Nipple Sparing Mastectomy with immediate reconstruction
Comments
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firedancer - yes we were discussing the nipples not being in the center - interesting what you PS said. I have no scar tissue - but will see what my PS says when I go in Feb. Also, its not that noticeable - I mean my breasts weren't perfect before either
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Hi-
I had mx 8 mos ago, with TE, while I went thru chemo. Pain following that was mostly burning/numbness from snb, but not that much breast pain as I recall. 19 days ago had NS mx with one step reconstruction/perm implant and surgeons did a beautiful job, able to use my own tissue instead of alloderm, and replaced TE on other side with perm implant. The newer mx side-drains for 2 wks, then tight ace for few more days. The breast is so painful sometimes. I bounced back much quicker from first surgery. I think it must be pectorals, because it's painful sometimes to take a deep breath, then twinges of nerve pain, and lots of sensitivity on outside and top of breast. Feels like migraine in breast when I first get up and at night. I used to be so physical and now I just want to vege out. Back at work after 2 wks, big mistake, but just 5-6 hrs, sitting. Does this pain level sound right? Going to see PS in am. Full range of motion.
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asmd- I wonder if the difference from your first surgery might be because with TE it is smaller right after surgery but the implant is larger and presses more on the skin which has just had trauma? I had TE's on both sides but I did have sensitivity and twinges also.
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that's what I was thinking plus I do a lot of weights so pectorals tight. but the difference between the two surgeries is huge and nothing I take helps-valium, motrin, tylenol, ice, warm. I have to see pts tomorrow and I already feel like whatever their probs are, mine are worse.
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kate33-noticed the comment regarding reconstruction pictures and wondered if there is a thread/topic on this site that shows reconstuction pictures. Will need nipple reconstruction on my right breast. Also, does anyone here know what I can expect as far as reconstruction needed on my double mastectomy with immediate Allergen 410 implants. Left breast was nipple sparing but no nipple on the right. My PS has been pretty vague and so far said lets see how you settle and discuss what might be needed, later. Thanks and blessings, and a speedy recovery, to all
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kate33-noticed the comment regarding reconstruction pictures and wondered if there is a thread/topic on this site that shows reconstuction pictures. Will need nipple reconstruction on my right breast. Also, does anyone here know what I can expect as far as reconstruction needed on my double mastectomy with immediate Allergen 410 implants. Left breast was nipple sparing but no nipple on the right. My PS has been pretty vague and so far said lets see how you settle and discuss what might be needed, later. Thanks and blessings, and a speedy recovery, to all
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Thanks all for the answers. But you know me Im the one with 20 quetions. So all this talk about revisions and FG is this covered by insurance? Is there a certain time limit that you have to get this done by so that it is? I know all ins is different but what is everyones experience?
ThisToo - That explains alot. I was wondering how you could say that the TE were softer. Everything I heard is the opposite it must have been the type you had. How are things going with the TE and your overall helath? How are the kids? Hopefully things are still going well.
asmd - I agree it is most likely because of the immediate implants they are a lot heavier and may take more time for healing. The weight of them can also be causing more pain. Take it easier a little while longer and hopefully things will get better.
Hope everyone is ready and has a great Holidat season! To all a lot of rest and wonderful recovery next year!!!
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Hi to all...asmd-I had a BMX with immediate implants on 12/1 and have the same type of pain you mentioned. I am comfortable most of the day, but, I feel a fair amount of discomfort by evening and I have a hard time sleeping since I just can't get comfortable and my chest area hurts. I am off all medications, in general, but think I am going to need some level of pain medicine at night so that I can sleep. I did go back to work, today, but just for a few hours each day. Overall, I think the implants will be great once things are healed and the swelling goes down. Hope you had a good day and are feeling better as well as everyone else.0
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asmd- Most PS's recommend not doing any exercises that work out the pec muscles for at least 3 months. The pocket around the implant is still healing and the pec is stretched rather thin supporting it. By working out the pecs you can not only overwork the muscle you can actually displace your implants. Most recommend just doing hand weights if you're trying to work on arm definition until completely healed. You may want to try taking a muscle relaxant of some kind and see if that helps but definitely lay off the upper body workout for awhile and see if things improve.
amom- Yes, insurance has to cover all revisions. I had my implants swapped out and the fat grafting done and it was all covered. They have to be very careful how they code it, though. If they use the word "lipo" rather than "fat grafting" it will be denied. There is usually no time restraint. For those of us with implants they will probably need to be replaced eventually and this will be covered even if it's 20 years down the road.
