One step implant procedure with Alloderm - Anyone?
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Hi Eileen,
There was some discomfort - very manageable. The breast area that got the fat had a big piece of tape keeping it smooth. I had a nipple reonstruction and dog ear removal at the same time so there was more bandaging for that. The tummy fat-donor was painful (also very manageable) and brilliantly bruised - quite a rainbow. I took it easy, but didn't really need to. I just watched the nipple healing and the muticolor tummy change. Some day I might work up the courage to post pictures on the photo site. I think that ease of recovery is a very variable thing, having more to do with pain tolerance, your own condition, and pure luck, than your age. I'm sorry you need to think about a redo, but you know, I think most of us wonder about it now and then.
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Hey. It's me again. Remodeling the house has everything in disorder so the only online access I have is when my DH's laptop comes home from work.
I have also been doing some "remodeling". My exchange/revision surgery was July 22. Eileen: At one week out from my redo I can say that this was so much easier. No hospital stay. No drain. I'm already back in regular bras (although I still sleep in the compression bra). If you look back to posts from Jan/Feb of 2010 you can find my posts complaining about how slowly I was healing. Not the case this time. PS removed tegaderm and steristrips yesterday and couldn't stop smiling. I'm trying to get used to having 20 yr old boobs on my 51 yr old body. It's weird but kind of a good weird.
So ladies, here's what happened: Exchange of my 425cc Mentor moderate profile implant for a 600cc Mentor moderate plus profile. This to correct some pretty obvious rippling and asymmetry in the area of my cleavage. Fat grafting will follow later if necessary. Then augmentation of my noncancer breast with a 250cc moderate profile in order to match me up size wise. End result- 32A pre MX, 34C now. Then a nipple reduction on my noncancer breast to make it more closely resemble my saved but much collapsed MX nipple. Pretty good outcome. Of course time will tell. Minor revision may lie ahead but right now I'm pretty happy.
Meg: LOVE the quilt! And your square is my favorite (although they are all nice).
fortunate1: I always love to see your art. That woman is stunningly beautiful. She gets to me on so many levels.
Carole: Isn't AK great? Your latest posts are bringing back all kinds of memories. I used to love sailing on Resurrection Bay.
Okiegal: Sharing your heat right now. And I know it bothers me more just because I'm forbidden from immersing myself in our creek til I'm all healed up. I also feel you re hot flashes. Mine are the result of Fareston (I didn't tolerate Tamoxifen well). Black cohosh taken daily helps with the symptoms of "personal summer". My ER+ means I can't take Estroven or other plant estrogens but my OC says black cohosh is fine. Bonus: cheap and easy to find at Vitamin Shoppe etc.
Tink: Thanks for thinking of me. It's good to hear from you. I want to respond to your last post but it's not on this page and I can't go back without losing what I'm writing now so I'm going to take a little break from the computer right now but I'll review your last post and be back shortly.
That's all for now but I'll be back soon. Hope you're all having a great day.
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Meg: Beautiful quilt! There were two bears in front of our cottage yesterday but I missed them. The neighbours all get an eye on them. They must be hungry if they are out in the daylight looking for food, usually they are only around at night.
Fortunate1: Wow! Thanks for sharing, your work is beautiful
Okiegal: My axilla is feeling better. I think it was muscles. I remember rolling up the left window with the help of my right arm (because it was raining and it was hard to roll up) and probably used something I seldom do. Electric windows next time!
Carole: Really enjoying your stories of your trip. It must be so strange having the sun up almost 24 hours.
Doing some landscaping around the cottage. Cut down a tree yesterday that was leaning too close to the building. We are going to take a break today and drive 2 hours to see my mother.
Hi to all and have a good week.
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Meg, I love the quilt. It's beautiful. A few days ago in Valdez, DH and I were driving on a quiet little road and a black mamma bear and three cubs crossed the road ahead of us. The cubs were adorable. It was so special to see the whole bear family.
Newbride, I'm glad you're happy with your revision procedures. I'll bet you look terrific.
Fortunate, thanks for posting the pictures. The female figure is gorgeous. I wanna look like her!!
Okiegal, good to hear from you.
We're on our way to Haines. It will take 3 or 4 days to get there. Haines is the place where we'll begin our inland passage travel on the Alaskan ferries. We have five passages booked and will make stops at Juneau, Sitka, Petersburg, Ketchican, and Prince Rupert.
It's hard to believe that tomorrow is August 1st!
