Nipple Sparing Mastectomy with immediate reconstruction
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I have my incisions under the fold of both breasts also!!
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My NS/BMX incisions were also under the fold of both breasts. I agree that it depends on the particular preference of the surgeon.
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I had my incision in the fold... unfortunately for me, the skin under the nipple above the incision was deprived of blood flow and I've got such bad scarring there that I now need a flap surgery to harvest skin... So what works well for some might not for others - I am wishing I'd done the keyhole option.
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My PS said he will cut me in the fold under the breast. Of course my left one already has two scars from previous surgeries. One I really hate as it can be scene in some clothing, urgh
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I'm with DocBabs, mine were out from the areola of both breasts. I wonder what determines where they make the incision? And they must have done a great job stitching me up because after 4 weeks they are very thin lines. I don't think they'll be very visible.
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FYI, I totally agree incision placements with NSM vary according to surgeon's skill and comfort level. I wanted LIMF or hidden under the fold incisions. Here is a new study released by my surgeons in support of LIMF incisions with NSM's, allowing for amazing safe outcomes. Note the pic rendering of exact incision placements.
The Lateral Inframammary Fold Incision for Nipple-Sparing Mastectomy: Outcomes from Over 50 Immediate Implant-Based Breast Reconstructions
Keith M. Blechman, MD, Chaya Levovitz, BA, Amber A. Guth, MD, Deborah M. Axelrod, MD, Richard L. Shapiro, MD, Mihye Choi, MD, Nolan S. Karp, MD.
New York University, New York, NY, USA.0 -
I had my exchange to silicone implants two days ago - so far so good! I just posted photos on the picture forum.
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Tina T: Big Congrats!! ohh I so wanna see pics..but soo happy for you, honey!
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miasanta2007: Thanks so much! You and Renn and Just_V are right behind me!!! Do you have access to the picture forum yet?0
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Hi Ladies - just had my f/u w/my PS this afternoon and confirmed w/her that I would like saline implants. I know I'm probably over-the-top with this stuff, but I just feel more comfortable getting saline - autoimmune stuff runs rampant in my family, etc. But she said again that the results would be sub-par (as opposed to using silicone). She said that there'd be lots of rippling and that I might be able to make out the edge of the implants along the top. Her assistant brought in another silicone implant for me to touch - said they didn't even have a saline one b/c they do so few of those. Ugh. So a couple questions for you:
1. Where is this picture forum, how to I get access, and might I be able to see examples of both sorts of implants?
2. For those of you who have saline - do you have significant rippling, etc? I should note that I am very slim on top, very little body fat up there (and hence, am a small B cup) - her assistant seemed to think that made the situation worse. Any experiences with this?
Any help with this is so appreciated. As my husband said "everything has tradeoffs, right?" I still feel like peace of mind is worth more to me, but I don't want to hate my reconstructed breasts, either.
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SAOIsenberg: Are you on the Implant Sizing 101 thread? If not, that might be helpful. Otherwise, the picture forum is a totally separate site from BCO. Please contact MBJ, Lilah, firni, or whippetmom to see about getting access.
Best wishes!
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Thanks, Tina - I have checked out the Sizing 101 thread - there's a lot of great info. there, but not quite what I need, unfortunately. My size is dictated by my formerly-treated breast - and really, so long as we're close, I don't care too much about those things. And I don't know how much I care about rippling, etc. b/c I've never seen what that looks like!? I've been married for 11 years and my husband and I both care more that I'm comfortable w/what I'm putting in my body and that I'll look "normal" in clothes, swimsuits, etc. He and I can deal w/whatever at home!
I did just message Lilah (only because that is my daughter's name, same spelling - who'd 've thunk?) about the picture forum - thank you for that info.!
Sarah
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Regarding the incision site. I read a study somewhere along the way that some surgeons believe there's a better chance to preserve the nerves serving the NAC if a lateral incision is made. In other words, some breast surgeons may prefer a certain type of incision to help with nipple sensation, some might be concerned with reducing risk of necrosis due to breast size, and some may feel compromise is in order to balance both chance for tissue survival and cosmetic outcome. Just like the plastic surgeons, it seems the breast surgeons doing nipple-sparing mastectomy each seem to base their techniques on research and their own personal experience.
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Sarah- What specifically are your fears of silicone? The older silicone implant were risky because they were filled with silicone liquid which could leak into the body if ruptured. The newer ones are more of a gel consistency, though. They are practically indestructible. Also, just wanted to make you aware that the saline implants are encased in a silicone shell so you are still getting silicone in your body. It's been proven, though, that silicone is very safe. It is what they use for knee and hip replacements too. Even with silicone implants you can get rippling particularly if you have thin skin. Saline will be much worse. And saline does not feel as natural either. Hopefully, you can get access to the picture forum and compare for youself how they look. Most of the photos will be of larger breasted women, though, as saline is the only choice if you want to go very large. I would try to find photos of women as close to your desired size as possible. Good luck!
