Nipple Sparing Mastectomy with immediate reconstruction
Comments
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hawaiik - not a weird question - my husband did take a few pics of me from the neck down, waist up, the night before surgery - you are reminding me that we need to do follow up photos as it's a month on Monday! I know women who've gotten themselves photographed nude - gorgeous art photos. There is a woman who's a ways out who frequents the BCO boards who cast her torso in plaster beforehand.
Lots of options - you should do what you feel comfortable with and what you want to do! For me, it was more to compare. My sadness around this surgery comes from having to physically alter myself for cancer, not b/c of loss of what I perceived to be gorgeous breasts . . . never really liked 'em, so I took a more clinical approach w/my pre-op "art"!
Sarah
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Not a weird question at all. I had pics taken prior not just for myself, but also to be able to show before and after on the fat graft board. I also had silicone impressions made of my nipples (kit from naturallyimpressive.com), since I could only have one nipple spared (DCIS too close on the other side). I am not sure if I will have nipple recon on the L side or use the nipple prosthesis, but now I have the option of either.
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Sarah, I also chose the NSM because I felt I would be back to the "new" normal as quickly as possible and hopefully with only one surgery. I think I got confused because my BS, who is precious and comes highly recommended, said I could be smaller and lifted during the procedure The PS explained that he would use whatever skin was left by the BS. Therefore, I'll be the same size I am now, DD. Then they showed pictures. I think they play good cop bad cop. The BS makes me feel better, the PS tells me everything that might go wrong.
I have decided to trust the BS. She is the best in the state and one of the best in the Nation. I have been on the path for the NSM since I started this journey in April, so I'm not going to change now. I can deal with whatever is handed me at this point. I think, LOL!!!
BS said that I would have extra long tubing in the drains so that I could shower. I'm not sure about all of that yet, but with the help of this board, I'll figure it out. They explained that the hospital gives us some kind of apron to put the drains in.
THanks so much for responding. It means so much to talk to someone who has been through this.
Denise
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Ginger48, They did mention that. I think that is when I got so confused. Because I thought all along I was headed in one direction and then the PS throughs out several scenerios that the NSM might not work and that TEs would be done. I think I started thinking maybe I should have done the TEs to start with. I did really well with chemo and now as surgery approaches, I'm falling apart. Maybe it has something to do with all the pink everywhere, that is keeping me in such a funk.
Thank you for responding,
Denise
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Dancetrancer - that is a great idea re the mold of your nipple - I'm going to keep that in my back pocket as a suggestion for women I know going thru this in the future.
Denise - It's the surgeon's job to tell you all the case-scenarios and it's good s/he did, but yeah, it's overwhelming. Ginger48 - good point on this, I was told, too, that my left side might not accept the implant b/c my muscles are tighter over there and the skin not as forgiving due to my prior radiation on that side. All went well for me, but there are things that the PS can't know 'til s/he gets in there. I was also told that if any DCIS or atypical hyperplasia was found close to my nipple/aereola, those would be taken. So first thing I did when I came-to in recovery is to take a look down at my chest to see what I ended up with! I got lucky, all intact and implant went in on left, but I psyched myself for whatever might've happened thinking that whatever they did was going to be best for my body.
Denise, as for not holding it together right now - 1) you've already been doing this for a long time and there is a point (or several!) where women just hit the wall with the whole thing - you want to be DONE with all this, right!? No one can blame you. This is so draining, physically and emotionally; and 2) I am finding the surgery difficult b/c it's a permanent alteration of my body. Yes, there were physical changes w/chemo, but hair grows back and skin gets more supple and your cheeks get rosier . . . once you remove breasts, they're gone. I'm doing great and know that this was the right decision for me health-wise, but it's hard to wrap your head around some days. I know it gets better though And no, Pinktober does not help. I found it annoying even years out from my initial DX when life was relatively easy and uncomplicated!
Sarah
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Hawaiik - yes alot of us have taken before surgery pictures and during and after the whole process. There is a picture forum - on a different site where many of us have posted photos, to help others going through the process.
