Nipple Sparing Mastectomy with immediate reconstruction
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Evebarry- I was supposed to have NSBMX with immediate reconstruction but woke up with expanders instead of implants. PS said my skin was looking too stressed after breast tissue was removed. My advice is to hope for the best and know there is a chance the plan will change.Good luck!
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Thanks for your responses. I have so much to learn in regard to reconstruction. I've watched a few u-tube video's on reconstruction. What you've shared helps me to be open to whatever is presented to me. The idea of hard rocks in my chest, and the length of surgery, healing is not all that attractive to me. The idea of no breast is worse. I feel like, literally, I'm between a hard place and a rock.
It might be a little easier for me because I never did rads. Not to be rude, but I'm not sure I want someone else tissue in me... Besides, wouldn't your immune system attack someone else tissue?
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Eve, the alloderm is treated to remove the donors' own cells, which bear proteins on the cell surface that are most likely to be triggers of rejection (attack by your own immune system). It is basically a lattice of "extracellular matrix" (collagen and other fibers) that your own cells will fill in and grow on (as I understand it). But some people do have a bad reaction to alloderm -- this might also be an allergy to an antibiotic the alloderm was treated with.
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evebarry - Allergan is currently in clinical trials with SeriScaffold, which is a support matrix made of silk rather than human donor tissue. I don't know how many plastic surgeons are taking part in the study, but here's a link with some basic info:
http://clinicaltrials.gov/ct2/show/NCT01256502
Regarding the immediate placement of implants - according to my BS and PS, tissue expanders placed at the time of mastectomy put much less stress on the breast skin, which is potentially in shock after having much of its blood supply removed along with the breast tissue. They feel it gives the skin a better chance of recovery and survival than having the envelope filled to maximum capacity with an implant immediately after mastectomy. That said, I have read both happy success stories and stories of women who have had complications (infections and healing issues requiring removal of the implants) with the immediate implant technique. I believe there is a thread dedicated to this type of reconstruction.
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Exbrnxgrl, may I ask you a question? Are your implants comfortable? Thank you in advance.
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This is my first post. I am 40 years , after mammogram I did Biopsy and was diagnosed on August 19 with Ductal carcinoma in situ and microinvasive ductal carcinoma . High nuclear grade, measuring 0.15 cm. The DCIS is of intermediate to high grade, ER and PR positive , NER2/NEU negative on left breast. I did MRI and MRI show calcification on the same breast 2 cm from first DCIS Then I did MRI biopsy on September 23 and result was again DCIS . Also I did genetic testing and I am BRACA 1 positive. I feel so bad . After I was diagnose I went for second opinion and they tell me the same. My BS said I have two option MX or BMX then I went for consultation to PS and he said I don't have tissue for flap recon and I am good candidate for nipple - sparing with one stage immediate reconstruction. I decided to do BMX with one stage immediate reconstructions. I was ask BS if we can do surgery after Christmas he said no he would not wait so long, then we ask to do surgery beginning of November . The reason we ask because we have difficult situation as my husband have retail store and this is a Christmas season, he will be very busy and also we have 13 month baby girl. Today I received a phone call from my BS that they can do surgery on November 21. My concern is if they can wait almost month from today before surgery, is one more month make a difference? If anyone have the same situation. When usually surgery done after diagnose? Also I am a very early stage and I am afraid if it's can grow and will be more invasive. Please help. I am very frustrated.
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Ella, if it is early stage, especially dcis, then it is slow growing. I waited 2 months for two different dx's and I wasn't the worse for it. About a month ago I was dx with idc, with the her2+++ factor and the surgeon doesn't seem to be in a hurry to schedule the surgery. I still don't have a surgical date. Because the area is small I think she feels it's not going to spread so fast.
Because I have had 4 bc dx in the last 3 years the bc surgeon is insisting on a brac gene test, and a test for the Ashkenazi Jew gene. I am sorry you tested positive for the gene. I've met someone who had a blmx as a result of the Brac gene...although she was never dx with cancer.
Hope it goes well for you.
