One step implant procedure with Alloderm - Anyone?
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SAO,
My PS had told me that I would most likely need revision surgery for fat transfer prior to the PBMX due to the difference in size of my breasts. However, I think I realized the right implant would need to be repositioned or replaced at about the 3 month time period for it had migrated to a place where it seemed I hit my arm against my breast very frequently. It seemed unlikely that it would correct itself.
I think most PS do not consider revision surgery until about the 6 month post-op time frame or perhaps later for things do continue to change for several months.
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Sandy105:
Thanks for taking the time to provide all of the very helpful information. I did meet with an experienced PS today - but was a bit surprised to hear that, despite his experience, he has only done about 20 NSS recon's. I stupidly failed to ask him how many of those involved one step recon with Alloderm.
He did show me two pictures of recons where NSS was done that were on his computer - both looked good. I was surprised to see, however, that I did not particularly care for the other photos he showed me -- which involved recons of the more traditional MXs - where the incision is horizontal across the breast and the nipple is removed. The "new" breasts, by and large, seemed too large -- not necessarily in terms of projection out from the chest, but too large in circumferance on the chest and too low overall. And I suppose those are the results he is most proud of since he is publishing them to prospective patients.
I have an appt with another PS tomorrow. That will be the third PS I have met with.
I still have to hear about the results of my SNB. I SO HOPE the lymph nodes are not an issue fo me (as we all do!!)
I am usually not at all this picky but as you note Sandy, it is really important to have confidence in your surgeon.
I may end up on a plane to NYC after all! Amsk.
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Hi to old and new members of our thread. Today was a beautiful day, sunny with the highs in the 70's. I planted pansies and snapdragons in the pots on the patio. Tonight we're watching LSU and Alabama.
Hope everyone is having a great weekend.
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Carolehalston, it was a balmy 30 degrees here with a wind chill of 10, brrrr... I wish it was warm here.
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Jen, thanks for joining me in this empty room! 30 degrees is very cold, especially with windy conditions. I'm glad to see you are stage 0 and DCIS. Your outlook for a healthy life is great.
I had a rare instance of good luck at the Beau Rivage Casino in Biloxi, MS, last night. DH and I stopped off there before going home. We had gone to Ocean Springs, right next door to Biloxi, to visit one of DH's former co-workers and his wife. Anyway... We were playing video poker. I was betting only 1 quarter per draw and got a little bored. So I decided I might as well go ahead and lose my $20 so we could head home. I switched poker games and started hitting the button for betting 5 quarters. I was hardly noticing when all of a sudden I drew 4 aces and the winnings started adding up! DH (sitting next to me) and I watched in amazement. My cash-out was $216.25!!! The $16 was the rest of my $20. DH immediately started hitting the Bet 5 button and lost the rest of his $20.
I gave him $100 and I kept a $100. We drove home! Of course, the next time I go to the casina, which isn't often, I'll try the same method and will probably not win a thing. The casino always wins in the end.
Hope everyone has a happy Monday!
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Thank you, I feel blessed that I am alive and didnt have to do chemo or rads. I did have a BMX as well with silicone implants. I am getting some fat transfers next month, I didnt have the nipple sparing on the cancer side so will get the nipple reconstruction at the same time.
We have no where to gamble except at a indian reservation 2 hours away, I am not much of a gambler but hubby likes it. I dont like to lose so I am a cheapo lol
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Hi, all of you 1-steppers out there. I miss connecting with you and hope you are doing well.
What are your plans for Thanksgiving? My DH and I are driving up to Decatur, IL, to have dinner with his sister and spouse and other family members. While I don't look forward to the road trip up I-55, it will be good to sit down to a big holiday meal that I am not responsible for putting on the table! We are taking oysters for the oyster dressing. My SIL uses Paul Prudhomme's recipe. She also makes conventional bread dressing. I was hoping to be thinner by Thanksgiving but the weight is hanging on tenaciously.
Wishing everyone a good night.
