Nipple Sparing Mastectomy with immediate reconstruction
Comments
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Kate - A friend was visiting me this wknd and casually mentioned she was interested in augmentation. I tried not to "squash" her ideas about it, but I was quick to let her know if sensation is important, think long & hard before you go for it! I'm kinda with you on the whole thing, not sure why you'd want to lose sensation to have a bigger bosom, but to each his (or in this case her) own, I guess! ;-)
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fire-dancer - I have some sort of sensation in my nipples as well. I would describe it as pressure when they are touched - it is a weird feeling. I agree with having an aumentation - why risk losing sensation?
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my thoughts too firedancer...why would a woman give up an important erogenous zone to have bigger breasts!....i was shocked and disbelieving to hear that this is what happens with augmentation..knew it happened with breast cancer surgery. really, it should be the next holy grail for the PS to achieve i would hope...that they will be able to preserve and regenerate one day...
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My PS officially declared my wound healed today! No more packing and dressings and tape! There still a small scarred hole and the whole blue dye area is still pretty inflamed and hard, but no more open wound, whew!!! We discussed a few ways they can smooth out or remove the "pothole" at the same time as my exchange surgery.
Can't believe it's been 3-1/2 months of this... I'm finally off restrictions - I can lift more than 3 pounds, exercise, stretch, garden, do housework (er, not so excited about that last one), whatever I want to do! They even partially refilled my TE. It's not caught up to the other side, but at the next appointment it will be. Woohoo!!!
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Tina- Wow! Such a relief and a milestone for you! I am really happy that things are finally straightening out and you can start moving forward. You've kept such a great attitude through all these setbacks and it's nice to see things working out finally. Your exchange date will be here before you know it! (((hugs)))
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Tina - i am so jealous - congrats!
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Wonderful Tina! I know you must feel so much better and be so happy!
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Tina-so glad to hear this! Soon your be on your way to exchange. Wish you the best. Keep healing well.
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Thanks everyone! As anxious as I am to have the exchange, we need a break from that long drive. I've lost count as to how many trips I've made to see the PS - probably at least 10 since mid-February. Yesterday was 7-1/2 hours of driving for a 20-minute appointment, the traffic home was awful I suppose because of the holiday weekend. Upside - San Francisco is a beautiful city, a great place to walk, and there are fabulous restaurants everywhere. I always do a Yelp search before my appointments and my husband and I eat at a different restaurant each time we make the trip.
I was told that I could schedule my expansions at 1 to 4 week intervals, my choice. I had 120cc instilled yesterday and feel perfectly fine today. My TE had already been expanded initially beyond this volume, but the PA said that I've been deflated for so long that it would be like starting from scratch. The muscle contracts pretty quickly. Fortunately, no discomfort at all! I've got a ways to go, but I can finally see the light at the end of the tunnel!!!
Thanks again for all the good wishes...
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Tina - so excited for you and the good news you are healing!!!
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Tina- Wow! I thought I had it made with my 4 hours round trip for my fills. Not sure if your PS would be up for this (or your husband) but my PS felt bad for us having to drive so far for such a short appointment. She taught my husband how to do the fills and we did them at home. It's actually pretty easy and foolproof and since I was still so numb it wasn't like my husband could hurt me. The nice thing was we were able to do smaller fills more frequently so it was very gradual and slow so no discomfort. If you're interested it wouldn't hurt to ask your PS. It worked great for us!
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Kate33: I think I read that in one of your posts way back when. It's so great that you were able to do that - sort of made up for your trip to Florida, right?
I am taking part in an Allergan clinical trial with my PS so I have to have everything done there and will see him at specific intervals even after my reconstruction is complete for the next two years.
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Tina- are you getting the tear drop implants that are part of the Allergan trial? My Dr does them and is the only one in the area, although I ended up getting the rounds.