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Thank you for your reply. My Ashkenazi Jew gene test was negative, however next test come back positive. I was think too that is will grow slow, however both BS suggest do not wait until January and no reason provided. I am so scary . I was think to do lumpactomy before my test and when test comback positive I desided to do BMX. I think I don't have other choices.
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Hi Ella. Have you gone for a second opinion with a different BS? If you're not happy with the care you're receiving so far with this BS, and that includes the way they're speaking to you and treating your decision-making processes, you should definitely consult elsewhere. If nothing but for peace of mind as to what has been recommended for your diagnosis.
Best of luck to you.
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Ella- So sorry to hear of your diagnosis. I know how overwhelming this can all be. If it helps I was diagnosed the end of December and didn't have my mastectomy until mid March. Some women live their whole lives with DCIS and it never becomes invasive. I don't believe 6 weeks would make much of a difference. It sounds like doing the surgery at the beginning of November is what works best for your surgeon, not you. (((hugs)))
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Hello to everyone on this NSS thread. I was diagnosed Oct 4th - I have multi-focal mixed IDC and ILC in right breast. Tumors are 2.5 cm and 1 cm. Stage 2, Grade 2, ER+ PR+ HER2-. It was tough news to receive and hard to process, but I am through the initial shock and, like most women here, working to educate myself and find/give support to other women in this position.
I was thrilled to hear I am a candidate for NSS. I was doubtful that I would be as one of my tumors is less than 1.5 cm from nipple. ( I realize there is a chance I may lose the nipple if the path tests show cancer in nipple.)
I had not heard, prior to coming on BCO, about the one step breast reconstruction option after NSS. I thought up until now that the only option was tissue expanders. I had started a separate thread called "Tissue Expanders vs Implants" or something like that, but now realize it is redundant with the information and issues discussed here.
I have an appt with another PS on Monday so will ask him about the implants instead of TEs. I read today an article about implants being inserted immediately after NSS. I have copied part of the article below. Does anyone know what the article is talking about when it refers to "acellular matrix grafts" used to create an internal bra to support your new breasts??:
During a skin and nipple sparing mastectomy (followed by immediate breast implant based breast reconstruction), breast tissue is removed from both breasts while leaving your surrounding skin and nipple areola complex intact. Lost tissue is then immediately replaced with breast implants which are appropriate to your body type.
Skin sparing and nipple sparing mastectomy also aids breast reconstruction by allowing a plastic surgeon to address each of your concerns in one procedure. For example, prior to inserting your breast implants acellular matrix grafts are used to create an internal bra which offer lasting support for your new breasts – avoiding the lengthy, and often painful, tissue expansion process.
This differs from breast reconstruction after traditional or modified radical mastectomy – which entails removal of the skin, nipple and possibly muscle tissue – wherein your remaining skin is pulled taught and (once the area heals) is typically insufficient to provide cover and support for breast implants. Tissue expansion is then required to create a pocket along the chest wall, stretching the skin over time. That process alone can last six months.
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hi welcome to all of you and yes, it does suck! I did this in 2011 so I will add a few words, I really really looked and decided I wanted one step ns immediate reconstruction which I did (size 36a before and made the decision to stay the same size. Other than fat grafting which is controversial, overall I feel that this is the best solution if you are going to have a bilateral (stage 1a ca in ny case with a hx of mother, aunt, greatgrndma, and dad's mom...). My body my decision.... Anyway, I have a pretty active job and felt I could go back to work in 3 weeks but my doc said stay out 1 more week which I did. I started physical therapy with in 2 weeks following surgery. Yes, it was painful and miserable at first (1 week with drains and misery) and yes, its not perfect . I do have weird pains (honesty) but I must say all practicioners comment that I am the best looking bilateral they have ever seen. I change in the gym in the open because unless you are really staring I don't think you can tell. Also I am a really busy person with a career and family and I wanted to give surgery a once not a twice ...... this did allow me to do this. I also believe the less time we spend under general anesthia the better (my total surgery was no more than FOUR hours) so again if this helps someone it was worth the efforts.
