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Nipple Sparing Mastectomy with immediate reconstruction

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Comments

  • mag1
    mag1 Member Posts: 8
    edited March 2011

    Thanks cc4npg / Sweetie 2040,

    I agree, I thought the PS was out to lunch, but I am afraid we may be stuck with hime. It is a combined surgery with the MX and he is unsure if he will use expanders, implants or alloderm. Not sure how I can get rid of him and switch to another PS. We are in Canda and health care is Gov't subsidized. The hospital has certain GS &PS that are allowed to use the OR. We lucked out with a good GS, but a bad PS. If we do not do immediate reconstruction, it may be more difficult after the chemo.

    mag1

  • Sandy105
    Sandy105 Member Posts: 160
    edited March 2011

    Mag1

    How did the phone consult go yesterday? I hope it went well and that you gained useful information!

    Sandy

  • cc4npg
    cc4npg Member Posts: 438
    edited March 2011

    Keep us updated mag1... and yes I would opt for immediate reconstruction.

  • mag1
    mag1 Member Posts: 8
    edited March 2011

    We did not have the phone consult yet. I will let you know

    thanks

    mag1

  • Sandy105
    Sandy105 Member Posts: 160
    edited March 2011

    Hello Everyone,

    I am seeking your advice about the New York Surgery Center and thoughts, pro or con, regarding Dr. Salzberg PS. and Dr Ashikari, BS. I am scheduled for a one step with Alloderm soon and would appreciate the thoughts you have and would greatly appreciate it if any of you would be so kind to share your experiences with these docs if you or someone you know has used them.

    Thinks so much for your help!

    Hugs

    Sandy

  • TNLady
    TNLady Member Posts: 219
    edited March 2011

    Sandy105, I have sent you a PM.

  • skkydiamond
    skkydiamond Member Posts: 8
    edited March 2011

    Had Bmx with TE on February 22. How long was it till you had the final implants put in? I will be 4 weeks after surgery on Tuesday, with. four weeks left on disability before going back to work.



    How long did some of you have to wait between your fills, how long between your last fill and the surgery?



    One more question, how long was it that some of you were out after the implant surgery?



    thank you!

  • KellyMaryland
    KellyMaryland Member Posts: 62
    edited March 2011

    Have yet to have my exchange surgery but was told that it will be 4-6 months after BMX/TE surgery. My PS does quick fills: most of it at time of surgery, then one more 4 weeks out.

  • sunny321
    sunny321 Member Posts: 37
    edited March 2011

    I had a uni-NSM on Feb 2nd and still have not finished my fills (and my total fill amount will only be about 400 cc's).  My PS says he like doing smaller fills so that the skin has time to divide and reproduce skin cells, creating more skin cells, as opposed to just stretching the skin and thinning it out.  Fills are just a quick appointment though, so I don't imagine it would much affect going back to work, unless your PS office is very far from you.

  • takeadeepbreath
    takeadeepbreath Member Posts: 68
    edited March 2011

    skkydiamond-I had bi lat nsm 12/14, started out post surgery at 120 cc, got weekly fills of just 30ccs...had 6 fills total to 300ccs and am scheduled for exchange April 21. My PS waits 6 weeks after your last fill before he will exchange. Pretty much 4 months start to finish (probably could have been a week or so sooner but I missed a fill one or two  weeks due to travel). PS says exchange surgery has no drains and a week off of work would be just fine.

    Ilene

  • cc4npg
    cc4npg Member Posts: 438
    edited March 2011

    skkydiamond:  With regard to your questions...

    How long was it till you had the final implants put in? My bilat mx was 10/7/10, had chemo from 11/29/10 to 1/31/11, exchange surgery was 2/28/11.  So for me it was about 4 1/2 months.  You'll find it greatly varies depending on your personal circumstances and what else you need (ie: infection, chemo, rads).

    How long did some of you have to wait between your fills, how long between your last fill and the surgery?  I had fills every week, 50 ml to each side.  Some women have higher amounts than 50 at each time.  My last fill was 1/24/11, so there was about 4 weeks between last fill and surgery.

    One more question, how long was it that some of you were out after the implant surgery?  This will vary greatly.  It really depends on your amount of pain, difficulty and length of surgery, what all the PS had to do during surgery, and how quickly you recover.  Most people have between 1-2 weeks off, but it also depends on the type of work you do.  I could have done a desk job easy within a couple days of surgery.  I had really no pain, very minor discomfort, and healed really quick.

  • fire-dancer
    fire-dancer Member Posts: 444
    edited March 2011

    Hi ladies!

    It's been a while since I posted here, kind of been in a "holding pattern" as the TE's did their work and got me ready for my exchange date this coming Monday.  

    I don't know if it's just me or not, but I am so overwhelmed by the idea that "this is it". Monday marks the day of the "new me".  I have been a work in progress for months now and it''s hard to believe it's really here...I have been reflecting alot about the past few months, kind of feeling emotional, but not in a terrible way, just in a 'looking back' kind of way.  I don't think I would have gotten through this with such a positive outlook if I hadn't done NSM.  I am grateful everyday when I look down and see 'me' still there...

