Nipple Sparing Mastectomy with immediate reconstruction
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PB 22 LOL you are hysterical, girl! Actually I did cook him a spectacular dinner one recent evening: worked like a charm, you are sooo right!!! Oh and thanks for the feedback re working the pecs. I've been hesitant to try getting back on the machines, just using free weights and much less than before surgery, but seems to be getting me toned up again....
Kate: thanks for the scoop, I'll check out the thread.
Caroline H: welcome and nice to hear from you!
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No pec work for me - PS says we don't need to build up that muscle!! One less muscle to worry about?
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vmudrow- My PS said not only do we not need to work the pecs- we shouldn't! During MX the pec muscles are kind of repositioned and working them out can actually cause the implants to gravitate towards the arm pits. (Never a good look on anyone!) Then I was talking to a stylist at my salon who had augmentation and she said her PS told her the same thing. She's a personal trainer, too, and says usually the only women that will benefit from working those muscles are small breasted women who want to appear bigger on top. What does everyone else's PS's say?
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My PS told me to work the chest muscles using light weights so as to move them around inside the pocket so as not to get the scar tissue causing the contracture. When he moved them manually he really got deep and moved them up and down, side to side. He actually said it would be good for them and to not worry about them going off to the sides as in they are in place with the pocket. In augmentation its nots as secure, being placed behind the muscle rather than sutured like we are. By the way I feel , the burning, I don't have the desire or see the benefit except I was experimenting with the range of motion with the fly. I feel that I can spend my time more wisely on other body parts. Without the breast tissue covering the muscle I don't want that ripple look either. Also, if chest presses tighten the muscle then I want it loose for the fluff so I thought the fly would be a good stretch. You also don't want you elbows to go back behind your body when doing the chest.
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Hey Caroline,
I too am from the vancouver area. I have Dr Kuusk and Dr MacAdams who works in Dr Lennox's office. Iam debating between a 1 sided Diep as I am thin and only have enough tissue for one side or a bilateral with implants. I will not be able to save the nipple on the left. I am glad to hear that you are pleased with your results. The surgical group is suppose to be excellent and I have really liked Dr MacAdams. How was your recovery? I am tempted to do them both but the diep is tempting with the tummy tuck effect. I cannot decide.
Thanks,
Trusting
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There is some good information on the exchange 101 thread regarding PS not recommending pec workouts. I need to find something in print to bring to my PS.
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In the interests of educating all the NSM advocates on here I wanted to pass on some information I got in a PM from a member named CandDsMom letting me know about a plastic surgeon in the Santa Monica area. His name is Dr. Jay Arthur Jensen. He is pioneering a new two step procedure enabling him to do NSM's on larger breasted women (even D cups) and has had great success! He elevates the nipple and does the biopsy in the first surgery and then the MX is done in the second one. I added his name to the list on the other thread but I wanted to pass this exciting news on, also. Hopefully, in the future, this option will be available to all women who have to undergo MX.
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Welcome Caroline H. and Trusting
I don't work out the pec muscles, I don't like the way they squish up. They do the "squish thing" at the most inconvenient times, and it is a little annoying. My husband says it's not noticeable, but I'm paranoid that other people see it. I would think it's better to keep those muscles loose, I think if they were tight they would make our implants look rippled. I don't know for sure, so I will just stick to working out my arms only.
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Kate, good news that this can be available for larger size woman. Was discussing today how my first surg implant was a 375cc and the girl I was speaking to was an augmentation using 375cc with her breast tissue and she was more slender than myself. I wish there wasn't so much guessing involved.
Im for a relaxed muscle also TN.
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TNLady- I know what you mean about the "squish" thing. It's like I can flex my pec muscles and they get all ripply. It looks really weird! I did it in the shower and was amazed at how they really tightened up and showed through as muscles. It's just weird to think our muscles have now become a big part of our breasts!
Kate33-that sounds awesome. I wish everyone had the choice of NSM if she meets the criteria nd it's sad that in a lot of cases the choice is not offered simply because her Dr. does not do them.
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sweetie- I agree. No one should lose any part of their anatomy because their surgeon doesn't bother to tell them there are other options available. It's just WRONG! Yet, I see it happen every day on here.
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Ladies, all I can say is keep those pec muscles loose! My "frozen shoulder" really isn't but all my pec muscles in a contious muscle spasm! The physical therapist is working on exercizes and massage to release them and get the blood moving. After one session, I'm extremely sore but I can tell my reconstructed side is releasing and more squishy.
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I don't understand why my friend's BMX NSM is being done as an out patient. I was there when she was initially told she would be staying in the hospital over night. When I questioned this, it was explained to me that its for insurance purposes and it would be changed after the operation.
How often do the one step women go to the PS after the operation and did you have a visiting nurse come? if so, how often?
