Nipple Sparing Mastectomy with immediate reconstruction
Comments
-
Ok guys...picts are now up. Let me know what you think of MaryKate and Ashley. MaryKate is the side with the smaller nipple...
0 -
sweetie and hurleygurley you both look absolutely gorgeous! I think having expanders with the NSM helps with going larger and getting a better result. Are your implants placed under or over the muscle?
I did not get the expanders but did the One Step with alloderm. My right breast is very stiff compared to the left (non MX side).
0 -
TNlady-good to hear from you! Congrats on the Komen race. I would love to do one some day.
Hurleygirl-I think with DCIS they would not do an oncotype DX test. From my understanding it a test done on the tumor in patients with IDC, unless I'm wrong about it. Either way DCIS is only stage 0 so your already at a lower risk than someone like who had IDC which is stage 1. We start dealing with these percentages like 1%- 5% risk when in reality there's a 95% chance it won't come back! I like looking at it in those terms better.
Speech529-I was admiring your results. I like the way your breasts had a natural look and I think they fit your body perfectly. It's not really always about going bigger but getting a result that matches your frame. I am not as big as I would have liked to be, I just want them to "fall" into place and look natural on my frame. I'm more worried about ripples and stuff like that like.
0 -
Speech529, I had under the muscle but when I dove deeper into exactly what that means...I basically had 2/3 under the muscle and the bottom 1/3 is not. That would explain why I totally feel the implants at the bottom..like they "crinkle"! I have been poking for months at my girlfriends' augmentated (sp?) boobs and they have some "crinkling" too so I think it happens to both augmentation patients as well as bc patients if you don't have tissue or not much of it! I saw your picts though and your results are fab. You look great!
Sweetie, I think you are 100% right. I only had the ER/PR status in which I was 95% sensitive! Kinda freaks me out since I was planning on getting preg and I know my estrogen is going to soar! Ugh.
0 -
hi all. I had NSM BMX Aug 13, 2010. Completed TE fills in September. Having permanent implants put in on Nov 17, 2010. Very satisfied with results so far.
0 -
Welcome, Brokendreams - Congratulations on finishing your fills and nearing exchange time. How wonderful it is that you are content with your results thus far. Just wait! The implants are worlds better.
0 -
sweetie and hurleygirly - just checked out your pictures. CONGRATULATIONS - you both look wonderful. Nice to be done - I will try to post pictures the end of next week.
0 -
Hi Whitedove...I am looking forward to the implants. These TE's are like hard bricks. I hope when the implants are put in I don't have to deal with those awful drains again.
0 -
vmudrow-aww thanks. I'd like to see your pics too, to see what 450 looks like on someone else. I too off this torture bra today and when I can let them be for a while they start to look much better.
Brokendreams-welcome. I am so glad to have gotten the TE out, the dues we must pay! Your exchange surgery will be here sooner than you think and you gonna love how soft and great the implants feel compared to the TE.
0 -
I had my NS mx 10/7 w/immed TE's and 25 ml put in at the time. I was a small A cup with not nearly enough in the upper quadrants to fill a bra. I'm happy to say that I actually fill the bra better now, just 8 days out and only 25 ml, than I did prior to surgery! The other significant news is that I've had feeling in my right nipple ever since surgery! Nothing in the left yet, but I'm hopeful and happy about the right. I don't know how much I'll have put in, but I will be posting pictures on the forum as soon as I can figure out how to so other's can know what to expect. My non cancer side looks a bit bigger than the cancer side... not sure if it's a little swelling/fluid or what but I'm sure it will even out.
0 -
Kate - where can I find the discussion forum about doctors that do nipple sparing in the different states? Someone is looking for a doctor in Washington - any ideas?
0 -
OMG, gone for a week and so much catching up to do!!! Maui was great though it was the first time these new girls have been exposed to the sun so almost scorched them. Luckily, my DH was keeping a close eye on them and told me when to add some sun screen- what a guy, huh? LOL!
Sweetie, twirlandcurl and vmudrow- CONGRATULATIONS on your entry into Yippee-Squisheedom. So glad your exchanges went smoothly and the Boob Fairy showed up as promised. Hope you are all happy and boobalicious!!!
mom38yo, brokendreams and cc4npg- Welcome to our thread!!! We NSM women are, unfortunately, a minority on BCO but we are doing everything possible to change that so more women know about this option.
mom38yo- Just wanted to wish you well on your NSM tomorrow and tell you that we are all here for you in spirit. As you recover (and beyond) let us know if you have any questions. Sending you some gentle (((hugs)))!!! Let us know how you're doing.
hurleygirly, sweetie and twirl- Just checked out your photos and you're all looking so incredible! (hurley- love the MaryKate and Ashley titles! I'm thinking about calling mine "The Pointer Sisters" since they are permanently "on"! LOL!)
