One step implant procedure with Alloderm - Anyone?
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Hi, hope you all doing great! I have a question...
Subcutaneous mastectomy (this is the one I want to be done) is a type of skin-sparing mastectomy which removes tissue through an incision under the breast, leaving the skin, areola, and nipple intact.
Nipple-sparing mastectomy( this is my plan
is another type of skin-sparing procedure that allows a woman to retain her own areola and nipple. Unlike the subcutaneous mastectomy (incision is made at the bottom of the breast), the incision for a nipple-sparing mastectomy is made around the areola. Although both techniques conserve the nipple, a subcutaneous mastectomy leaves more breast tissue behind. In the nipple-sparing procedure, the nipple-areola is completely removed from the breast, scraped clean of tissue and regrafted back onto the breast.My understanding is more tissue left during sub mast , but it gives more chances for nipple to survive, am I correct? I wonder if I can ask Dr to perform sub mast for me or he will not let me make a decision?
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HI BRCA1 - I had a prophlactic bilateral mast on April 29 of this year. My PS did the incision in the middle and around the top of my areola and then removed some skin (a lift) and then pulled up the skin including the nipple areola and did not have to graft the nipple back on. I do have a scar right across the middle of my breast and then above my areola (which you can't see because of the aerola). I had some sagging so that is why he wanted to lift me. I had no problems at all with my nipple even turning colors. Feel free to PM me for any questions.
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My procedure was similar to Tashrox'....the BS used the lumpectomy incision (and extended it) to open the breast and remove tissue. My nipple/areola was never fully removed from the breast. I did not realize that NSM meant the nipple was removed and sewn back on. My BS called my procedure "skin sparing" but my nipple was definitely spared.
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NewBride, Great to hear your mamo was normal!...I'm sure MRI will be too! I'm so happy to hear that you intervened for the bears! That's exactly what we need to do...educate, so we can coexist with them.
)Okiegal, Welcome back...sounds like you need a vacation from your vacation!
Speech, I've never been to Timtam's site. I think you're the first on our forum to post!...good for you! Also, congratulations on reaching the summit!
UpCreek, Glad to hear you're back to biking! Congratulations on your promotion and enjoy your trip to the cape. Happy 21st birthday to your daughter! Is 21 the legal drinking age in Canada too?
Fortunate1, Thinking of you and hope you're OK.
BigApple, Hoping you are well too!
It is raining and we are expecting high winds this afternoon. I'm not feeling so great today...major headache for the past few days and now some stomach upset. Going to grab a blanket and take a nap. Hope you all have a good day!
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Speech, your so BRAVE! I need to do the same...as I've stated previously. Maybe soon.
NewBride, it would have been nice to meet up! Alas, my visit was a bit hectic with all of the driving to visit friends that I hadn't seen in six years. I also thought about how close (but far away) Fortunate1 was in San Diego.
Hi to all of you one steppers! Hope eveyone has a good day. It's one of those rare pre-fall sunny, temperate days here. Love it!
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Hi all, sorry about the silence on my end. I am OK, really, and have a mammo/sonogram on Monday morning. I am sure I will be fine. Or I should say almost completely sure. It's the little squeak of doubt that angers and upsets me now and then. I got news this week that a friend has been diagnosed with what seems like a very aggressive lung cancer. Cancer is a filthy beast.
On the other hand, I am very pleased that we are all doing well. We are a whole group of (relatively) fortunate ones. Hugs to you all.
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fortunate1 good to hear from you and you do sound better. Glad you are getting these tests done so you can be at total peace. So sorry to hear about your friend...I've lost too many in my family to this horrid thing.
okiegal and meg9 no bravery here....I had 3 glasses of wine before I actually posted! When I went on the site I tried to find examples of "our" surgery and there aren't many. I thought it was important for women to see another option. Yes, it is scary to post, I won't lie. As I lay in bed last night I thought, oh boy, I just put myself out there. I hope it benefits someone!
meg I hope you are feeling better soon--good for you to take care of yourself.
newbride celebrating your normal mammo!
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Speech, I visited the photo site. I am so impressed with your courage... wine or not! I have wondered at our lack of representation too, but have always chickened out. Soon, with you as our pioneer. You look beautiful.
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fortunate1 Thanks....it's not an easy thing to do. I figure there will be many more posts to bury mine on page 23 one of these days!0
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When my left incision wasn't healing properly, I first used a cream that heart patients with angina use. It was a prescription cream and I applied it to a piece of special paper that came with it and then pressed the paper against my skin. Almost immediately I got a headache. I was told in advance about this SE. The headache lasted about an hour. The cream causes blood to come to the area. After a week or so, I stopped using this cream and began using the silvadene, which is for burn patients. It had no SE's. After all this application of creams, a portion of the incision was still black (dead skin) and the PS was worried about losing the implant. So we went back to surgery and he trimmed the dead skin. After that the incision healed quickly and the recovery from the surgery was very easy.
