Nipple Sparing Mastectomy with immediate reconstruction
Comments
-
Julie, that is good to know... I'll sit tight for at least two more weeks then!
Kitchenwitch, if you think to ask her about iodine, I'd be curious. These are a couple of several articles I found on how iodine heals/regenerates skin:
http://thyroid.about.com/library/derry/bl2a.htm
http://www.thyroidscience.com/cases/Derry.Iodine.Regen.6.7.08.pdf
That first one impressed me so much (especially the part about the Civil War soldier with all those wounds that his wife diligently painted with iodine, and they all healed perfectly and he went on to live a full life after that) that I first ordered Lugol's iodine after I read it. At the time, I was about 6 months out from my re-excision, and the scar was horrible... all spread-out and dark pink.
I started using iodine on the scar and within a couple of weeks, it had already faded and looked so much better. Also, the biopsy scar I'd had for nearly a year, pretty much disappeared once I started using iodine on it. I decided then I would be using iodine after my mx (as soon as the steri-strips came off). It dawned on me that it would be perfect for the nipple area too, so that's what I've been using it on so far.
One thing about iodine is that, like hydrogen peroxide, it should never be used on a fresh wound (the way our parents and some of us grew up using it). As soon as a scab is formed is the best time to apply iodine.
0 -
Very interesting about the iodine. The Drs. started the iodine on my dusky nipple in the hospital the day after surgery and also on the other breast skin due to some bruising. I have been applying it twice a day and keep it covered with gauze. It stains terrible. I guess I'll just keep on for awhile since I don't have another appt. with the PS until mid-Feb. The appearance hasn't changed much on the nipple - still just a black scab and a smaller nipple than the other side.
0 -
I decided yesterday that I was just sick and tired of smearing that part of my nipple with ointment and covering it up under a bra, so I just decided to use a panti-liner (PS's suggestion) to protect the bra from anything - and I'm going to give it 24 hours to see if a more middle-of-the-road approach works. So far it seems good. A little bit drier, not putting out that amount of ... uh.. stuff.... but not too dry.
Last night I had a dream that I was looking at my nipple and it looked terrific - still red, but wasn't so sunken, and was definitely going to be OK. Happy new year to everyone and best wishes for continued healing!
0 -
Hi Girls,
Happy New Year!
I wanted to share with you that today I had my 3rd fill. My Right Breast 160cc and My Left 130cc. (I asked to do just 130 because they looked a bit uneven.) So that brings my total to 470cc on Right breast and 440 on left breast. I am excited! I will post the pics on the forum , let me know what you think.
0 -
Hi, everyone - Just thought I'd share latest update on my nipple. I've been kind of worried about the way it looks - most of the aerolea is very white, though it seems to be regaining color in a spotty way from the outer edge moving in. the nipple itself is sunk and doesn't stick out. Saw PS today who said they scraped away a lot of the tissue underneath so the color might not really come back, in which case she'd tattoo it, and she said about the sticking-out-ness that she'd do some little surgical tweak.
This has left me all feeling kind of sad and shocked. I mean I know in 6 months to a year it'll probably look really good, but what did I go through all that for if I'm just going to have to have these other procedures to make it look OK?
I know I shouldn't be bitter. My DIEP worked great and the shape and size are beautiful. I just imagined somehow that nipple sparing would mean an intact untouched nipple.
0 -
Hi!
My scabs have finally fallen off and the nipples are pink, I am just about a month out from surgery. My incsisions are pretty red, but healthy. I was told not to put anything on them. How long did you ladies wait to heal before working on minimizing the scar, and what was your preference for treatment? Am I just better to wait till after exchange since it's going to be opened again?
I also had a question for you ladies who have done fills or are finishing, I am at 170 cc's (started w/ 50 at surgery and 2 fills of 60cc's each). I plan on going every week, that is, if I can handle it. I am aiming for 350 for each side, then I'll see what they look like. I am 5'6", 125 lbs (pre-surgery weight, 120 after surgery, I didn't think my tiny boobs could weigh that much?!?! ;-) ) and want a "solid" B or maybe a small C (I was a solid A prior to BMX). My question is: if I go every week, how long after you reach your desired size does the PS have you wait till exchange?
I apologize if I am inquiring too much on the "wrong" thread...it just kind of came to me to get your opinions. I might need to spend some time on the tissue expanders and exchange threads...I haven't really dove in there yet...I think I am nervous about size and how far to fill, etc...
Kitchenwitch - I can understand your disappointment about the nipples, but I am so glad to hear your DIEP looks great! Since I am anxious about the size and shape I will be someday and it's great to hear you are happy with yours!