    Well, I plan on keeping busy this weekend with the family and I have no doubt it will be Sunday night before I know it!  I wanted to say thanks for the info & support I've received on this thread, BCO is a pretty amazing place!

  • vmudrow
    vmudrow Member Posts: 415
    edited March 2011

    Megan - sweet dreams on Monday!!

    Does anybody know if a NSM on one side can be made to match the natural breast - a friend of mine is trying to decide to just have the bc side done, or to do both breasts?  One PS said they can match the natural pretty close, the other PS said a better outcome would be to do reconstruction on both breasts. 

  • tinat
    tinat Member Posts: 2,235
    edited March 2011

    vmudrow: I don't mean to be glib, but I'm sure the symmetry would be very dependent on the skills of the plastic surgeon.  The two PS responses might be a clue as to how comfortable they feel about their ability to "match" a reconstructed breast to a natural one.  It wouldn't seem like a good decision, for instance, to ask the second PS to try to make a match when he/she didn't recommend it.  

    It's a tough decision for sure!

  • sweetie2040
    sweetie2040 Member Posts: 470
    edited March 2011

    Firedancer-so excited for you to finially reach your destination! I felt the same was as you. It is very emotional. It is like everything up until this point your progressing forward for something, surgery, recovery,fills. Now it comes to the time when this indeed is it. Your going to look and feel great. It will be another adjustment but a good one. Keeping you in my thoughts and prayers.

    vmudrow- I know someone who had a NSM on one side and breast enhancement on the other. She seemed pretty happy with the results. I think the bigger is issue is not so much about matching but what does she feel she really wants to do. Does she want to keep one breast or is she more concerned about symmetry, etc. Some people want to try to keep the unaffected breast if at all possible. Others like myself felt more comfortable removing both. I agree with Tina a lot depends on the skills of the PS and some like to make it easier for them self by suggesting we remove both. I remember being told that by all three that I saw. I didn't base my decision totally on that though. I really made it on what gave me the most peace of mind.

  • sunny321
    sunny321 Member Posts: 37
    edited March 2011
    vmudrow:   I opted for a NSM on one side and the other side is natural.  I haven't had my exchange yet, so I can't comment on the final result, but I will say that I agree with the previous response about it depending on the PS.  I have great confidence in my PS, and often find it interesting how many people in the waiting room at his office say that they switched to him from other doctors after having issues with the other doctors and that they have had great results with him.  My PS doesn't seem to think it will be an issue to match the MX side to the natural one.  I of course have no guarantee that I won't be the person he screws up on, but I think my chances with him are as good as any.  My main point of advice is to make sure your friend has a doctor that she completely trusts the skills of.  Another thing to consider is that it seems to me like nearly everyone who has a BMX ends up going up to a D-cup - like no one who had a average or small chest wants to go back to it.  The final size your friend wants might also play a role in what she chooses.
  • Kate33
    Kate33 Member Posts: 1,936
    edited March 2011

    fire-dancer- Right before exchange is very emotional for everyone so it's very normal.  There is so much riding on that surgery.  It's the one that's supposed to return us to normalcy- or as close to it as possible.  I found the thought of going through another surgery, when I was finally feeling pretty good physically, to be a little daunting but this surgery is so much easier than the MX.  Have you checked out the thread "Exchange City"?  Lots of good info on what to expect immediately after your exchange.  It takes your implants awhile to settle (they call it drop and fluff on there) so don't freak out when you first see your implants.  (I believe most of us described them as squashed hamburger buns.)  This is NORMAL and it gets better each day.  Mine probably took at least 6 months to soften and appear more natural.  Definitely check out that thread, though.  It's kind of long so if you have specific questions just post them on the end.  They are really great on there and go me through my exchange.  Good luck on Monday!   We call it getting your "Yippee Squishees"!!!!!

  • Kate33
    Kate33 Member Posts: 1,936
    edited March 2011

    I forgot to ask but another member asked me if anyone has had a NSM with DIEP, GAP's or TRAM's?  She regularly posts to new members who have recently been diagnosed with DCIS and they want to know about treatment options.  Has anyone had anything but implants on here?  

  • justagirl
    justagirl Member Posts: 633
    edited March 2011

    Well ladies, I've done it!  Double masectomy with one LD flap and two permanent silicone implants but no nipples as I had thought.  Just before I went into surgery two weeks ago, the breast surgeon and the plastic surgeon said trying to save my nipples as they had both been (successfully) removed twice before with previous surgeries posed a significant degreee of risk for infection if they didn't take....and we all know what that means - out comes the implants, waiting and wondering if reconstruction can be done down the line.  So, since I've come this far, I agreed, and I'm nippleless but happy and have no infection so far.  I was in the hospital 10 days with 6 drains.  I'm still sore and tire easily but it's all okay, thanks to all of you who have shown me the way.

    Now, question is, down the road, is the making of a nipple from the skin on the breast look good afterward and the tattooing is done?  My plastic surgeon said she wanted to wait at least 3 months before doing anything to make sure my implants have settled in.  I went for small implants 190cc and 225cc to decrease the stress on the muscles and tissue.

