Nipple Sparing Mastectomy with immediate reconstruction
Comments
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carol50 - I had bilateral surgery so can't help with the lift and matching issue (but I'm sure someone will chime in). I was not interested in the large abdominal scar from a flap surgery so I went with implants. Since I wanted to be fuller than my pre-BC "barely B" size I had expanders rather than immediate implants. Just wanted to let you know that I'm 7 months post exchange and I'm very pleased with my results.
Please take your time and gather as much info as possible so you make the decision that will make you happy for the long haul. Might sound silly, but......if you took your children out of the equation what would your choice be? Gather as much info as you can about the pros and cons of different reconstruction approaches rather than just looking at the fastest way. Just my two-cents' worth
.Best of luck!
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Hi,
I am in process of going thro left mastectomy and immediate recounstruction with implant. I am very confused and scared. any help would be aprreciated.
thanks
Bela
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BelaT - Im in the same boat. Lets share any info we get. My surgery is april 12. (hugs)
Carol
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Hi Carol,
Mine would be around same time.may be 12. Definately keep in touch. I am looking in to no nipple sparring with silicon implants. You?
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Hi Carol, I just sent you a PM. I had my NSM with immediate implants on 2/24 at MGH as well. I am very happy with my experience. I am a divorced mom of twin 11 year olds, working full time and the one step surgery was a godsend. They did a beautiful job at MGH.
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I did mine at MGH as well. Feel free to PM with any questions. My NSBMX was 6/22/11 and exchange to implant was 10/27/11.
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I guess my main concern with an implants is - does it end up hurting your chest muscles? I like to run and bike and generally be active and Im worried that this is somehow going to hurt my ablility to do active things. Not that I use my chest muscles too much that I know of, but somehow that is what worries me about the implants. Also, I just happened to read some of the threads of people who were really unhappy about their implants - so Im hoping to hear that those are the exceptions and not what a lot of women experience.
Thanks to eveyone who replied especially the women in Boston and I hope to speak with you soon.
Carol
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I got a Left side NSM with immediate implant and FlexHD (like alloderm). I haven't had my right side symmetry surery yet as I am waiting 3-6 months for the left to settle in (plus, I just finished radiation).
I absolutely LOVE my new foob. It is smaller like I wanted (from a DDD-F to a small D) and so perky but not "fake" looking at all. Very natural.
I am a very happy camper.0 -
Carol - You are making a huge decision. Your gut will tell you what you need to do. I chose the DIEP flap primarily because I knew I could not make the multiple appts with implants (I have a high-needs daughter I care for). I also did not want to have to work out replacments in 10 years. At first I thought I'd do implants, then the flap settled in my mind. It seems in the end, the recovery from the bmx/recon is not terribly different. As far as not being a flap candidate, it all depends on the surgeon. Some are very experienced in working with less and creating very good results (Charleston, New Orleans).
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kcshreve,
So if you do a flap no implant?
If you amswer I would appreciate
Thanks
Bela
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Carol - I had the same concerns, which is why I opted for microfat grafting instead. I did not have enough fat for an actual flap, and I was scared of interfering with the function of the pec muscles. Microfat grafting for full recon is a relatively new procedure, though, so it can be a challenge to find a doc who will do it in your area. I do believe that a Dr. Delvecchio (?) is in Boston and does this. It also requires several procedures and a significant time investment in wearing a device called a Brava to expand the graft site prior to surgery. There are several threads here on the board where you can learn about it, and there is also a website called fatgraftpatients.com.
All recons have pro's and con's - take your time to learn and decide which one is right for you. I wish you all the best!
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Hi everyone, long time not talk . I finished my chemo two weeks ago and now I feel much better. I need to start radiation . I met with two RO and both suggest to do radiation because of my young age and lymphatic vascular invasion . After BMX i did one step reconstruction with implant and I am very happy with the result, however with radiation I have 30 % complication with implant. I am so scare to do RAD. Is anyone did radiation with implant? Please help.
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Hi Carol. I did BMX nipple sparing one step reconstruction with immediate implants in November 11 in Dana Farber . I am very happy with result. I was size B and the same with implant. They did great job. You can not be active a couple month then you can run with no problem. You can PM me with any questions.
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Hi Everyone,,I havent been here in awhile so i did wanna post an update about my surgery.Its gonna be April 23,,Not far away at all and i will say im getting nervous..I go for all my preop testing on this coming monday.Then tuesday i see the ps so he can get the implants ordered..Reality is really setting in...
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I am kinda disapointed right now after meeting with my surgeon for the first time. He was very cautious about my desire to have a nipple-sparing, skin-sparing double mastectomy. The tumor is approx 8cm away from the nipple and there is no skin involvement. Am I missing something? I had a breast lift 4 years ago and still have sensation and feeling in my nipples. I would love to hear from anybody that shed light on my dilemna.