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I had my implants exchanged and fat injects done on 11/11/11. I am recovering nicely and worked today. I am very happy with my final outcome. So I guess its not exactly 1 step.
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Hi everyone. And hi my dear Carole. I'm not keeping up very well. On Thanksgiving we'll be going to my brothers house for the usual incredible feast. My assignment is always several pies, cranberry sauce and fresh out of the oven rolls.
Then on Saturday another Thanksgiving at our house for DH's family. Last year was so much fun. we skipped the turkey for already cooked chicken (since everyone had already had their fill of turkey) and then went nuts making lots of different side dishes and desserts. Hmmm, maybe a ham.
Dixiebell, congratulations on the next step. I think there's often something more to be done. But I'm still grateful for the comparative ease of the one-step. It seems so long ago now, and yet I notice it every day. I don't like the slow yearly creep through my "anniversary" months. Not as many intrusive memories this year - so far.
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Dixiebell, I'm glad you're happy with your exchange surgery. We'll have to get together since we live only a few miles apart.
Fortunate1, it's great to hear from you. Your Thanksgiving get-togethers sound delightful, especially the fresh out of the oven rolls.
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Today was such a beautiful day. Cold this morning, high 30's or low 40's. Brilliant sunshine. Warmed up to 60's by early afternoon. I played golf with my Friday group at 9:20. Had to laugh at the way the other three women were dressed. One had on ear muffs and a scarf around her neck. All three of them were wearing long underwear under their clothes! Before an hour was up I had taken off my vest and light sweater and was wearing a cotton turtleneck and slacks.
You should see the adorable little bicycle parked in the living room. My present for 2-yr. old Olivia, my great niece. It has training wheels and is painted so cute.
Hope everybody else had a delightful Friday like I did. It all goes to prove that you can enjoy life without A plus reconstruction!
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Hi everyone,
I had not one, but two gorgeous meals. The lavish use of butter made us all happy and I am holding my own - barely - against weight gain. This weekend is my Holiday Pottery Sale with three of my best pottery friends. We're part of a larger citywide San Diego Pottery Tour this year. Signs, flyers, website, more publicity than I can do on my own. Hope it works!
Back to cleaning (so much cleaning!) and cookie baking for the customers to come. Wish me luck.
MMMMMMwah! big kiss and a hug....
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Fortunate, tell me your secret for eating two meals with much butter and not gaining weight! I came home from our week-long Thanksgiving trip to Illinois up on the scales 5 1/2 lbs. It seems I have to stay home and eat my own cooking to maintain and gradually lose weight.
How does the city-wide pottery sale work? Do customers come to your studio at your home?
I'm playing golf today with a 9:30 am tee time but my side yard was white with frost when I got up at 7 am. There will be a frost delay since play can't begin on the golf courses until the frost has melted.
Tonight I'm invited to a Girls Night Out dinner at the nearby Methodist church. The women at the church each decorate their own table where they sit with their invited guests. Last year it was very nice.
Aside from the weight struggle, I feel good. I have an order for blood work which will check my cholesterol and sugar levels. I'm taking a statin for high cholesterol and a med for borderline diabetes. I suspect arimidex may be causing the high cholesterol. Adult diabetes runs in my family. I eat very little white carbs and very little sugar so my diet isn't causing the insulin resistance.
Hope everyone is doing well.
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Hi Carole,
I spoke too soon. Two pounds up. Drat! The secret - as far as it goes - is that I didn't really eat much else during the feasting days except for the grand extraveganza meals. I think it might have been all the leftovers that got me.
The San Diego Pottery Tour has been going on casually for a few years with a number of us all selling out of our homes on the same weekend. I pass out other potter's cards to my customers and vice versa. This year we have cards and maps and a website and advertising and a sincere hope that we can all benefit each other. I am one of the hosts so customers will be coming to my home to buy work by me and three friends - the Four Potters. I just spent the day setting up tables and putting out part of the work. I am exhausted. None of the four of us is very young anymore. People love coming into my scruffy studio and my lovely garden. We feed them cookies and pottery talk and my dear husband writes up the sales.