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Denise-I agree with SAOlsenberg. You need to believe that it will go the way it is supposed to and just be a little prepared if the plan changes. If there is one thing I have learned on this BC journey it is that the plan often changes. I think it is good for the PS to make sure we understand that sometimes things happen to change the plan. Mine kind of mentioned it in an offhand way and I did not gie it much thought. Therefore I was not prepared to deal with the last 4 months in "expander-land"
I am having my exchange on the 27th so we will be recovering at the same time.Feel free to PM me if you have any questions. I sometimes get lost on these threads and don't always make it back right away. Hang in there.
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Ginger and Sarah, Thank you both so much for the words of encouragement. I'm feeling much better emotionally. Maybe it's because my daughter is home for fall break. It's always easier to put my worries at bay when my house is full. I'm trying to remind myself of all the positive instead of thinking about all the things that can happen. I'm just ready for this to be over. Sarah, since you have had this procedure, do you think I'll be able to visit my daughter at college and attend football game 2 weeks postop?
Thanks again, I feel better since discovering this thread. I don't personally know anyone going through this and there is no cancer in my family. I'm the one that gets to change my children's medical history
. Now they "get" to mark that they have a family history of cancer. UGH!!!0 -
Denise - glad you're feeling better lately - kids are such good therapy, no? I have an 8-year-old and she keeps me in the moment when she is around. No worrying about what "might be" - she needs me now!
How close are you to your daughter's school? You may be fine to do that 2 weeks post-op, but I would've been much too tired. My surgeons warned me that the fatigue would be intense, and I was still very surprised by it - I am 42, in excellent physical condition and super healthy and I felt sidelined until this past Sunday, really, which was the end of my 4th week. I did have some post-op hiccups that set me back a bit (terrible rash from an allergy to one of the anesthesia drugs or maybe the narcotics I was given for pain), so your experience could be different. The one thing I've learned in the past month is to take a "wait and see" approach for activities. Just told everyone I'd have to see at the last minute and they all understood. I hope you'll have the energy to do it!!
Sarah
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Thanks Sarah, I'm 48 and I have 3 children. The youngest and only girl is a freshman at the University of Arkansas. Five hours away. My heart is telling me that I should probably not plan on going that weekend. I hate missing "stuff", but I keep telling myself that if I get through this, soon I can claim the "new normal" and get back to life. My youngest son, (middle child), is getting married in July, so I want to enjoy every minute, (hopefully with hair!!).
Thanks so much my new friend,
Denise
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Denise, I second what Sarah said. Try to play it by ear. Everyone's recovery is different. You may have the energy to visit your daughter at college and see a football game; I would have been too tired to do anything like that two weeks out. Just driving two hours once a week to go see my plastic surgeon wipes me out for that day. So pace yourself.
This Thursday will be four weeks since my surgery and it's only in the last two days that I've started to feel anything like my "old self." Funny, I thought I was before, but now I see that I really wasn't. Enjoy having a full house! My kids are coming back home at the end of the month and I can't wait!
Best,
Stephanie/Therese 9
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Hi all,
I think it helps if you go into this whole breast cancer thing knowing that it will be a roller coaster ride - there WILL be ups and downs guaranteed and there WILL be good days and bad (and sometimes you won't even know why it's one or the other
). I've done pretty well emotionally by trying to take things one step at a time. When I'm at a tough spot or having a crummy day I try to recognize it as one of those dips that will run its course and eventually be over. I give myself permission to feel rotten and shed some tears every once in a while. So many things have gone right for me through all of this so I really try to focus on that.0 -
Stephanie - that's funny - I felt the same way about thinking I was getting back to my old self earlier...then reality hits when you try some old stuff, LOL! And Denise, I agree with everyone else - we all respond differently. I went to a small outing for about 4 hours at 2.5 wks post-op and did better than I expected. However I did not commit to that outing since you just never know.
