Nipple Sparing Mastectomy with immediate reconstruction
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Gunner here,
Just went to get the mail and this neighbor says gee u look great I said what do you mean well considering what u have been thru, Breast cancer 2x and now I need an ooph his words sent me into an anxiety attack. What is this, I hate Octomer as it is am I surpose to look dead -I went to my docs at UCSF and am awaiting surgery schedule for ooph so I can be put in menopause so I can start Arimadex since I got a blood clot from Tamoxifen. I hate my neighbors.
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When folks say that to me, I tell them people were telling that to Donna Summers the week before she died. :-)
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My surgeons (breast & plastic) wouldn't commit to a particular incision prior to surgery - but were fairly certain that NSM would work (note: at time of PBMX we didn't know I had ILC BC). I have horizontal incisions , rather short (maybe 2" at most), from armpit area & then about 1/3 of the way around the top of the nipples. I didn't have any black scabs or such. My surgeons explained that the IMF incisions may not be as good if you're going to need a alloderm sling at the bottom. It made sense to me from a mechanical perspective. I honestly believe that my recovery was easier with the incisions being straight across so that there wasn't any extra strain on the incisions and so that there wasn't any pressure from bras and such.
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Just wanted to let you know that my meeting with my PS went very well. (6 months post BMX -- the first meeting I've had with him since July 2). It was so reassuring to hear that he had basically the same assessment as I was expecting about needing a mini breast skin reduction on both sides along the inframammary fold and anchor vertical scar. He will take off the small "dog ears" at the edges and so the incision will be a little longer than the original. He is going to move the right implant about 5mm lower and widen the pocket a bit towards the underarm to get a better match between the two sides and reduce the upper pole problem. He will work on the symmetry since my left breast is softer and looser and the right breast is firmer and higher with NAC pointing more to the right. For my left breast with my real nipple and areola, he will make a crescent cut towards the upper pole to move it slightly upwards.To re-create the reconstructed nipple that I lost on the right side, he cannot use the skin from the mound because of it already being grafted skin. But he will use some of the excised breast skin to create a nipple. Hope it works this time (although I wonder why should it when it already failed once already during BMX -- I had reconstruction with the implants on the same day? Maybe because this time I will have less parts of my body to heal and can focus healing powers on the nipple?)Although I asked about it, my PS has a "policy" against using any of the pig collagen and alloderm type products of Cook support for achieving nipple projection, but perhaps that is just his conservative nature and none of his patients ask for it.My revision surgery is scheduled for Dec.4th and I will have to have a general anesthesia, and stay just for one night. Then if nipple takes, tatoos 3 months out.Do any of you happen to know of any definitive studies from Journal of Oncology Plastic Surgery or similar that show nipple failure / success rates depending on sources of tissue and method used?What would those with successful nipple reconstructions recommend for how to increase my chances of the nipple surviving and staying projected?Thank you for your advice. Fearlessfoot0
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I found this page on Facebook and wanted to share with everyone - great resourses on Breast Cancer foundations! https://www.facebook.com/pages/Breast-Cancer-Resources/424395840954618?fref=ts
Hope everyone is doing well!
XOXO
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Tina13 - Good to hear from you! Glad you're hanging in there!!!
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Hi girls! I cant seem to find the picture forum? I had a NSM with TE on 10/12/12. I will be getting Sientra implants, and wanted to see pictures since they are so new.
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annemarieh - I'm so glad you were able to have NSM, somehow it seems there are still women who don't find out until after the fact
I hope all's going well with expansions. The picture forum is a totally separate site, not affiliated with BCO. It is privately moderated and sort of "invitation only" at the discretion of the creator and gatekeepers to protect the privacy of those who post. Please establish a presense here by asking questions and sharing your story, then you can send a PM to Lilah here to inquire about access.
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I was told by my surgeon that they are going to do a mastectomy on my right side and a reduction on my left side so that they match. Now my question is say they go down/up to a C cup what happens if I lose weight? Will I be lopsided?
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Hi blackcat - Are you having implant reconstruction or a flap surgery on the cancer side?
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Good question as I have no idea yet. I see the PS next week. I know I am having a mastectomy and the BS said immediate reconstruction. I am very large an I cup so implant on the cancer side with a reduction on the other side to match. At this point (I am still on the fence).
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blackcat - There are many reconstruction options these days. There is implant reconstruction, flap surgeries (DIEP, etc), microfat grafting, and sometimes combinations of these surgeries. It sounds like your PS plans implant reconstruction on the cancer side and a breast lift on the unaffected side to balance. If that is the case then, yes, weight loss and gain can affect the two breasts differently. The implant is a foreign body and won't react the same as the real breast tissue on the lift side. There are women who have the initial surgery with tissue expander placement then delay their final implant placement until they reach their desired weight. This is usually with women who are planning a fairly dramatic weight loss. One of the plusses of autologous reconstruction like DIEP is that your own tissue is used so it feels warmer to the touch and reacts to weight changes.
