Nipple Sparing Mastectomy with immediate reconstruction
Comments
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Kate33: OMG, is that you? You're just as cute as a big kid as you were as a little one! Thanks, I kind have been saying "yikes!" every time I look in the mirror. Although nipple sparing is great, I realize now how there are some limitations on reconstruction. Rather than building a breast and adding the nipple last, our plastic surgeons have to build the breast around the nipple and skin. I don't want to be any bigger at the bases, but would like a bit more cushion at the top. So, if the type/size of implant isn't the answer then I guess we'll be talking about some other procedures. PS said that a breast lift sounds like a simple solution, but would affect the nipple position, etc. It definitely is an art!
I have been in touch with whippetmom and she has given me some good advice. We're taking a break from the long drive so I have some time to mull this over...
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alypatphi: Hi, so your surgery was about 5-6 weeks ago and your mastectomy incisions aren't healing? That does seem like a long time, but everyone's body is different. Be sure to watch for signs of infection as your doctor recommends. Get lots of rest, drink lots of water, and eat plenty of good foods (especially protein). Did they give you limitations regarding lifting, stretching, etc? Seems like anything that pulls on the sides might slow things down.
Please take care of yourself and call the doctor if you have any doubts. My doctors have all been very receptive to communicating via email and find pictures especially helpful. If you have any doubts about healing would you be able to send your doctor some pictures?
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alpatphi,
as stated before you should be on the watch for any signs of redness, swelling, oozing fluid, tenderness and warmth coming from your incisions. By now, like 6 weeks post-op for you, your incisions should be healing. Has your PS checked you for seroma fluid build up which occurs under/below the incision? It is not a sign of infection, just the bodies response to the invasive nature of your surgery. This fluid, if greater than 50cc can impede healing.
You shouldn't be doing any lifting or stretching greater than 5 pounds, like no lifting of your daughter! Usually after 6 weeks you can start to lift heavier things, but as far as lifting your daughter - that should be no sooner than 12 weeks! Sorry.
You should wear something when you are up and about which supports your new breasts but doesn't put pressure on the incisions.
Don't overtax yourself for your daughters birthday. I realize, as a Mom, the importance of a first birthday, but all she needs to know is you love her. If someone can help you, and you want to celebrate, think about keeping it very small and to close family and friends. Order a bakery cake and ask a couple of your friends to provide simple food. You could make a fruit platter easily and it won't require lifting in the kitchen.
Now is the time to be proactive. I do truly think, as I write this, that you need to bang on your PS's door and tell him your concerns. Waiting for incisions to go gooey is a sign you have an infection.
Did the PS put you on preventative antibiotics after your DM? Are your implants the size your natural breasts were or larger? What I am thinking is if there is excessive strain on the incision but as your incisions are on the side its better than the frontal horizontal incision.
Take care of yourself - we care. It's frustrating to not be able to bounce back into your life's activities right after surgery but remember it was major surgery! Take the time now to be on top of your new breasts and it will pay off in the long run.
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alypatphi- Just wanted to say welcome, too. Sorry your incisions are giving you fits. You've gotten lots of good advice from everyone. Have you tried putting scar tape over the incisions? My PS gave me some that stayed on for several days. It was supposed to help the scars heal faster and smoother. Seemed to work pretty well. Can't remember what the name of it was but I know they sell something similar at the drug stores. Maybe, if nothing else, it would protect it as it's healing. Definitely wear a good supportive bra. The ones that worked best for me were some cotton front closing ones they sell at Walmart. Super comfy but good support. Hope things turn around soon! Happy Birthday to your daughter! The 18th is my birthday, too! (((hugs)))
Tina- You're so sweet! No reason to say Yikes now! You're looking great! Don't worry about the upper pole fullness. Believe me it's easier to fix that than get a realistic nipple so I would take NSM any day. I just had fat grafting and it's definitely improved the upper part a lot as well as the sternum area. So there are options if you need them down the road. I think you'll look great, though!
