One step implant procedure with Alloderm - Anyone?
Comments
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I was a full C to small D. I had a "one step" with alloderm. I am more of a full C now, but my 32 D bras still fit fine. My PS could not guarantee that he would be able to do the direct to implant route until he got in the OR, so he sized me for tissue expanders at my pre op visit, just in case I did not have enough skin left or the pec muscle would not stretch enough.
I did end up having a revision to the pocket and repositioning of my implant when I had my nipple reconstructed 5 mos. later. So, please understand that the "one step" description is often somewhat of a misnomer. Just something to keep in mind and ask your PS about.
Good luck!
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Thank you, 1openheart
anyone have one step with nipple sparing? can't find much info on it. i am eager to get started on this process so i could get this ordeal behind me!
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shabby I had one step NS w/immed silicone implants 4 months ago - there is a thread here with info. Is there anything specific that you want to know?
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I had nsm/ss one step with Alloderm. As someone else mentioned my ps made no guarantees and took TE's into the OR. I was a large B small C and wanted to remain that way. My ps said he thinks one step works best if you want to stay a C or smaller. Of course, there are other factors involved in sparing skin and nipples that trump cosmetics. I love my results. Best of luck to you.
Caryn0 -
thank you joyh1109 and exbrnxgrl
i am hoping that i will be a candidate. i live in ny and have two consults set up for april. my BS said he thinks i am a good candidate for nipple sparing but said i needed to talk to the PS about the one-step.
how was the surgery and the recovery? how do the implants feel? i have heard many women complaining about them not being comfortable. are you happy with the results?
i will look for that thread. i get so lost on this site but it has been an absolute godsend! thank you so much for taking time to reply to me. it is such a tough decision...
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Shabby,
The surgery and recovery were about what I expected. I needed the full 6 weeks and really let myself heal but st the same time exercised and walked when I was allowed to. I was very conscious of the need to be as active as my body allowed but rested when I felt tired. Pain was moderate but I stopped the prescription pain meds as soon as I could. Sleeping propped up on a bed wedge with lots of pillows supporting my arms wasn't bad. I also used a u shaped neck pillow. The Alloderm felt very tight for a while, but now, after 6 months, I don't notice it much. I am very pleased with the results as I look almost exactly like I always did but never have to wear a bra if I choose. I did have to lose one nipple because of concerns about dcis too close to the area. I am completely comfortable, after several months, but please remember that those who are not happy tend to post more than those who are satisfied .
Caryn0 -
shabby I am happy with my results, after 4 months out from surgery. I was a larger B, smaller C too and am pretty much the same size now. Recovery went relatively fast, I took pain meds for a week after surgery and then didn't need much of anything. The positions and pillows needed for sleep were uncomfortable for me, but after a few weeks it got so much better. The Alloderm was tight also for me, and I did exercises starting 3 weeks post-op with a PT to stretch which helped alot. The implants are comfortable, although there is still numbness on the outside of breasts and nips and from what I hear this may last for awhile.
Good luck in your decision.
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I am 10 months out from my BMX and I still cannot feel anything. I had nipple sparing on the non cancer side and cannot feel it either. On the cancer side it is the front, in the armpit and some of the back that is numb. I doubt it will ever come back.
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alliesmom15 I've heard that feeling may never come back. Oh well - price to pay I guess for some peace of mind.
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Shabby, I'm doubtful that the one step would be appropriate for a d cup. You would have so much extra skin. One of our old regulars, Meg9, was a large C cup and went smaller to a B cup. Perhaps you could PM her? She isn't active on this thread any more.
Don't take me as an expert, but it is my belief that the one step is for women who are satisfied with an A or B cup size.
Good luck to you. I'm glad your dx is in situ. That's the best possible case for a bad situation.
Hugs.
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Hi Shabby, I am 4 weeks out. I couldn't be happier with my results so far and I am feeling very good. I had NS with immediate impants and some new disolvable mesh rather than the Alloderm. I was a large C/small D prior to my surgery and they were able to keep me the same size.
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thank you carole & mammashells,
i consult with two teams first week of april so i will know more.
mammashells~ where did you have your surgery? Would you mind saying who you used and how the recovery was. did they do the node biopsy? how do the implants feel? many thanks!
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Hi, I had mine done at Mass General in Boston, they did the node biopsy and it came back all clear. They went through my tissue very carefully, and came back with more LICS, ALH and ADH on the right and ALH on the left but nothing worse. The surgery took about 7 hours in total and they sent me home 2 days after surgery. They used an experimental pain block that worked really well and I felt nothing until the morning after the surgery.
