Nipple Sparing Mastectomy with immediate reconstruction
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Monika- Just wanted to welcome you as well! I think it's great that you are being proactive in getting the results you want. Unfortunately, the majority of breast surgeons are not trained in NSM so they seem to always want to talk their patients out of having it. It's one thing to be told you're not a good candidate by an experienced surgeon who performs this type of MX. But I would never take the word of it from one who isn't qualified. My first surgeon tried to talk me out of it, but then I found out she had never trained in the procedure. Like the rest of the women here I am so glad I found one that was as I think it went a long way towards accepting my MX. I had to drive 4 hours round trip to find an experienced breast surgeon but it was worth every mile. Good luck! Keep us posted!
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Monika, when I had my NSM, I was never told that inversion was a possible SE of the surgery. I would be curious to ask your surgeon how many he has performed. If he is skilled in this newer surgery than I wonder why an inverted nipple would be a reason to tell a woman not to keep their nipple. I would ask him, if it were his penis and there was a concern over how it hung than does that warrent removing it.LOL. Why is it these surgeons are so cavalier on removing this body part, they would put more thought into saving a toe nail.
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OMG PB22 LOL
You crack me up! Thanks for bringing some humor into this! But how true. Don't even get me started on how different the system would be were men the ones getting BC. Not to be reverse sexist, but I found my PS and BS, who were both women, were exceedingly pro-NSM as well as good at "needlepoint". My stitches were meticulous and left clean, minimal, hairline scars. IMO, I think women are better at this sewing skill: which comprises a large part of surgery. (I wouldn't ask my DH or dad to hem a pair of pants if you paid me!) In my journey they have also been extremely empathic about keeping the breast intact.
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PB22: You made me laugh! Thanks for your sense of humor. I will keep you ladies posted. Have a great weekend . Monika
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Well I don't find it sexist, but you ight be right! My BS is a woman and he care and concern and the whole way she runs her practice makes so much difference. I can't imagine a man being that way. They offer you warm luxurious robes when you get undressed for your appointment, not little paper or hospital gowns. There is soft music playing throughout the office. Coffee, tea, bottled water and juicee...and cookies available as well. She even hand-makes personalized cards for her patients! I sure can't imagine a man doing this stuff? My onco is at a big cancer center here and even though he has a great demeanor and "bed-side" manner, he doesn't go that far.
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PB22: right on!
bcincolorado: wow I wish I had your experience with my doc!
I've never been told inversion is a possibility and my experience is like what has been said: if anything they become erect a LOT, rarely are they flat. If you can keep your nipples, do it!
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PB22- too funny! thanks for making me laugh tonight.
Bcincolorado-I want to go to your Dr's office, it sounds more like a spa experience!
Fairportlady-I have the same issue even though there is no feeling there.
My BS is a woman and she is wonderful, funny, compassionate and very intelligent. My PS is a man but he is very skilled and is Italian, so that's a big plus!!
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bcincolorado- Wow! Your BS sounds amazing!!! Maybe I should start flying to Colorado! My BS is also a woman but she must have missed the class on "ambiance". Now if we could just get them to start offering a nice glass of Cabernet and a few complimentary shots of Botox or something!
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BC- what school of doctor etiquette did your BS go to? Let's clone her!
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Monika, Never heard that one before. Personally for me, my nipples look the same, never had a problem and I highly recommend this procedure if you can get your hands on a highly skilled/ highly confident breast surgeon. They are out there, but it may take severals consultations to find the right one!
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Well ladies what doesn't make sense in all this regarding Monika and her PS is that isn't a PS the "go to guy" to fix inverted nipples? Here her PS is telling her that he's going to have to remove the nipple because it could become inverted. Monika, your response could have been, "well aren't I at the right place if that happens?"
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Isn't it kind of like saying we're going to remove the tires from your car because they might go flat?
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I agree that I was very blessed to have such a wonderful BS! If anyone meets someone who wants to travel here, her name is Ingrid Sharon. I think she tries to make everyone feel comfortable since you are already so terrified when you are in her office. She even hands out her cell phone number for you to call if you have questions! She calls with pathology results and doesn't make you wait for those either.
I'm pretty picky about docs since I've been though so much with DH before transplant and having to deal with incompetant and bad mannered docs and staff. I definitely don't think anyone deserves bad treatment from medical personnel at all, especially when dealling with bc!!!
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Brilliant analogy Kate. Reminds me of that PS who described his own work as "well this is all kadywhampas" or the hair dresser who wants to shave your head because your hair cut might come out uneven.