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No, I am taking part in Allergan's SeriScaffold clinical trial: http://clinicaltrials.gov/ct2/show/NCT01256502
SeriScaffold is a silk support matrix used as an alternative to Alloderm. My PS is one of the docs in the trial. It is already FDA approved for safety, this is a clinical use trial. My doc is very excited because it is an "off the shelf" product, doesn't require special handling like soaking, comes in large sheets, and is less expensive. It has been used for other types of surgery, but it's new for breast reconstruction. When he asked if I was interested in participating I liked the thought of having a silk sling instead of cadaver tissue. I have agreed to check in with my PS at specific intervals for the next 2 years, plus they will take a small tissue biopsy during my exchange surgery. Studies apparently indicate that when the body absorbs the product it forms a stronger natural sling than with Alloderm.
My PS doesn't like the teardrops. I will have Allergen smooth round implants.
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Tina- That's so cool that you volunteered for that. Sounds like a great option for Alloderm which some insurance companies won't pay for because it's ridiculously expensive. It's so exciting to see more options becoming available in recon.
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Kate - I was just online looking up my PS and noticed he just chaired a conference that your Dr Khouri presented at. (At least I believe it was him!) It was the Boston Breast Workshop 2011. There were about a dozen PS and I noticed your Dr. K was one of them, too. I was looking mine up to see his experience with FG, as I meet my PS the end of June for my 3 month visit, I have some issues with a shelf/divot on one side that I was "possibly" interested in getting FG'd. Lo and behold he was just chairing a conference on the topic. Anyway, I just wanted to share, because I have been following your comments on your surgery and have been interested in FG (although I know you surgery was more intensive than average FG). I figure if my PS is hanging around with some "heavy hitters" in the field of FG-ing, he must know his stuff, right?!? ;-)
...I hope you are feeling well!!!
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Tina-that sounds facinating. This is the first I heard of that type of sling. Maybe it will help with reducing ripples somehow? Good question to ask your Dr because I had alloderm and have tons of rippling and adding more alloderm doesn't always help either. I could have had the tear drop or the round. Ripples and all I am still happy I choose the round although the tear drops look really great on the girls who have them on here.
Firedancer-keep me updated on what your Dr does. I live in CT so RI is not too far for me. I would like to see what my FG options are as my Dr doesn't do it at all or support Dr. K.'s method. I am waiting for it to become more widely available in this area and by a Dr on my plan.
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Sweetie - I will keep you updated! My PS is at MGH and I actually never asked him about FG. Today I googled him (sometimes I do that just to see what my Dr's have been up to in the news, does that make me sound stalker-ish?!?!
) I wanted to look into FG and his experience with it. I just figured I'd cross that bridge if/when I got to it. I am interested in finding out more, but promised myself I would NOT pass judgement on my implants until the 3 month mark! I really like the size/symmetry, it's just that my bony chest is apparant in scoop-necked shirts. You can definitley see a divot. I figure if I can do something about it come the fall, I might!
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sweetie2040: The trial is so early on that I doubt there is any data compiled yet. My PS said it was not like an earth-shattering new innovation and that it did not really change his surgical techniques. He keeps saying the main advantage is that it's easy to keep in stock, does not require the advance prep that Alloderm does, and it comes in nice big sheets. The part about it creating stronger collagen once absorbed came from Allergen. I'm sure that's one of their hopes. PS will be sampling a small piece of the sling for Allergan during my exchange surgery. I'll ask about the ripples, but I doubt there's been enough experience with it to make any promises or predictions along those lines.0
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fire-dancer- That's great about your PS! I hope he will offer the FG as well. I do know that Dr, Khouri teaches workshops all over the world as well as in Miami. (In fact, he had several doctors observing the day of my surgery so that was a few more people I've shown my boobs too now! LOL!) I think it's wonderful that he is willing to teach this method to other surgeons. BTW, the fat grafting is wonderful for covering up the bony sternum. I had that, too, and now it is gone. I can wear low cut tops again! And it looks totally natural- like breast tissue. No one would ever know that it's really too many desserts from my stomach!