Hi to everyone else not mentioned.
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hello, I have been reading a lot of this forum (probably about half the pages - gulp!) and am trying to decide whether one-step is the right procedure for me.
The PS I have met with says she has done about 20 one-steps and "hundreds" of TE procedures. She says it's because she is very picky deciding which patients to try a one-step. And she says even if she thinks she will do a one-step, she might decide during the operation that the skin is too thin after the BS removes all the tissue, or that it can't handle the tension of the immediate implants. At that point she would do TEs.
She says her success rate for one-steps is about 70%. I don't know what to compare that to, frankly. Is that good? Should I be worried about that? It sounds low to me but I don't really have a frame of reference.
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Dawmson, I had a bilateral skin and nipple sparing mastectomy with immediate reconstruction (memory gel implants) on June 28. My BS said I was a perfect candidate for it, but, like with you, I wasn't sure if I would wake up with expanders or implants. I was so happy when I found out the implants were in place and I thought it would be smooth sailing...well today I saw my plastic surgeon and some of the skin and one of the nipples won't make it. So I will have to have another surgery, where he'll cut the dead skin out. He has to take the implants out and put in expanders.
I just wanted to tell you my story, I think the necrosis of my skin would have happened either way.Are you having the skin and nipple sparing mastectomy?
Good luck with everything! You are lucky to have an experienced surgeon, I would love to hear what you decide.
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miasanta2007 - ugh, so sorry to hear that the one-step did not work for you. My PS said that I would have to go thru the same thing if the one-step didn't work.
Yes, I am a candidate for nipple-sparing mastectomy. I hope that your other surgery goes better and is a success. Thanks so much for sharing your story. Just out of curiosity, did you try to increase your breast size with the implants or stay the same as what you were? I am an A cup now and hoping to be a B cup after this is all done.
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@dawmson: I didn't request to be bigger, but they did turn out to be a little bigger. I am happy with the shape of them, but now they need to be taken out...and at this point I (and my husband!) just want it all to be done and over with!
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I just asked my PS about this procedure because I am VERY interested in having one surgery to reconstruct after my BMX. The following was his reply. Maybe I am just a little sensitive but it seems like he just doesn't want to do it. Also, I am not sure why he says I would need graft, etc. If the mastectomy is done with this reconstructive surgery in mind, wouldn't they save the skin needed to support the procedure? Appreciate anyone's comments......one other note, this PS is really pushing for TE/implants which is the most common procedure for reconstruction that I have read about. I have Kaiser HMO insurance so I am somewhat at their mercy unless I make a lot of noise about it. Do I have any reasons to push for this?
"The alloderm is placed with the thought that it allows you to not have complete muscle coverage over the implant so that if the skin dies the implant will not be exposed and you could theoretically do skin grafting at some point over the alloderm. I have experience with using alloderm since 2003. The problem with it is that it does not get incorporated into the tissue and acts like a foreign body. I have even seen it extruded from wounds. So I do not like to use it. When a mastectomy is done skin is removed. The only way to replace the skin is with a flap, graft, or expansion."
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Hi Lisa, The one-step is a mercifully easy and quick reconstruction, but it is not done by everyone. You're right. The expander route is the most common. I was told that complications are rare, and that your own tissue grows into the Alloderm. There certainly was no skin graft in my case and the skin streched easily over the implant. But all we know is what we're told or read or that happens to us. A crazy process, reconstruction.
I think you have a surgeon who just doesn't like the procedure, or has personally had no success with it for some reason. It doesn't sound like his objections have anything with your own personal situation - am I right? I wouldn't pressure a surgeon to do a procedure he objects to. If you want it, or even just want another opinion, are there any other surgeons available to you? Good luck, and feel free to ask anything. It seems that everyone here is off enjoying their summer, but I bet there will be women on hand to answer your questions.
Dawmson, 70% sounds low to me too. Is that 70% success with the actual one-steps done, or 70% get one-steps and 30% get TE's at the last minute?
miasanta, So sorry to hear about the skin necrosis.. Hope that the tissue expanders go easily and your skin tolerates the expansion. The best of luck to you. Let us know how you're doing.
Everyone else, hope you're all having a wonderful summer. Carole, if you're checking in - did you see the aurora borealis? I read that sunspot activity was very high and that there could be a spectacular sky show for you. Hmmmm, one of my dreams.....
Hugs to all.