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Denise- i was really out of it for the first 3 weeks post surgery and could never have made a 5 hour trip to sit at a football game. Would you be staying overnight somewhere? i still had 2 drains that were removed on the 14th day. It is best to take a wait and see attitude if you can. I think that is a lot to bite off so soon. I really was not myself till the 5th week and then went downhill when I started having trouble with the TE. Good luck to you!
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Okay, I think I have to decided to not count on going to Fayetteville on the 12. I'm going to do as you all recommend and just wait and see. One day at a time. I have to get through this surgery first and the closer it gets, the more nervous I get. I'm ready to get it over with, but nervous about the outcome and the fact that it is such a LONG surgery. Thank you all so much for your words of wisdom. I'm going to take it slow so I'll hopefully be ready to enjoy the holidays.
Denise
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Denise - I was FREAKING OUT about the surgical aspect of this pre-op. I haven't had any major surgery, ever (did have general anesthesia for two of my 3 lumpectomies in '01-'02 but the surgeries were super short day surgeries). My surgery was 6 hours and then I was told 2 nights inpatient (turned out to be 3 b/c of my allergic reaction issue). I can honestly say it was better than I had anticipated. Even if you have troubles (and I had a world of 'em, none related to my BMX!!) there is something to be said for just dealing w/whatever comes your way and not having to anticipate it any more. You are stronger than you know, and you will get through this, just like all the rest of us. And then you'll be on BCO, sharing your words of wisdom with other women!
As for your decision about Fayetteville, I think it's wise. It's just such a bummer to have to put life on hold for something so awful as cancer. But your eyes on the prize of the holidays will help you get through. Keep us posted on how you're doing and remember, we're all here for you.
Sarah
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I had NSMs on 8/15, and just had my last expansion of my TEs to 550CCs. One of my nipples has looked liked it is being sucked in at the bottom ever since surgery, and the other is starting to lean to the left. Not sure if this is due to wearing tops that are compressing them too much? Has anyone had that happen? Do the nipples go back to normal after the exchange surgery?
Also, my PS said that I can't wear a bra or anything tight so I don't restrict the blood flow to the nipples and develop necrosis. When is it safe to start wearing something that compresses my nipples again? I'm very selfconscious as my nipples have a lot of projection.0 -
I haven't had my mx yet...still waiting to see the Plastic Surgeon. I wanted the fat grafting, but it seems that it might not be an option for me right now. I really like my new breast surgeon and there is only one plastic surgeon she works with, whom I'm waiting to see. He doesn't do fat grafting, but know it can be done at a later time elsewhere, hopefully. But, for now, I wondered if I can have the nipple sparing mx with immediate reconstruction. Do they have to go under the muscle for this? Couldn't they just slip an implant inside the breast shell? I only want to be a modest size B. I would love to have it all done in one surgery. From what I read the TE's are painful and uncomfortable...for a loooong time.
What exactly do they put in the breast for a nipple sparing mastectomy...sorry for not reading all 89 pages...probably should.
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Hi Evebarry,
I had a nipple sparing bmx with one step reconstruction almost 6 weeks ago. I can't say with any certainty what all the possibilities are but I can tell you about my experience. My breasts were a large B, small C and I wanted to remain that way. I have Allergan Natrelle style 15 silicone implants. They are under the muscle because the skin of the breast, without any breast tissue would not support the implants. I also have Alloderm slings. My nipples remain in the same place they always were but one had to be removed after the path report showed some dcis too close to areola. The implant was able to remain and still looks good but reminds me of a Barbie boob.
Caryn0 -
Im scheduled to have direct to implant surgery on Dec27th, BMX. My surgeon does not use alloderm. Not sure how she does it. I am a small b cup. I think a Barbie Boob would be ok , are you ok with it? I am not a candidate for fat grafting. Not enough tissue. I am looking forward to being done!
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Hawaiik,
Well, I would have rather kept that nipple but not at the risk the dcis posed so in that sense, I'm fine with it. With clothing on, no one can tell. As I still have to have chemo, I'm going to wait to decide what to do, if anything, about it. I am considering a 3-D tattoo because right now additional surgery sounds very unappealing.
