One step implant procedure with Alloderm - Anyone?
Comments
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Welcome, tracyanne, to our small group. We're happy to have you as a member and look forward to your input.
For the first time today, I wore a pullover knit blouse, and I can't say I really like the shape of my breasts in the blouse. They're too flat on the front, but at least there's a shape there. Once I heal and can shop for a bra, maybe I can find a bra that will improve the shape. My natural breasts were smaller than these mounds but had more "pointedness," to coin a word.
The movie JULIE & JULIET was really good. Meryl Streep was outstanding as Julia Child.
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Pointedness is an excellent word. A bra will help, when you are healed.
Definitely want to see JULIE & JULIA. Meryl Streep can play anything.
Back to work for me, I'm being lazy again.
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Finally figured out how to put info into my signature.
Fortunate1, I'm supposed to take Arimidex for 5 yrs. and then Femara. Apparently you are taking Femara and have not taken Arimidex?
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Whoops! Error in the signature. Had to correct it.
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Ha, I tried to update my signature too. I seem to have lost my touch, or it just takes a while to activate.
My oncotype 20.5 is going to look a little scary next to your 9(!!!!!). The onc convinced me I'm fine without chemo, just Femara. He said five years, nothing about anything more - I'll ask. Doesn't all this variation drive you nuts? He had better be right. An inexact science, even with all the advances.
Hey, the addition just showed up.
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i am currently using dr mia talmor, i absolutely love her,, she has done a great job,, i dont have any kind of pain,, my expanders are in and all filled up and i am ready for my silicone implants, if you have any questions you can email me with anything at sfeigy25@aol.com anytime,, good luck0
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Hi ladies. I haven't posted in a long while. I have been busy with little energy after work and I am grieving. I am 3 months post-chemo and am still feeling the effects. Also, I lost an aunt last month. I am missing my sexuality which was in full swing a year ago at this time and which is now entirely gone. I am hoping this winter my man and I will have a chance to have some mellow times together and sort that out.
While walking today I was very uncomfortable with how the girls just don't move. I feel so obviously fake and really stiff. They are flat in the front. I got some horrible little silicone, nipple enhancer insert for my bra and they look strange. Nice shape but zero jiggle. I am wondering if it's too late to have a flap procedure. In terms of down-time from work I would have to do that later and would have to pay for it myself. I don't know if I feel it's worthwhile. I know I need to accept my loss but that's going to take longer for me.
I'm still grappling with it all.
Work is trying but I will try to log on more this week. Glad to see you are all still posting. So long for now.
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Yearofthehat, you're back! Welcome! I wondered where you'd gone. You started us off and then vanished. I do hope you'll have time and energy to keep in touch.
No, I don't think it's too late for a diep flap. I don't think it's ever too late. It's fairly common to get the implants first as "space holders" with a diep scheduled for later after chemo treatments. I'll bet your insurance would pay for it, too. However, I've been reading some posts by women who had the diep and the recovery is long and not easy. You have an abdominal incision from side to side with drains. I don't know whether you'd have drains from the breasts, too since you are already healed at this point.
Also, not everyone who had the diep flap is thrilled with the results. There's a lot of luck and hit and miss in breast recon. I talked with a local woman, 5 yr. survivor, who had the TEs for a year while she did chemo, then had the diep flap in NO. She told me she was sorry afterwards, wished she'd gone ahead with the implants instead. I think her complaint was with the abdominal incision. She rides horses.
So far every woman with whom I've communicated who had the recon. with Alloderm & implants has the same flat shape on the front. I do, and I had the nipple saving surgery. Also various lumps and bumps and edges show up from day to day and disappear in the same mysterious fashion. I don't know whether at some point the shape is stable or not. I try to be thankful that I'm not flat and disfigured.
I had a pleasant outing today. Attended a book club meeting with a younger neighbor who had invited me. The author of today's book was present. She and I were once members of the same writers group, and I enjoyed seeing her. Her name is Robin Wells, and the book was HOW TO SCORE. It's a romantic comedy set in Tulsa and quite entertaining if you're looking for an easy escapist read. Available in paperback at all the big bookstores.
Hope everyone is having a good day.
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Hi Everybody,
Fortunate1, I know what you mean about all the differences in tests, treatments, etc! I was concerned when I heard that many had a PET scan and I had not. Yesterday, I asked my oc why. She said because I had DCIS...the earliest stage of cancer so there was no need. We really have to trust our doctors, but when in doubt...get a second opinion. When the OC told me I did not need chemo or meds my family pushed me to get a second opinion. The second oc said the same thing... giving me peace of mind.