0 -
fire-dancer- Every PS is different as to how long they make you wait from the last fill to the exchange. Mine was only 6 weeks which is about the shortest time I've seen. I think the average is about 8 weeks but I've seen others that had to wait 12 weeks or longer. I think it has more to do with how quickly or slowly you did your fills. I did mine very slowly so my PS didn't make me wait as long. If you've stretched your skin quickly then I think they like to wait for the skin to adjust. Another consideration would be whether or not your PS is planning on overexpanding you. If you're trying to decide how much to fill I would go to a thread called "Breast Implant Sizing 101" and talk to a member named "whippetmom". She has helped many of us determine the right size for the results we want.
Kitchenwitch- I know it probably doesn't help but I have the opposite problem with my nipples "standing at attention" 24/7. I look like I'm constantly cold or aroused. (No, honey, it's not you.....) It can make dressing a challenge sometimes so there's always a flip side to every coin. I don't think this nipple sparing is an exact science, yet, unfortunately. You probably will continue to see some changes, though, so don't be discouraged yet.
0 -
firedancer: I had my TE placed at the time of my mx and after the fills were finished he made me wait over a month. I had my exchange in June, 6 months after my mx. As far as how much to fill, you should talk to your PS about what size you want to be afterwards. They will know what will give you results you need. Some women decide to go bigger and some smaller and some want to be the same.
0 -
Hello Everyone:
Iam wanting to look into having a nipple sparing masectomy. I live in Saskatchewan, Canada . Does anyone know a good surgeon. I dont think the procedure is done alot out my way so any referrals at all would be a place to start.
0 -
Polly: Sorry you have to go through this. Check out this thread:
http://community.breastcancer.org/forum/44/topic/750056?page=2#idx_48
It is where a lot of us have posted our doctors. There might be somewhere you would be willing to travel to (I know many women do) if you don't see someone listed there.
0 -
Hello bcincolorado
Thanks a bunch . I will check that site out and see what I can find.
0 -
fire-dancer: yes, i am taking comfort in the fact that the whole boob itself looks pretty amazing (aside from the weird dents that sometimes appear because of the bra I'm wearing). PS really did a terrific job.
Kate33 - well.. I'm still kinda jealous! I wish it stuck out all the time, I'd prefer that to not really having one which is the way it looks now. Do you ever stick a bandaid or something over it? I remember reading that tip in a magazine once. I can see where it would be annoying sometimes!
0 -
fire dancer - I am also 5'6" and weight 120 pounds. I was filled to 400ccs and then 450ccs put in at exchange surgery. Whippetmom gave me her opinion as to size - which matched the doctor's opinion also - so that's what I went with. I was barely an A before and now look like a B or small C - but actually wear a 32DD - sounds weired, but the implants need to be fitted differently and I certainly don't look like a DD. You can check out my pictures under Valerie on the picture forum if you are interested. Oh and I had surgery in May and could have had exchange 4 months later, but had some vacations planned so it ended up being 6 months later. Glad to hear things are healing well!
0 -
Wow, I feel like Tubby Tubberson! I'm 5'6" and weigh 150!
Though I'm working on it! 
... I'm assuming you probably have a smaller ribcage? Mine is 31 1/2". I want the same "look" (B or small C) but it looks like I may have to go to cc's in the 500 range. I just don't want to look too big! Measuring as a DD sounds so scary! lol!0 -
you guys are great - thanks for the input. The nurse practioner gave me a fill last week and she suggested 350 for a b/small C. This week my PS surgeon just said get to where I want, then go one more, gee, thanks for the advice ;-). Well, I have NO IDEA what I want, like you, Susan, I don't want to be too big...and I purposely didn't do one-step for fear of being too small...
Valerie, I'm going to head over and check out your pics, thanks for that - I have YET to become savvy enough to even load pics onto the laptop, geez, my poor kids might never see their christmas pictures!!! I am definitley behind the times ;-)
Well, I'm going to head over to the exchange thread and inquire with Whippetmom, thanks for the advice ladies!!
0 -
The Nurse Prac said 350cc for a b/small c? (did she mean implant or TE fill volume) ..what is your ribcage measurement? My PS tells me to go home after each fill and try on clothes to see when I am satisfied and want to stop. But the TE's are shaped diff than the implants, right? So how do you really know? Gosh..I wish it wasn't so difficult!
0 -
Susan - she meant for TE fill volume, My ribcage is about 30 in. Right now at 170 I see absolutley no difference in clothes. Out of clothes I am almost what I was before, just no real projection. I am starting to think I might need more than 350, maybe 410? I also think I might go more for the smaller C than B... I get 60 cc's at fills weekly. My PS does over-fill and suggested I do that and he will get me to where I want in the end.
