

    I've been on the January chemo board for so long - it really is so nice to be able to talk about this procedure with others who have had it.    

  • carolehalston
    carolehalston Member Posts: 7,876
    edited July 2009
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    I'm now scheduled for my bilateral with one-step reconstruction.  July 25th.  Here's hoping I can report back afterwards with good things to say.  I've read so many comments by women who've gone the TE route that the experience brings with it a lot of misery.  Plus the process takes months.  I really want to get this surgery over with and put 100 percent of my energy and focus into recovery.  I'm really grateful that I have my husband to nurse me through this.  He isn't squeamish like I am and won't mind emptying drains.  I really dread the drains after reading so much about them.  I dread looking at the incisions afterwards.  What a wimp!

  • jaelsne
    jaelsne Member Posts: 39
    edited July 2009
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    Hi--not to put a damper on your plans, as most people are successful with this.  My surgery was not successful (and I have an excellent ps--it's not his fault).

    I chose the one step procedure with Alloderm for the same reason most of us do--do avoid subsequent surgeries.  I had my surgery on March 24.

    I had been a good candidate for this, as I had a small tumor, and wouldn't need follow up treatment.  Lo and behold, I need both chemo and rads--and getting the implant in before rads is not a good idea, as rads shrink the capsule and cause deformation.  

    Two weeks ago, I developed some weird stuff going on with the implanted breast.  It had started to peel, and I had some white spots on my incision.  I rushed in to the ps, who sent me to surgery THAT DAY to remove the implant.  It had worked its way through the Alloderm and was trying to work its way out of the incision.  He said that it would have caused massive problems, and it would occur within a week.

    So--my chest is now very, very ugly.  I have a concave area near my breast bone, and two rolls of breast tissue everywhere else.  I will definitely need further surgeries, even if I decide to go the prosthesis route.  Meanwhile, I'll get through chemo, and rads, and live with this for the rest of the year.

    Not the most awful story--but my message is this...  If there's any chance that you may need radiation, don't do the one step.  I think that the rest of my story regarding the implant "bursting out" is pretty rare.

    Jo Anne 

  • YearoftheHat
    YearoftheHat Member Posts: 66
    edited July 2009
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    Jo Ann -so sorry to hear what you are experiencing.  I do remember now that my PS was very concerned about whether or not I would need radiation when I first met with him.   I know he would not have recommended the one-step surgery, and maybe not implants at all, if there had been a good chance I would need rads. 

    As it turned out radiation was not recommended for me.  It is true that the pathology from the mast. can indicate a need for radiation that might not have been determined from the original biopsy.  

    carole - I really did not find the drains painful at all.  They were just awkward and I had to stay aware of them all the time to make sure nothing was pulling at them.  Having them taken out was super quick and easy too.  I may have them again with my revision surgery and I'm not concerned at all.  They do look weird!  but it's so temporary.     

  • fortunate1
    fortunate1 Member Posts: 467
    edited July 2009
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    Yearofthehat- I had almost the same experience. I had a great deal of frustration working my way through diagnosis to treatment - long waits, delays, insurance messups, general confusion and the holidays in the way. I read the books I was given and educated myself as well as I could, didn't find these boards though. So I read about the flaps, but what I read wasn't up to date enough to include the newer flap proceedures as anything more than an advanced technique with a few expert surgeons doing it. The one-step was not mentioned at all. The PS I was sent to by my surgeon told me about the one-step when I stressed my objections to any compromise to muscle strength and function. He made no mention of diep or muscle sparing tram. He had been doing the one-step for a couple of years and had worked with alloderm in burn treatment. I wasn't really even fully aware of the difficulties of tissue expanders. So for me too, it was a crash course, few details, great pressure to get things moving ASAP- get this cancer out of me now. I lucked into it too. 

    Shuff- My implant is comfortable. I felt quite affectionate towards it immediately, if you can believe it, as a cancer free life saving new breast. The recovery was astonishingly easy. My sympathetic friends and family couldn't believe it.  That said, it is not the same as my natural breast. It is firmer, it is flatter. The PS says that for an implant it is very soft, and that the alloderm helps to avoid capsular contraction. I had the bad luck to have that strong pec muscle contribute to very active jumpy breast. However I am finally getting used to it and see it as more comedy than tragedy. This is such a personal decision to make, and so difficult. My surgeon told me that I would have a wave of relief when I made the decision, and was quite surprised that he was right. I do admit that sometimes I second guess myself, but I'm just like that, unfortunately.

    Jo Anne, I'm so sorry you are having a hard time with this. I've never heard of that happenning- very very scary. I did have a scare about radiation. The margins were pretty darn close to the muscle, but the radiologist said I would be OK without it. 

    Carole- The drains were the only problem I had in healing, and not much of one. Removing them was such a relief. It hurt, but was over in a second. I just snuck up on looking at the incisions, big black stitches for me instead of the tape I was expecting. My curiosity got the best of me, and then everything was fine.

