Nipple Sparing Mastectomy with immediate reconstruction
Comments
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Kate- does the fat grafting help with the coldness of the implant so many have talked about? Also if I choose the bmx would there still be a need for Tamoxifen? The answer to that could really help me make up my mind.
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Diana - if you are DCIS only and have a BMX, typically Tamoxifen is not prescribed b/c most of the breast tissue is gone and your risk for distant recurrence is nil if DCIS only since by definition it does not leave the ducts. However, be aware that in about 20% of what is thought to be DCIS only (based upon biopsy) cases, after full analysis is done of the MX specimen, IDC is found. If the IDC is large enough, Tamox may be prescribed to reduce distant recurrence, even if you have a BMX. I am not sharing this to scare you, just to make sure you aren't making the BMX decision solely based upon thinking you won't need Tamoxifen. I thought I wouldn't need Tamox or rads after BMX, and I need both (my situation is a rare case, but still, I just feel like women need to know there is no guarantee with a BMX).
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Dancetrancer- thanks for the info. I had DCIS over 7 yrs ago in the left breast. The right breast has IDC and possibly DCIS as well(biopsy for that scheduled next week). It is so hard to know what to do. I feel like I'm on a roller coaster and can't get off. I am meeting with a new BS on Monday and I hope she can shed some light on this. I am worried about time off from work and losing my job. That would put me over the edge. All I know is that the IDC is about 1 and a half cm and ER/PR positive. Does the biopsy tell the grade or do I have to wait for the next surgery to find that out. This is all I have been told.
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Dianarose the biopsy should give you the grade as well.
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Diana, if the IDC is ER+ and 1.5 cm, most likely tamoxifen will be recommended (if premenopausal, different med if postmenopausal) no matter what surgery you have. I surely understand the rollercoaster and wish we could all get off! You are doing a good job educating yourself so you can ask the right questions and feel some sense of control (not like we have much control, but we take it where we can get it!). I always ask for copies of my pathology reports and mammo's, etc. so that I can educate myself and be an informed patient. Your biopsy path report should tell you the grade. You will also want to ask if an oncotype was run on the IDC and get a copy of those results.
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Dianarose- The fat grafting definitely fixed the coldness of the implants. Not sure if it works for everyone but the way my PS did it my skin is now just as warm as the rest of me. I didn't realize what a big difference that would make for me.
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Dianarose - It's hard enough making all these tough decisions while in a post-diagnosis fog. I'm sorry that the added pressure of threat of job loss has to even weigh in for you. I know it doesn't sound logical when you're under stress, but your long-term health and well-being are so much more important right now. Are you able to mentally leave your job out of the equation to make the best decision for you and then try to figure out how to make the job work around it?
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Dianarose- If you're concerned about your job you may want to check out cancerandcareers.org. it gives great advice on insurance legislation, your legal rights as a cancer patient in the workplace, insurance issues, etc. There's even information on financial assistance. No one should ever lose their job because they are dealing with cancer.
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Thanks so much to all of you. You are so helpful. Another question, what is oncotype?
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Diana, this website should give you a good understanding of oncotype. It is a test done on the IDC that helps you and your doctor decide if chemo is warranted or not.
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Is it a standard test or do you have to request it?
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Dianarose - It is standard for some oncologists, but not all. In other words, don't assume it's going to be done. My oncologist used a statistical model called Adjuvent Online. I requested that the Oncotype DX also be done and she happily obliged. It can be done on either a biopsy specimen or surgical specimen. The test is very expensive so some insurance companies don't like to pay for it. If you feel very strongly about wanting it and insurance won't pay the Oncotype people are very helpful. They are great about answering any type of question you have about the test, technical or financial.
There are a number of Oncotype DX threads here, not all of them are really very active. Here's one:
http://community.breastcancer.org/forum/69/topic/730468?page=21#idx_619
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Oh, and yes, if you decide you want the test, you can have oncotype do what is called a benefits authorization first, where they tell you what your portion of responsibility would be for the test (depending on your insurance). You would want to make sure the doc fills out the paperwork so that they do this benefits check/authorization first.
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Thanks all for the information. I keep writing down questions for Mondays appointment.
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QUICK question: I had a NSUMX almost 3 weeks ago on Monday with an immediate implant placed. Above and below my mastectomy scar, at the end of it, sort of near my arm pit it is hard. Both above and below. It is not reddened, streaked, no temperature, and not warm. I am not sure if this is just scar tissue forming or what? I am going to my PS tomorrow, but am SO nervous it is maybe fluid build up? Did anyone have this problem. I am 1 week out of having my second drain out. Also, there always feel like there is pressure on my chest. Like my new breast with the implant is so HEAVY...does anyone have any input?
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@Kate33 does insurance typically cover fat grafting for this purpose?
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tigerw0man- Most insurance companies have been covering fat grafting but recently it seems they are rethinking their position. Several women on the fat graft thread have run into snags with insurance. I really hope this isn't a trend as I think fat grafting is wonderful to supplement the implants or even for total recon. One member said that BCBS will only cover it to supplement but not for total breast recon using only fat. Another said her policy with Cigna was no longer covering it. Unfortunately, this might be another thing we have to fight for. I would check with your insurance company and see where they stand. I have United Healthcare and they covered all of it- the swap to smaller implants and the extensive fat grafting.