Kate, I bought a bottle of the vitamin water. I'll see if she likes it before I buy a case. She did drink the protein shot.
PB, I asked Lori about lidocaine and was told they would apply it topically via a cream.
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Was wondering how you are doing Delray. When is the surg. date?
What size implant did your friend decide on?
I was an overnight stay. Your friend should call her insurance company and see what they cover regarding length of stay. Hospital wants you in and out and surgery likes you out before you get any infections. However in your friends case with no one home with her I would stay the max that is allowed by insurance. What you were told was its an outpatient overnight procedure, if there is a medical reason to keep longer than they will convert her. They would have to prove medical necessity to her insurance because she's being preapproved by the insurance and so far they are approving for overnight- she needs to speak with her insurance to see what they allow for this procedure. Did she tell them there is no one at home to help her. Make sure the hospital instructs on how to milk the drains, they did not do that for me. Make sure she has the iv dose of antibiotic that is ordered for her the next day to prevent infection this needs to be given before she is discharged. Mine was set up only after I told them I'm ready to leave. Check that the staff is wearing gloves(take gloves home with you) if they don't tell them to. Don't let the housekeeping sweep the room while she is there, stirs up dust and she's leaving that afternoon anyway , they can wait. Wear a shirt that is easy to get in and out of opening in front. Following day after surgery when surgical nurse comes in to check her dressing, make sure her rubber drain is not under her surgical bra as it was mine, causes skin irritation and welts having the rubber rub.
PS visits are the day after surgery he checks the incisions. Then you go back one week later to check the drains, if the drains are not removed because still draining then another week later. Then its two I think , once the incision has healed at week 6 he may bring you in three weeks later to see how things are dropping. You actually look forward to these visits to ask questions and see how things are progressing.
I knew the lidocaine was topically when I had it. Does nothing to stop the burn from the injection. However from the other threads other facilities are adding it to the injection as there is a published study that says it doesn't interfer with the pathways. John Hopkins mixes lidocaine in with the injection.
What is the pain control planned during the hospitalization ie if she wakes during the night in pain?When she wakes it will feel like her chest is under a ton of bricks. Her hands will be at her sides so in the hospital it will be difficult for her to reach the nurses call light, make sure when you leave that she can reach it. She won't be able to reach the tray table to take any sips and she will have dry mouth and will need to call the nurse to help her.
Have her take a stool softener from day one at home and she needs to walk for the gravity to help with her bowel regulation. Stay ahead of the pain, even if she has none keep on the pain med schedule. Most likely she will be too uncomfortable to sleep, thats where the ambien sleep med helps.
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Delray- All great advice from PB22. Also ask if you can get her prescriptions filled ahead of time. It's just one less thing to worry about after you come home from the hospital. Hope she likes the Vitamin water. If not, have her drink a LOT of water starting a few days before the surgery and after she comes home. It really will help so much in making her feel better. Please keep us posted on her surgery date and how she is doing.
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I plan to have ssm done sept 10 with immediate reconstruction we are doing inplants .hope any one that has had it done can tell me what to look out for . all of this posting stuff is new to me .
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Delray, I stayed overnight and was very thankful that I did. They put a cath in, so I did not have to get out of bed until I left the hospital. I live an hour away from the hospital, I don't know if that made a difference in insurance approval or not. My PS came in the next morning to check on me, then I did not have to go back to him until a week later.
I second Kate, great advice from PB.
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Hey everyone- I put new photos up on the picture forum. NSM 7 weeks post exchange. I feel like my nipples are too low. I don't know why since they didn't feel that way with the TE's. I guess I should just be grateful I have my nipples, though! The good news is I am starting to get a lot of sensation back which I wasn't expecting at all. (Not in the nips but in the surrounding skin.) I just have one patch on my right shoulder blade that is still pretty numb.
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Kate - How do you get to the picture forum? Yeah, I feel like my nipples are too low too..... wonder if that is b/c we are both NSM. My PS said with regular reconstructions, he can put the nipples where he wants whereas with me, he has to work with the skin I have. Go figure. I had a second, third and fourth opinion .... two of which said to go larger.... that this will help the rippling too. These are docs that do a lot of augmentation, private PS. Trying to decide if that's what I want to do.
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vanderlady- The picture forum is kind of in flux right now. They are in the process of setting up a new site on a new server. When it gets up and going someone will hopefully start a thread on how to access it.
They are hoping to transfer all the photos from the old site to this one but it hasn't been done yet. Access to the old site was only granted after a member had posted frequently to ensure that only legitimate members could view the photos. It was a way to ensure the women's privacy. I'm not sure if this is how the new site will be set up but if so you may want to post more frequently.