Upcreek, I wondered whether you had accepted the promotion. Is the new position more stressful? I hope not. Be sure and tell your delightful daughter hello from me and my DH.
Fortunate, I'm waiting for some good news from you that nothing is wrong.
Our summer travels are coming to an end. We're in Joliet, IL, in the Empress Casino RV park. This weekend we'll be staying with DH's brother at his house and visiting various family members including DH's aunt who is in her 90's. After a stop in IN for a couple of days to visit a niece and her family, we'll be heading back to LA and should be home by the weekend. I just did laundry today for the last time on the road. It will be great to have the luxury of a nice laundry room again. And ironed clothes after being the queen of wrinkles for months!!
Wrinkles and all, DH and I took the train into Chicago yesterday and spent part of the day browsing through the Chicago Art Institute. We had lunch in the garden cafe with tables grouped around a beautiful fountain. It was an ideal day for walking up Michigan ave. later. We're thinking we'll stay an extra day and go back into the city on Mon. Taking the train is so easy
It has been a wonderful trip. Not least among the pleasures was meeting Upcreek and her DH and daughter.
Hi to everyone.
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Yesterday I saw an oncologist for a 2nd opinion on whether or not to go on Raloxifene (Evista) or Tamoxifen. He reviewed all the research and his summation was this:
(1) DCIS is not cancer (precancer) but needs to be treated (2) Risk of recurrence in my natural breast is about 3% (3) Either drug will reduce that by 1.5% (4) Serious side effects (thrombosis) affect 1% of women and they are usually not active (I am very actice) (5) A genetic test may be able to test the effectiveness of Tamoxifen (15% of caucasian women have a genetic makeup that interferes with how the liver metabolizes Tamoxifen and renders it basically useless) Here's an article http://www.drugs.com/news/gene-test-might-predict-tamoxifen-s-effectiveness-20232.html (6) Doc recommended the book Anticancer: A New Way of Life by David Servan-Schreiber Author is a doc who got brain cancer, researched lifestyle issues affecting cancer and is in remission.
I made my decision a while back and I dont want to take a pill daily for 5 years for a 1.5% possible risk reduction. I would rather monitor and manage a healthy lifestyle (exercise, nutrition, etc). Just thought I'd share what Iearned.
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Speech529, your pictures are wonderful, just beautiful.
KelleyMaryland, I was told I could do any exercise even pecs. My PS said the pec exercises will help to prevent the scar tissue from forming that contracture problem. He said the implants are not going to move toward the armpit. My personal experience is that I can do all exercises except pecs because it burns the next day and I don't want to see ripples. I figure what benefit would I get from it. I concentrate on arms, back, shoulders, yoga, but have difficulty with the cobra and plank positions. My chest feels funny when I lean over as if the implants are now putting pressure on the outer skin or nipple area. Your body will tell you what you can do.
Regarding scars , I had a lift so my scar is from aerola down straight and a curve like the letter J. Works for me, It cannot be seen from the side if wearing a swim suit and I can't see it if looking down at myself. Some of the prophy's are scarless.
Devorah, several woman on the nsm site have had the same concerns with their nipple which all have said it turned purple, fell off and the underneath was healthy and pink.
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PB22 thanks and your thoughts about pectoralis exercises are similar to mine...my pec muscles burn afterwards and the movement is definitely toward the lateral aspect. I am doing what you are doing...the yoga positions that are hard for me are chaturanga, updog, cobra and planks, too. I keep trying. I am listening to my body.
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Carole, it has been so wonderful hearing about your summer trip. I'll be sorry for the stories to end, but I'm sure you'll have more to come back home!
Speech, not to quibble with your doctor, but I keep hearing confusing descriptions of DCIS. As I understand, it IS cancer, but just at a very treatable stage. It isn't invasive because it hasn't grown or ruptured outside of the duct. In my book, if the treatment necessary was a mastectomy and possible chemotheraputic drugs, it counts as cancer! I'm sure my insurance company would gladly agree. Do you think doctors say that to keep patients from freaking out?
I am avoiding doing any pec flys (and similar exercises), which mainly stress the pectoralis major and doing everything to strengthen the surrounding muscles. I can do plank, these days, but don't know the other yoga exercises you all mentioned. Guess I need to buy a yoga video? I also do countertop pushups. If I overdo those, I have tingling, "pins and needles" pain, mostly in my upper body.
Lots to do today....it's Monday!
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Thanks very much for exercise information- particularly the yoga poses. I had a first consult with my plastic surgeon for PBM and asked specifically about yoga poses that work the pec muscles. He said that once healed, I'd have no exercise restrictions. Also, I have young kids and he thought my kid lifting would only be restricted for a month or so. I was encouraged by this but skeptical?? [Edited to add that this PS said he would not consider one step for me; expanders then implant.]