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Hi everyone! I'm BACK! It has only been a yeah but a lot has happened. Just wanted all of you gals to know that I always think of you even though I haven't been on here in such a long time.
I had a baby girl back on September 23rd whom I named Milana and she is now almost 5 months old. Motherhood has been great and I am enjoying my new role in life.
As for the foobs and now being a good year and a half almost from exchange surgery, I can say that I have quite a bit of feeling hoonestly...I mean not like they were but not too bad. I can feel when my daughter pinches me! I also had a very bizzaro experience that happened a few days after giving birth...I actually had some milk come out. I FREAKED out of course and immediately went to my BS and spoke with my oncologist. They basically said that whatever trace amounts were left were working overtime to produce the milk. It wasn't very much at all but it scared me.
Well, just wanted to say hi to everyone and catch up! Hope everyone is doing well.
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Hi everyone,
I'm having a bilateral skin/nipple sparing masectomy this Monday. I'll be having silicone implants with an alloderm sling. I have no history of bc but am very high risk. After reading the recommendations of getting mri's every few years to check to make sure there are no ruptures, I'm concerned about the overall cost out of pocket. Are there other options other than Mri's to check for ruptures? Is everyone who has silicone implants planning on following the recommendations? Any feedback would be great. Thanks!0 -
Hi everyone, I have read that most have choosen silicone instead of saline, why? I am nervous about it. Is there a weight difference? I have small breast and I am small framed. I wouldn't want ones that are heavy.
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Hi dianarose!
My ps recommended silicone instead of saline because it feels more natural. I am also small framed and do not want my implants to be heavy. She is planning on taking in 4 different sizes to surgery:200cc's,225, 250 and 275. I guess it will depend on the condition of my skin and what looks good for my anatomy.0 -
Hi Huskylover, thanks for the information. I would be totally lost if I had not come across this site. It is all too much to take in some days. Yesterday I was trying to remember where I was at in my life before all this started. I am trying to decide if I want to have the other side done at the same time that I had a lumpectomy and radiation on 7 yrs ago or just leave it alone. Even though it has been 7 yrs it still has pain. Not everyday, but especially before my period and I know when a storm is coming. It's really weird.
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I chose silicone after handling both in my ps's office. I had a direct to implant surgery, no TE's. I am small framed and petite. I wanted my foobs to look like my natural breasts. Current silicone implants are cohesive gels. Mine are Alergan Natrelle style 15, 457 cc. They do not feel heavy at all and after almost 5 months I hardly notice them. They are firm, in a youthful way, not hard, and warm. I do have Alloderm as well. Saline felt less natural to me.
Caryn0 -
I choose silicone I have a broad chest c cup and wanted to stay close to that size- My PS took 3 sizes in with her to see what would work the best. I am 4 weeks out and need another surgery to do my nipple transplant and fix some issues. I don't find them hard or cold .
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Hi ladies!
I have silicone without Alloderm and I love them personally...the saline ripple a lot more. They are not heavy and honestly feel very natural. No one can tell that I have had a masectomy nor can they tell even in a bikini that I even have implants!
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Hurleygirly - CONGRATULATIONS!!!! I am soooo happy for you, I remember when we first started the journey on this board and now look how far you have come. You deserve the best!!
Hugs, Valerie
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hurleygirly - We all love to read happy stories here. Congratulations on your little one!!!
Dianarose - The chance of rippling with saline implants is much greater than with silicone. However, if you're small and have thin skin there is a chance of ripples even with silicone. If you're not already on the Implant Sizing 101 thread you might want to check that out. There's lots of helpful info right in the header of the thread so I recommend reading that first. From what I've read many women who initially choose saline end up switching to silicone. Best thing is to read up as much as you can and talk to your PS.
huskylover - I believe MRI is the best way to check for implant integrity. I've been dealing with a number of post-exchange lumps and have had a number of ultrasounds. Both the radiologist and the BS who did ultrasounds on me said that you can't tell a leak/rupture with ultrasound so I've ended up having both ultrasound and MRI. In addition, breast ultrasound is usually done of a targeted area. It's difficult to ultrasound the whole breast as they can only look at a small area at a time.
Take care...
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Last night I felt a small bump under my skin and I'm wondering, did they miss something? I had skin sparring UMX in Oct. At first I was hoping it was a pimple, but it feels like it's not. I also had lat flap to help support the implant. Could it be something else?
I'm terrified!
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jwilco - I had my exchange to implants last August and I am currently on watch for (now) 3 lumps. It's a bit disconcerting to start feeling lumps and 99.9% of the time it's related to post surgical changes. I'm very happy that none of my docs feels compelled to simply assume it's scar tissue so I've been underway with ultrasounds and MRIs to follow those areas. I was very excited to find at my appointments this week that one of the lumps seems to be a bit smaller by both palpation and by ultrasound. So far, nothing ominous. They are either scar tissue or post surgical "gunk" as my BS phrased it. One of them seems to be getting smaller.
That said, it's always best to have it checked out, but at this point isn't likely to be anything to lose sleep over. Keep us posted!
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Thanks. I'm trying but it has ruined my frame of mind for the weekend. My fear is that it feels extremely similar to what I felt that got me started with this whole mess. I just saw the breast surgeon a month ago and I don't think it was there then. I had very slow growing type of BC so I'm hoping it is something else. <sigh> Thank you though for your words of encouragement.
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