Tina- CONGRATULATIONS on your YIPPEE SQUISHEES!!! Glad it all went well!
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Have been reading this thread with a lot of interest as I have been experiencing some problems. I had a SS BMX with immediate recon using TE's. I am a larger woman and was a D cup. They did not believe I would get a good result with NS surgery because of the size of my breasts. When everything is done, I should have a B or C cup. At this point, I just want something resembling normal breasts.
I have a very significant family history -- my mother died of breast cancer, my sister has been a 20 year BC survivor. I also had 2 aunts on my father's side with BC and 5 of my cousins have had BC and 1 had ovarian cancer. In addition, of my immediate family of eight siblings, 5 of us have now had some form of cancer.
My cancer was on the right side. ILC. I did a lot of research and have had many issues over the years. I have had calcifications biopsied and removed in 2003 and 2006, they were benign. I have had a discharge from my left nipple since 2006. I have always been on "high alert" because of my family history and in 2006, my BS recommended I consider prophylatic BMX because of fibrocystic breast disease. I went on Tamoxifen instead, but because I developed uterine issues requiring biopsy and had other risk factors, my OB/GYN felt that the SE's of Tamoxifin were too great for me and I was taken off of the Tamoxifen. I just continued to go thru the stress of getting mammograms every year. Mind you, I cannot remember every having a mammogram that did not require at least a call back and/or US and Breast MRI's.
Fast forward to 2011. Had my routine mammogram on March 15. Got my normal call back and had another mamogram of the right breast on March 30. This resulted still in abnormal findings and saw BS in early April. He did a core needle biopsy right then and there. This came back benign, but since the cells still showed abnormalities and because of my family history, he wanted to go ahead and remove the lump as soon a possible within the next 3 months. I ended up having a wire guided exisional biopsy on May 9. Because the original biopsy was negative and the BS did not expect it to be cancer, I was shocked when he told me I had ILC. This was on May 16. He said I would probably be OK with just a lumpectomy,sentinal node biopsy with addition tissue removed to get a clear margin plus radiation and possibly chemo. With my history, he said he would understand if I decided to go with a UMX or a BMX. I talked to my OB/GYN, my primary care physician and my family. Even my BS said that if I was his wife or mother, he would want me to have BMX. I took some time to research ILC. Less than 15% of BCs are lobular. Lobular cancer has a higher risk of spreading to the other breast. It also has a tendency to hide in dense tissue and often does not form distinct lumps. I have lived with the worry of getting BC for so long, that I finally decided to do the BMX. The BS referred me to a PS (I didn't like the first guy, so he refrerred me to another one). And after much discussion I ended up having the SS BMX with immediate recon with TEs on July 21st. The biopsies on both the remaining breast tissue in the cancer breast and the prophylatic breast both showed precancerous cells as well as lobular and ductal hyperplasia. This just confirmed to me that I made the right decision. I am now almost 6 weeks post op. I came out of surgery with 250cc in the prophylactic breast and 300 in the cancer breast. I only have very slight little breast mounds as a result, but at least there is something. I had 4 drains in, 2 on each side. the 2 of the right side came out by the 3rd week and only 1 on the left came out just last week. I did get an infection on the left, which increased the drainage output significantly and I still have 1 drain on the left. I have developed a large seroma on the right side and will have surgery this coming Wednesday to drain it and to reinsert a new drain on that side. This has all interfered with the expansion process and I have had only one expansion since the original fill.
I am soo tired of the drains. I am constantly on antibiotics. I struggle with my appearance and how my clothes fit. It is hard to go from a D to less that an A. with the seroma on the right, I have a large bulge out to the side of the breast and under it which is visible through my clothing. I try to focus on the results 6 months to a year from now, but it is hard. I will at some point have the exchange to the silicone gel implants. I did a lot of research on this as well and am convinced that they are safe and a much more natural looking and feeling choice over saline implants.
I am getting encouragement from reading your stories here and it is helpful the go thru this with people who have the same ups and downs. Not a club you would join but choice, but still nice to be here with some company!
Phyllis
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Hello Phyllis. Reading your post, I kept nodding - yep, yep, me too. Family history/ calcifications/ fibrocycstic breasts/ ILC. Likewise, I was fortunate to catch it while <1cm. And yes the BMX is rough, especially when there are complications such as infections. I also had my surgery July 21 - the cancerous breast looks ok now but the right one still (still!) has a horrid scab where the nipple should be and the breast skin is a combination of red and purple. Not sexy. Not one bit. My PS has me on a fill "hiatus" while my skin recuperates.
And it all seems to take forever. Once you pass the month mark, and you still have issues, it is like hitting a wall. I can't even look at "after" photos for encouragement, because I am dealing with this intermediate phase and six months or a year seems so far away.
