Nipple Sparing Mastectomy with immediate reconstruction
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SooCee - I would definitely get an elevated commode to put over your toilet so that you don't have to get up and down from such a low surface. That will make it a bit easier on your legs, but if your legs/back are really bad, you still may need your arms...definitely talk to your surgeon about the restrictions and your particular situation.
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I saw the BS today and asked for her take on mammograms after MX and implant reconstruction. She said, "Mammograms are useless. Physical exam - first line of defense. If anything odd is felt do an ultrasound, then an MRI, then biopsy if necessary...NO mammogram". She seemed pretty adamant about it!
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Another interesting topic came up at my BS appointment yesterday. My NSBXM was 9 months ago. She asked if I have any feeling back in the nipples yet and I responded, "Yet? I figured if it hasn't happened by now it's not going to happen". She does LOTS of NSM and encouraged me to be patient - some women report return of sensation 2-3 years post-MX. I don't believe it's a "feel good" kind of sensation, more a sensation of touch and/or pressure, but it's something.
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Hello ladies! I finally have a firm surgery date scheduled for my NSS BMX of next Monday, November 21st. I am very happy to be getting it done sooner rather than later (last week it looked like I wouldn't be able to get surgery scheduled until mid-December).
I have a concern that the 2 tumors in my rt breast seem to be expanding even though my cancer is supposed to be slow-growing. My right breast is swollen, tender and painful. In fact the pain woke me up last night even though I was sleeping on my left side. I am concerned that the 2 biopsies I had may have enabled the tumors to grow.
Anyway, one tumor is close to the nipple. My BS has told me I am a candidate for NSS - but I guess I won't know for sure if they are able to save the nipple until after the surgery.
I am wondering what other women who have had NSS BMX have decided to do with the nipple on the non-cancerous side if the nipple on the breast with cancer cannot be saved. I suppose I would have the option of having both removed - for symmetry. Or is the nipple reconstruction good enough to match my real nipple? Interested in your thoughts. Thanks. amsk.
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Amsk - I had the nipple spared on my R side (which we thought was prophylactic - ended up having DCIS but not too close, so I was able to keep it). We also tried sparing the L areola, but when pathology came back, found out DCIS was too close (dirty margin). So, I had a 2nd small surgery to remove the L areola - today in fact!
So now I have one nipple, one not. I made a mold of my nipples prior to surgery via www.naturallyimpressive.com, just in case. So now, I will have a silicone nipple I can wear that should match my other side very well. I may or may not attempt nipple recon down the road.
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Help!! I'm not on here much as my exchange surgery was 13 months ago. Now it seems like one of my nipples is off center (always has been just a bit), but now seems quite noticeable. Like it is pointing to the right. The implants have not moved. How could it move? Any ideas?? Do I need to see PS?? And what could he do??
Hugs, Valerie
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Hey Valerie - my nipples have never been pointing the same way - a result of surgery to my L breast 10 years ago - BUT, my PS mentioned to me at my last appt. that in 6 mos. we will visit the idea of "general housekeeping" on my foobs and their surroundings, and that she can "tack up" the right side a bit so the nipple will match the left much better. So I think it's definitely worth a call to your PS, especially if it's bothering you!
Sarah
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Hey Sarah- that is good to hear since we have the same PS and mine are definitely pointed more towards 10 and 2 o'clock. I will have to ask her about that. I am just so happy to have them that I was willing to leave them that way.
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Hi Ginger - yes, it's pretty amazing what they can do, and I don't even think this is that complicated. To do that and to lipo out the fronts of my armpits where the implants are making a bulge would take "no time" she says, although I would need general anesthesia - but likely no intubation, right? I might go for it - but not going to worry about it 'til May. For now, getting my life back in order after all this junk!!
Sarah
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Hi all,
Despite having lost the left nipple, the implants are looking great. As time passes they look more and more natural and pretty much like me, which was my goal. I was wearing a fitted sweater today, no bra, and no one would have known that they weren't the real McCoys. Given my issue with a collapsed lung, I'm very grateful to have skipped the TE phase. I was quite scared to touch them for a long time but now do regular massage. If you are a candidate for one step nsm, I say go for it.
Caryn0 -
Asked this question on another thread but this is probably the better place to pose it. Is it possible to have NSS and delayed recon? I would think not - but thought I would ask the question.
(There is a chance I will need radiation - which would probably incline the PSs to delay recon; however, I would love it if my skin and nipples could be saved.) Thanks. amsk
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amsk
That's a good question - I would ask your BS. Maybe a temp implant/expander can be put in that is rad friendly?