It seems that all "one step" ladies have that flat boob syndrome! I found a bra by Warner that adds a size. It does this by adding (filling) the point. The first time I wore this bra I looked exactly like my natural self...size C. Everyone said I looked great. http://www.warners.com/_view/bra-Panty-Styles.cfm?ID=2008 There are a few styles...buy the one that says..."add a size."
I think we all have been through a lot...we have to give ourselves time and all things will fall back in place. My breast are far from perfect. The truth is the old breasts had some problems too: One was larger then the other, One hung lower then the other, When not in a bra they were flat. Even with the new breasts imperfections I'm happy to have them instead of nothing. I just hope they don't cause me future problems.
HearoftheHat, Sorry for the loss of your Aunt. Losing a loved one is always difficult. I hope your energy and spirits are lifted soon.
Carole - Sounds like you had a fun day. It's a great day outside here. I'm going to try to get out there now.
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Meg9, what was the store where you found this bra?
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Carole - I purchased the bras at Macy's. I bought every color. You buy the size you are and it makes you look a size larger. For me it takes the flatness away.
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Carole - I just noticed on the site for the bra there is a store locater. Just have to put in your zip code.
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Yearofthehat. Our founder is back! I hope we can help in your down time.
You're not alone. For me, after the turmoil of diagnosis and treatment, a life altering fall for my Dad and then death of my Mom all during the same time, everything calmed down. Everything but me. Freed to get back to work, I sometimes wander the house and make excuses until I simply have to work or fail. I'm often overemotional and weepy. I'm supposed to be all better now. I definitely know I am fortunate. The bad stuff mostly stays in the background.
Delayed reaction - grief - post traumatic stress - whatever, that background's not all better yet and I think it will take quite a while. Meg is right, we have all been through a lot. We have reason to grieve. I'm glad I found all of you. I hear hints of the same feelings in the posts of others. Give it time and conversation. You're not alone.
I'd better get back to work. Hope this is a help and not just another downer.
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How nice to be welcomed back! Carol and Fortunate, your posts are a big help and not a downer. That's why I haven't posted in a while. I have been supressing and have felt uptight. I don't want to have a negative effect on anyone. What you each deal with is hard enough.
Fortunate, you have had a lot to deal with. I haven't had quite as difficult a time perhaps but, yes, I have been through a lot this year. We all have. I cried a little last night and feel so much better today. I also sense from non-survivors that I should be all better now and need to be strong and put it all behind me. Thank goodness for all of you.
I do have an implant exchange surgery scheduled for September 21 and am finally facing the reality that without the connective tissues and glands, these implants will not likely have any of that natural give. I am not sure that flap procedures are the answer. I just don't think there's much good plastic surgery in my local area. It's so hard to know that definitively but this is a backwater of sorts and I just don't come away from visits to my ps with any great degree of confidence. I'm always unsure. I need to see photos! Have any of you figured out how to view the photo site, whatever that is? I see it referred to in posts and have no idea how to find it.
There is a woman on the Jan. '09 chemo board who had no reconstruction. I don't think I would wear that well but I wonder if it isn't more comfortable. I have so much tightness there. There is extra tissue on the sides where my underwire sits and that gives me a burning sensation. I have other twinges and pains too, when I exert myself even a little.
I am thankful for my reconstruction. After I have spent some time mulling it all over and getting used to my body, I know there will come a point that I'll tell myself to stop being concerned about it all and to simply accept it. I'm not there yet.
I have to say I am so impressed by the intelligence of the women on these boards. This is certainly a stellar group. What great company we keep.
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Yearofthehat, maybe you should ditch the bras with an underwire? I never wore them because I was small-breasted and didn't need a bra except for the ones with a little padding. I tried a few with the underwire and found them horribly uncomfortable. At home I've always gone braless. At this point, though, I'm more comfortable wearing a soft cotton sports bra. It feels odd to be without one. The snugness of the bras lessen my feeling of internal tightness.
While I was walking this morning, I was making a mental list of questions to ask the PS next Monday when I go for another inspection of my left incision. I want to know if my pecs have stretched to the maximum at this point, 5 wks out.
BTW, the little yellow strip of skin along the left incision, about 1 in. now, is getting smaller every day. I may be glimpsing a light at the end of the healing tunnel.
I think younger women have a harder problem adjusting to losing their natural breasts than women in my age category. Sexuality isn't a major concern for me. My dh and I are life partners and companions at this stage more than passionate lovers. We share a lot of interests. After all, we've been married 40 years and never had children. Which left me more vulnerable to bc!