Caryn0 -
Caryn, did you have to have a TE? If you chose to be small then I see no need for expanders. What is your pain level? Do you feel like you are wearing a bra all the time? Is it possible to take it out later and do the fat grafting?
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Evebarry,
No, I didn't have TE's. I think that it is not only size that allows for one step reconstruction, but how much skin can be spared during the mastectomy. As I said, I have no medical expertise so these are great questions to ask your ps. My pain level has been very manageable and continues to improve. The tightness, of the stretched muscles and the Alloderm has improved considerably. I never looked in to fat grafting so can't answer that question.
Caryn0 -
Caryn, sounds like our diagnosis and surgery choices are very similar. My largest tumor was at 4cm before I got started with chemo. I had chemo first and now surgery is scheduled for Friday. Plan A is to have bilateral NSM with immediate reconstruction using alloderm and saline implants. I'm a D-DD and I hope to be a C when all of this is over. What can you tell me about surgery? Pain, drains, etc... I'm getting very nervous as the time draws near.
Thanks, Denise
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Denise,
I have silicone implants, but I think the immediate aftermath of the surgery is about the same. Every ps seems to be different but I only had one drain on each side, more of an annoyance than a pain. Overall pain was easily controlled once they stopped giving me morphine which I am, apparently, sensitive to. My chest was tightly bound by a tube top like bandage. It was really tight but bearable. My fear of the whole experience was worse than the reality and I suspect that is often the case. After 10 days my drains came out as did the tight bandage. Ahhhh, what a relief. I tired very easily ar first but got better week by week. I did have to have surgery again at week 5 to remove one nipple and implant port. That was a bit of a set back, but I'm 10 days out from that and starting to feel more normal. Chemo starts next week Try not to worry (hah!), you will be fine.
Caryn0 -
What is Alloderm? You were able to have a one step process...why? Why doesn't everyone choose the one step process? Does the nsm take the same amount of surgical time since it too goes under the muscle? My appointment with the plastic surgeon is next Monday. I have so many questions.
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Evebarry, Alloderm is a sling device that the saline/silicone sets in. I have been told to expect an 8 hour surgery. 4 hours for the breast surgeon followed by 4 hours for the plastic surgeon. I certainly don't know all of the answers, but one reason not to do the one step is if your skin cannot be saved. My PS will have both the saline implants and the TE's in the OR suite just in case we have to go the route of the TE's. I chose the one step hopefully to keep from having to have more surgeries and also because I live 2 hours from my PS.
I don't know if that is much help. I feel pretty helpless right now.
denise
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Evebarry- Alloderm is actually human tissue grafted from cadavers. It is used in a lot of different ways. Of just breast reconstruction. In breast recon they use it as a sling to support the implants and can use it over the entire breast as an extra layer. It is extremely expensive and not all insurance will cover it. There is also a small increase risk of infection. My PS used it when she placed the TE's and during exchange, though, and I didn't have any problems.
Also, some PS's won't do one step on radiated skin so that may be why some women do the TE's. The skin, and pecs, can be stretched very gradually.0 -
Just to jump in here - also, Evebarry, some PSs don't have the experience w/one-step, so they won't do it.
I chose "one step" b/c I wanted a "quick and dirty" answer to reconstruction - it's still a 6-8 week recovery time, but provided there are no complications, that's pretty short compared to say, a flap reconstruction. And FWIW, I have a prior-irradiated left breast and we had no issues placing the implant on that side - it just depends on your specific situation. PS did warn me ahead of time that I might see a TE on that side if things were too tight to place the implant.
Sarah
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Thank you all for jumping in on the Alloderm and one step. Evebarry, as Denise said, even if one step is what you prefer, it may not be possible due to what the situation is at the time of surgery, so I imagine that most ps's have TE's on hand if they need to go that route. You've asked many good questions so make sure you write them down so you can ask your ps.
Caryn0