I think our first year really pleased the few customers we had. It rained buckets, and we set up inside my house. Everyone was touchingly delighted to be inside my little house, drinking coffee, checking out my furniture and buying pots. Last year just before the sale one of San Diego's best and most beloved potters died, way too young. Fellow potters came to our sale and we swapped stories and comforted each other. It is a close community.
If only you were here I'd feed you cookies and coffee and pottery talk and we would have a wonderful time.
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Hi im new here i have been diagnosed with BRCA 1 ..The docter wants to do a nipple sparing mastectomy with immediate one step reconstruction..Seens as i have to go threw all of this crap i was wondering if its possible to have bigger breast with the one step reconstruction??? Can anyone answer this for me??
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It is generaly not a good idea to plan on having breasts significantly larger than they currently are with the direct to implant. The docs fill the existing skin envelope and thus, your new breasts will be about the same size as they were prior to sugery. Sometimes, the size can be changed slightly, I think, but believe the size change to be not very great.
If you decide on tissue expanders, I think it is then possible to alter the size of the new breasts. I did not have TE's so other lacies on this thread can speak to this question.
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Hi Shawna,
I am not a doctor and what I have to say is what my ps said to me (you will find many differing opinions among ps's). One step reconstruction is most successful for woman who are smaller busted, C or less, and wish to remain that way. I was a generous B before my bmx and told my ps I wanted to look as much the same as possible. I was pretty perky for a 55 year old and am still the same size but even perkier. Good luck to you!
Caryn0 -
I was a B cup barely before my BMX and I had immediate reconstruction and went to a C. I had fat transfers after 6 months of the reconstruction and they are a little bigger now.
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I agree with the other opinions that you should consider TEs if you want to go bigger. The women who choose the one-step immediate reconstruction do not want to undergo the discomfort of the fills with the TEs. I was a small A and am now a small B after the one-step. I could go back for revision and get larger implants if I wanted larger breasts. But I probably will not. Good luck with your decisions.
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I am glad this discussion forum is here because I have seen very little on the "one step" and that is what I want to do. Just admitted to myself on Friday that I needed a mastectomy and my BS confirmed this. I've pretty much decided on a BMX. I am so new to this and I have my first consultation with my PS on Thursday. Is it possible to save all the skin and nipple and just refill it with the implant? Also, I am small breasted (and am fine with that) and was wondering where they make the incision? I think my BS said maybe across the base of my breast (i.e. under my breast), but of course the PS and I will be discussing this. Does anyone know of a website that discusses this process further?
Thanks for any information you can provide.
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Hi Stac,
I am happy to tell you about my own experience but everyone is different and each ps has their own opinions and level of experience which may make them more comfortable with one procedure over another. I had a skin and nipple sparing bmx in early September. Only my left breast had cancer but my right breast showed calcifications so I chose to have it removed. I met with my ps and although I was set on implants,he presented all possible reconstruction options and thoroughly discussed pros and cons. My breasts were a generous B and "youthful" ( as ps noted). I wanted to look as much the same as possible. He said he would try for a one step with silicone, but if he felt it would not achieve good cosmetic results, he would go with TE's. I really appreciated his honesty and his attention to detail. I ended up with the one step and Alloderm slings. My incisions go from the nipple toward, but not into the armpit. Sort of like darts on a blouse. I eventually had to have my left nipple removed due to dcis to close to the area. I look virtually the same as before and can easily go bra less but I recently bought some beautiful new bras which made me feel very "normal". I may have the left nipple reconstructed or tattooed but haven't decided yet. Please feel free to ask me anything!
Caryn0 -
Caryn,
Thanks. It's so good to hear from you. Your post and some of the other forums I just searched have started giving me the answers I need. That really does help as I move forward. I'll see what my PS says on Thursday. I know he does do the one step sometimes. With appreciation, Stac
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I could not save my nipple on the cancer side but had skin sparing on that side. On the opposite side I had nipple and skin. I just had the fat transfers last week and had a nipple reconstructed on that side. It looks so good, I cant wait for the tattoo.