I plan to while away another day. Picking up roast beef poboys at a local eatery famous for their poboys and taking them to my mom's house for lunch with her. Thurs. is the day I usually take her to have her hair done, but the hairdresser has a medical problem.0 -
Yearofthehat,
I'm relieved my post wasn't too much of a downer, I was worried, reluctant to say the bad stuff, even here.
I wonder why your implants feel tight? Are they the extra firm gummie bear ones? I have a different perspective as I still have one natural breast. Unfortunately I don't know much about what my PS used. Wide, round, definitely not the fully cohesive, and I think moderate profile. It is soft, not natural soft, but close. It will jiggle just a tiny little bit, notably different from real. I'm realizing that the flat area is very common, maybe universal. With your extra tissue I figured you would move well. Adhesions in there? Capsular contraction? I wish you had a better rapport with your PS. I'll PM you the info about the photo site.
Sexuality was a problem for me too, at first, but has markedly improved. I'm feeling sexier bit by bit. Even with a remodeled boob and absolutely no estrogen, sex will have it's way. For him, there never was a problem, only me.
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Hi Joann,
I hope this brings you HOPE! I read a study about a woman much like yourself: she needed no follow up radiation and they placed implants with alloderm. Lo and behold (as you stated) she ended up needing radiation. Much to the shock of her surgeons, she NEVER developed capsular contracture, and NEVER "lost" the implant. Because they were so impressed with her, they did it to four other women and NONE have lost their implants to capsular contracture. They study is saying that Alloderm protects the implant from the effects of radiation subsequent capsular contracture. I am researching this because my PS wants to do a LD flap and I am opposed because I am into bodybuilding and feel I won't be able to continue to work out as I have for the past 25 years. I was looking for an alternative for me and came across this. I am going to paste the text of what I found at the end of this message. It is long so I hope it all fits in. GOD BLESS YOU in your journey.......see below
Abstract
Disclosures: K.H.B. is on the speaker's bureau for LifeCell. Objective: To preserve the mastectomy skin envelope in select patients destined to receive radiation following mastectomy, we performed immediate tissue expander-implant reconstruction with a subpectoral tissue expander and an inferolateral AlloDerm hammock for complete implant coverage. We hypothesized that the AlloDerm hammock may allow greater intraoperative volume expansion and potentially avoid the need for an autologous construct. Methods: Tissue expanders were filled to 75%-85% capacity intraoperatively and 85%-100% prior to radiation therapy. This allowed for maximum preservation of the mastectomy skin envelope prior to radiation therapy and provided a sizable breast mound immediately following mastectomy. Histology of irradiated and nonirradiated capsules was compared. Results: Five patients aged 29-51 years had immediate implant (1) or expander-implant (4) breast reconstruction followed by postreconstruction radiation 2-6 months following the procedure. Patients were followed for 2.5-5.5 years following implant reconstruction and 2-5 years following radiation. No capsular contracture or implant loss was observed in any patient. No patients required or requested autologous reconstruction following radiation and all currently have silicone implants. Capsular biopsies from radiated and nonradiated implants showed identical collagen architecture on histology, confirming clinical observations. Conclusion: Tissue expander-implant breast reconstruction following mastectomy preserves the skin envelope in patients who receive postmastectomy radiation. Further investigation is warranted to determine whether complete implant coverage with the pectoralis muscle and AlloDerm hammock mitigates the deleterious effects of radiation.
Immediate breast reconstruction with implants or expanders is the most common method of reconstructing the breast following mastectomy.1 Implant reconstruction allows young, otherwise healthy women an expedient return to work and their active lifestyles. In addition, autologous reconstructive options are preserved for recurrent breast cancer or implant failure. The recent introduction of an inferolateral cadaveric dermis (AlloDerm, Lifecell, Branchburg, NJ) hammock for immediate reconstruction allows improved positioning of the implant or expander in the postmastectomy pocket and thus a superior aesthetic results.2-5 In addition, the pectoralis muscle-AlloDerm pocket may protect the mastectomy skin by decreasing the gravitational force that would otherwise be transmitted to the lower pole envelope when the patient is standing or sitting.
The role of implant breast reconstruction in patients who have had radiation or who will undergo postmastectomy/postreconstruction radiation is controversial. A high incidence of implant loss, infection, and capsular contracture has been reported in this population.6-8 For these reasons, breast reconstruction is deferred by most surgeons if radiation therapy is part of the intended postmastectomy treatment plan. Following radiation, the skin envelope contracts and stiffens. Therefore, implant reconstruction is deemed not feasible and delayed reconstruction is performed with autologous tissue. Although autologous tissue can match the contralateral breast in contour, the skin island is invariably different in color and is surrounded by a scar, which may negatively impact the overall aesthetic outcome.