You were blessed with your PS bcincolorado.
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bcincolorado- Maybe suggest to your BS that she hold nationwide seminars for all the other BS's out there? Or write a book titled "Simple Things You Can Do to Make Your Patient Feel Soooooo Much Better"? Sounds like you met an angel in a white coat!
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Hi Ladies, today was my last chemo! I feeel tired but excited that I finished the treatment. I have a question for you: Anyone in this page that had NSM is also a triple negative and BRCA1? Please let me know.... Have a good evening ladies.0
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I had my exchange surgery yesterday. Pretty sore. I am running a 100.2 temp so I feel rather blah. But all in all not too bad. To create symmetry my surgeon places a larger implant on the smaller side and voila, I look rather close. Can't wait till the swelling goes down to see the new girls. PS says I may want a revision in four months. I can't think of that now...
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Monika- Just wanted to say hi and congratulations on finishing chemo!
Dustysmom- So glad everything went well with exchange. Does your PS have you on antibiotics for the fever? Hope it's gone soon and you're feeling better so you can enjoy your "yipee squishees"!!!
Did everyone see that the president and founder of BCO, Dr. Marisa Weiss, was recently diagnosed with BC? It sounds like they caught it early. Here's a link to her video-
http://www.breastcancer.org/about_us/press_room/press_kit/video/mw_message.jsp#mastheadwrap
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Saw the PS for my post op the other day - (post exchange, not NSM). I'm not totally happy with the implant placement/look, and don't find them to be dropping/fluffing as I might like. He's sending me off for PT to loosen up the muscles, and then we'll see after 6 weeks. I personally suspect I have a surgical revision in my future, but will try this, certainly! I have to wait 3 months to see how they are then before any more surgery anyway.
He and the nurse were both amazed at my insistence that I wanted them lower, though. I think they're crazy! I feel like a lot of the curve is above the nipple and there isn't a fold at all! I don't want to look like I'm wearing a push up bra all the time! Maybe it's just me... Anyway, it doesn't matter if they agree about what I should want, as long as they do what I do want. Just thought I'd share, I hadn't really thought about the possibility of PT for cosmetic purposes. Now I know.
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Jessamine-So sorry your not happy with your exchange. What type of implants did you get? Maybe a different profile or size would help. I don't know because I haven't had my exchange yet, but a lot of ladies say it takes several months for things to settle and for the final appearance to be evident. I definitely think you have every right to be happy and get the result you want, but let's hope over the next few weeks things change and maybe you'll like them more. I would try PT. I go to PT now and my PT already told me after my exchange he will do work in that area to loosen everything up because of a lot of scar tissue and tight muscles,etc. Wish you the best,hang in there.
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Thanks sweetie! I think the implants are fine- it's just placement. My muscles are tight, and- well I don't know. I'll try the PT and then we'll see I guess. I suppose if my PS and I disagree about how they should look (as has recently become apparent) he may have used a higher profile then I would have chosen- but if he has to go back in anyway, they can be changed I imagine.
For the record, they are much better than the TEs! Just not perfect...
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jessamine- We've talked about it before but I feel like a lot of PS's act like, as BC patients, we shouldn't also care about aesthetics. I think you should do everything you can and want to do to get the results that make you feel most whole. I hadn't heard about the PT thing, but it makes sense. I hope that PT, and time, helps so an additional surgery isn't necessary. But if it is, I say go for it. You deserve it!
For those post exchange, has anyone had issues with pain still? I had my exchange at the end of June and am still having some pain. It's really bad in the morning, even though I sleep in a sports bra, but it just feels achy all day. I've also had some neck and shoulder pain. I may look into PT, also, but just wondered if anyone else had this problem this far out from exchange?
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Dustymom: Hope you are feeling ok. Wishing you a speedy recovery.0
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Hi everyone!
I'm pretty new to all of this, and I feel like I'm on this roller coaster going 1000 miles a minute right now! My brain is on cancer overload and my massive online searching is beginning to all run together.
I'm trying to determine if nipple sparing is a consideration. My BS believes studies will indicate safety in this area, and is willing to do it provided I understand the nipple will come off if any cancer cells are found after mastectomy. I'm small breasted, triple negative, BRCA2 positive. My cancer is thought to be extremely early/small, fairly deep (no clue what that means since I'm so small anyway), and inferior. It would seem that my cancer is at about the 6 o'clock position.
