Nipple Sparing Mastectomy with immediate reconstruction
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Thanks Tampa,
My GP said it was hard to say what was happening at this point but agreed that I should probably stay on the antibiotics so he wrote me another prescription. It did appear a little less angry looking to me today, I am taking everything I can think of to help with wound healing, but I will give my PS a call in the morning anyway just to be sure!
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Well I e-mailed the photo to my PS, glad i did, he wants to see me tomorrow, hopefully everything is OK
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Lisette hope everything is OK
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Good for you for doing that, Lisette. And I am so happy for you that your PS accepted and responded to your emailed photos. I think you will have a great outcome to your current problem.
And it is good that you now have your PS on point with this. With the surgical and specialty training a surgeon gets, it is important that you have care from your PS in addition to your GP. Your GP has a place, but it does not replace your surgeon who has much more training in this area. Good wishes to you.
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Lisette- Just want to wish you luck for your PS appointment tomorrow. Hope it all turns out o.k
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Does anyone know anything about NSMX not being possible on someone who has had previous breast lift? I was told by the surgeon and plastic surgeon that it wouldnt be possible to do it because the circulation would be impaired. Does that sound right?
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Nightnurse- I haven't heard of this before. I tried googling it but couldn't find any information. Does your surgeons have a lot of experience with NS? If so, I guess you'd have to accept they know what they are talking about. If they haven't done that many I would try to schedule a consult with someone else who has. Is there a reason they couldn't at least try with your understanding that there would be a much higher risk of failure? If the nipples don't survive they could remove them at that time but at least you would know you tried everything possible to get the results you wanted. So sorry. I hope you can find a way to work it out. (((hugs)))
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Nightnurse - I couldn't find anything online either. My BS has done many NSM. I just sent her an email asking her if she generally considers breast lift a contraindication. I'll let you know if she responds.0
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Nightnurse and Kate33 - I got a response from my BS. According to her, breast lift and breast reduction are contraindications for straightforward NSM. The NAC (nipple areola complex) would be unlikely to survive if left intact on the breast skin flap. However, it may be possible to remove the NAC and use it as a graft.
Nightnurse - Good luck with whatever decision you make!
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Hi Ladies,
My PS didn't seem overly concerned, he gave me some antibiotic ointment to apply twice a day and will see him again on Monday, he thinks it will likely heal up in time. And I got my drains out today, yipee!!!!! Will also get my patholojgy report on Monday, fingers crossed. Thanks everyone for your thoughts.
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Hmm... confusing, since when I had a breast reduction last year, I specifically asked my PS if this would still make it possible to do a NSM, should I need one in the future. She said that the reduction made me a better candidate for the prospective NSM, since being large breasted can often compromise the blood supply to the nipple. She does a lot of reconstruction in her practice.
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momoschki - Like many other aspects of breast cancer and reconstruction there seem to be different approaches and opinions among PSs and BSs. Both our surgeons work in large metro areas. My BS is a seasoned veteran in NSM. You're right, it is confusing...
I just found a recently published article online:
It describes a small study at Georgetown University. Carefully selected patients had a stepped procedure where the mastopexy was done under strict surgical guidelines to preserve as much circulation as possible in anticipation of the NSM several months (or more) later. So, progress is being made to offer NSM to more women.
Best wishes!
Edited to add: The first time I pulled up this article the entire thing came up. Now when I click the above link or go directly to the site I can only see the abstract......
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I've seen some women do either lifts or reductions on one side in combination with a MX on the other. If it's more difficult, if not impossible, to do NS after this I have to wonder if these women are being told this. There's always the possibility of having to do a MX on the healthy side down the road. I would be extremely upset to find out that NS was off the table at that point. Again, surgeons need to be sharing all this information with their patients. They also need to advise if something can be done but they, personally, don't have the training or experience to provide it. I found an article by the NY Times where they said breast reconstruction patients are not being given the full picture of all of their options. I posted this on another thread but want to share it here, too. Please don't assume that your BS or PS will tell you all the options out there. Mine certainly didn't. Do your research, ask questions and time permitting have several consultations.
http://www.nytimes.com/2008/12/23/health/23beauty.html?_r=1&pagewanted=all
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Tina- Unfortunately was just dx with LE in both arms and truncal which I believe was caused by surgeon error during my revision. It's very painful and will require life long management. There's a great LE thread on here, though, which has been extremely helpful and I've found a wonderful physical therapist. Anyone who has had nodes removed, even SNB, I would advise you to educate yourself on preventing LE (lymphdema) and follow the protocol. Don't trust your doctors will do what's necessary to prevent it.