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Hi fortunate1,
Well, my PS responded to my follow up email and he explained that he really has not used the one step procedure. He is checking within network to see if any of the PS's have any experience with it. I am so glad that your reconstruction was such a success. Other information that I have found on the procedure is that it is only used 12% of the time, that most surgeons opt to do the staged implants. I don't know if this is because of added risk or complications or just that it is a lesser known process or maybe it is more expensive???? It sure sounds better than the tram or diep and for sure better than enduring a 3 month process for implants. Surprised it is not more popular.
Best to all.
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Having this tomorrow at 10am . BMX with the alloderm with skin and hopefully nipple sparing. I did not have enough body fat for the flap procedures. I do know there is only about 20 doctors doing the procedure in the US. He is the link to those physicians. I am doing mine in New Orleans. DEEP BREATH!!! http://breastrecon.com/id27.html0
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Good luck dixiebell! Although there aren't as many doing the one-step, it's not as rare as only 20. I think that Salzberg is the pioneer, or one of them. Is he your surgeon? Ah, by the time you can answer, you'll be done! And in New Orleans, the mecca of breast reconstruction.
Lisa, I think tradition changes slowly. Expanders work and are the long time standard. I bet there would be someone in San Francisco, if you can travel.
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dixiebell - will be thinking of you this morning! Hope it goes smoothly!
Lisa - as fortunate1 said, the standards in reconstruction change slowly - and I agree that you don't want someone inexperienced doing ANY of these procedures . . . they need to have a comfort and skill level, and you need to feel confident in their abilities.
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Thank you, fortunateone. My surgery is scheduled for 8/18
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Best wishes to dixiebell!
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Ladies (fortunate1, dixiebell, SAOlsenberg)
Thanks for your good advise. I have to stay within my HMO network but am checking to see there are any other PS's in the network that do the single phase implants.
Dixiebell, wishing you the best with your surgery. Please check in when you can to let us know your outcome. Prayers are with you.
Best to all.
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My PS in Louisiana once did the TEs and fills, but now he performs the 1-step exclusively. His wife is my BS and she partners with her husband and also with the surgeons in New Orleans who are nationally known for their DIEP reconstruction. I was offered the DIEP alternative but chose the 1-step because it involved less surgery and offered easier recovery.
I would guess that the TEs and fills method is more expensive than the 1-step because there is a 2nd trip to surgery for the implants. This type of reconstruction is better for women who want large breasts.
Good luck to our bc sisters who are making these important decisions and who are undergoing surgery.
I'm writing this post in an rv park in Juneau, AK. My dh and I have begun our travel in the inside passage. On Tues. we made the passage from Haines to Juneau. Our next trip will be to Sitka. Today we took a bus to downtown Juneau and toured the Capital Building. We had lunch down on the docks at Tracy's King Crab Shack. We had crab bisque, crab cakes, and a King Crab leg. All three were yummy. In Haines we had steamed Dungeness crabs and they were very good, too. The weather has been wet for the past two days with drizzling rain. Our rain jackets have come in handy.
Meg, we saw two grizzly mamma bears, each with two cubs, in Haines at the Chilkoot river, which is a beautiful swift-running river with rocks. The bears were fishing for migrating salmon. So were quite a few fishermen but they cleared out of the way when the bears appeared! There were also eagles at the river. What a wonderful place for viewing nature. I went there almost every day and sat on a big rock on the bank, absorbing the beauty. I deserted the rock when the bears showed up!
Hello to everyone.
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So had a rough time ended up in hospital 6 days but finally home (fever vomiting and diarrhea). Did have lymph node involvement 2 of 18 nodes. The pain is only on the side with the lymph nodes removal. The right breast feels like nothing happened. Have 2 drains 1 in each breast. To answere questions Dr Stolier was my surgeon and was wonderful and Dr. Dellacruce did the nipple and skin sparing alloderm reconstruction. I cannot say enough good things about these 2 men. Glad to be home!!!
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Welcome home, dixiebell! Sorry you were in the clink for so long . . . when I had my nodes biopsied, it hurt for several days - something about them rooting around under that arm. I hope you rest well and heal up nicely. Keep us posted - rooting for you!
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Dixiebell, we're neighbors! I live in Madisonville. When I get home in Oct., we'll have to get together. Healing vibes sent your way.
DH and I are in Sitka, AK. Beautiful little town on the inside passage. From our rv site I look out at a lovely harbor and see a white lighthouse on a shore of an island.
Hi to all.
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Hi carolehalston and how nice to be traveling. Good for you. Would love to meet.