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Ella1998: Did you have skin-sparing also? Do you have any sensation in your nipples or skin? I'm so glad it worked out for you like you wanted!! We're behind the eightball so much that when things "go our way" it's a good day!0
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Nightnurse - From the info you posted you seem like a good candidate for NSM. It unfortunately isn't unusual for women to be discouraged from or simply not even offered procedures if their docs don't perform them or if it's simply not standard or accepted procedure in the community. Typically, in NSM the BS will core out the tissue behind the nipple for separate on-the-spot analysis. If it initially looks clear they will spare the NAC. There is always the possiblity that if cancer is found in this tissue during the more thorough pathology another surgery would be necessary to remove the nipple.
NSM has to be a collaborative effort between the breast surgeons and plastic surgeons because reconstruction takes place immediately. In my community NSM is not offered because apparently there are no plastic surgeons here who offer microsurgical flaps (such as DIEP). The one local PS I saw initially downplayed NSM as risky. Of course, he does not do them. My local BS was wonderful enough to send me 2-1/2 hours away because she knew I was a good candidate for NSM, but the plastic surgeons here are not on board with it. In my post-diagnosis haze it seemed so overwhelming to travel that distance. I actually had complications and ended up making the trip many, many times. Would I do it all over to have NSM? Absolutely!!! Many of us have had to research, get second and third opinions and travel. It's difficult, but it's worth it if you can do it. I believe NSM has made all the difference in how I've dealt with my breast cancer.
BTW - It is quite rare to retain feeling in the nipples after NSM. Most who do have feeling often describe it as more of a sensation than pleasurable feeling. This will like also be true of most of the skin in the mid-breast. Everyone is different, but this seems to be true for most - feeling around the periphery, but not in the central breast skin.
Good luck in your search. I hope you can make this happen!!! Keep us posted...
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TinaT: Thank you for the wonderful information. I will continue my search for a breast surgeon who will do this! Thanks again!
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Nightnurse- I will second everything Tina told you. My first BS (who never even told me NS existed) tried to talk me out of it when I happened to find out about it when researching about MX. I found out she was not even trained in the procedure. When I consulted with a BS who was trained in it, and very experienced, she said I was an excellent candidate. It sounds like you are, too. The biggest issue if your cancer isn't close to the nipple is how large breasted you are. Most BS's won't do NS if you're very large because it is too difficult to preserve the blood flow to the nipples if it has far to travel. I would definitely consult with a new BS. I know for me it made a huge difference being able to keep my nipples. I had to go to a BS 2 hours from my house but I would have traveled any distance to find someone who did the procedure.
Lisette123- It's been about 10 days since your NSMX. I just wondered how you are doing since you haven't posted? I know the first week is rough but hope everything is o.k. We're all here for you! (((gentle hugs)))
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Hi kate,
Thanks for thinking about me!!! I am up and about and feeling OK, just been stuck on the March 2012 board!!! First few days I had a headache and nausea problem, once that subsided I could cope with anything. Spent a few days at my Brothers house as he lives close to where I had the surgery done and then travelled home. It was good to get home. My surgeon ended up going direct to implant, and said the surgery went well. I was too scared to look for the first week, but couldn't stand not having a wash any longer so decided to get in the bath yesterday, I am worried that I should have looked earlier, my right nipple looks great, but the left is very dark, I have read this is not unusual but the skin around the nipple is very red, it doesn't look good at all, so Im feeling very nervous about that. Not seeing my surgeon for another week yet so not sure what to do about that? Also my Foobs are definately not sitting at the same height, one is higher than the other, has any one experienced this, can it be fixed later??? Otherwise they look pretty good so I am hoping these issues can be resolved. It's nice to be up and around and feeling that the surgery is behind me.
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Lisette- So happy that all went well with the surgery. I would definitely give the BS and PS a call and let them know about the left nipple. You may even want to take a picture of it and see if you can email them. There's always a chance of infection and if that's what's going on you'll want to get on antibiotics right away. As far as them being uneven don't worry too much, yet, about that. It can take as long as 6 months for everything to settle. (They call it "drop and fluff" on here.) If after some time it's still not right there are definitely things they can do to fix it. Even though you went direct to implant there's a great thread on here for any questions like that called "Exchange City". I think the women on there know it all! Good luck with the continued healing! (((hugs)))
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Hi girls,
Haven't been here for a while, still dealing with things here and there. Hope everyone is doing good.
Wanted to reply to Lisette123,
I don't want to scare you but you should absolutely call your ps and ask to be seen. Go with what you feel in your heart and if you are worried, get your ps attention. I definately think that waiting another week to be seen is not a good idea. I had some complications after prophylactic double mastectomy with immidiate implant and nipple sparing and had nipple issues as well and my ps saw me every 3 days after I alerted him about my nipple.
As for them being undeven, I also agree with Kate that the swelling is prominent and will most likely come down quite a bit and settle. Usually they won't "sit" in the right spot for close to 6 months and many have uneven.
Sending you healing vibes0 -
Thanks Ladies,
My PS is a few hours away, I am seeing my GP tomorrow to have some of these drains removed so I will let him assess the situation, I do think it looks a little better today than yesterday, I think I will take a photo for sure even just so I can compare images over time.