  • YearoftheHat
    YearoftheHat Member Posts: 66
    edited July 2009
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    Even though I will go back and have another procedure, this requires so fewer trips to the doctor than those who have tissue expanders.  Comparatively, it is mich easier in that sense.  Even though Alloderm was used I think my skin was stretched quite taught with the initial surgery.  That was uncomfortable at first but gravity has done its job.  I am lose and soft and I almost even have some giggle now!

    My impants are covered by muscle over both the top and bottom I believe.  There is a weird flexing breast effect that you have with certain fitness activities, but I doubt anyone would notice unless they were really staring.  That was an awkward sessation at first.  If my muscles are tight then I feel it especially across my chest.  It is weird but you get used to it.  At this point I am just so glad for my life.  At first I worried these oddities would ruin the quality of my life but that has not been the case at all.  Now that I am dealing with them, they seem minor and worth it - just like all cancer SEs!    

  • carolehalston
    carolehalston Member Posts: 7,876
    edited July 2009
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    Thanks so much to all of you wonderful ladies for the sharing and the encouragement.  It's very helpful and makes me feel much less alone.  My husband and friends and family are supportive, but they don't know what it's like to be me in my current situation right now.  This is the first time I've ever felt this much a part of a sisterhood.

  • fortunate1
    fortunate1 Member Posts: 467
    edited July 2009
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    I second that. It is so good to find you all. I don't feel as unusual now.

  • Annabella58
    Annabella58 Member Posts: 916
    edited July 2009
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    Well, hello ladies this is sure a nice thread to find!  I am contemplating a prophy mtxmy on my non cancer DD girl as i have spent the last two years healing from a lat flap and cancer on my left.  I now have a nice C and a DD and i am sick to death of worrying about cancer in the other one!  So it's a prophy for me, and I certainly feel the same way towards my new girl; she's a pretty, life saving, boob.  My hubby and I felt like we were only stuffing new cushions on the couch...same old couch, new stuffing. :).

    I am so glad to hear about the one step!  i should be able to have it I believe as there is no cancer and the boob is too big anyway, so there's alot to work with there.  I'd like to keep the nipple tho, and i go to see the PS on Friday to discuss next steps.

    Anyone want to know about lat flap procedures, it's fine and I can give info!  No loss of strength, no issue whatsoever and it made an extremely natural looking boob.  Altho I also have the "jumping boob" thing, which makes a good party trick.  JK, but you have to laugh at parts of this stuff.

    xoxo

    annie

  • Meg9
    Meg9 Member Posts: 306
    edited July 2009
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    I saw my PS  today. I had bilateral mast and one-step reconstruction 6 weeks ago.  Today my PS said I did not have to wear the sports bra I have been wearing 24/7.  Yeah!  PS said to massage my breast 2x daily to break up scar tissue. This will also help to prevent capsular contracture.  The pain and pressure I have been feeling is all a normal part of the healing process and I can expect it to continue to feel this way for a while. PS explained that BS cut a large nerve near my armpits during mast and that it takes a long time to heal. My incision are even and are healing well. PS also said I can resume exercise.

    This was my first surgery. I had never been in the hospital before and I didn't know what to expect.  I don't think we have enough time to make these decisions.  Chosing the one-step meant no second surgery and that is why I chose it. I don't think I would have been able to go through the TE and other reconstructive procedures. I just wanted this over with as soon as possible. The one-step was the right choice for me, but this is truly a personal decision. 

    Thank so much for sharing.

  • carolehalston
    carolehalston Member Posts: 7,876
    edited July 2009
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    Meg9, I'm so glad your recovery is going well.  I hope I'll be able to write a similar post 6 weeks after my bilateral with one-step, scheduled for July 25th.  Thank you for sharing.

    What wonderful instructions to hear--resume exercise!

    How long did you keep the drains? 

  • okiegal
    okiegal Member Posts: 333
    edited July 2009
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    I agree, it's nice to have this little togetherness!

    Carole - My experience with the drains wasn't that bad, eventhough they were in for 2 and 3 weeks. It all depends on how much output you have. They are mostly an annoyance, not painful. Mine had a stitch that held them in place. Again, not painful, just an occassional itch. You'll need a blousey top if you want to be able to hide them when you go out in public. I didn't feel a thing when they took them out and as far dealing with measuring the fluids, there are much more disgusting things in life for sure. I'm thinking of messes with babies, dogs, people with the flu...don't want to be too graphic. It's amazingly doable and for me, I think being post surgery puts you mentally in more of a survival mode so that you can handle more than normal. Don't know if that makes sense. I think we are all stronger than we think. Or maybe it was the pain meds!

     Yearofthehat - that's funny that you noticed a little giggle! I was wondering about that.Something to look forward to!

     

  • fortunate1
    fortunate1 Member Posts: 467
    edited July 2009
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    Welcome annie, Love the comment about same old sofa, new stuffing. It got me and my jumping breast laughing.

  • TracyDenver
    TracyDenver Member Posts: 3
    edited July 2009
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    I had the one-step proceedure done about 6 weeks ago. So far, very happy with the results. There was some pain in the first couple of weeks but I am now back to doing full and normal activities. My plastic surgon told me it was not necessary to wear a bra - we you told the same? There are large indentatons on both sides (around the arm pit and side of breasts) where the surgeon took a lot of tissue away, so the plastic surgeon is planning to fill these area in with fat tissue as a secondary proceedure - did anyone else experience this? Thanks for any input.