I am shocked at how good my reconstruction looks. It's not quite the four week mark, not sure what is normal or not normal but I feel very blessed so far. From the time I got out of the OR, I wasn't bandaged and there were no bruises. They looked like very tight breasts, but they looked decent even the first day/week. The absolute worst part were the drains! The second week both nips got dark and scabby, I thought for sure they were goners but they came back. The color is still a little funky and they are flatter than before, but they are mine and I am thankful. I did read (after the fact) that the C/D and beyond breasts have more nipple complications in a single stage surgery and that may be why the expanders are more common. I was fortunate in that I had lost 40 lbs, had been a DD/E at one point due to nursing twins and down to a DD until the weightloss. I was a big C/small D for surgery and had some skin to spare. The year prior to surgery, I focused on getting healthier and fit and that may have played a part as well. Many of the before and after shots of the NSM patients that the PS had performed looked better than before. I think that mine may end up looking better than before as well, I know that my poor right side that had tons taken out with the initial surgery definitely looks better already. The incisions are very minimal and under the breast toward the side.
The first set of drains came out 5 days post op and the second set came out 5 days after that. I was definitely in pain and took my pain medication around the clock for the first two weeks, after that I stepped it down and this week I'm taking tylenol in the morning and before bed. I was very tires, and couldn't drive for the first three weeks. It was not easy, but manageable.
It's a tough decision and there are no guarantees what we will look like or feel like if mastectomy is chosen. I know that people say it all the time on these boards, but with LCIS you do have the time to really think through what you can and cannot live with and take the time that you need to choose what you feel is the best option for you. The diagnosis sucks, but we really are fortunate to have these options available to us. I'll admit to feeling guilty sometimes because of the options and choices available with this diagnosis. We're in this together and you are in my thoughts, please feel free to PM me any time.
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Shabby: on my left boob, I had a nipple sparing mastectomy with immediate implant and FlexHD(same as Alloderm). I am 45, 5'11" and 185 lbs. my bra size was 36DDD or F. My "foob" is a small D. I am VERY happy with the results. I just finished Radiation last Tuesday and, so far, so good. I am a bit swollen but the RO says everything looks great.
I think whether or not it can be done has a lot to do with your surgeon and the elasticity of your skin (genetics). My skin is not loose or saggy at all.
I will be getting symmetry surgery (reduction and lift) on my right boob in 3-6 months as I have to wait until my body and foob are all healed up and well-settled.
Just remember, everyone is different. If you trust your medical professionals, then trust them to know what will work for you.0 -
MammaShells, you look gorgeous in your photo! And your post was wonderful in its clear detail.
I'm so glad you and Geester responded to Shabby with some up-to-date information. I learned a lot. In June it will be 3 years since my dx. It sounds like much is happening in the use of the one-step. Originally, the procedure was recommended mainly for women who were content with A or B cup size.
Hugs all around.
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After reading my post, I want add:
I specifically asked if a smaller cup size was possible. I never liked having a large chest and being able to get the size I always wanted was icing on a crappy cupcake. The PS could've given me an implant to match my original size, I chose to go smaller.
Hope that clarifies.
Smiles!0 -
Hi everyone,
Just wanted to update. I had my BMX with immediate implants on march 8th. I was a very small A (probably a AA lol) so I had my plastic surgeon go for a small B if the skin allowed it. :-)
So far, so good! They look better than the originals, except for the incision lines of course, and are a B. I had nipple sparing too, so those look a little rough still but doctors say they are healing well.
Feel very blessed that I was offered this option, since my doctor is the only one in Denver to do this one-step procedure. (Dr. Hunsicker)0 -
hi teelag,
i was just diagnosed with lcis and am looking into the bmx with nipple sparing. would you mind giving me a little more detail about the surgery and your recovery. type of implants? pain?
it seems rare to find many women who have had this surgery. thank you in advance.
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Hi shabby 6485,
My GS did the mastectomy part and then the plastic surgeon placed the implants, did the alloderm "hammock" and then closed. It was skin sparing, nipple sparing. I only went slightly larger with the implants than my natural size as to not put too much stress on the skin and nipples. Basically my plastic surgeon said that first and foremost in importance was for the skin to survive and the implant size was secondary. If I had wanted to go a fair amount bigger than I was naturally, I would have had to go the tissue expander route. Tissue expanders was also our plan B fall back in surgery in case there were issues.
I would do a search on google for direct to implant mastectomy reconstruction to get more information and to see if there is a surgeon in your area to do it. Then have a consult to see if you are a candidate.
Another thing was that we were almost positive I did NOT need to do chemo or radiation, so that might play a part in whether or not the one-step can be an option for you.
I am still recovering (still have nipples that look pretty rough) but overall I was glad to have the option to be done in one step. I did have the 4 drains for 2 weeks and those were more annoying than anything. I had the pain ball with numbing medication infusing the surgical site for the first 3 days and that helped a lot. Now I am almost 3 weeks out and just have mostly discomfort at the incision sites. It gets better daily though.
Hoping to get the go ahead this week from the PS to start the physical therapy. :-)0 -
Thought I would add that I had Mentor smooth round moderate classic profile implants put in. I like them. They are nice and round and fuller than my natural AAs were.
Here is a link to a couple of pictures from my plastic surgeon's website so you can take a look. I know different surgeons put the incisions in different places. I have incisions just like in the pictures.... On the side curve of the breasts and slightly into my armpit where they had to do the node dissection.
http://www.revalla.com/procedure_breast_reconstruction.php
Last but not least, in order to do the nipple sparing, the tumors have to be fairly far away from the nipples. So that's another consideration the doc makes.