TNLady- So glad to see you back! It's because of you we have this great thread and can spread the word!
Valerie- There is a link at the top of this thread to another called "Where are the Skin Sparing Nipple Sparing Procedures Done?" I wish we had a better resource. I asked my BS if there was a website women could go to to find a surgeon in their area that was experienced in NSM but she said there isn't one. Just one more thing to advocate for. Anyway, here's the link-
http://community.breastcancer.org/forum/44/topic/750056?page=2#idx_48
Hope everyone's having a great weekend!
0 -
Kate33- So glad your back. We missed your presence here, you always make us laugh! and Maui?! You go girl!
0 -
Kate, the pointer sisters....hahahahah what a crackup..u know there were t sisters right?0
-
Kate, the pointer sisters...what a crackup...u know there were 3 sisters right?
0 -
We should start a thread just for kicks..a thread called "What would we name our foobs"...Sonny and Cher, Cheech and Chong, Donnie and Marie, Dumb and Dumber....
0 -
OK I don't have a lot of time to get on the forum and post, had my NSM 11/11/2010 and other than drains no pain at all ( drains more annoying) go this mooring to BS and PS, hopefully will get two drains out! Had 250 fill at time of NSM, left nipple dark, right ok.
0 -
OK I don't have a lot of time to get on the forum and post, had my NSM 11/11/2010 and other than drains no pain at all ( drains are more annoying) go this morning to BS and PS, hopefully will get two drains out! Had 250 fill at time of NSM, left nipple dark, right nipple is ok. I will post after Appt. Hope to go back to work this week.
0 -
My NSM was elective, BS was not happy about it, but did good job. This was my PS 2nd NSM, I will post pics after exchange.
0 -
hurleygirly- LOL! Three sisters? Well, that wouldn't be pretty, would it? OK, here's some off the internet- Bask n Robbins, Betty and Veronica, Bambi and Thumper, Bert and Ernie, Thelma and Louise and Tweedledee and Tweedledumb.
0 -
Kate, you are on a roll!
0 -
I am 43, mother of a 16 year old boy and a wonderful DH, newly diagnosed and having a BMX NSM. I have already met with the BS and am meeting with 2 different PS this week. I live in Washington State and saw that someone was inquiring about NSM surgeons here, so I would be happy to give them their name.
I've got my list of questions (thanks to this site
and am trying to keep my positive attitude and humor about this whole thing. I felt so much better about the BMX (which I chose even though it's only in one breast) after I heard about NSM and that I was a candidate. I have my first PS visit tomorrow and am very interested in hearing what he has to say.
My main questions for the PS: TE vs. immediate reconst? Silicone/Gummy vs. Saline. And what happens if they find out the nipple cannot be saved (they will take a frozen scraping? during surgery to make sure there are no cancer cells near the nipple). Will they only cut out the nipple..and leave most of the skin?
I'm small breasted so the BMX doesn't seem so bad when you can get a NSM and eventually end up with perkier fuller boobs!
I mean... how many types of cancer surgeries have the "bonus" of a insurance subsidized boob job?
0 -
SusansGarden- One important question I would ask both your BS and PS is where they are going to do the incision. Some, but not all, will do the incision under the fold of the breast especially on smaller breasted women. But I have seen others take the incision right through the center of the breast (horizontally) and, for the life of me, cannot figure out why they do this when it can be done the other way.
Don't want to be a downer, but even though we are all very fortunate in that we were able to have a NSM, it is nothing like a boob job. During MX the pectoral muscles are usually relocated which will cause very strange life long sensations. The reason they do this is to try and cover the implant which is usually covered by breast tissue in a boob job. Also, during MX many nerves are cut which can cause various problems as well. I'm only telling you all this because I went into all this thinking it would be just like a boob job, too, except they were going to remove the breast tissue first. Nothing could be further from the truth and I think you should know that. That being said, having a NSM is definitely the lesser of evils. I, too, felt much better about the MX when I found out I could have NSM as well and definitely felt a lot less disfigured afterwards.