I totally agree, the tissue expanders make me feel like I am "all boob" up there and I just want nice perky round ones that will look awesome in a tank top. (I have been re-watching "Lost" and have become midly obsessed with Kate's boobs ;-)
I am so worried of going too small or too big...I completely didn't give this part thought until a week ago, I was so wrapped up in the whole surgey-part that now I feellike I am entering a whole differnt unknown, but since we are doing it, we deserve to get the size we want, right? yes...so difficult!!!
0 -
I totally can relate about the not giving it a thought until recently since we were so wrapped up with surgery/recovery!
I'm just thinking that (personally) I would rather be a little too small , than too big. Just because I could always "fix it" with a bit of a padded bra. That's what I liked about my size before. They were small enough to not have to wear a bra.. I could wear tank tops with "shelves" and look fine. But if I wanted to fill out a certain sweater better (hey, I rhymed! ;P ) I could just wear one of my more padded bras. Though I did find myself wearing padded bras more times than I didn't. Hmmmmm.
0 -
I am one month out today from my UMX-NSM! I had the tissue expanders placed during surgery, and my PS wants me to wait 8 weeks before the permanent replacement surgery.
I have been happy with my nipple so far. My breast surgeon prescibed an ointment, Nitro-bid, to be applied for the first week. After that, I used Neosporin. I also had a black scab on the tip, but it came off about 2 weeks out, and is nice and pink. This nipple looks a little flat compared to the untouched side, but it's beginning to stand out a little, and the doctor says that once the permanent implant is in, it will probably adjust.
Did any of you opt for just expanders-implants without the DIEP or Latissimus Dorsal option? I chose to just go with the implant ( he has used Allederm, too) and he will do a lift on my healthy breast so that they match up. I am in my mid-50's and not that large breasted. 5'9" 160lbs, wore a 34C bra. It's not too late for me to do the Lat. Dorsal flap if necessary.
One other thing--I noticed at the beginning of this thread TN Lady described the NSM scar as being shaped like a keyhole. My surgeon only cut below my breast. That scar is barely visible.
My plastic surgeon said not to worry about creams to erase this scar until after the final surgery because he'll go back in the same way.
0 -
Sue4LSU- I did just TE/Implants and I have to say there are pros and cons for both. From all the postings I've read the two main dissatisfactions with implants are the feel of the implants under the skin and problems with rippling. These seem to occur mostly in women, like myself, who have very thin skin. Even after two rounds of Alloderm I still have a lot of rippling with the silicone implants. Some PS's will do fat grafting to try to cover up the ripples but others are opposed to it. Obviously, the downside of DIEP or other procedures would be additional scars. Either procedure you'll look great in clothes but maybe have issues you don't like unclothed. A third option some doctors are doing is created a breast strictly with fat grafting- no implants, no additional scars. Unfortunately, there are very few PS's trained in this procedure so far. In regards to the MX scar there seems to be some debate amongst BS/PS about this. My BS did the incision below the fold of the breast as well but not everyone does. Even some surgeons at the Mayo Clinic here in Phoenix still take the incision right through the center of the breast in their NSM's which, for the life of me, I can never understand. Why disfigure any more than you have to?
0 -
So why is Alloderm used on some and not on others - I don't think I had any used on me, but now am not sure and will ask at my final appointment in a couple of weeks?
0 -
Hi, girls - last night a little piece of scab fell off my nipple, and just like you all said, there was a perfectly healthy pink nipple showing underneath. Ahhh, relief! Hope the rest of the scab falls off soon. I was at 3 weeks yesterday.
The incision is looking good too. Thank you, iodine!!
Kate, my incision is off of the nipple, only because I already had an incision there from my lumpectomy (and that had scarred horribly, although it finally started looking better when I started using iodine on it). If I'd had a "virgin" breast, I would expect my surgeon to have gone underneath. As it is, my scar isn't going to be too bad... it's not alllll across the whole breast, it just goes over where the lumpectomy scar traces along the underside edge of the areola. I should look pretty much the same as I did after the lumpectomy/reexcision (hopefully better, since I know to use iodine now).
Kitchenwitch, I'm sorry you're having some color/projection frustrations... hopefully the color will come back on its own and the nipple itself will resolve without more procedures!
0 -
Sue: I am a "uni" and I had my mx Jan 7th of last year and exchange June 11th. Each PS has their own time table and I think some of it may also depend on your treatment and how fast you heal as well and how much he can fill at the time of placement of the expander. Mine was done with the mx. I chose not to "lift and reduce" my "good side" since I personally wanted to have as much of me as I could keep as "me". I am 50. So I have one 50 year old boob and one reconstructed one that is not saggy. In a bra no one can tell the difference and I look "normal". As far as Alloderm goes I think that might have something to do with how much skin was removed during surgery and if they need more. Just my idea though. I'm definitely not an expert by any stretch of the imagination!