Good luck all and take care,
CR
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I had second opinion in different hospital and different BS. I am in the best hospital in Boston Dana Farber. Maybe I have to talk again to my BS
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amsk - Hi! The accelular matrix grafts are Alloderm. If you do a search here on BCO or just Google it you'll find lots of info about it. Also, here's a thread specifically about one-step reconstruction with Alloderm:
http://community.breastcancer.org/forum/44/topic/736507?page=86#idx_2560
Best wishes!!!
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amsk- Like Tina said, the accellular grafts are the same as Alloderm. Alloderm can be called lots of different names but it is all basically the same- it is human cadaver tissue. Here is an exact description from the Alloderm website-
Donated human skin tissue supplied by US AATB-compliant tissue banks is aseptically processed using LifeCell’s proprietary technique to remove the epidermis and cells that can lead to tissue rejection and graft failure. The result is an intact acellular matrix of natural biological components that promotes rapid revascularization, white cell migration and cell repopulation, as shown in animal studies.0 -
Hello to everyone . I just received phone call from my BS and he is saying that this is our choice to do surgery on November 21 ( when is first available) or wait til January however this is not really good time for us with Christmas season. This is very difficult situation. Is anybody knows if I can do some test to see if my DCIS with microinvasions growing to understand if will be not to late first week of January. I know that this is long time since I was diagnosed Aug 19, but maybe its does not make any difference and really important for us. But also I don't wanna take a risk. I am so frustrated. Please help.
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Ella - you are hormone positive, so perhaps you could start on Tamoxifen in the interim if you do decide to delay? I have been dx'd with first cervical cancer, 12/2/2008, then breast cancer, 12/15,2010. In both cases, there was no one who said it was a good idea to wait. My rad hyst was 12/16/2008 and my NSMBMX was 1/31/2011, which was the soonest date the BS and PS and OR could get together. However, all that said, you were dx'd in August. It may be slow growing, but waiting another 30-45 days might be the difference between a node being positive or more nodes being positive. It could mean going to a higher stage and then indicating chemo. It just depends if you are willing to gamble on this. Only you can decide if it's right to postpone.
Christmas season this year might just be a little different, you and your family and employees can look for alternatives to the solution or you can delay and chance it. The thing is, you may never know if it cost you personally health-wise anything. You could delay till January and not have positive nodes at all, or you could do it now and already have positive nodes. One other thing to consider as we are approaching the year end is insurance. You may have already gotten your co-pays and deductibles and such out of the way, and it could cost you more money out of pocket if you wait till next year. Or maybe you want to have everything in the next year cost wise. Anyway, another consideration for you.
Amsk - my understanding on the one-step procedure that does not use TE's is that it does limit you from a size perspective. Alloderm is very commonly used, with TE's, with implants, etc. Also, I think if you might need radiation you may not be a candidate for one-step. This is a fantastic web site to learn about the latest in procedures and where to find docs that are doing it and patients who are pleased with them. I encourage you to find out all you can!
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Here is a great article on medicalnewstoday.com regarding nipple sparing mastectomies. One thing that stood out was it said that studies have shown "women are psychologically better off in terms of self esteem and sense of self than those who have had their nipples removed". Hopefully, more and more surgeons will start training in this procedure.
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Kate - thanks for the article!
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Kate33 - Thanks! Just about every time I look at myself in the mirror I am reminded of how lucky I am that NSM was available for me. It hasn't been all smooth sailing, but I'd do it all over again without a second thought.
I had a discussion with my local BS a few weeks back and asked how many patients she is "sending away" for NSM (sadly, not done in this area). She said she refers as many as possible, but many of her patients are either uninsured or have bare-bones insurance and often are diagnosed way too late, their cancers are large, and they are not longer candidates. She also realizes that traveling a distance for surgery takes a real time and financial commitment that, sadly, many can't manage.
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Thanks for the article Kate. Since both the BSs I consulted recommended this procedure for me, I didn't think much of it as being a newer type of option. I guess I didn't realized how lucky I was to be a good candidate for it. I was still reeling from the DX of BC to begin with... but the more I read now, the more I realize that it's not as common, or at least not yet. Good to know.