To maximize the amount of postmastectomy skin available for reconstruction after completion of radiation therapy, and potentially avoid the need for an autologous skin island, we placed an implant or tissue expander into a retropectoral pocket and covered the inferolateral implant surface with AlloDerm as described for immediate implant reconstruction.3 Tissue expanders were filled to 75%-85% capacity intraoperatively and to 85%-100% prior to radiation. We report initial results of 5 patients who underwent immediate reconstruction with implants or expanders and an inferolateral AlloDerm hammock followed by postoperative radiation therapy. No capsular contracture or implant loss has been observed in their 1- to 4-year follow-up.
METHODS
This retrospective study was performed according to institutional guidelines. Chart review was performed on patients who had immediate breast reconstruction with implants or expanders followed by postreconstruction radiation.
In all cases of expander-implant reconstruction, the expanders were filled with injectable saline up to 85%-100% of their capacity during the initial reconstruction as determined by the amount of mastectomy skin envelope available for complete tension-free implant coverage. All expanders were placed into a retropectoral pocket, and AlloDerm was used to cover and suspend the portion of the implant not covered by muscle as previously described.3
Histology was performed on capsule biopsies 1 year after completion of radiation therapy in one patient with bilateral tissue expander-implant reconstructions who received radiation on one side.
RESULTS
Five patients aged 29-51 years had immediate implant (1) or expander-implant (4) breast reconstruction followed by postreconstruction radiation (Table (Table1).1
). Radiation was given 2-6 months following the procedure. Patients were followed for 2.5-5.5 years following implant reconstruction and 2-5 years following radiation (Figs 1-3
). Histology of the implant capsules in a patient with bilateral reconstruction and radiation on one side showed indistinguishable collagen architecture 1 year after radiation therapy (Fig (Fig4).4
). Complications included one small wound dehiscence following implant reconstruction but before radiation. This was treated with local excision and closure. Neither infection, capsular contracture, or implant extrusion nor loss of implant was observed in any patient.
Patient characteristics
Immediate left-sided tissue expander-implant reconstruction following mastectomy and postoperative radiation. This 50-year-old woman received radiation 3 months after immediate tissue expander reconstruction. (more ...)
Histology of tissue expander-AlloDerm capsule at the time of bilateral implant exchange. The upper photo shows the nonradiated left breast capsule and the bottom photo shows radiated capsule. The two capsules (more ...)
DISCUSSION
Immediate breast reconstruction with an implant or expander-implant and an inferolateral AlloDerm hammock offers a cosmetically acceptable reconstruction option for young, active women or those who desire preservation of autologous tissue and a rapid recovery from surgery. Radiation is a formidable foe, and complication rates of radiation combined with implant reconstruction have often deterred surgeons from offering this option to breast cancer patients.
Delayed reconstruction with autologous tissue has been the mainstay of breast reconstruction in the setting of postoperative radiation therapy. The use of autologous tissue for delayed reconstruction can lead to a successful outcome; however, there are certain limitations. A subset of women lacks suitable autologous donor sites. Another subset simply refuses autologous options secondary to their active lifestyle or the associated morbidity of the procedures. Aesthetically, the contour of autologous reconstructions is generally quite good. However, the color mismatch of autologous skin surrounded by irradiated mastectomy skin can detract from the overall result. In addition, if the construct is placed too superior or medial, the scars may limit choice of clothing in some cases (Fig (Fig5).5
). In this report, we describe 5 patients who underwent immediate implant or tissue expander/implant reconstruction with an AlloDerm hammock followed by radiation therapy. No patient lost her implant or developed capsular contracture. This preliminary observation has served as the impetus for a larger institutional review board (IRB)-approved study currently underway.
Delayed breast reconstruction with TRAM flap in 2 patients after left-sided mastectomy and XRT. Despite good match in volume and shape, the aesthetic results are compromised because of visibility of TRAM (more ...)