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Firedancer-I like to google people too! I brought a used car for my daughter and googled the salesman to see if I could find out if he was on the up and up.
I have the same issues as you with the bony chest and divot one side. My ribs show up in the middle when laying down too. I figure with reconstruction it's all about trade-offs. I do feel grateful though. I talked to my friend's mom who is 80 and used to be a MX fitter for a store and back then every woman who came in had huge scars and just about everything removed including muscle. She said it was so sad and the women would cry as she fitted them. In that respect we do have better options today.
Tina-that sounds interesting. The larger sheets should help. I think alloderm is really expensive and I have heard some people have had issues with it. I think is always good to have a Dr who is willing to be up on new procedures. Sometimes I wish they would move faster on these new advances.
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This is in response to the discussion on breast/nipple sensation. I had a right unilateral NSM with augmentation on the left side on 6/28/2010 (almost a year ago). I knew I would lose sensation on the right, but was not told about reduced sensation on the left. After one year, the sensation on the left has returned. The tip of my nipple is not sensitive to pin prick, but it is to everything else. That's odd but it is what it is. I guess pain and pressure are perceived differently.
My right MX breast sensation is spotty. I have about 50% sensation about an inch around the areola but anything closer in to the nipple is completely numb. It is a weird feeling. Sometimes my right breast feels like a blob hanging on my chest. The left does not feel this way, but feels normal.
I went from being almost flat chested to having a real woman's figure, which looks nice but I would take back my pre-BC days in a minute. What a carefree life that was!!
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speech, thank you for your very helpful and clear response...not sure if i was really the one that started the discussion but i certainly gained from reading your post and am very grateful for all the ladies on these boards taking the time to light the way for those at the beginning of their breast cancer story...i am currently weighing up whether to go unilateral or bilateral...understanding what to expect in terms of numbness is one of the key factors in my decision making process. i understand how many would just go the bilateral route, but there are also so many personal determining factors in there...thanks again, rosemary
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Saw my BS yesterday and she says that I am a candidate for a NSMX. She really only wants to do a uni even though I said if my insurance would pay for a double I would like it but said I would wait until I meet with the PS next week to make up my mind. I have already had radiation and I am thin so not really sure what my options will be for reconstruction. My BS said they will do a wonderful job, they are the best. I have nerve damage from lumeptomy and rads finished it off. It has been very painful so the goal for me is to have no sensation at all and be numb. At this point it would be better than the pain I have been in since December when I started rads. Looking forward to being pain free.
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Sherry- Great news that you can have NS! It will go a long way towards you feeling whole again afterwards. As far as your reconstruction options you can definitely go with tissue expanders and implants or immediate implants if you're not going too big. Since you've had rads, though, I would definitely look into micro fat grafting. They can use this to either cover your implants or there is even a doctor in Florida that's creating entire breasts using the BRAVA system and fat grafting. You can check it out at miamibreastcenter.com. His name is Dr. Roger Khouri. I live in Arizona but flew to Florida to have my revision surgery with him. He exchanged my implants and then did the fat grafting over the top and I'm really happy with the results. Wishing you the best of luck with everything! (((hugs)))
For anyone interested, I just posted new NSM/fat grafting photos on the picture forum.
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Thanks Kate
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I just posted some updates to the picture forum...
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Tina- I just saw your photos and I think you are looking amazing. So glad your PS got the healing under control. I'm amazed how great it's all looking (doesn't even look like TE's) but especially considering all the complications! You are going to have beautiful results!
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Hi, i just had a nipple spaing double masectomy. i am 34. my sister was diagnosed with breast cancer 35 last year and discovered we both have BRCA1 gene. i decided to do a prophylactic nipple sparing double masectomy. my operation was april 26th. my incisions are like 2 inches long on the outside of each breast. my incisions are healing very slowly. has this happened to anyone? i am worried because my daughters 1st birthday is the 18th. my dr says to watch it and make sure it doesnt stay gooey in areas..
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