  • carolehalston
    carolehalston Member Posts: 7,876
    edited July 2009
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    TracyDenver, how wonderful that you're back to doing full and normal activities 6 weeks after the one-step.  If you don't mind my asking, what is "full and normal" for you?  What sorts of activities do you enjoy?  I'm a golfer and am hoping to play golf again at about the same level once I've recovered.  I worry about damage to the pectoral muscles.

  • YearoftheHat
    YearoftheHat Member Posts: 66
    edited July 2009
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    Tracy - I'm glad to hear you are feeling well and pain free so soon after surgery.  I had the one step procedure about 8 months ago.  My doctor also said not to wear a bra.  He said not to wear tube tops either and to let gravity do its job.  I hadn't thought about wearing a tube top since 1979 so there was no dissappointment there.  The left implant has fallen a little and the inframammary fold will have to be raised on that side. I would guess (and I can only guess) that has nothing to do with not wearing a bra.  That side was a little bit different right from the beginning.

    As far as tissue is concerned I have the opposite situation - too much tissue which will be removed in September.   

    Carol - I am thinking about you!  It really is wonderful not to have to deal with expanders.  When I first sat up after my surgery my back felt so freed and strong and I felt felt so much lighter.  It really was a pleasant surprise to have everything feeling so lifted and light.  You will do great!    

  • Stonebrook108
    Stonebrook108 Member Posts: 13
    edited July 2009
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    I had a PBM back in Jan 09 w/ one step implants and Alloderm I was very happy with the results. Once the swelling went down and I started to heal I did get some rippling with the implants.  My PS said that he could do some revision surgery and I would get better results if I went up a couple of sizes in the new implants. I had the surgery back in April and the new implants are fine.

     Best of luck to all of you considering this surgery

    Ann  

  • TracyDenver
    TracyDenver Member Posts: 3
    edited July 2009
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    Ann

    I also have a little rippling and am thinking of going up a size ( I feel I am to small anyway )  I was a D cup before and now a small C.  I just did not like the idea of more surgery but am told the revision surgery is no big deal. Were your Ist implants small?.

    Carol  I do many activities tennis is one of them, I am going easy but so far no problems.

  • Stonebrook108
    Stonebrook108 Member Posts: 13
    edited July 2009
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    Tracy,

    Before my mastectomy I was an A cup. After the one step I was then a B cup. Now after the revision surgery I'm a C cup. It just keeps getting better and better.Wink  

    I too am active. I like to work out with weights and bike ride. So far I've had no problems. It takes time to heal.

    Take care,

    Ann

  • carolehalston
    carolehalston Member Posts: 7,876
    edited July 2009
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    Tracy, I played tennis for many years before I switched to golf.  My husband, who just turned 70, still plays tennis as well as golf.  This morning I walked 3 miles and then did strength exercises with hand weights. 

    I'm thinking I would like to go to a physical therapist once I'm enough recovered from the surgery.  Has anyone done that?  It's important to me to get back to my pre-surgery conditioning. 

  • AnneW
    AnneW Member Posts: 612
    edited July 2009
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    Carole,

    I always use a physical therapist for post-op conditioning. (Three times now!) I know what exercises I should do, but I do better with someone to make sure I'm using the right form and working the appropriate muscle groups. It has helped me get back into my routine much easier and without injury (hiking, cycling, Pilates, rock climbing.)

    If you can find a PT who has worked a lot with implant patients, that will be a plus.

    Anne

  • YearoftheHat
    YearoftheHat Member Posts: 66
    edited July 2009
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    Hi gals.  A friend visited me today to let me know she was just diagnosed with bc.  I can tell she's in that initial shock stage where she is still learning a lot very quickly.  She is opting for a bilateral and she scheduled with my PS coincidentally.  I am so glad she'll have the one-step.  I really think that will make everything easier for her.

    She seemed so calm and rational!  I was a nut when I was diagnosed.  She has arthritis.  I hope she takes her pain meds.  If she has neulasta or Taxol she will need it!  She'll be fine though.  She's very bright and strong.        

    Tracy I was also a d or more before surgery and am a small c now.  I am having larger impants put in in September (600 ccs).  Even if they look fake Iam looking forward to having my old size again.  I was used to it and I'll feel more like myself.

    Smiles and hugs to all!

  • carolehalston
    carolehalston Member Posts: 7,876
    edited July 2009
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    YearoftheHat, I had a phone conversation yesterday with a 5 yr. bc survivor who was also a patient of my cancer dr.and plastic surgeon.  Jennifer was so upbeat and full of life that talking to her cheered me up immensely.  I'm in that "initial shock stage," too.  It helps to communicate with survivors who aren't just coping but are continuing to live their lives fully.  You come across as that kind of person.

    My bilateral and one-step have been pushed forward one day to Fri., July 24th. 

    Would you mind sharing the story behind "YearoftheHat"?