AlloDerm is being used with increasing frequency in aesthetic and reconstructive surgery for rhinoplasty, hand surgery, lip augmentation, chest wall reconstruction, abdominal wall reconstruction, mastopexy, and nipple reconstruction. Its soft, pliable consistency makes it easy to work with, and its safety has been demonstrated by clinical experience over the past 10 years. However, there are few articles that address the effects of radiation on AlloDerm. In a rat model, Dubin et al9 demonstrated that graft thickness and neovascularization of AlloDerm were not adversely affected by a field that had received external beam radiation (EBR). Ibrahim et al10 implanted AlloDerm into rat hind legs and subsequently delivered 20 Gy of EBR. In this model, EBR hindered recellularization of the AlloDerm in the early posttreatment period, but graft thickness, recellularization, and graft survival were not adversely affected at 12 weeks.10
In our experience over the past 6 years, the addition of an AlloDerm hammock to breast implant reconstruction has offered superior aesthetic results by allowing precise implant positioning in the mastectomy pocket.3 Furthermore, capsular contracture in these patients is remarkably diminished. Although implant reconstruction has been performed successfully in patients before or after radiation therapy, a high rate of contracture has been reported and up to 50% of these patients may ultimately require an autologous construct.6,7 For this reason, prior to our experience with AlloDerm, we typically avoided implant reconstruction in combination with radiation.
Serendipitously, we performed immediate bilateral reconstruction with silicone implants and AlloDerm slings in a patient who was not scheduled for radiation as part of her treatment. Postoperatively, we were informed that there had been a change of plans and the patient received for breast irradiation. Much to our surprise, she did not develop capsular contracture in the following 5 years.
On the basis of this positive experience and the desire to preserve the mastectomy skin envelope, we subsequently performed immediate tissue-expander reconstruction with a subpectoral tissue expander and an inferolateral AlloDerm hammock in 4 select patients scheduled for postmastectomy radiation. Tissue expanders were filled approximately 75%-85% capacity intraoperatively and 85%-100% capacity prior to radiation. Filling the tissue expander to 85%-100% capacity prior to radiation therapy allows maximum preservation of the mastectomy skin envelope as little expansion can typically be achieved following radiation. In our patients, good mastectomy skin envelopes and the off-loading of mechanical stress by the pectoralis-AlloDerm pocket provided an ability to fill tissue expanders to 75%-85% capacity and provided a sizable breast mound immediately following mastectomy. This can be very important as radiation oncologists typically prefer to start radiation 6 weeks following mastectomy if no chemotherapy is needed or if it was received preoperatively. This limits the plastic surgeon's ability to expand the skin envelope prior to radiation.
Radiation therapy was typically started 6 weeks after mastectomy and reconstruction. We monitored all patients during their radiation therapy in 2-week intervals and did not observe any skin breakdown other than typical radiation-induced skin changes that were treated topically. As anticipated, no patient developed capsular contracture after completion of radiation therapy. To confirm our clinical observations, we performed capsular biopsies on a patient who had bilateral tissue expander reconstruction followed by radiation on one side (Fig (Fig4).4
). As expected, the collagen architecture on histology was identical. The shape of the reconstructed breast mounds remained aesthetically pleasing and the skin quality and color was comparable to the contralateral native breasts. It was therefore no surprise that all patients preferred implant exchange instead of autologous reconstruction at 6 months following radiation. In subsequent follow-up, all patients remained free from capsular contracture. Symmetry operations on the contralateral native breast were performed as needed.
On the basis of these positive results, we have been working closely with our radiation oncology department to design and implement an IRB-approved protocol to perform a larger study to prospectively evaluate the influence of postoperative radiation on implant-AlloDerm constructs. Our radiation oncologists limited the size of the current study as they believe immediate tissue expander and even autologous tissue reconstruction following left-sided mastectomy might prevent adequate delivery of radiation and necessitate an excessive cardiac radiation dose. They have since determined that most women with implants can be sufficiently treated, and that a preoperative chest computed tomography simulating pre-XRT mapping can help identify this small subgroup of patients who are not good candidates for preradiation implant or autologous reconstruction based on their chest wall dimensions.
In this report, we describe our favorable experience with postoperative radiation in 5 patients with expander-implant reconstruction and AlloDerm hammock. If our initial observations are substantiated, the expander-implant-AlloDerm construct may offer a reconstructive alternative for women destined for radiation who lack adequate donor sites or who wish to avoid the morbidity of autologous reconstruction.
Immediate left-sided tissue expander-implant reconstruction following mastectomy and postoperative radiation. This 46-year-old woman received radiation 4 months after immediate tissue expander reconstruction. (more ...)
Immediate bilateral tissue expander-implant reconstruction following bilateral mastectomy and postoperative radiation to the right side. This patient had bilateral immediate tissue (more ...)
REFERENCES
1.