Nipple sparing surgery was limited to smaller-breasted women with cancers a specific distance from the nipple. But, I'm reading more and more about NSM being done on larger breasted women. Sometimes the actual surgery is performed a bit differently as there is a higher risk for nipple failure in large breasts. You might ask your PS what his/her success rate is for someone with I-cup breasts. Just a suggestion...
On the Breast Implant Sizing 101 thread there are a number of women who have had unilateral surgery or have gone through weight loss programs before getting their final implants. Not necessarily nipple-sparing surgery, but you might find some help in regards to your other questions.
All the best!
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hey, all:
had my nipple and skin sparing bmx on 11/6. had to go back for a little surgery last week to remove some necrotic skin. my doctor showed me how to the do the boob massage to loosen things up. here's my question. at what point will it stop feeling like i'm wearing the iron maiden bustiere? i've also been doing shoulder rolls and the sun pose in yoga. this just feels weird.
thanks all.
susan
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TinaT-Thanks for the info!! I totally understand! My fills have been slow going. Just like gritgirl, had to go back to the OR this past friday to have a small necrotic area fixed up. PS had to remove about 100 cc's to close up the incision site. So now i'm kinda lop-sided! I have a post-op next tuesday!
It's great being here, and having such great people to vent to, and get great advice from! You guys are wonderful!
Annemarie
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After BMX I had a long stretch dealing with necrosis and ended up losing part of one nipple and some adjacent skin. But, it has all healed up pretty nicely. So.....hang in there everybody!!!
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Hello,
I just had corrections to my May 2012 BMX, nipple sparing on one side, with immediate silicon gel implants. I went from a 34DD pre surgery to a 34B-C, so the technique used was incisions of the style: anchor and keyhole cuts (moved left nipple areola complex (NAC) up higher on left breast). My left NAC survived and my right NAC was reconstructed from excess breast skin. (Note my right NAC's vascularization had been comprised due to incisions during lumpectomy so PS thought not worth trying to save -- I wonder now!) The areola took but the nipple necrosized within the first month and healed over flat. The implants were generally fine but I had excess loose skin along the underside inframammary folds of both breasts and the positioning of each implant -- especially the right one -- was a little high causing a kind of fold on the upper pole, and both were closer to the sides or armpits.
So this week, 7 months post BMX, I had these revisions done under general anesthesia in a 2 hour long operation by my perfectionistic and humorous PS. He told me that during the operation he stitched and restitched the positioning twice, because it wasn't exactly right. He said the op staff just sighed with his persnicketiness but he was proud of what he had accomplished.
My doctor would not let anyone go home until the drains are out, so I had to spend 3 days, 2 nights. I felt fine the whole time. It was nothing like the BMX. No pre-op calming drugs before the general anesthesia (I didn't want any I was calm), only paracetomal and antiinflammatory pills afterwards. Lots of water and tea. The clinic is like a luxury hotel disguised as a hospital, so I shouldn't complain, but I just wanted to get HOME!
But still, the question is.... will my nipple take? He just used a graft of my excess breast skin to make the nipple. I had queried him about nipple implants and alloderm etc, but he would listen to none of it. He had considered adding injections of hyaluronic acid (a naturally occuring substance in our bodies used in fillers for cosmetic purposes I guess kind of like botox), but decided to wait because that could be done on future office visits if needed.
He checked my breasts by pulling off the industrial hospital tape that is acting like an Egyptian mummy-like bra. I looked down and thought the breasts looked really big and different! I don't want bigger boobs! He promised me he hadn't switched the 270cc implants for bigger ones and said they would calm down in due time. He said they were closer now and so I would show some cleavage (which I didn't before). I just have to be realistic about the high risk that the nipple will not survive, but I will try to send healing messages throughout my body (I don't necessarily believe that will do anything, but it can't hurt). If the new nipple doesn't survive, I think I will just go for tatoos and a stick-on kind. I am just not interested in doing anything more plastic surgeryish. He retaped me back up and said to come back to his office Tuesday with my sports bra and velcro band which I will have to wear again for 6 weeks -- ugh!
I will ask about the nipple cones and other protective devices, which he never used on me before.
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So happy to hear this news! Love that dancing girl ! Joy joy joy for you!
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Fearless, I am happy you got the nipple reconstructed. If there's anything about all if this we learn it is patience. I'm continually surprised by how things change over time. For a time, I thought one of mine were doomed. I wish you the best.