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Hi girls im back,,I had my NS and Ss BMX with immediate reconstruction on monday..The first few days the pain was the worse..My nurseing wasnt the best .i couldnt move my arms very well and getting in and out of bed on my own was impossible..I feel i could have had way better help..Thank god i was able to come home Wednesday..My DH and children have taken far better care of me then thoses nurses did..So far so good Skin and nipple apear to be doing great..The TEs are a little uncomforatable but are new and i seem to be getting better with that by the day..I will say i cannot wait for the drains to come out,,they really bother me and my DH was told to strip the lines onces a day and i hate that i can feel the suction and were they are running against my TEs ..I seen my PS yesterday and he wants to keep them there untill next week ,,only they couldnt fit me in untill next friday..I think once they are out i will feel soooo much better and i will say i am really looking foward to my first fill..Thank you all for your support threw this journey..This site and all of your persanol stories have been very helpful
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shawna32 - There's no place like home, right? Glad that your family is looking after you. You should be feeling better every day and you'll definitely feel better once those annoying and sometimes ouchy drains are gone!
Take good care of yourself and keep us posted....
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Hi, I'm doing my BMX with 1 step to implants on May 7th and was wondering about ladies who did that and went up in size. I'm a 34B and wanted to go up to a C, not a full C just a C, so I was just wondering if any of you ladies went up and your experience in that.
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Soyaandpepper- The boards are usually pretty quiet on the weekend. I'm sure you'll get a response in a few days. I didn't have the 1 step but went with TE's. I did go up in size from a B to a C. One thing I'd be concerned about is the skin will need to be stretched to accomodate the larger implant over your natural size. This can put a lot of pressure on the nipples which are in a very fragile state after MX. With TE's they can add the saline gradually depending on how healthy the nipples look and can always remove some if there's an issue. You don't have that option with 1 step. I know the thought of TE's and an additional surgery can be daunting but I would definitely ask your PS about the possible risks with each method. I'm sure you'll get some feedback from other women on here who have had the procedure, though, and what their experiences were. Good luck with whatever you do.
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Soyandpepper-I had NS with direct to TE. They have not been bad at all. I have had one fill since surgery and will get one more for sure maybe two. I was a A cup before and would like to be a full B when done. I love the fact that I got to keep my nipples. Took me three PS's before I found one who thought they were worth saving.
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Hi Girls i am 7 days out from surgery ..Today i noticed a dark spot on my nipple and the areola is darker than the other one any ideas?It is not black just darker in color. I dont know what to expect as far as the healing process of a spared nipple.Is there anyone who can give me some insight please?
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Shawna,
I had a NS SS left mastectomy with DIEP reconstruction in January. I cannot speak to TEs but I can speak to having the top of the nipple turn dark and then get hard. I was frightened that I was going to lose the nipple because I was not aware that this could occur. Since I already had an appointment with a physician's assistant to check my drains I didn't have to make a separate one. Based on her examination, the PA assured me that in my case this would flake off like a scab and my nipple would be fine underneath. It did in fact become a small scab and then came off and my nipple was fine. I was actually trying on a top in a fitting room when that little booger dropped to the floor.
When it comes to reconstruction I believe it's better that someone takes a look at it. But that's me ... I felt better because I wasn't describing something over the phone and having the PA visualize it. She could see it and touch it and make an assessment.
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Hi just checking in 2 months post-op...
Kate33, I am so sorry about the development of LE.It's unfortunate that physical therapy and LE prevention aren't standard parts of treatment. I'm glad that you have found good care and pray that the pain and swelling subside.
Soyaandpepper, I had 425ccs of tissue removed and 500cc direct implants put in. It's weird though, they are technically bigger but they are smaller. They are perkier and more round, but flatter to my chest...if that makes any sense at all. I was a 34C-D before surgery and I still am but they are less projected. I am actually very happy with them, but I can't say that I feel like I went bigger. The one step was remarkable though, so thankful for that option.