American Society of Plastic Surgery. Plastic Surgery Procedural Statistics. 2008. Available at: http://www.pubmedcentral.nih.gov/redirect3.cgi?&&auth=0Zw2QGwEXTJjXo6OgnKB7CSDKLUWos5B9YL3JV5gn&reftype=extlink&article-id=2683576&issue-id=175653&journal-id=527&FROM=Article%7CCitationRef&TO=External%7CLink%7CURI&rendering-type=normal&&http://dx.doi.org/www.plasticsurgery.org.
2.
Breuing KH, Warren SM. Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings. Ann Plast Surg. 2005;55:232-9. [PubMed]
3.
Breuing KH, Colwell AS. Inferolateral AlloDerm hammock for implant coverage in breast reconstruction. Ann Plast Surg. 2007;59:250-5. [PubMed]
4.
Salzberg CA. Nonexpansive immediate breast reconstruction using human acellular tissue matrix graft (AlloDerm). Ann Plast Surg. 2006;57:1-5. [PubMed]
5.
Zienowicz RJ, Karacaoglu E. Implant-based breast reconstruction with allograft. Plast Reconstr Surg. 2007;120:373-81. [PubMed]
6.
Spear SL, Onyewu C. Staged breast reconstruction with saline-filled implants in the irradiated breast: recent trends and therapeutic implications. Plast Reconstr Surg. 2000;105:930-42. [PubMed]
7.
McCarthy CM, Pusic AL, Disa JJ, et al. Unilateral postoperative chest wall radiotherapy in bilateral tissue expander/implant reconstruction patients: a prospective outcomes analysis. Plast Reconstr Surg. 2005;116:1642-7. [PubMed]
8.
Nahabedian MY, Tsangaris T, Momen B, et al. Infectious complications following breast reconstruction with expanders and implants. Plast Reconstr Surg. 2003;112:467-76. [PubMed]
9.
Dubin MG, Feldman M, Ibrahim HZ, et al. Allograft dermal implant (AlloDerm) in a previously irradiated field. Laryngoscope. 2000;110:934-7. [PubMed]
10.
Ibrahim HZ, Kwiatkowski TJ, Montone KT, et al. Effects of external beam radiation on the allograft dermal implant. Otolaryngol Head Neck Surg. 2000;122:189-94. [PubMed]
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The last post was puzzling. Who is Joann?
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No idea, and the same thing was posted elsewhere, too. Well at least it's more info backing up what my PS told me.
I'm glad to hear about your progressing healing. That's great news. Were you in poboy heaven for lunch? Here in San Diego it is blistering hot. I just abandoned the studio and am hiding out in the house. I'll write notes for class and watch TV.
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Hi, What was that?
I think it read AlloDerm with expanders. That's a different procedure then the "one step"
Carole - Happy to hear the healing continues. That's how it goes for us....day by day!
I am married 28 years and have one adopted son. No pregnancy here either. I believe that is why I had bc also. I have two older sisters...no history of breast cancer. My mother's two half sisters had cancer in their late 70's...one bc and one colon cancer.
YearoftheHat - I agree with Carole ditch the under-wire. That must be painful. Around the house I go bra-less. Sometimes when I go out I wear the bra I posted earlier. Other times I wear a bra called "barely there". It's like wearing nothing, very comfortable...just provides coverage. http://www.barelythere.com/style.asp?cid=4&sid=1&id=44 A soft sports bra makes me feel comfortable also. I feel like a bra saleswoman. lol
Fortunate - It was a beautiful day. A cool breast...almost felt like fall! I can't believe summer will soon be over.
I went for my pre-op tests this morning. I couldn't believe I was back at the hospital so soon. Instructions the same...go to the fifth floor, etc...Ugh! I worked today and then spent some time catching up with girlfriends. I should be cooking dinner now...just can't get into it.
Hope you all had a good day.
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Good morning everyone,
108 degrees forecast for today, but I think an air conditioned classroom will save me. Then to visit Dad to try and cheer him up.
One son here. I think there are so many reasons, as yet unknown, why we get breast cancer. Most of the 'contributing factors' are pretty small. It seems the scariest is mothers and sisters with BC and the gene mutation. I think, at this stage of knowledge, we're just unlucky.
Hugs to all, before it's too hot to hug anyone. Anyone know a good bra that can balance out my pointy and non pointy sides and not be thick and hot? I think I'll wear a loose top.
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Meg9 is our bra expert! I went to JC Penney's yesterday afternoon in search of the Warner bra that Meg9 recommended. There were two racks of Warner bras but no Up a Cup wirefree. I haven't been cleared yet to wear any bra other than a soft sports bra with no uplift and the bra I wore home from the hospital, a stretchy little garment that will soon fall apart from laundering it regularly.