I definitely admire your positive spirit, though! As far as TE's vs immediate recon I think it depends on how large you want to go with your implants. If you want to go much bigger than you are naturally you may want to consider the TE's as they stretch the pec muscle gradually and also allows your skin to stretch slowly. As far as the nipple biopsy during the MX if they detect any cancer cells they will remove the nipple at that time leaving the skin. Some will leave the aereola and some will not so that is another question to ask your BS.
There are lots of threads on here about silicone vs gummies vs saline and everyone has their opinion about that. For me- I felt the silicone would be softer and more natural feeling than saline with less chance of rupture. Most surgeons use the cohesive silicone which is a gel consistency. Some surgeons have started using the anatomical cohesive silicone (sometimes called gummies or gummy bears). (They haven't been approved by the FDA but some surgeons are participating in the clinical trials.) They give a more natural appearance but can be very firm and don't have much movement.
Anyway, I'm sure others will chime in with their opinions as well now that I'll let them get a word in edgewise.......:)
0 -
Kate~ Thank you so much for your honesty. I like to hear the bad with the good! I would rather not be disappointed from high expectations!
Question? Regarding relocating the pec muscle for BMX... talking to some friends (had NO idea how many people out there had boob jobs!) .. they all tell me that most boob jobs are now done under the pec anyway. That they are rarely done over the muscle. I found out a neighbor just had one done and hers was under the muscle? I wonder if this is true? I do understand that I may not/probably won't have feeling in the skin and/or nipples.. and will be lucky if I do. I have SO many questions lined up for the PS! It will be interesting to hear if the 2 different PS's have similiar answers or not.
0 -
SusansGarden: I had NS BMX 10/7 and am also very small, was probably a 34 barely A cup. Definitely ask exactly where the incisions will be, and what will happen IF cancer is found under the nipple. I was fortunate, no cancer found in the frozen section of tissue under my nipple during surgery. My incisions go from right under the nipple/areola and slant slightly upward toward my armpits. I had stitches and steri strips. Also ask your PS what he'll use to close the incision. Some use staples, others glue, and others do what mine did. I'm not concerned about the scar really, because a good PS will be able to make it almost invisible and I believe this is done more at time of exchange, but I'm not going topless so no worries. I DO have sensation in my right nipple (non cancer side)... and I'd say it's about 95 to 100%! I do NOT have sensation in my left... at least not yet. I have feeling at the sides, and under my nipples, but from nipple up to almost collar bone, it's numb and very strange feeling. I don't know anything about how they do regular augmentation w/o cancer, but I was told it was behind the breast tissue and on top of the muscle. I would think to augment under the muscle would mean a TE prior to implant. After surgery, you will feel very tight in the chest... rubber band sensation is a good description... like wearing a way too tight bra. It isn't pleasant to stretch out the muscle, and only do stretching when they tell you to, but it's necessary and will help get range back and is totally doable. I'm a nurse aide and have worked with rehab patients. This gives me a new appreciation for those with contracted muscles!!0
-
SusansGarden: I too was smaller chested and had my NSM back last May (just had my exchange almost 3 weeks ago). In hindsight now, I have to say that it was one of the best decisions in my life.
I had only a small amount of DCIS in the right (5mm) and opted for the bilateral NSM. I was super paranoid bf my surgery. I went overboard with supplements (ask the ladies...I was snorting cayenne pepper in my hospital bed). I just went nuts looking up what could possibly help maintain good circulation so that if my nipples made it through surgery, that they would continue to live! I kid you not..my husband brought in cayenne pepper and I ate it with water while at the hospital! I was always a very very flexible person (I don't know why because my family can't even touch their toes) and did all types of pec stretches before surgery (things like back bends and gymnastic back walk overs). Anywho, my surgery didn't cause me any pain and I had only a slight feeling that maybe my boston terrier was on my chest. I immediately started walking the night of surgery and thereafter. I think I started riding my bike around at week 3. Did being flexible and limber help? I kind think it did and my nipples stayed good so maybe some of these crazy anecdotes worked. Oh and even though my docs all thought that my lumpectomy probably caught all of my dcis, my final path report concluded I had another half a cm of dcis in the removed mastectomy tissue!