Shawna32, I remember when my friend told me that I was in her prayers...and asking her to pray for my right nipple! They both ended up very dark and crusty in places; and whitish where the nipple met the areola. They looked pretty scary for about a week. My PS said to put bacitracin on them and non-stick gauze pads over it and that helped soften up the scabs and eventually it peeled away and they were pale but pink underneath. About four weeks out they were just about normal in color and now at two months out they are fine.
I'm feeling pretty good, went to a wedding on Saturday. First big family event since my separation and my surgery, and it felt very liberating...like a newer, stronger me. I was pretty sore and tired the next day from dancing all night, but I DANCED ALL NIGHT! It seems like I've gotten a little more energy back every day since about the 6 week mark. Still have some mobility issues with pulling motion, I found a physical therpist locally who deals only with LE/MX patients and I start on 5/13. I've put on about a pound for every week of recovery...so I'm hoping to turn that around now that I'm feeling better!
Hugs to all...
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shawna32 - Chances are the nipple will be just fine. Many PSs are open to emails and I often was asked to send a good photo or two rather than try to describe over the phone. It helped them decide if the situation was worthy of an office visit.
The PA did comment, however, that if the patient can't take great photos it can be difficult for them. Good, natural light and macro settings are best.
Good luck!
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Shawna- A lot of times the darkness is just a kind of bruising. Our nipples take a beating during MX. Most find this resolves pretty quickly. Sometimes it forms a scab first but not always. When it does it's almost like an umbilical cord on a baby after it's born. It can get pretty dark and crusty looking and then one day it just falls off and it's all pink and healthy underneath! I'm sure it will be the same for you!
I'm trying to get my lymphedema (LE) under control and I'm encouraging all of you to get educated on it. Find out what to avoid and tips for preventing it. (I was following all the precautions but then a stupid PS put incisions in my armpits, rather than the IF as agreed upon, during revision! Grrrrrrr!) LE SUCKS so do everything you can! Even if you've only had SNB you are still at risk.
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Kate33. Could you explain where the PS put the incisions. Where exactly they were supposed to be ... What is IF? And why you believe this contributed to or caused your lymphedema if that is what you mean?
I am continually attempting to educate myself about lymphedema. I see a specialist for PT regarding cording, manual drainage, and le prevention. Following chemo I am supposed to have radiation but am concerned about how this will increase the likelihood of my developing le. This is a lifelong vigilance I know I will have to embrace. Tonight I am just tired of thinking about it all0 -
Soyaandpepper: You wrote that you are having BMX with nipple sparing and 1 step to Mentor silicone implants and trying to go up one size to C cups. I am curious if your PS will place the implant under your pectoralis major muscule and use an acellular dermal matrix (ADM) like Alloderm for a lower sling to hold it in place. This seems to be quite commonly done. For my case, however, where I have risk of nipple and skin necrosis because of much cutting and stitching necessary to go from a larger to a smaller cup, my PS is suggesting he should avoid ADM altogether and use total sub-muscular placement which provides superior blood flow to the jeopardized skin parts and nipple-areola complex. Just wondering if anyone else has had this medical direction?0
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Kate - so sorry about the LE!!!! I haven't been on here much lately - so are we still at risk for LE even 2 years out from surgery!!! That's just crappy
Hugs, Valerie
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dltnhm- My original MX incisions were in the inframammary which is the fold under the breast (IF). During the consult for my revision it was agreed that my new PS would use the same incision to swap out my implants as it is barely visible. During surgery, however, he put new incisions (very visible) in my armpits instead. Axillary incisions should never be used on BC patients. I had a consult later on with two different PS's who said they never use those incisions at all on anyone and that the only possible reason to do so was it was more convenient for the PS. Unfortunately, I can't prove this PS caused my LE but I believe he did.
Valerie- My BS told me because I had SNB I never had to worry about LE but I've since realized this isn't true. We have a lifelong risk of LE anytime we have any nodes removed. My lymphedema therapist is working with a patient who developed it 25 years after she had BC. They are now realizing that some of us are predisposed to LE and any disruption (nodes removed) pushes us over the edge. Unfortunately, no one has developed a test to see who is predisposed and who isn't so you should always take precautions- no BP readings, shots, i.v.'s in the affected arm. If anyone wants to learn more you can go to stepup-speakout.com LE is really painful, there's no cure and it can be expensive and time consuming to treat so I would do everything you can to avoid it. Anyway, How Are You?!? Hope all is good!
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