-Kelly
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Hello. Would you pls help me with one more question I have? My app with PS this Friday and my head is spinning around with all the questions and I guess I am panicking too...
I am C cup now and I heard that AlloDerm one step is mostly good for A or B . For C most chances I will be recommended expanders...is that true? I don't want to get bigger , but I don't want to go smaller ether.
From what I understood sensation / feeling in whole breast is gone forever after the surgery. Nipple, skin , all numbed. Am I correct?
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BRCA1 - I was a C/D when I had my surgery and I am now a 36D. I had plenty of skin so he did not have to use the expanders. He also did a lift when he did my procedure. The only thing is I do not project like a 36D because I have silicone implants and they are not the "gummy bear" that are formed anatomically like a breast. I probably look like a large C. As far as numbing my nipple and everything below it are numb. It is really everything below where the incision was. I also had a prophlactic BMX.
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Hi tashrox, would you rather choose "gummy" if you knew the final result? I think I need to do my research for silicone, seline and gummy? I have no idea which one is better and why...
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BRCA1 - The gummy bear are not available to everyone in the US. I would have liked them better just because I would have more projection no other reason. I was told that the saline would ripple more so that is whey I chose the silicone. Also the silicone feels more natural.
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Meg,
I really wanted to be a large C but the PS said my breasts were too large and after 4 hrs. of surgery he almost went with TE's. I have no idea what they look like, I'm afraid to look. I think one of my nipples is turning dark. I see the PS again on the 11th so I'll know more then!
Robyn
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BRCA1 I think you described your desires perfectly. Just tell the PS exactly what you wrote here and he should be able to measure you and recommend the best process based on your desired outcome. I think there might be some confusion about terminology...the term "gummy bear" is used frequently to refer to the newer silicone implants as well. At least that was my experience. Most PS tends to have their favorite brands and there will probably be a display that you will be able to see and feel at the office. Like Tashrox, I chose silicone for the more natural feeling and because they won't deflate or leak like saline. Your PS will probably use "high profile" implants. They will give a little more projection. Finally, you will be lacking sensation wherever breast tissue is removed. I have normal sensation at the top of my implants and in between my breasts (and everywhere else on my body!), but not at the front, bottom or sides of my breasts.
KellyMaryland You'll definately have to take it easy for a while and your PS sounds like he gave you a good estimate. I would think your recovery would be fairly quick with expanders because unlike the "one step" your muscle has time to accomodate more slowly to the expander. I was also concerned about strength and was extremely anxious AFTER surgery because I discovered that the pectoral insertion is cut slightly where it inserts at the chest. It seems I worried (needlessly) about a lot in those days! Today, at 16 months post BLMX, I feel as strong as I did before. However, repetative exercise, like swimming, still feels a little weird. I haven't had the opportunity to swim extensively, but from what little I swam this summer, I can say that my stroke was back to normal. I even beat my niece in a little race! On the other hand, I always loved swimming in the ocean and now would probably avoid it for fear of not being quite as strong. It's a good thing I don't live near an ocean anymore!
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Hi everyone,
I just got back from the breast center. Just a quick note to tell you all that as I expected, the lump is still just scar tissue. If the Onc is still worried, the ultrasound doc suggested an MRI or having the lump removed. Wouldn't that just set me up for more scar tissue? Hmmm. So, I am fine, but what a morning. It is no fun to walk into that place with a lump, and I'm realizing how much - under the happy surface - cancer still has its hooks in me.
Bah humbug, and happy to still be "fortunate".
Pec exercises.... in the studio yesterday I was working with clay and watching the absurdity of my breast jumping all over. Don't think I'm going to outgrow it. I am still strong though, that's good.
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BRCA1, it is my understanding (I met with 3 surgeons) that you can "swap" your implant for a larger one in 6 months with the one-step if you are not happy with your size.
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Fearless, I had the one step and did a swap 6 months later for a larger implant. The swap is not a big deal.
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fortunate1 Yippee! I know you are relieved and I am, too! That's fabulous news.
okiegal Yeah, I agree if you have to have an mx or lumpectomy + rads...that smacks of cancer to me. It puts one in a strange situation--for example--do I consider myself a BC patient/survivor or someone who had some weird stuff in her breast and had it removed in one giant lumpectomy????
BRCA The ideal candidate for the one-step is a person with A or B cups to begin with--but I think it depends on the integrity of the breast skin. I think the weight of the implant is the concern. I was barely an A and my doc made me "a large B or small C". I have a B cup bra and a C cup bra...both Warners, so go figure. I think I look larger than a B for sure....with a bra and clothing, I think I look like a full C. Certainly talk to your doctor about this that you don't want to be smaller. And I would trust the ladies' comments here---if you have to exchange later it's an easy thing.