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Hi Stac - I had the one-step with immediate reconstruction and I chose saline implants. I was a B-cup before, and my surgery really is as you described: my PS saved all the skin and my nipples and replaced the breast tissue with the implants. On my right side, my incision is under my breast fold and extends a little way up toward my armpit, but you can hardly see it. On the left, she went in through an old lumpectomy scar on top of the breast, so as not to make a new incision. I look almost exactly like I used to, just a little firmer and perkier. It has made the adjustment easier, I think, although I of course have nothing to compare it to.
I don't know of any websites that discuss the one step in more detail - honestly, the most helpful information I got was from this site and then my PS . . .
Feel free to ask more questions - lots of women here to help!
Sarah
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Thank you for the replies! Jen, I hope you love your tattoo.
Sarah, thanks for the info. How long was the recovery? How long were you off work if you work? How long for the pain and how bad was it? I am so glad it went well for you. How did you decide between saline and silicone? Are you pleased with that part of it now? Thanks for your willingness to share for your experience.
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Stac - I had the surgery Sept. 19th, and I'd say around week 5 I started to feel a lot better. I think that was a week or so later than some other women who'd had the same surgery b/c I had some complications (allergic reaction - nothing related to the procedure) that set me back a week. I was not in much pain at all - only took narcotics in the hospital and for a couple of days after I got home (in for 3 nights b/c of the allergic reaction, normally my doc keeps you in for 2). After that I took regular-strength Tylenol. There were some muscle spasms within the first 24 hours after surgery that were pretty uncomfortable, but they gave me valium for those and they were gone w/i 36 hours, I'd say. I'm not a toughie when it comes to pain, and this was not bad.
I was uncomfortable for a while, though - lots of pillows to sleep, tough getting around w/no arms (though my trunk and leg strength are great - went into this in great shape and it does help if you are, or if you can get yourself shaped up before surgery). I'm still uncomfortable at times even today - almost 3 months out - I am by no means back to 100% physically, which is amazing to me since I am in excellent physical health and was in super shape going in - and only 42. I didn't think it'd take this big a toll on me, but it's a major surgery - they warned me, I didn't listen!
I chose saline b/c I'm a worrywort who didn't want to add a silent rupture of silicone implants to my list of things to worry about. This is my second round w/BC and I'm looking to reduce my worry (and screening), not increase it, darnit. My PS was dead-set against saline - said the cosmetic result would be awful (rippling, etc.). I have no rippling and my breasts look just like they always did! I know women who have silicone and who have issues w/rippling . . . so it's not a definite. I will say that silicone would feel more natural to the touch - when you squish my breasts or push on them, they feel more like bags filled with water (although very firm, not sloshing or anything), whereas the silicone would have a much more realistic breast-feel. Your PS should let you handle both, if you haven't already.
But I've been married for 11 years and it's not a big deal to either of us . . . so I chose what I wanted based on peace of mind. There are a gillion women w/silicone who have had NO issues at all, so you should choose what seems right for you.
I'm happy with all the decisions I made. I'm back to all my former activities, just not with the same intensity, yet. My goal was to get through this as quickly as possible and with as little lasting effect to my body as possible (so no lat-flap, no tram, and even no diep or free-flap as the surgery and recovery are much longer, plus, not enough tissue for diep). I'm still in the early post-op stages, so time will tell more in terms of satisfaction, but so far, so good.
I'm happy to share - it helps so much to get different opinions on all of this. The decision-making process is one of the hardest stages in this whole thing, I think!
Sarah
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Sarah,
Thanks so much for sharing more of your story with me. That is so helpful as I move ahead. I want the one step and meet w/ the PS on Thursday. Did you have drains? If so for how long? Were they removed in office? How long before you can use your arms for things such as carrying a dinner plate or opening a door? I have heard many people mention the pillows, so is that for propping them up behind you for sleep, or what? How long before the average person can return to an office job? Right now I have blocked off 3 weeks.