I've read about radiation given to the nipple during surgery... but he hasn't actually mentioned any of that, nor did I ask because I was unaware at the time. I didn't think it was an option to begin with, so hadn't done research. He's not concerned at all about the prophylectic breast and nipple sparing, and believes I should be a candidate for the small cancer. I can't really find percentages online one way or the other. Everyone here seems to have so much knowledge, it just seems appropriate to ask.
Thanks in advance!
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hurlygirl - when is your surgery again? Mine is the 8th and for some reason I am getting really nervous about it. (Hope I won't be too big, will I recover quickly, will the boobs look ok, on and on).
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Vmudrow-my surgery is the 1st and I can't stop thinking about it. All of the sudden my TE feel huge! He ordered three sizes all bigger than my TE and now I'm panicking thinking I'm going to look to big although Whippetmom reviewed the sizes with me and thinks any of them will be fine. I think it's because this the final step and then life is supposed go back to "normal" whatever that is. Anyway, I know how you feel and I'm going before you so I'll let you know how it turns out.
ccnpg-welcome. I know how hard it can be sorting all this out. The women on here have been a God send to me. I was able to do the NSM and am so glad I did. It sounds like you may be a candidate for it. It works well on small breasted women and gives a nice final result. The other thing is you will need one less surgery because you will have your nipples. I would pursue this option because as I have said before women with BC need to have EVERY option available to them so they can make the best choice for themselves. We are here for you if you need any advice.
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cc4npg- I would definitely recommend NSM if you are a candidate for it. My breast surgeon said current research shows it is just as safe as traditional MX in regards to rate of recurrence. There is an extremely low percentage of cancers that start in the nipple (and even those there is some controversy as to whether they started there or not). Breast cancer almost always starts within the breast tissue and is fed into the nipple through the ducts. Since the ducts are removed during MX, as part of the tissue, there are no longer any pathways. During your MX the surgeon will scrape the inside of the nipple and they will biopsy it right then and there while you are still under. If any cancer cells are detected they would remove the nipple at that time. I think it is very rare for this to happen, though.
You are very lucky that you have a surgeon trained in this procedure as there are not that many of them out there. I would ask how many of these they have done, though. You definitely want someone very experienced as this seems to directly correlate to how often the nipple remains viable. You also need to have a plastic surgeon who is equally experienced as NSM is a team effort between both surgeons. I think you will be very happy with the results, though. For me, personally, I feel a lot less disfigured being able to keep my nipples. A lot of women have nipples "created" when they are done with reconstruction so it will be one less procedure to go through. Just be aware though that almost everyone loses all sensation in the nipple. One thing I would add (to this already long post) is to ask your surgeon where they will be doing the incision. Some surgeons do it straight through the middle of the breast but if you are small breasted you are an excellent candidate to have yours beneath the fold of the breast. This, also, is a lot less disfiguring. My surgeon said when I am completely healed no one would even be able to tell I had a MX which I think is pretty amazing. If you have any questions post here or you can send a private message to me or any of the other women on here I'm sure.
Didn't mean for this to be a chapter in a book. I guess I get very passionate about "Save the Nipples"!!! LOL!!!
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valerie and sweetie- (((hugs)))!!!! Sorry about the yippee squishee anxiety!!! We've all been there! Just wanted to say I was expanded to 365 and went with 375. My PS told me implants appear about 25 cc's smaller than TE's but I think it's more than that. You will lose a lot of projection which, I think, is what makes the TE's look so HUGE! Also, a lot of women have the TE creeping into the armpit situation so when they bring the implants closer together they appear less wide which makes them look smaller as well. From what I've seen Deborah is pretty darn good at picking sizes, though I did go with the low end of what she recommended. My PS took 2 different sizes in- the size she thought and the size Deborah thought. She went with the bigger one (Deborah's suggestion) and admitted afterwards that the other would have been too small. I totally understand the pre-exchange stress, though. The 2 weeks before mine I was a crazy person!!! (Just ask hurleygirly and whitedove- LOL!!!)
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OK, sorry I'm being a "thread hog" today......
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Kate33-Thank you,thank you,thank you! You just totally eased my mind. The thing that is worrying me is the projection in these TE seems so huge! I'm glad if they will look smaller. If they turn out this size with less projection I'd be fine with that and even if they turned out smaller. It's so weird for me to have boobs after being so small for so long. I like it in one way but in another way I felt more petite when they were smaller. Don't know which is better because when they were small I used to get frustrated not being able to fill anything out and always wearing a push up bra.
Your not a thread hog, I love your advice! Keep posting cause you always help me!
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