As far as numbness is concerned--yes my nipple feels nothing. I am numb about 2 1/2 to 3" circumference around the nipple (more below than above). On the implanted (nonMX side) I am also numb but the feeling is returning. This may be TMI, but I will tell you anyway because I think it is important to women who are wondering about how it may affect their sex lives. I still enjoy being touched and perhaps its the thought of being caressed, but it still is a turn on for me. I was worried about it affecting my sweet life with my DH, but it hasn't....it's only better. He likes the new me very much. I have cohesive silicone implants and they feel very real!
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Thanks speech. I was feeling growly earlier, but teaching took me out of my funk and the students cheered me up.
Brca1, At 1 1/2 years sensation is moving in from the edges for me.... nothing in the middle though.
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Fearless & PB, That's a good point about being able to go up in size after the "one step". If I remember correctly, that's what Yearofthehat, who started this thread opted for. And I think she was happy with the results.
Fortunate1, I'm relieved for you, too. I still worry about my twin sister, although, so far she has been declared DCIS free. Glad to hear you are feeling better.
Speech, I felt like an impostor walking in the Susan B. Komen 5K, but I know that a large number of the women are probably in the same boat. I walked anyway because we are part of the picture of BC and because I hope that by being healthy and wearing the "survivor" shirt, I can give hope to others who are battling some aspect of the disease.
I'm joining my mother this morning to look for tile for her small, bathroom renovation. She's having trouble choosing a color that looks good once she gets home. You'd think it would be easy, but there are so many little variations in size, color, pattern, price, etc. that it has turned into an ordeal for her. Hope I can help, maybe we'll get lucky. Have a good day!
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You are all amazing!!! Thank you for answering my questions, it helps me a lot! I can't wait for my app this Friday . I am mentally ready to have AlloDem one step, but here in Canada, for now, I will have to participate in study and they randomly choose (50/50% chance) who will have AlloDerm and who will have 2 steps with expanders. For me the only option is AlloDerm, so I hope I will win this "lottery" and if not...I will be heart broken and will have to wait until Canada will approve this procedure...I am just scared it may be too late, my mom had BC at 34 , I will be 35 in few months and it feels like I am a little late already
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Hello Everyone,
In answer to some of the discussions....I was originally a large C. When I met with my PS she said the most I could be was a large B. If I wanted to be larger I would need expanders. I was not a candidate for nipple sparing, because there was too much skin for the nipple to be place properly. At first, my silicone gels implants where firm and high, but have softened, dropped and moved to the outsides. I also have areas of stretched skin. I have no feeling on the bottom half of my breasts. I avoid pec muscles, because I feel a tightness and/or pain afterward. I do lift my implants up, down and side to side to avoid CC. I am not as strong as I was. While swimming, I am stiff at first and then I loosen up...also, hanging on a float or tube is uncomfortable. There is a definite problem with my left breasts. I am aware of this because the right breast feels more normal.
When I received the phone call from the radiologist informing me of the results of my biopsy she said, "You have DCIS...the early stage of cancer." "You will need to make an appointment with a breast surgeon." When I met with the BS he said DCIS is the earliest stage of bc, but not invasive because it was in the duct. I was to have a lumpectomy and radiation until an MRI found DCIS in the other breast. I had no choice but to have bmx.
I visited 2 OC. One said DCIS is the earliest stage of cancer. One said like a precancer (meaning it was not invasive). Both stated that having an mx with clear margins would not require any additional treatment. I should have an MRI every 3 years to check the health of the implants. No need for mamos...nothing left to check. I will get nipple tattoos when I find someone I feel comfortable with.
Robynkk, I did not look at myself for a while. DH changed my dressings and emptied my drains. I think it is normal...when I had my follow up visit the NP asked if I looked at myself. When I said no, she was not surprised. I hope you healing well. (((hugs)))
Fortunate1, Happy to hear the good news!
Speech, I'll have to find TimTam to see your picture. Maybe I should post a picture so some can see the not so pretty outcome! I think I'll have to lose the 10 lbs I gained first! The weight is more upsetting to me!
It is in the 60's and raining today. Off to talk my 3 mile walk. Hope you all have a good day!
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Okiegal, you and the others with DCIS are no impostors. Maybe some fine day, the researchers will find that some DCIS will never become invasive. But now it seems that it has not spread yet. Who wants a time bomb in their body? I'm glad your sister is being closely watched.
BCRA1, good luck on Friday. Robynkk, I peeked while I was still in the hospital... shocking, big black puckered stitches, the pec trying to push the implant out under my arm. And still I was in a haze of good will towards all... the cancer was out! Needless to say, its appearance improved quickly.
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