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Hi Everyone: I had a NS mastectomy and reconstruction to fix a lumpectomy defect on one side, and just had my exchange to implants 12 days ago. It has gone pretty well. I posted some photos on the picture forum (the one you need permission on). Search for "Unilateral Nipple Sparing MX" but be sure to select "30 days and newer" under "Thread Age"---o/w it doesn't come up for some reason! Lucky
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Lucky- Just checked out your pics and you look great! You'd never guess you had a lumpectomy first. Took you a little longer with all that but it will all be worth it. So glad you got to have NS. It makes such a difference in the final result. You looked wonderful! Your PS did an amazing job!
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Hi - Thank you all for your great advice. I went to see my PS and he said this happens with the nipple sparing procedure because they make a small incision so basically the skin gets pretty beat up. it is healing he said just really slowly. i got back next wednesday and he might have to recut me open and cut out the dead skin and restitch. on a good note I am numb there anyway! lol. my daughters birthday is saturday so after that i dont care what he does as long as i am okay for her party. I dont have my implants in i have the tissue expanders. so my last visit he didn't give me an expansion because he wants it to heal. so who knows?!?! thank you guys for responding to me...... i will keep you posted p.s. Happy Birthday Kate33!!!!
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alypatphi- Thank you!!!
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Tina- Thanks! I always seem to have a lot of Geminis in my life. (Birds of a feather....)
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Thanks Kate33,
Thanks so much for allowing me to view your photo's.
You are absolutely gorgeous.
I will be pursing this course of action--implant with fatgrafting--or fatgrafting only.
You've certainly given me back hopes for a pain-free future.
Again, thanks so much, Eileen
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I just posed a question to my breast surgeon, who does lots of nipple-sparing procedures. Since she's been doing them for a while now and follows up with patients I asked how many comment on return of sensation. She just emailed me, "About half seem to get some sensation back. It is more like knowing that you have your sweater on than normal sensation." BTW, she tries to make the incision below the breast whenever possible.
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Tine - It is good to hear that your BS finds so many do get some sensation back! I am almost 3 months out now from my surgery and I have a fair amount of sensation that has already returned. I also have strange itching that comes and goes from time to time. Has anyone else experienced this itching?
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sandy - i am just 7 days out from NSS with incision in the fold and i had quite a bit of the itching that i would scratch but not feel (not on the nipple but just outside and above the areole).
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Sandy105: I had partial necrosis of one nipple so no longer have a "matched set"
. It looks like it will be easier to take the other one down a bit and I'm trying to decide if I really want to tinker with it IF some sensation returns to that side. But I haven't heard anywhere that the sensation is more than my BS describes it - not necessarily a pleasurable feeling, just sensation. A few on this thread have actually said it's actually sort of weird and uncomfortable. Is yours like it was pre-MX or is it more like you're just aware if it's in contact with something?No itching for me...
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Tina- I did get a lot of sensation back but now have lost it again after my revision. (New nerves being cut.) It probably will never feel like it did before but it usually does get better. I found that it was most numb in the center and then the sensation increased out from that. I have completely normal sensation down the center, underneath and a few inches above the nipple and around the side. Prior to my revision I could feel everywhere but it was just kind of numbed down a notch. No sensation in my nipples at all, though.
For those of you having itches you can't scratch- It's maddening, I know! It's very common and almost always goes away within a few months. If it's really driving you crazy the prescription Nuerontin helps quite a bit. It's also good if you're getting those little zaps of pain that come and go. (This indicates the nerves are regenerating so it's a good sign when you have those!)
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Kate33: Same here - feels pretty normal over the sternum, below the breasts, and above the TE ports. Sides of the breasts have a tiny bit of feeling, the skin over the ports is creepy-weird uncomfortable. The rest - no feeling at all.