One other risk factor for bc is regular consumption of alcoholic beverages. I was aware of this risk factor but enjoy having a pre-dinner cocktail with my husband. The same risk factor is a beneficial factor for avoiding heart disease! More women die of heart disease than bc. Is that rationalization or what?
With all that said, there are many women with bc who are mothers and non-drinkers and who don't have a family history of bc.
I'm staying home today and in addition to walking 2 mi. this morning, I did a little housework. The kitchen floor had not been mopped since before my surgery when I gave the house a thorough cleaning. I would love to hire someone to clean house every few weeks, but have lacked the initiative to go through the process of finding a person or persons. In the past I was never satisfied with the people I hired, but I don't really like cleaning house.
Fortunate1, I hope your visit with your dad does help to cheer him up.
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Hot hot hothothot, nasty hot, but the air conditioner in the classroom refrigerated us wonderfully.
Dad is very quiet, doesn't really want to do anything, naps a lot. I think DH and I will try a pizza and movie evening for him soon.
I love the alcohol rationalization, works for me. If there was a reason for my BC, maybe the worst thing I did was to take years of birth control pills and then hormone replacement, also many years. It was all state of the art at the time. Oh well......
It's too hot to want to stay conscious. It's nap time for me too. Have a good weekend.
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Hi Everybody!
I saw my GYN to discuss the D&C on Thursday. My DH came with me and then we went out for dinner. DH is looking totally stressed.
Fortunate1, It is cold here. I had to take out a fall jacket! Temp during the night was in the 50's! Today it is cold again and raining. I'm going to the mall today. Not far from me is the second largest mall in the US. It's a lot of walking!
Sounds like a good idea to take your dad out. I've been there... with my parents until they passed. Sometimes it can be difficult, especially with life's other demands. Now that they are gone...I'm glad I was there for them.
Carole - I think that bra is in big demand, because when I went back to buy another all in my size they were gone. You can alway try to buy it over the Internet.
I am really beginning to feel much better. My PS said to expect a least 3 months before I would feel like myself. I have resumed walking on my tread machine daily; and started to work out with 3lb weights. No chest muscles. I have lost 3 of the pounds that I gained since bmx. I have 2 more to go. That is making me feel better also. I found that I have better range in my arm movement and finally my breasts are beginning to feel a little softer. I think my chest muscles may have been harder because the weight lifting. I am also getting used to them.
I have been back to cleaning the house for a while now. My DH takes care of the floors and bath. I have never had luck with having someone to clean the house.
I think the reason I had bc will always be a mystery to me. I am generally in good health. BC was my first real illness.... I eat well, exercise and I do not drink or smoke. Most foods I buy are organically grown. Who nows!
Have a great weekend!
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At 5 wks out, I'm starting to feel more like myself. This morning I got out the ironing board and did a little ironing. The motion didn't cause any chest discomfort. I think my internal healing has gone very well. Range of motion is pretty good. I let my body tell me when I've reached high enough.
Meg9, I would even tolerate a little rain for evenings in the 50's! We would be raising our windows and snuggling under a blanket at night. We had several days with lower humidity this week and the forecast calls for several more days next week. We don't usually start to get cooler fall weather until mid-October.
My mother has me booked for two days next week. A dr's apptment on Tues. and a perm on Wed. While she's having the perm, I'll go check out the nearest JC Penney and Dillards and look at their bras. I'm going to need a bra to give me a better shape when I wear my knit tops. Right after the surgery, I thought I might be a C cup, but now that swelling is subsiding, I can see that I'm a B cup. I think I would feel self-conscious suddenly showing up with noticeably bigger boobs, so the B cup is fine.
My breasts have always been soft, right from the first. The implants are cohesive gel. My PS thinks these implants are the best that are available now, but there's a new cohesive gel coming on the market that is superior. It's already being used in other countries, particularly by surgeons doing enhancement on women who can afford to pay for the procedure. Dr. C. also said that the insurance companies are likely to balk at paying for these implants for recon. because they're much more expensive. I'm waiting to see my insurance statements and learn what my surgery cost.
One weird thing with my breasts is that every now and then I can feel and even notice an edge under the skin. I think it must be the alloderm because the implants are rounded and have no edges. It seems like the little divets and edges come and go. I suppose normally we just don't inspect our breasts so closely and often. One of these days life will go on and I will give as little thought to my chest as I did before dx.