Hope that helps!0 -
Teelag, I am going to Dr Hunsicker as well. She is wonderful.
I had the fat transfers done in Dec to go over my implants. I had nipple sparing on one side but the cancer was too close to the nipple on the other side so I lost it but Dr Hunsicker reconstructed one for me and it looks so good. I get my tattoo in a couple of weeks and hopefully I will be done!
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Alliesmom....what a small world! :-)
She is just so awesome.... I feel so lucky that she was recommended to me and I couldn't be happier with the way things are going. I just got PT clearance so am starting that next week and doing my "wall walks" for now.0 -
Hi Ladies,
thank you teelag for your information!
I was diagnosed with LCIS and am pursuing a pbmx.
I have all my consults lined up for next week hopefully to be discussing a nipple sparing direct to implant.
are there any questions that i should be asking my PS and BS? my concern is that being a d cup they won't be able to do it. i SO want to avoid the expanders if at all possible.
would you mind telling me what your cup size was and what you ended up being after the surgery?
this seems so real now and i am getting anxious...
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Hope everyone is doing well. I go for my annual checkup with my BS next week. I am having sensation now in the left nipple. Hope that doesn't mean anything bad. Also along the suture line of that same breast there's a little thin spot where I can push in the skin on a small bump and feel something like a balloon. I guess it's the implant?
In June I'll be reaching my 3 year dx anniversary and in July my 3 year bmx anniversary. The years have gone fast and brought with them 3 years of aging. But life has been good.
Hugs to all.
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Hi to all. Looks like we're slowing down on this thread a little. Nice to see you Carole. Best of luck at the BS appt. I am also regaining sensation. It seems to be creeping closer and closer to the nipple as time goes on. I get nice little surprises like when a ladybug lands on the MX side and I can feel it.
Well, I'm about 2 1/2 years out from my MX and About 2 years post chemo. So far so good. 2 clean mammograms so far. Reconstruction looks good but I will be getting fat grafting at the end of June to correct a little step off on the MX side. I believe it is the same procedure that Fortunate1 had. Outpatient surgery. Liposuction to belly and maybe muffin top, fat injections to the upper pole and cleavage areas. Only about a week of recovery.
I'm going to research the Tamoxifen/Fareston vs. oophrectomy(sp) choice. I'm not having a wonderful time on Fareston. Couldn't tolerate Tamoxifen at all. Both have pretty bad interactions with my asthma meds and I'm tired of dizzy spells too. Not really looking forward to more surgery but having my ovaries removed may be the lesser of two evils. Then maybe on to Arimidex or Femara which do not have the unfortunate drug interactions with the asthma meds. Ladies, please chime in with your thoughts on the subject, especially if you have chosen ooph.
Well, that's about all for now. I'm off to the ooph forums. Hope you are all doing well and I'll check in later.
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Newbride, it's good to hear from you! Good luck with your research.
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I had a nipple sparing bmx in January of this year with TEs put in. The margins ended up being not very clear just beneath my right nipple. It was a huge decision for me to make, re; to go back and surgically remove the nipples after the "tease" of having my own nipples spared. My boobs had looked great. After a lot of debate, the decision was made for me to have another surgery and remove my nipples in March. During this surgery my ps also exchanged my TEs with my implants. I had myTEs in for 7 weeks. Turns out my nipple did have DCIS in it and it was the right decision to remove them. At least they were not removed in vain. Huge bummer but potentially life saving for me. I share my story because I think it's important to find out how far the cancer is from your nipples and if your surgeon is sure he/she can give you clear margins. Just my2 cents worth. Best of luck!!!
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Thanks for sharing your experience, Chantal. My tumor wasn't close to the nipple. Hope your nipple reconstruction went great. Best of luck in life after bc!
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My cancer was in my nipple, I kept my other one though. Had nipple reconstruction in Dec and just got my touch up tattoo last month. Hopefully I will be good for awhile, I feel a lot better about how I look, I actually flash my hubby now LOL
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Almost one month out from BMX immediate one stage reconstruction w alloderm and removal of nipples and I can say that I am extremely happy with the results. This is because:
-the aesthetic results are good, moved from size A to a large B which I am happy about, scars are clean and straight, nice realistic tear drop shape. the two sides are not exactly the size, one is a cm or more lower and one is a bit flatter on the very top, but this is not perceptable to others unless i point it out
-pain was completely manageable at all times- first 24 hours after surgery Diladin, and then Percocet for 5 days, Extra strength Tylenos for next 5 days, after that no pain killers of any kind required. Side with previous surgery has been much more sensitive and tight. Full range of motion back at 3.5 weeks altho, not totally comfortabe, some tension and soreness on side with previous surgery still.
-Now I have a 98% chance of having cancer free breasts for life!
Although it is still early for me and I am cautious as I know problems may still occur, at this point I would highly recommend this procedure to anyone who is able to do it.
I would be interested to know what women`s experiences are returning to physical exercise involving the upper body after this surgery...
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