Since you have the same issue with the nipples being lower just curious- did you go larger, smaller or the same as what you were before MX? I went a little larger but not too much. But when I had my TE's it seemed like they were in the right place but I had more projection with them too. I don't think I want to go larger so I'm hoping my PS will have some suggestions for the rippling. I've heard some are doing fat transfers but my PS wasn't crazy about them so I don't know. I probably won't do anything for a few months and just see how things settle.
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Kate33- Just wanted to tell you I saw your pics and your looking amazing! Your looking even better now than you did right after surgery. The nipples seem to be in a perfect place. I don't see any rippling in the photos. Your PS really did do an amazing job. I'm hoping for the same! Keep me in your thoughts.
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Hey ladies-
I had reconstruction immediately as I was told I did not need rads then....needed rads. So, my implant that was radiated is rock hard and not pretty and my other side has dropped so I am not looking so cute. I am having some staples put in to hold up the drooping implant and some scar tissue removed from the radiated side in less than 3 mos. Anyone out there have this? My PS told me the recovery is painful - hoping and praying for a good result.......
Thanks
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sweetie- Aw, thanks! I appreciate it! As far as the rippling, it only happens when my arms move a certain way. I don't know if that's normal or not. I'll ask the PS at the next visit. How are you?
chicagomom- I am sorry for all the complications you are going through. That is rough. I haven't had the same experience but hopefully someone will come along and give you some help. I just wanted to say welcome. Your picture is adorable! Makes me miss those days when mine was that little!
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Kate -- I went larger... I was a 36A (if that) and am now a 36B (thought I would get to a C, but that didn't happen). A full B on the recon side and unfortunately smaller on the augmented side. About the ripples, I did have fat grafting with the exchange but I still have one big ripple from 2 o'oclock on the perimeter all the way to the nipple, then a smaller one from 11 o'clock to the center, and a third one on the superior edge.
Interestingly, I wore a soft bra the other day.... the straps were loose and there was a lot of puckering on the top. As soon as I tightened up the straps, the puckering went away. I've had two other PS said to go with larger implants for the ripples.... I too am concerned about that. I wonder if with the allograft, the pocket gets elongated and there is a greater chance for rippling. Does anyone have any ideas about this?
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vanderlady- I did read that massaging is supposed to help in reducing the rippling but I was told to hold off on that since I have the Alloderm. I guess the PS likes to make sure the Alloderm has regenerated into your own tissue before you try that. She didn't, however, say how long I am to wait. I will see her in a few weeks and will ask her then.
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Delray, My surgery was scheduled for 3:30 in the afternoon. At first I thought it was a terrible time since I had to wait all day, but it actually worked out well. I was able to go to work that morning and get last minute things done (and keep my mind off things somewhat) and then go to the hospital and do all the pre-op stuff before I went in at 3:30. Because it was late in the day, I got to stay overnight, which I'm glad, since I got to be on a morphine pain pump. I wouldn't have had one if I had gone home and had surgery in the morning. My BS saw me the next morning (her office is next to the hospital) and then did my discharge and I got home by 11 the next morning. Of course then I was on pain meds and out of it, but that is to be expected.
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Kate - Hmmm, massage, that interesting. I saw my massage therapist last month and she showed me how to work across the muscle above the breast to break down the knots. My alloderm is on the bottom of the breast so I'm not massage near that. I had my mx in Jan and by March 13th, I had an infection where they exchanged the TE. The resident told me at that time the Alloderm was completely regenerated into my skin and they were very happy with that.
I was told by the PS nurse that with the fat grafting, sometimes little balls of fat can get underneath the muscle and cause them to spasm/ pain. So massage and heat helps with that too. One other reason I'm not so sure I'd want any more fat grafting.
I'll have to try to take a picture of my rippling and send it to you to see what you think. One of the second opinions I received, he was very surprised by the extent of it.
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Hi Trusting! Nice to hear from another local lady. Sorry I haven't gotten back to you sooner; just noticed your questions. Re decision-making, I didn't have the option of radiation (I've had previous rad) or DIEP (not enough tissue), and also didn't want to comprimise my core muscles. I chose bilateral sx as my dense breasts are hard to check (have had various false positives over the years), there was a 50% chance over my average lifespan (I'm 43 - about 10% / decade w rad x 4 decades) of recurrence in my other boob, and I wanted symmetry in reconstruction. Turns out on tumour exam there was precancerous tissue in the "healthy" boob, so just as well. I did need to use my abdominal muscles a lot during recovery from bilateral surgery, so that I wouldn't stress my arms and chest muscles. Then again you may like to have a normal breast, with the sensations etc. Good luck deciding on what's best for you. There's also info on the Alloderm link re my recovery experiences; feel free to join us there too!
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How come there haven't been many posts here lately? Hope everyone is busy having a good summer. My exchange date is Oct. 8th - can't wait!!
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vmundrow, So glad you have your date, you don't have long to go. It has been very quiet on here lately. Maybe everyone is taking a break, I know I have to now and then.
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