I plan to take a pitching wedge outside next week and see how it feels to "chip" a golf ball. I know that putting will be all right, but it has been too hot to go to the putting green and not drip with perspiration.
Meg9, will you have the D&C as an outpatient?
Nice to have a little Sat. chat! Hope everyone is enjoying the weekend.
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Hi everyone!
Carole - To bad you can't find the "warner" bra to try it on. I didn't find it made me look a size larger as advertised...it filled the "point" I no longer have. Maybe I am a bra expert! lol
I have a busy day ahead working. I also need to get a few things done before Thursday and the D&C. The D&C is same day surgery. I will arrive at the hospital at 6:30am and I hope I'm home by 1:00pm.
Hope you all have a great day!
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Meg9, I'll be thinking about you Thurs. and sending healing thoughts.
I'm off to see the PS this morning for him to take a look at my left incision, which is looking better week by week. The inspection takes about 5 min. My next apptment with my BS is on Sept 29. At that time I'll get the prescription for Arimidex, the horror cancer drug that blocks all estrogen production. I'm not looking forward to taking it, especially after reading the Arimidex thread. Sure hope I'm among those who say they have few SE's.
Fortunate1, what kind of SEs are you having with the Femara?
Yearofthehat, I hope you're doing okay.
Everyone, have a good Monday!
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Good morning everyone. It's morning here anyway, 8:00. I imagine you are all out and about, maybe even thinking about lunch. I can already feel the heat getting ready to blast away again. No fires, please, please.
Carole, I'm so glad to hear that pesky incision is continuing to improve. I love the realization that some lucky ones can keep nipples.
Now, Femara. I believe it's basically the same as Arimedex, just made by a different company. I was in menopause anyway, so maybe that's the reason I haven't had any problems. I had a few hot flashes, and now and then have night sweats. Easy. Now that I've been on it 4 months I'm wondering about a few more possible SEs. My skin seems drier and more 'crepey', and I have a bit of trouble remembering words now and then. Both are most likely normal aging that I'm just more aware of now because I'm watching every little thing. For me, only a change from menopause to super menopause.
Meg, I sure wish I could make everything better for Dad. He had always been so strong, in command and active. The pizza and movie will be at his house because he will no longer go out. It hurts too much. His caregiver has gotten him to agree to a visit with a friend. I'll be watching to see if the pleasure of the visit outweighs his discomfort. Fingers crossed.
Yearofthehat, how are you?
Talk to you all this afternoon. I'm going to be good and take a morning walk before the blast furnace starts.
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Back to the surgery center tomorrow. Dr. C. has decided to trim the narrow strip of yellow skin on the left incision and resuture. It isn't healing to suit him and he's concerned about losing the implant if the skin pulls away from the healthy tissue. The procedure should take about an hour. He's also not totally satisfied at this point with the symmetry of my breasts. Later on after enough time has elapsed for the Alloderm to be absorbed, he may want to reposition the right implant so that I have a natural droop to match the shape of the left breast. We'll see. I just may be able to live with asymmetry. There's a chance, too, that a "droop" could occur on its own. This must be what YearoftheHat meant when she referred to "revision."
My poor mom doesn't have me for a chauffeur tomorrow and Wed. I hope she can arrange a substitute.
Fortunate1, your dad's situation does sound distressing. It's awful to be in so much pain that you can't enjoy anything. Is there any possibility of improvement in his health?
In what part of CA do you live? Last year on our way south to Vista, CA, we travelled down the middle of the state, towing our big 5th wheel. We wanted to avoid the big city traffic of San Francisco and LA. It was quite hot in Sept. and we passed through some desolate terrain. Also through some fertile farming areas.
My poor dh is outside doing yard work that I usually do. He's having to do his chores and mine, too. I know he looks forward to the day when I can return to normal life.
Meg9, we watched the PGA golf tournament at Liberty National Golf Course this weekend. The cameras kept panning to the views of the Manhattan skyline and the Statue of Liberty.
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Ah yes, I didn't wait until late afternoon, but I wanted to check back in.
Carole, Dr. C sounds like a real jewel, and an artist too. I hope your resuture is as easy as mine was.
Yes, poor Dad's situation is distressing. He is OK at home in his own chair, but slowly losing strength and feeling. At this point the doctors don't have anything more to suggest.
I live in San Diego. If you were in Vista you could have driven another half hour and parked that thing in front of my house for a visit. The central valley is pretty amazing. Food production on a huge scale. People don't always think of Cailf. as a farming state, but it is,.....fruit and veggie heaven.
Back to work, you guys are my treat.
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