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kate33 I was wondering about upper body exercises, and hadn't heard the 3 month time frame. It does make sense though. I've started PT stretches and light upper body strengthening, but pecs start to kick in at weird times - really strange. My PS is liberal with his exercise advice and says that if it doesn't hurt, go ahead and try it. I'm happy to hear that revisions are covered under insurance, no time limit.
So lefty looks different every day - sometimes no rippling and other days lots of it. I guess that it is still settling. Right one has looked the same all along. Tomorrow is 6 weeks post-surgery and I'm feeling good. I'm not sure if I'm supposed to, but am able to sleep on my side hugging a pillow, and even on my belly. Tightness at the sternum is getting less and less. I'm grateful that this has been a relatively easy process so far, considering everything.
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joy- Glad things are going so well for you! As far as sleep positions I've never heard of any PS's restricting this. I did sleep in a really supportive sports bra for awhile but this was more for comfort than anything. I would say, unless you're waking up sore, whichever way you're sleeping is fine. Good luck with the continued healing!
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I slept on my side as soon as I was comfortable doing so but my ps said no stomach sleeping. I don't remember if he gave me a time frame on that because I'm not a stomach sleeper.
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I am a 2 1/2 year survivor who did not have a mastectomy (I had a lumpectomy for a very large tumor), and have been working for the past year & a half for an upstart medical device company - we make a nylon cone-shaped device designed by a South Carolina plastic surgeon to propel silicone gel implants. As soon as I started with this company, I asked about reconstruction and the funnel's use with it - and we're in the process of getting information for both surgeons and patients on how this can be used for recon. The doctor who invented the funnel, Dr. Kevin Keller in South Carolina, uses nipple-sparing mastectomies when he can - and he has perfected a one-incision method for putting in the sizers and final implants - to not only minimize the scarring and healing, but to make it as clean and asethetically pleasing as possible. And the implant goes in using this funnel, and thereby is no-touch, which helps reduce complications and infection afterward. I have been pushing to get as much info on reconstruction as I could, since it is close to my heart. Oh, and most times, the funnel can be reimbursed to the doctor for the additional cost, so it's good for not only the doctor but YOU. Ask your surgeon to look into doing your recon with a "skate flap" (that's what they call it), making one incision to remove your expander and then put in your implant, rather than opening up the large incision all over again. If you want info on the product (and I'm working on adding this section to both sides of our website), look us up at www.kellerfunnel.com. If you want additional info or doctors in your area already using the product, feel free to message me. I want to help as many of my sisters as possible!0
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Hi girls,
Back from ER. Right breast infected again and fever. I have intravenous antibiotics hooked up with a self-dispensing pump. 2 weeks out from my emerg surgery and 4 weeks out my bmx & recon. Insanity when you get so mad that you want to laugh like a phyco.
Mad at my ps as he just saw me on Tue and said he wants to start expanding this poor "breast" or what is left of it. I said I think it looks bad and he was adamant that we start explanding. Well, ER dr didn't think that it was ok and was surprised that after my first infection, they put me back on the same antibiotic. So I have been on the same one for 4 weeks and they definately don't work. Mad I didn't go to ER when I first had fever 3 days post original bmx and recon.
Everyone reading this - if you have fever post you bmx and recon and your dr tells you to just take Tylenol like mine did, please just go to a different hospital er and get it checked. I might have been able to save my nipple and tissue but what's done is done and I just pray someone learns from my stupidity and self-doubt. Listen to your gut!
Has anyone ever tried switching their ps in the middle of all this?
I just hate the guy and he always ignores me. What to do? Do I just quit seeing him and then what? So confused.
Hope every one is doing well and healing along.
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Hi This Too.... I hope you can get some sleep and comfort tonight. I think I'd fire that PS, too.
So sorry for all you're going through.0 -
hello all, first time posting here, so glad to find this forum! I had NSM 5 weeks ago, and was feeling good after the 4th week. My nipples were black at first, then the skin shed and they were still raw, but beginning to look better. However, about 3 days ago I started noticing a pale discharge with a hint of blood from both nipples onto my sports bra. I had my oncologists appt yesterday, had him look at it, he just said to continue using Bactarin, but I am concerned, esp with the holidays around the corner that its getting worse. Anyone else had this?? Should I be concerned?? How long did you use Bactarin or Neosporin on the nipples?
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ThisToo- {{{{{{{{{HUGS!!!!}}}}}}}}} I am so sorry for everything you are going through. Please don't feel that any of this is your fault. We are taught to trust our doctors and that they are going to do what is best for us. We are at their mercy because, for most of us, this is all new and bewildering territory. It can be difficult to think about starting over with a new PS but it may be best. You've still got to work with someone for several months for fills and then the exchange and it sounds like you have lost all confidence in your current PS- which is understandable. It wouldn't hurt to see if you can get in for some consults and maybe find someone you feel comfortable with. I hope you can find someone and you can move forward with confidence.