Sorry you had it, then lost it
. Hopefully, at least some of it will return!0 -
I have sensation on my good side nipple. I am really surprised since there was so much work done on the breast. I am also very pleased that at least one operates normally.
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hm... I am still waiting to see about my how much nipple and skin of my NSS is viable - my PS has postponed the fills twice now, not wanting to do anything until he sees how much of my skin survives. I should have expected it - I am such a slow healer - always have been. So I have been totally into zombie books, movies.... and I look at my nipple and skin around it and laugh b/c it looks like the same color as they describe the zombies as being.... surely hope it is bruising and not re-animation (zombie boob, oh my!)... well, I will write again after my PS visit on the 29th - he told me to get an appointment on the 27th but is not in town - so that would have been a lonely, lonely visit!
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vhshea: I'm crossing my fingers for you! Even though I did lose some tissue to necrosis (blue dye) I did also have lots of fresh pink nipple and skin under all that yucky charbroiled mess. It took 6 or 8 weeks before we knew. Be patient, it can take a while!0
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wow - tina - six to eight weeks - knowing that does help! thanks.
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vhshea- Zombie boob! LOL! Let's hope not!
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Hi. Newbie here. I had NSS BMx on 6/2 and my path report report just came back with news that the r nipple has cancer (a shock to me and surgeon as this was supposed to be the healthier breast). Anyway, just writing to see if anyone else has been thru a nipple save only to have to lose later on - and if so, did you have a reconstructed nipple? (I secretly hope no one writes that this has happened to them) thx Catherine
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olearca: Welcome! So sorry to hear about the nipple
. My BS told me several times that it was a possiblity that the retro-nipple tissue could look good at first glance, but if anything was found on the more thorough pathology that a second surgery would be required to remove it. Fortunately, that didn't happen for me and again I'm sorry that it did for you.There are lots of discussions about nipple reconstruction on the threads about implants and exchange surgery. Look for the search function at the top of the page and type in nipple reconstruction and you'll find lots of good info.
Best wishes!!!
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olearca- I've been posting on here about 15 months and you are, unfortunately, the first one I've heard of where undetected cancer showed up in the path report. My final path report showed multiple areas of DCIS never detected so it can happen. Yours unfortunately had to happen in the nipple. I guess it's good it's so rare but I'm sure that doesn't make you feel any better. I do know they can do amazing things with nipple recon these days. There is a member on here named FACECRAFTER who knows a lot about it. I'm sure she'd be happy to answer any questions you might have. (((hugs)))
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Olearca - ugh - so sorry to hear about nipple and the cancer... my BS is not sure if mine will make it yet or not, but he reassures me that if it doesn't, he will make me a nipple...sounds reassuring. The post-op path (haven't gotten the final path yet) showed additional cancer in another duct (the one they found in the mammogram and MRI had gone slightly invasive, and the second was still DCIS) - so that is not unheard of, but my breast surgeon indicated that she did not expect cancer in the nipple given that I had cancer beginning in the ducts - I did read a med report that indicates that DCIS type cancer is generally not a candidate for NSS since the ducts lead to the nipple - so not sure why my BS seemed comfortable with the NSS - but I am sorry to hear about your losing your nipple... keep us informed.
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Thank you all for your support and referral to the nipple recon threads. There's just so much to learn and take in.
Vhshea Here's fingers crossed that you keep healing!
Kate33- I'm actually glad to hear that I'm a rarity as it is my hope that everyone gets the option for NSS and I feel so fortunate that it was an option for me. And i guess it's better to have the DCIS head toward nipple than invade nodes. Thanks for your support.0 -
olearca- I really wish everyone would get this option. Unfortunately, I've discovered on this site that there are still a lot of women out there that are never told that this surgery even exists. My first BS never told me. I just happened to read about it when researching. (Luckily before my MX!) So I tell everyone to spread the word because you never know who might need the information some day. (And, you're right, better to have it head towards the nips than the nodes!) You have such a great attitude!
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