Day 10 drains still putting out about 120 cc day each so think I will be stuck with them for a while longer although they do not bother me. Still NO feeling under my left arm. Worried about that. My breast do look nice (well as best as can be expected.) In fact the non cancerous side had no pain at all so no problems with the 1 step alloderm. My problems seem to be because of the extensive lymph node removal on the left.
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Misianta and Dixiebell: Thinking of you both during your recovery.
Carole: Is it getting warmer as you travel South? Have you shed your winter jackets yet?
Just returned from a week of camping with my family and some of my DH's family. Crazy but fun week. No bears this year!
Meg, Okiegal, NewBride--you must be having a good summer?
Fortunate1: We saw Northern Lights this past week.
Hi to all.
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Hi Ladies,
I had my BMX with alloderm and immediate implants that can be filled afterward--I'm not sure what they are called, but they are by Mentor.
It has been 18 days now, and I'm still having a lot of pain. Now I can feel the fill ports under my arms, and they are really bothering me. Has anyone else had this experience? And boy, I'm sore all over. I had a little infection that is going away now after a few days of Keflex. I go to see the PS tomorrow to make sure the infection is going away, then I have an appointment @ the pain clinic at 2, as the PS doesn't really know how to treat what I'm experiencing (or doesn't want to). He offered to remove some of the fluid from the implant, but I don't want to be any smaller than I am! I was a DD and am now about a C, and it is a little bit of a shock--my shirts are not as filled out as the used to be!
I'm also retaining fluid due to my period--could that be causing the discomfort from the ports?
Thanks in advance for any insight!
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I had the one-step w/Alloderm, first in April 2006 (eons ago I know) and then the other breast sometime in 2009 (done as a preventive measure; I wasn't ready for a bi-later mx at the original time of diagnosis but went ahead after thinking about it for a number of months).
My ps also warned me that he may decide to do a TE for various reasons after beginning the surgery but all went well. Interestingly, he does not do the one-step any more as he said that too many patients ended up with infections and unsuccessful results (he had stopped by the time of my 2nd surgery in 2009, but agreed to do the one-step for me b/c of my previous surgery).
For the first (cancerous) side, revisions were minor and it was a very short surgery. I did go through radiation and ended up slightly lumpy/puckered on the side that had the rads but it hasn't bothered me enough to want to revise it again (I'm in my early 50's, married, and have already had and nursed my kids).
For some reason, the second (non-cancerous) breast required two revisions, it hung too low. The second revision (where it was lifted) was the only time I felt more than minor pain - apparently the ps had go to deeper into the chest, or it involved more muscle, or whatever.
If you are in good health, I would absolutely do the one-step. It worked out very well for me.
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Does/did any of you get terrible pain in the port site? I almost want to tell the PS not to fill me up anymore, just get these $8&@! ports out of my armpits!
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Kerry - so great to hear encouraging stories like yours - my BMX is coming up 9/19 and although I'm definitely mentally ready, I'm of course worrying about how it will all turn out. Just out of curiousity, did you do silicone or saline implants?
@Eema - have no advice for you, but I'm so sorry you're having so much discomfort!
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Hi everyone, and especially Eema,
With the one step you don't have expanders and fills, as the pocket for the implant is created with alloderm and the implant is placed during the same surgery as the mastectomy. So we can only sympathize but not really advise.
Sarah, it's good to feel ready. The very best of luck to you. Ask anything. There is a lot of great support to be found on this thread. Everyone seems to be off on vacations but will return I'm sure. For me, the surgery was relatively easy - unilateral with a silicone implant. It came out very similar to my remaining breast. Definitely not perfect, but undetectable in clothes. The silicone is nice and soft, which I appreciate.
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Fortunate1, I have post surgical adjustable implants, so I DO have ports and am supposed to have fills, is that not the same thing? I did get alloderm and have a permanent implant, or what will become permanent once the ports are taken out. Thanks.
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Thanks, Fortunate1. I had been super nervous about the surgery itself - and the associated recovery time, then it was pointed out to me by an oncology social worker friend that I was probably remembering how awful my experience w/chemo, etc. was years ago - resting and not feeling rested, etc. etc. and that every week after surgery should bring big gains in comfort and energy. Trying to reframe my expectations now!
Eema - w/the "one step" reconstruction, the implants that are placed during surgery are filled. So no fills/ports/etc. post-surgery. So although you don't have expanders, it's still not quite the same as what women here have had/are slated to have.
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