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I had a NS/PBMX in March in NY. I wanted to have the least number of surgeries possible and this seemed to be the best choice for me. I had silicome implants at the time of the surgery and also had Allo-Derm. I did require minor revision surgery in September to correct imperfections.
While there has not been enough time to see the final results from the revision, so far everything looks quite grand. I think most ladies find the Allo-Derm to be quite satisfactory and also pleased with the direct to implant surgery.
I am happy to answer any questions you may have about the proceedure.
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Hi Sandy 105 and others who have had the one-step implant procedure:
One question I have is whether the implants are inserted under the muscle when Alloderm is used, or over the muscle. Or - do different PSs do it different ways?
I know with TEs, they are placed under the muscle.
I wonder why more PSs don't offer the one-step reconstruction with implants. Seems like the vast majority of drs use TEs. I called Cleveland Clinic about the one step reconstruction and they reacted like I didn't know what I was talking about and had never heard of such a procedure! I am going to try to contact Sloan-Kettering to see if they offer this procedure. I am in Pittsburgh - so if anyone knows of any PSs in my area offering the one step reconstruction with Alloderm, I would certainly be interested in learning the names of those PSs. Thanks everyone.
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sandy105--I am interested in fatgrafting in new york. request name of your ps in new york, who did your ns/pbmx--since your results worked well--would like to find out if this PS does fatgrafting as well. thanks, eileen
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Amsk and Eileen,
In direct to implant MX, the implant is placed under the pec muscle and the Allo-Derm is used to form something similar to a sling to hold the implant in place. The Allo-Derm attaches itself to your own tissue quite soon and becomes part of your body. There is a good picture of the Allo-Derm on the Allo-Derm web site. I cannot remember the link but will be happy to search for it for you if you cannot find it. Just send me a PM if you need me to look.
I believe many PS and BS do not do the direct to implant surgery for it takes time to learn how to do the proceedure and many have learned to do TE's rather than the one-step. The direct to implant is also not a suitable surgery for some ladies for it cannot be done on very large breasted patients. I also believe it is more difficult to perform but I might very well be wrong in this thinking.
Eileen, I did not have fat grafting. I had direct to implant with immediate silicone implants at the original surgery. I did have some "fat transfer" at the revision surgery. This was lipo and the fat obtained was transferred to the area above the implants in areas where I needed more "fat." I don't think this is the type of fat grafting of which you are speaking but it could possibly be.
My PS in Andrew Salzberg, MD and he is is Westchester, NY. I am happy to answer any questions anyone has about my surgery or my results. Please feel free to send me a PM if you need any other information!
Sandy
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Amsk, I have AlloDerm and my TEs were still inserted under the muscle. It may be because the AlloDerm only covers the bottom third or so of the breast.
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amsk - how is UPenn for NSM? I know they are a pretty cutting-edge teaching hospital - might be worth checking it out, although I haevn't been treated there, (my sister does preventative measures/monitoring there) ... just some advice to check out...
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Next week I have appointments with 2 different Plastic Surgeons. What are good questions to ask? Did most of you stay over night in the hospital after the mx with reconstruction? How many nights? Does one procedure differ in the recovery time, the one step or TE. I am now considering the TE until I find someone good who can do the fat grafting? Are you flat when you come out of surgery? How much pain with the one step compared to the TE's.
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WOW !!!..just wanted to share one of the first LONG term studies released in support of NSM, very validating indeed. I'm sure u will all agree.
Georgetown Researchers Examine 21-Year Series of Nipple Sparing Mastectomy Cases and Find No Cancers.
http://explore.georgetown.edu/news/?ID=60002&PageTemplateID=295
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Hey LisaMG - thanks for posting that - couldn't get access thru your link, so for others, here's another link to the release: http://news.health.com/2011/10/27/nipple-sparing-mastectomies-may-be-right-for-some/ Always nice to hear news like this!
Sarah
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