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gritgirl Haha! I completely understand what you mean! But things will loosen up, don't worry
I had my NSM on October 3, so over 2 months ago, and even went to physical therapist, because I could not open my shoulders and lift my arms much. THe PhT was just gasping the whole time at how stiff I was and really made me worried! She told me to do some stretching exercises which did feel really weird, so I stoped doing them And now things are good, I guess the body just needs time to heal and we shoudn't try to speeden things up - I got my full range of mothing without almost any discomfort, but yea, the tissue expanders still feel like coconuts under my skin. I'm doing chemo now and hope that after I switch them to implants I will stop getting people bruised when I give them a hug. XOXO
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8 days post nipple reconstruction and BMX implant adjustment my PS took off my industrial strength hospital tape. The bandage over new nipple still on so I haven't seen it yet. I am now in tight sports bra with a separate velcro band across top to keep implants down. Shocked to find out he did capsulectomies on both sides. He was going to adjust them but found some encapsulation or scar tissue. I am freaked out. the nipple is still covered with a flat bandage. Will get it off 13 days post nipple reconstruction. He does not use nipple protectors; he prefers pressure caused by tight bandage to compress, reduce swelling, and encourage faster vascularization. The excess skin from inframammary fold was used to create a nipple mound which he grafted onto my healed grafted areola. Sending healing thoughts. What creates encapsulation? I thought I was doing fine! My doctor was very vague. Not happy about his info transmission skills.
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Fearlessfoot - This is the way my PS explained it to me. The body recognizes the implant as a foreign object and wants to "get rid" of it by walling it off. So the tissues tighten up around it. Massage helps because it keeps the scar tissue in check. By gently forcing the implant in all directions within the pocket it fools the body into thinking the implant is taking up more space than it actually is so the scar tissue doesn't encroach too much. Our bodies are all different so likely this just happens sometimes no matter what precautions are taken
I'm sure this is a very simplistic explanation, but it's very visual for me so I always do my massage. Perhaps capsular contracture is more common with the surgical approach your surgeons use?
I hope your nipple surgery turns out beautifully...hang in there!
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Hi everyone! I finally had my necrotic tissue removed on 11/30. Everything went very well. PS had to remove 100 of the 300 cc's I already had to make sure tissue closed. I had post op appt on tues 12/11, where he removed a few sutures, and steri strips. He then placed a little surg glue and more steri strips. I had lost 65 pounds prior to my BMX, so I thought I had enough tissue...until now. The incision is healing very well, but feels tighter. I have to drive 1.5 hrs into NYC for fills. The 100 cc fills were not TOO bad, but I guess I will try to get another 100 ccs to catch up. My right side looks awsome!! Will my left side have to strech even more now? I want my TES filled to capacity (550)
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Im pasting this from my post on my chemo thread and othet pages so I don't have to type it all over again.
Hi ladies, sorry I've been off the grid lately. Life has been busy. I've had 4 rounds of TC and my MO said she wants 6. I had a fill in my TE's last Monday and on Christmas Eve when I woke up, my right breast was double the size of the left one and had blood blister like bruises all under it (near my port). My PS opened his office that afternoon just to see me and to find out what was going on. He said it looked like I had torn some internal scar tissue and it bleed out. He talked to my MO and she postponed my next TC treatment so he could do surgery to wash out the blood to prevent infection. Since I was where I wanted to be with regards to my expander size (650cc), he went ahead and exchanged my TE's for my squishies. I had the surgery yesterday. I'm pretty sore and my chest looks so much smaller than I anticipated. I was always big busted but didn't want 800cc because I figured they'd be perky and higher so they'd be TOO large. My PS said we can go back in 3 months or so and he can make them bigger if I'm still not happy.
Anyways, there's an update on my happenings. I hope you all had a wonderful Christmas.0 -
Hey Ladies! I finally had a fill today after 5 weeks of waiting for the necrotic tissue to heal! My left radiated side is still a little funky/wrinkly looking, but, boy my right side is looking fantastic!!!!!! I'm at 400 of 550 cc's. Today when I got home, and looked, It was the first time I actually SMILED since my BC DX!! Lovin' my PS!!
Annemarie
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annemarie great news
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Hi Everyone, I am wondering how long it will take for the big black scab to fall off my nipple-spared, flap reconstructed boob? It's been over 60 days!
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Chilly - Is the scab on the nipple or elsewhere on the breast? It can take a good long while for a spared nipple to recover from the shock of surgery. If it's the breast itself I would be a bit more concerned at 2 months out. In either case, if you haven't seen your PS lately perhaps a call or visit is a good idea. Or, if he/she is open to email communication a good macro photo might ease your mind.
When in doubt, check with your PS!
Sending good healing thoughts your way...
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Sherry~ugh! I thought I was used to looking at the left side, but it's really annying me. the skin is tight from the radiation 2.5 yrs ago, it sits high in the pocket, and it's not very plyable like the right, it's got a huge crease on the lateral side. looks nothing like the awsome right side.I'm hoping PS can fix it come exchange! Thanks for your encouagement!! You all here are SO helpful!! xoxo
Annemarie
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Thanks TinaT, it's the actual nipple itself. I have an appointment with the PS soon. Happy Sunday:)
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Chilly - The waiting can be nervewracking. Please keep us posted. Hang in there!!!
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