Thanks for sharing your info on implants, I will look at those when I visit with the PS. I am glad you are happy with the decisions you have made. And yes I'm sure it takes quite some time to get back to full normal b/c it is such a major sugery. Hearing your expeience is so helpful!
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Ladies - I will be having a PBM early next year, I still need to meet with the PS. Question on the Alloderm procedure - what is the recovery time like, limitations etc, and do you eventually get your strength back? Does the surgeon do anything to your muscles when he attaches the sling?Also can you sleep on your side/stomach in time? Thank you in advance for your help.
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Stac,
Sarah and I had our surgery about two weeks apart. Our biggest difference is that she had saline, I had silicone. We both had ns and Alloderm. My ps said that a mx without reconstruction was a 3 week recovery but with reconstruction, 6 weeks. Although we all heal differently, I would guess that not too many women who have had bmx with immediate reconstruction go back to work after 3 weeks. It would also depend on your job, of course. This is very major surgery and you really do need to let your body heal.
FarmerLucyDaisy,
See above for recovery time. Yes,there are some major restrictions in arm usage and limits on weights one can lift. I think I was originally told not more than 5 lbs. I had a hard time opening heavy doors, turning jar/bottle lids. I could not open the child proof lid on my meds! It is very important that you follow your ps's restrictions but you will find that they each have their own opinions. Yes, you do eventually get your strength back. Post bmx exercises are very helpful and if you can see a pt to help you with these, even better. I can now sleep on my side, but my ps advised me not to sleep on my stomach for at least 6 months (had my bmx in early Sept.). As far as attaching the Alloderm, I will beg ignorance here and hope someone else can answer. I am very, very pleased with my results and I loved my ps. Good luck.
Caryn0 -
Stac - as Caryn said, the recovery time w/the implants is about double - for me, the PS said 6-8 weeks, and my restrictions were: no exercise that got my heart rate up for 4 weeks (so strolling OK, brisk walking not); no arms above 90 degrees, no pulling/pushing; no lifting anything over 5 lbs.; no side sleeping 'til after week 6, after week 8 side & stomach OK. I do sleep on my sides now, haven't slept on my stomach yet, but I have done "supermans" on my stomach for exercise and it's not a big deal. I think b/c my implants are so small.
3 weeks is very ambitious, I think - I realized I didn't answer this for you previously - I'm a stay-at-home mother, so I'd say my job is much more strenuous than a desk job. I started doing more and more after 5 weeks, but was pretty much incapacitated until then, and couldn't even open our refrigerator 'til 8 weeks (super-tight seal, we got a mini one that I stocked each a.m. before my husband left). It's a huge pain in the butt, but as Caryn said, you need to follow your PS's recommendations b/c you can really mess things up if you don't (i.e., pop an implant out of place, cause major swelling, disrupt healing and set yourself back even further). I was literally sitting on myself by week 8 b/c I was going out of my ever-loving mind.
Pillows - you will NOT want to sleep horizontally for a while post-op - so the pillows are to prop you up to whatever degree is comfortable and also for your arms. Many women rent/buy/use recliners after surgery - we don't have one and so I used something like 6 pillows, on average, to sleep at night. I also found one of those bedrest/"husbands" useful (like a big structured pillow w/arm rests that can sit against your headboard) for watching t.v. and reading.
FarmerLucyDaisy - your pecs are affected in that the PS inserts the implants underneath them, so they're streched out and rearranged a bit (you will have muscles in your breasts, post-op, which means fun party tricks and a weird feeling when you ARE allowed to exercise - not pain, but you can feel the muscles moving over the implants). IIRC, the Alloderm is stitched to your chest wall. You need to be very careful initially b/c it's all placed in there w/some stitches, etc. and until your body starts to heal around it, you can disrupt the works.
Hope I covered it all here!
Sarah
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