Thanks for your input and healing vibes.
ThisTooShallPass,, can I ask who your surgeon was, there is a lady in here from Ottawa looking for someone to do a NSM and she is having a hard time finding anyone in her area.
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I had a BMX with nipple sparing on March 26th. My left breast had previously been radiated and it took me three Dr's before I could find one that was willing to take the chance to save my nipple. He won out. He actually is my PS but because I had already dealt with my cancer and my MRI was clear he was willing to do both MX and reconstruction. He said he could control the cosmetic outcome much more by doing it all. I was fine with that because I was going to have to find a BS because mine lived in another town and I did not want delayed. The PS practice so this alot as they have women fly in from all over the country for them to use as they do alot of DIEP but I was not a candidate for Diep and we did TE's with implants to follow. Everything looks great, drains are out and I am in a regular bra 24/7 and out of the surgical bra.
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I just wanted to give my experience to those of you who are getting surgery soon! On January 31st I had a left sided nipple sparing mastectomy with immediate implant including alloderm. I had two drains placed after surgery which were tolerable. Honestly it has been 2.5 months and cosmetically I am really happy with the choice I made. My tumor was far enough and small enough to do the NSM without issues. The swelling goes down day by day and I just have one smal incision in my arm pit and the other from nipple over to my arm pit. I rub Vitamin E oil into those once to twice a day to decrease scarring.
As far as doing a direct implant and its' effect on the muscle..yes it does make your chest muscle VERY tight. I am 26 years old and was not willing to lose ANY range of motion in my arm or ability of my chest muscle (not that anyone is). I started physical therapy as soon as I could which I think was like 4 weeks after maybe?? I got approved for only 8 times, but it was a God-send. My PT would stretch me out and massage me..she is amazing. She gave me exercises and stretches I do twice a day and made a world of difference. My arm is fully functional and my chest is still slightly tight, but not anywhere NEAR what it was initially. If you get a head of the game and do those things right away, in my opinion, your better in the long run.
Overall, I am very happy with my surgery and unfortunately was the easy part at least for me. I am not doing hormone therapy and ovarian suppression and the surgery is a thing of the past...almost
Good luck to you ladies!!!!
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I can vouch for PT being a God sent. I needed it after rads but no one refered me. finally I asked my MO to give a referal for PT because I was so miserable. He did and I ended up spending 3 month going twice a week. The therapist said if I can come soon after rads I probably would only have need 4 to 6 week. I Got most all of my range of motion back. Had my BMX 2 weeks ago. I see the Ps in two weeks for my first fills and I am going to ask for PT again for my range of motion.
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I am a physical therapist and have been self treating from the get-go post BMX and then again during rads. I have never been so happy to have my training. My pecs tightened up significantly, and I had to do exercises every single day to stay ahead of the game. The rads was just as bad - can't believe PT isn't prescribed as a matter of routine to at least TEACH people what they can do at home to keep ahead of it. Even 2 or 3 sessions to teach a home program would make a world of difference. I am now a few weeks post rads, and STILL am tight, despite doing exercises every day - although it is improving markedly.
I am really happy to hear y'all have had great experiences with your PT. Thank you for spreading the word and saving others from long term chronic tightness and pain.
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What kind of PT would be indicated after uni NS mx? especially with immediate 1st fat graft and then Brava to follow? I'm ashamed to say I haven't lifted weights - or done much of anything in years, though 2 days ago I picked up my 5 lb dumbbells to work on my arms and shoulders. Disgraceful - I used to use 15 lbs lol!
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Meny - I would see a PT that specializes in cancer rehab/lymphedema tx (even if you don't have LE, you should see one who knows how to teach you exercises that won't bring it on). If you have minimal tightness, you can be seen for just 2-3 sessions to get a home exercise program and education on how to progress it safely. Or see them once or twice, then go back in 3 or 4 weeks for a quick reassessment to see how you are progressing and make sure you are ready to fly on your own.
Now, if you have moderate to significant tightness, you'll want to see one 2 or 3 times a week for several weeks. But just know not everyone has to go to that intensive amount of therapy. It's hard to fit that into your schedule - and you shouldn't have to do that much if your issues are mild, which they should be, if you are being seen on a more preventative basis. Hope that helps!
And by the way, if you have a node dissection, even sentinel, you have to do very, very light weights (often none at all at first) to prevent LE. And most sources say wait 10 days before starting any significant motion/exercise to the arms for the same reason. You have to allow healing time for the lymphedema system.
The Brava will actually make your pecs tighter after wearing it, I can attest to this. So it is important to learn very gentle stretches you can do to stay on top of it...but only after it is safe to start!
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Hey, Lisette. Good to hear you are feeling better. Do send your PS photos, if he will accept and respond to them. My PS is not close to me either, but not as far away as yours. Please realize your BS and PS will have a different perspective and views based on their particular expertise. I do not think they are interchangable. So while you need to and should see your BS, try to find a way to get to your PS if you can as that expertise is very important right now. It is good news that you are doing better.
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