0 -
yay crunchy!!! soooo happy to hear you lost some scabbing...don't worry, I am sure even more beautiful pink skin is on its way!!!!
I totally get the feeling of relief, it's amazing how important it became to have perfectly pink nipples!!! ;-)
0 -
Hi ladies,
I have spent the last hour reading all the posts on this thread. WOW! Have I learned a lot!
I was just diagnosed with IDC on Tuesday, and have a double MX scheduled for next Tuesday. I need LOTS of advice! Please share everything you can think of for recovery, comfort, what to expect, etc... I don't know what questions to ask the doc because I really don't know what I don't know, yet. Never even thought about a back scratcher, zip front bras, or heart shaped throw pillows, so throw everything you have at me.
I'm doing reconstruction at a later time, so right now, please help me to understand what to expect. For example, I was thinking I could drive my husband to the airport and be home by myself for a week the Sunday after surgery. Now, I'm concerned that I need to make some other arrangements? This is all happening so fast.... I appreciate all the info you can share! Vicki
0 -
vmudrow- According to my PS the main issue with Alloderm is whether or not insurance will cover it. She told me most will not as it is very expensive ($10,000 for each piece). She always got pre-approval for each surgery. I would think your PS would have discussed it with you if they were going to use it as some patients are freaked out by the whole donor tissue thing. You never know, though.
0 -
Hi Vicki!! ~ Sorry you have to join us, but you are doing the right thing coming here and researching and asking questions! I spent HOURS upon hours perusing this board from the day I was diagnosed. It's how I found out about Nipple Sparing Mastectomies before I even saw the Breast Surgeon (which was 3 days after diagnosis!). There is SO much to know.. that I would suggest going through the different threads in the appropriate categories NSM surgery, Preparing for surgery, etc. ... then post questions for answers you can't find.
Also you can Private Message anyone as much as you want too (since you are limited to 5 posts per 24 hours when you first join. I am on the tail end of the first part of this journey (had surgery over 5 weeks ago and will be starting Tamoxifen). And no... I don't think you should be alone the 2nd week after surgery!!!! I believe you will be restricted from driving for at least 3 weeks! Hugs to you!! Kate~ My PS indicated he was going to be using Alloderm on me from the get go at our first consultation. He said he uses it at the bottom in order to make the "natural shelf" because you don't have any breast tissue left to achieve that after a mastectomy. He made it sound like he always did that. I don't remember seeing a large bill from his office for the TE surgery (it was under $10,000). Weird?? I will ask him more questions at my fill next week.
0 -
I'm confused again. I didn't have NSM, I had SSM with the nipples reconstructed and I am now 4 weeks post-op. I have had about 3/4 black nipple on the left and 1/8 black on the right. Because I live so far from the PS, I went to my local surgeon yesterday. He ended up scraping off the black deadness which revealed pink and pussy looking nipple. The one on the left is so tiny and disfigured from all the black that was covering it up. My surgeon wanted to get the black off to make sure I didn't have an infection underneath. He sent off a culture to see. He advised me to use hydrogen peroxide on it twice a day. I tried this and could here it bubbling, but could feel no pain. I had previously been using iodine on the nipples when the black was there. I just read back on Crunchy Poodle Mama's post and read where you said not to use hydroxen peroxide on a new wound, which is what this looks like now, a new wound. Any advice would be appreciated.
0 -
Hi Vicki: I am sorry you have to be here too! If you haven't looked at this thread in the surgery section there are some great ideas there: http://community.breastcancer.org/forum/91/topic/699896?page=1
I can tell you that if you are going to delay reconstruction, I know you will heal faster. Both my BS and PS told me that before my mx last January. How fast you can drive might depend on you somewhat and your pain level and how fast you come off pain meds. I personally was not up to driving for about 6 weeks but I did have TE placed and drains in for about 10 days post - surgery.
You will also find there are varied opinions with PS about showering after surgery with drains in. Mine was against it. Some don't mind.
I hope your surgery goes well and you recover quickly and your nipples can be spared!
0 -
I wonder how recent that text was updated? Personally, I have no concerns with keeping my nipple/areola. My tumor was nowhere near my nipple. I had clear margins. And they do an analysis of the tissue directly behind the nipple area during and after surgery.
Because NSM is a fairly new procedure, I'm sure there won't be any definitive results from studies until sometime in the near future. I think it's great to know that NSM is an option, but also to know any potential risks.
0