     Thanks ladies!

  • vmudrow
    vmudrow Member Posts: 415
    edited March 2011

    Thanks everybody for your answers about being able to match an implant with a natural breast - I'll let my friend know what to as the plastic surgeons.  I appreciate it!!  I have told her about this site - so hopefully she will join us. 

  • KellyMaryland
    KellyMaryland Member Posts: 62
    edited March 2011

    Megan, thinking about you as you get ready for tomorrow!

    Kelly

  • fire-dancer
    fire-dancer Member Posts: 444
    edited March 2011

    Thanks for the support, Ladies!  It's nice to hear I am not alone, I have been so emotional and reflective, but turned a corner this weekend and feel more confident and ready to take the plunge! :-)

    I'll check in when I get home and am up to it - enjoy you Sunday's!

  • fire-dancer
    fire-dancer Member Posts: 444
    edited March 2011

    I'm home and everything seems to be going ok - I have only peeked, but my new "girls" seem to be pretty great, so far...I know I've got a lot of time to see the end results, but I am thrilled that my PS went with the size & profile I wanted (mentor 450's hi-profile).  The pocket work is probably the sorest part, and also along my mid-chest bone...ok - everywhere is sore, I guess! ;-)  I've been sleeping for much of the day and staying hydrated.  I'm so grateful to be home & where I am on this journey right now...

  • tinat
    tinat Member Posts: 2,235
    edited March 2011

    I'm just about 5 weeks post NSBXM with TE.  I have 600cc TE and 350cc instilled at time of surgery.  One nipple looks pink and healthy, only a little skin sloughed off the very tip and looks good as new.  The other side is still ugly and half charbroiled looking.  The skin just adjacent is also still healing, black and crusty around the area where the blue dye for the sentinel node localization was injected (I can see blue and pink skin between the crackles).  I'm beginning to wonder if it's partly a reaction to the dye???  I am allergic to lots of weird things like preservatives, etc.  Just a thought...

    Sorry for the gross description, but if anyone would understand it would be this group, right???

    I'm supposed to go for my first outpatient fill on Friday.  Has anyone else had fills while the nipple(s) is still struggling a bit? 

  • sweetie2040
    sweetie2040 Member Posts: 470
    edited March 2011

    Tina-I had the black nipples too and scabs. I did lose part of one. I think it was because it was the cancer side and they really scrapped hard in there. I still have part of so it looks OK. The other side is fine. However, I believe I am the only one on this thread who had that happen so it's VERY rare. I think more likely in time the scab will fall off  and your nipple will be just fine. I did have fills while my  nipples were still healing. Hang in there a lot of these things just take a long time healing.

  • fire-dancer
    fire-dancer Member Posts: 444
    edited March 2011

    Hi Tina, my nipples turned black and scabby, too - it is unnerving to watch it happen but more often than not, like Sweetie mentioned, things turn out fine, the scab falls off and reveals a pearly pink nipple! And yes, it can take a while, I think it was several weeks for me and I had a fill or two in the meantime...I know it's hard, but try to hang in there and hopefully things will just heal on their own.

  • SMH
    SMH Member Posts: 13
    edited March 2011

    Ticklewench - Yes, implants can be placed above or on top of your muscles. I had double nipple sparing mastectomy just over 7 months ago. I had immediate implants placed over my muscles in a bra or hammock made out of Alloderm. I went from an A cup to a D cup with only 1 surgery. My recovery was very fast! I'm sorry to hear that Alloderm was not available in Australia, so this might not be an option for you. I do believe that the Alloderm bra is what makes it possible. The Alloderm thickens your skin and helps hold everything in place. My left breast looks great; my right one (cancer side) has some rippling. This is a new procedure but I'm here to tell you that it is being done! Check out Mayo Clinics in Phoenix, AZ, that is where I had my procedure done. PM me if you would like to talk about it any further. Thanks.

  • tinat
    tinat Member Posts: 2,235
    edited March 2011

    sweetie2040 and fire-dancer:  Thanks for the encouragement.  Half the nipple is pink and the other half (on the outside near the dye injection site) is black.  It's really distorting the shape of the nipple and actually has split open at the base.  About 3 inches of skin lateral to the nipple is also partly charbroiled/scabbed.  There is a hint of the blue dye all through this area that's why I'm suspicious that I may have reacted to it somehow or it's compromised healing.  I've been in close contact with the PS (3 hours away) and sent pix yesterday.  They don't think it's infected, but instead of my first "fill" tomorrow I will likely be having wound debridement and damage control.  

    Things have been going pretty smoothly for me though my breast cancer journey and I've been telling myself that there would be bumps in the road.  I guess this is just my first bump Undecided

  • nora_az
    nora_az Member Posts: 391
    edited March 2011

    Kate.....my NSM was done with DIEP

    All done at the same time prior to chemo....I am very happy

  • Kate33
    Kate33 Member Posts: 1,936
    edited March 2011

    nora_az- Thanks!  Now that you said that I think I remember.  Didn't you have it done at the Mayo Clinic?  I'll let the other member know.

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