So I try to think about the progress so far. And then I realize that it has only been 5 weeks. Seems like sooooo much longer. Hang in there. Once your last drain is out and those fills can happen - you'll start feeling better about how you look. When I had the drains, I bought myself a loose, pretty, patterned top that buttons down the front - one that I would still like to wear post-drains. I got my hair cut and colored. Manicure/ pedicure. I smiled all the time. People smiled back. It helped.
This is a great resource for those of us who are traveling through all of this. Women who are at the latter end of this process (YAY! Tina! Congratulations on the Exchange!) are like lights at the end of the tunnel. We will get there.
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Tina- I had my consult with the local PS and think the implant issues are just scar tissue so that was good news! She wrote me a script for some PT. Am feeling better every day. It's been about 3 1/2 months since the fat grafting and very little, if any, of the fat has been reabsorbed. Swapping to smaller implants is so much lighter on my chest yet I stayed about the same size as before. I think as time goes on it will continue to feel better and better. So glad to hear you breezed through the exchange!
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Lisamg, Very interesting article.Guess who was my surgeon and plastic surgeon?? Amber Guth and Nolan Karp, authors of the paper!I have an appointment with him on Wednesday and I plan to ask him why he didn't use the incision that he touts as being cosmetically optimal.
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DocBabs- WTH?!? That would be my first question, too, especially since the finding they submitted said they were doing this technique from June 2008! I'm sorry, but this is so WRONG! Let us know what they said.....and if you want us to attack their office with pitchforks!
This just makes me more determined to try to get the word out to women about ALL of their options. I just submitted a letter to 60 Minutes asking them to do a story about the total lack of information regarding breast reconstruction. I got an email back from their Director of Audience Services asking me to submit more information to their Story Editor! My biggest issue is most surgeons are not forthcomiing with the information we need to make an informed decision about these things. They wait for us to ask the questions when we don't even know what we're supposed to be asking. I wouldn't know half the things I've learned without BCO. What about all the other women who don't have a computer, internet access or knowledge of BCO? This has got to be changed!
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Kate33, you are the man
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miasanta- LOL! 0
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Kate - good for you. We all support you - get the information out there!!!
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Kate - Let the Save the Nips campaign begin!
For all the uncertainly of these last post BMX five weeks, the pink skin of my very own left nipple is such a wonderful sight. (still waiting on the right - c'mon nip - you can do it).The LIMF just makes sense as the least visually intrusive surgical approach and, considering the healing of my own breasts, it makes sense that less trauma to the skin near the nipple would result in less necrosis and a prettier cosmetic result.
There is no one-size-fits all answer. (Pun intended) But I have felt woefully ignorant at various points in this process. Thank goodness for everyone sharing.
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I would just like to add a comment with re: to the placements of LIMF incisions. Not everyone is a candidate for this type of hidden incision with a NSM. It is implemented mostly with preventative or early staged BC cases for the most part. Possible contra-indications may include an invasive diagnosis and /or location of the tumor, any prior incisions/surgeries, large breasts, previously radiated skin and the comfort level/expertise level of the BS. Any one of these may hinder the outcome/goal of the mastectomy, i feel.
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Hi Everyone.
My cancer is apparently about 4 centimeters and rather close to my left nipple, although the BS does not seem to think it will stop the PS from doing successful nipple sparing surgery. Does anyone have experience with this? I think I'd be so sad to wake up and find out that PS couldn't save the nipples after all (or could only save one-- and then what about the desired symmetry?).
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Therese9,
If your tumor is 4cm away from the NAC, this seems adequate, according to research studies. Its the BS, and not the PS, who performs the nipple sparing and calls the shots. The PS does his portion based on what the BS leaves, whether its a skin sparing or nipple sparing mastectomy. I am confident u will have a successful outcome, pending subareolar biopsy findings to be sure no cancer cells are present within the NAC. What/where type of incisions will you be having too? Best wishes.
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Therese- During the MX the BS will core out the nipple and perform a biopsy right then to look for any cancer cells. This is done no matter where your cancer is so everyone does run the risk of waking up to find the nipples could not be saved. Provided they don't see any cancer you shouldn't have any problems having a NSM. The biggest contributor to the success of your NS is the level of expertise of your BS.
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Therese9: Hi, the cancer is 4cm in size and close to the nipple, not 4cm away from the nipple, right? As Kate said, most of us went into NSM knowing that the nipple(s) would be cored out and examined separately and we all knew that there was a possiblity of them not being saved based on that info. But, best to at least give it a shot, right?
I'm also puzzled by what your BS said. It's my understanding that the BS always does the entire MX and is the one who decides whether or not the nipple(s) can be saved and handles that. The PS usually steps in after the MX is complete and begins reconstruction.
I hope it all works out for you!!!
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