Dingomama- Just want to welcome you. Sorry you're having some issues. If you read ThisToo's post I would say it's better to be cautious. If you're still concerned I would ask to see the doctor again. They may want to put you on antibiotics. If nothing else ask if they will phone something in so you have it on hand in case it gets worse over the holidays. Good luck.
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I just caught up reading the last 4 pages of your comments. Thistoshallpass, wow, you've gone through a lot. I hope things get better for you. Find a ps that will listen to you and give you what you want. When I first began the whole BC journey Dec 2007, I was intimindated by the surgeons. Now...I don't care what they think. I'm the one who has to live with what they do and pay for it.
My mastectomy is Dec 27th. Because the present cancer in my right breast is invasive my bs won't let me keep the nipple. She plans to take the left breast as well. I talked her into keeping my nipple and skin on the left breast. Now, I'm considering leaving the left breast...not taking it off. If they mess up on the right breast at least I have my normal left breast. Plus, I can sleep on my left side which is important to me as I can't sleep on my back. I must have a little arthritis in the middle of my back because it hurts to lie on it. I often roll over on my stomach in my sleep. I usually wake up tummy down.
I did sign off on a blmx during pre-op appointment. The surgeon worked me until I signed. I asked her to at least leave the skin on the right side. She said I could change my mind the day of surgery. I called to tell her plastic surgeon I would only be doing a uni yesterday. He said they wouldn't change anything until the bs called them. I left the message with my bs as well. I haven't heard back from her. I fear her determination to do both breast will win over my desire only to remove the one presently infected cancer breast. I'm not sure when I go in for surgery if I will wake up with one breast or two small bumps. I've already changed surgical teams once, and it's been about 3 months since dx. Can't afford to leave the cancer in the breast longer...got to go through with it.
Encouraging to know that later on if we like we can do the fat grafting. Too bad no one in my area knows how to do whole breast grafting. I have to work...can't afford to take time off to go to Florida for fat grafting. They do partial fat grafting here in the NW.
You've all have gone through a lot. I've learned a lot from you laides, yet I still don't feel prepared for what is coming up or what I will have to face. Hopefully there will be no complications with reconstruction.
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Hi Ladies, my new Sisters! I was diagnosed Oct 28, 2011 and just got my surgery date scheduled for Jan 19, 2012 after a lot of researching, asking questions, changing my mind, etc. I have invasive lobular carcinoma [officially invasive mammary carcinoma] in the L breast about 4cm in size. The mammo that barely picked it up only showed a small tumor [3mm] but when they did an MRI on the breast somehow it turned out to be a much larger area involved. I have decided to have a BMX with immediate implants [no TE]. My PS says the implants will be fairly small at first, but later I could increase them? If there's no expanders how do you put something bigger in? I'd like to do the FG down the line and want to increase size just not sure how that works. My BS said she will do the nipple and skin sparring on R and whatever is feasable on L once they're in surgery and get a better idea.
Unfortunately, the 'don't use the upper body for____ weeks' part of this whole thing will be impossible for me. I will be doing so day 1 as I use a manual wheelchair to get around. So I will be pushing myself, lifting to transfer, etc. It'll be interesting to see how that all plays out. Not looking forward to that part of it, but it is what it is, so I'll push through it [pardon the pun...lol]
What's weird to me is there was concern of met to the liver based on a lesion seen, so I had to have a special MRI for that too. Luckily it came back negative for cancer and so now I'm feeling like the BMX isn't such a big deal. I guess it's a matter of perspective. God knows I'd rather not have the cancer at all and certainly not loosing my boobs, but worrying for the worst it could have been while waiting on that liver MRI completely changed my mindset. I'm sure the closer it gets to surgery date, the more I'll go back to freaking out though
Sorry we all have to be here, but so glad we are all here for each other!
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Thistoo- i would definitely look into switching drs. You must be comfortable and trust that they are working with you and in your best interest.
Dingomama- I agree with others who say better to double check than have something be missed or ignored. I would have it checked out again.
Evebarry- Hope it all works out the way you want it to.
mskassie- Wow! I am sure your arms are stronger than most due to all the extra work your arms regularly do but I am wondering if you will be able to do it in the beginning. The first night in the hospital I could not even hold the phone up to my ear. It was physically impossible.I have heard others here call it "T Rex syndrome" You have really short and useless arms in the beginning. Have you spoken to your PS about your concerns? You could do damage to the incisions with too much activity. Is it possible to get a chair that moves for you for a short while and have someone help you with transfers, etc? I wish you all the best!