I too had the option to do the immediate implant route but opted not to for 2 reasons: 1. I wanted to go bigger and 2. I read on the internet how the expander route usually gives better aesthetic outcomes. I figured that I was going to have to go through pain anyway, so might as well get what I want in the end. I was lucky because nothing caused me pain..soreness yes but nothing that held me down. I did take the meds though in the beginning because I was paranoid about pain and started to see "what happens if I don't take a pill". I agree with the ladies that you should ask about getting your incision through the inframammary fold. If you are small chested, a good surgeon can remove what needs to be removed through this incision...even if he needs to get a node.
I can't speak to the gummys...felt them at another ps office but thought they were on the firm side. I now have a nice set of non-gummy silicone high profile implants and love them. I cannot get over how real they feel.
Your question about what happens if they have to remove the nipple is a question I actually asked my bs. He told me that he would do the usual removal of the nipple and areola area which leaves a scar across and so I asked him, "couldn't you keep the areola?" and he said, "I have never done that but I could" which was kind of funny to me...thinking I was down to be his first areola sparing mastecomy...hahah Sometimes YOU have to come with some solutions and push them or inquire "why" or "why not?"
Kate is indeed right about the NSM not being as easy as an augmentation but a lot of us do feel that we look better with the foobs we have today than what we started out with...I do. I like my foobs! (= I don't think I was really attached to my old boobs though anyway...
The loss of feeling I can address from my experience....when I woke up from surgery, I had a lot of numbness (even wrapping around the side area towards my back). Little by little, feeling is coming back. I would say that I have 95% of the square boobage has feeling now. I even notice some slight feeling now in my right nipple which is insane to me because it did not have any feeling before the exchange! I don't feel sad about some of the feeling that is missing..it may even come back even more!
All in all, I am happy and so relieved. I hope this helps!
0 -
um..dunno why the first part is italicized....ugh
0 -
Gummie bears are not yet approved in the US. I had cohesive gel implants (June 2010). My PS said you get less rippling with silicone. She also told me she has a waiting list of women for the gummies as soon as the FDA approves. They are used in Canada and Europe.
Kate is correct. I have one breast that was a mastectomy and the other an augmentation. I lost nipple sensation in both breasts. The left (augmented side) sensation is returning. I can feel about an inch out from the areola all the way around. I was surprised that this happened.
My right breast is numb about an inch and a half around and probably always will be.
I was barely an A and now am about a C--I look much better than I did before, but I would have preferred to have avoided all of this!
0 -
SusansGarden- this is my first post on the forum, although I have been reading all of the threads for months and they have been so helpful. I had a BMX on 4/6/2010 and went into surgery planning on NSM on both breasts. Initially thinking it was extensive DCIS on right and several cysts/fibrous stroma on left. I had very dense tissue and it turned out the DCIS was closer to the surface of the skin, in my right nipple and two opposite areas on right had pin head size (1.2mm) invasive. They had to take the nipple, areola and a fair amount of skin. My left breast (non-cancerous) was completed first with a silicone gel 400cc implant placed under the pec muscle. Because of the amount of skin that had to be removed from the right they had to place a TE on that side, which could only be filled to 200cc to close. From May until July the right side was expanded to 550cc to slowly stretch the skin/muscle. I had my right exchange surgery (silicon gel 400cc) on 10/6/2010 and life is getting back to normal (the past two weeks without the TE on the right has been heaven). My upper neck and lower back no longer ache from being lopsided. Sorry for all the details, I was trying to give you a little background so you would understand something you may want to consider. If you are going with TEs initially, the PS will be able to use the same amount of saline in both breasts to keep them even during your expansion. If you decide on immediate reconstruction with silicone or gummy - ask your BS/PS to start your surgery on your cancerous side to make sure they will be able to do the NSM and fit you with the size/type implant you want. If for some reason they cannot place the size/type of implant on the cancerous side at time of surgery and they have to place a TE, consider having them place a TE on the non-cancerous side so you can expand both breasts at the same time, keeping them even until your exchange. In hindsight, this is what I think would have made the process a little easier, if both breasts were even I don't think I would have had the neck/back ache and sports bras and tops would have fit more comfortably. Stay positive, lots of women have successfully had their BMX NSM w/immediate reconstruction on both breasts. And, if things don't go as originally planned there is always a solution, it just may take a little longer than originally anticipated. Take your time in making your decisions.
0 -
ACinAZ- Just wanted to say hi and welcome. It sounds like your reconstruction has been challenging. So glad everything has worked out with your exchange surgery. I am also in AZ- in Mesa. How about you?
0