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ThisToo So sorry to hear of your troubles. Maybe a new PS is what you need - sounds like it's pretty frustrating to be dealing with your current one. Sending hugs and prayers your way. Please keep us posted, and know that our thoughts are with you.
mskassie Welcome to the sisterhood, sorry that you have to be here. I too would see about getting some help after surgery. I came into surgery super strong, but had almost no use of my arms for practically a week. It was extremely difficult, for example, to open the fridge.
evebarry You will soon be on the healing side of this - sending hugs on our upcoming surgery.
Happy Holidays, Merry Christmas, Happy Chanukah!
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Thanks Kate 33 and Ginger48 for encouraging me to see my drs for my 'leaky' nipples.
I didnt think I would get much support as all of my docs were out of town and it was the friday before xmas. Much to my surprise, both my surgeon and Ps called within the hour. My surgeon was returning to houston, 5 hours away, and she told me she would come see me in her office on her day off, as soon as she made it back. I am so glad I have a team of docs that care enough for their patients welfare.
As it turns out, I had fluid trapped that was draining through my 'montgomery glands', which are the bumps in the aereola area. She extracted 25 cc from either side and send it to the lab, gave me prophylactic antibiotics and a steroid cream. Happy to report the drainage stopped by the next day and things seem to be going back to normal. I am scheduled for a followup tomorrow.0 -
Dingomama- glad it worked out; great that your docs responded so fast!
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I had a NS BMX with direct to implant using Alloderm on Oct. 25th, PS said it was the best way to go. I was a B cup and told her that's what I wanted to stay. From the beginning, the left side was much bigger than the right, and the right was way too big as it was, I hated them, they bulged under my armpits, and felt so tight and hard. Dec. 2nd, went back into surgery and had told her I only wanted about half of what the right was and wanted a lower profile. 2 weeks after surgery the right was better, and the left she stitched too high underneath, her profile said she was proud of her stitching technique, and the minimal scarring. I have small openings with knots hanging through, she still gave me high profile implants, and since the 24th, both have gotten bigger, harder, and tighter. They hurt, burn, sting, but she won't be back until the 4th. Has anyone had this, or know if I could be rejecting the Alloderm, or encapsulated, or leaking? I have been nauseous, stomach pain, and headache since yesterday. Please help
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Irie4now I'm not a BMX NS expert, but can share my experience 6 weeks post-surgery. It took about a month for one implant to "drop" - it was visibly higher than the other. As far as tightness and burning, gentle PT stretches have helped to loosen the sternum and upper rib cage tightness. A PT also did a manual sternum-area skin stretch which helped. Does your insurance cover PT? Hope that you're feeling better -- almost sounds like you have flu-like symptoms?
Dingomama Good news on your caring doctors - glad to know that they're out there!
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Joyh1109, I do have insurance for PT, Do you go to a specialized PT? I can't wear a cami, or any type of bra, the constriction and pain is so uncomfortable. Sleep has been very difficult. Thanks for your response.
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Irie4now I was lucky to have found a PT familiar with breast cancer surgeries, and she has been great. I would specifically ask for an experienced PT familiar with BC. It sure sounds like you have tightness from scarring - bound muscles - ill-patterned movement - truthfully only your doctor or a good PT would know after seeing you. Definitely check it out. Sending hugs your way - let us know how you're doing.
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Joy, thanks, I will check it out.
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This thread isn't too active, but I do have a question for those that have gone through revision, so here goes.
I'm 2 months out from surgery - NSS w/Alloderm & immediate silicone implants. So far everything for the most part has gone well. Right implant (prophylactic) is fine, feels great and looks a lot like I did pre-surgery.
Lefty is aligned more towards the armpit, so that when I lay down the bony left outer edge of the sternum can be seen. When I'm standing, implant looks fine. Lefty is also somewhat uncomfortable, like it's just not part of me yet. The comparison in the way lefty feels compared to righty is huge. If I wear a tight bra, lefty aligns more to the center and feels better. Is this something that can be fixed with a revision? I know that there are still several months to go of "drop and fluff" but this doesn't seem like something that will get better. I will see the PS again in a couple of weeks.
This seems kind of trivial, as I'm so happy to have BMX over with and be getting back into the routine. I will consider a revision if things aren't more comfortable, though.
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joyh1109 - Actually, this thread typically IS pretty active, don't know why it's been quiet for the past few days or so...
I went the TE / exchange to implants route so can't exactly relate to your surgery. Could be that your BS was a bit more aggressive on the cancer side and/or the PS had difficulty making the pockets symmetrical for some reason?
If you're not already on the picture forum you might contact (by PM here) Lilah, estepp, firni, or Dawne Hope. It's a totally separate site and not connected to BCO. "A picture is worth a thousand words" and you might get more helpful feedback.
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