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Valerie- So funny you asked this question. I just had a consult with a PS in Beverly Hills who said mine are slightly pointing out, too. He said this happens when the implants are placed too close together. Not sure if this is what happened in your case too. He said over time they start pointing out. He said a lot of PS's will try to get them close together to create cleavage, especially in MX patients who don't have breast tissue in the center. If I do another procedure he recommended swapping out the implants and moving them a little farther apart and then filling in the cleavage with fat grafting.
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To Tina T, with regards to nipple sensation returning, i now have positive/pleasurable sensation 15 months after my NSM. Its amazing and, yes i agree with your surgeon in that it takes time and not to be expected. I first noticed sensation very early on after my initial surgery, but in retrospect it was probably "phantom" pain and then nothing for a long time. I would have to say 12 months or more seems about right so, time is on your side!!
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Sarah - thanks for the input. I will ask the PS next time I go in - which isn't until Jan.
Kate -my implants are really close together!! They looked fine at first - but really do I want to have surgery again? I thought I had done something to cause it - like lifting weights etc. - oh well I'll ask next time I go in.
Thanks, Valerie
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Hey all - I had a UMX NSS with immediate TE insertion in June, had the TE removed in July, and ended up with a mess of scar tissue under the nipple and in part of the nipple - so I had to move to a flap option, and went with DIEP... and a new PS.... 10 days ago I had a NSS proph UMX and a double DIEP... my proph side looks sooooo good - the nip still has a bit of a high beam even, and the other side, well... the PS had to remove the nipple because it was too badly compromised, but he straightened out the nipple after removal, and skin grafted it back on... I am so happy to have both my nipples still.. too exciting.. Phase 2 (in about two months) will be shaping of the breast and a breast lift on the proph side, and some work on the permenantly low beam skin graphed nipple.... NSS rocks...
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Valerie- I wouldn't have a revision just for that but was having some other issues which is why I had the consult. He thought PT would help with those but if not he would revise and would fix the closeness of the implants at the same time. I'll be curious what your PS has to say about it. Good luck.
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LISAMG - Wow, that's fantastic, so happy for you! I have posted this question on various threads here periodically and haven't gotten much response except that some have sensation, but that it doesn't necessarily feel good. Same as you, I was excited that I felt "something" after MX, but it totally went away after a while. I believe I read somewhere along the way that the MX incision location can make a difference. What type of incisions did you have?
Kate33 - Sorry you're still having issues. What a long road you've traveled. I 've always wished I had a bit more cleavage, but I realize the nips just wouldn't be positioned quite right if I did. NSS is wonderful, but doesn't afford us as much flexibility to "recreate" ourselves.....not that I'm complaining!!!
Just_V - Wow! So good to hear from you. Amazing...removed and repaired that nipple and grafted it back on? Pretty cool!!! Best wishes for an uneventful recovery. Congrats!!!
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TinaT , my incisions are lateral inframammary, under the breast folds and away from the nipple / areola complex. Not sure if this makes a difference, but in my case its certainly had a positive effect with the return of sensation. Its been 15 months since my mastectomy and 12 months exactly with my exchange. Remember, good things come to those who wait. Good luck, time is on your side!
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Valerie - I have the same issue. My nipples are off to the sides, and seem that they have drifted more in the past months. It bothers me somewhat, but I figured I could live with it till the implants need to be replaced someday. I think my implants might be too close together, I have cleavage and it looks good/normal, but when I press in the mid area of it, my skin isn't laying perfectly flat,it's like it's lifting a bit from my chest wall, do you experience that at all? I assumed because my chest wall is narrow, that this was just a "side effect" of that. I think we have the same implants 450's HP?
I am interested in what you added, Kate, the consult you had and the way the PS could alleviate the problem sounds awesome! I'll have to look into it when the time comes for me to swap these babies out. I definitley will swap out my implants for smaller ones and more FG at the least, I'd hope for just 100% FG, ultimately. I am satisfied with the way they look, but now about 8 or 9 months from exchange I think I can feel the "weight" of the implant. I was so small-breasted before and I do feel the awkwardness of the implants 'in there'. It's nothing I'm willing to go and have surgery for just yet, I just can feel the "fakeness" of the implants inside now... I'm just starting to feel like I'm getting back to life and not fixating on the BC/boob stuff so much...
I hope you all have a great Thanksgiving!!!
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fire-dancer- That gives me hope that you are "getting back to life and not fixating as much on the BC/boob stuff"...that is my goal too!
Happy Thanksgiving to everyone!
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Ginger, it's been a long year, my BMX was just about a year ago and sometimes it seems like yesterday. My hub and I sometimes reflect over the past year and amazed that it actually happened...much of it was a blur...but I've noticed more "normalcy" enter into my life in the past couple months...we all are going through/have gone through some huge life-altering stuff, I think it takes time to put bc/bmx/implants into that "place" where it isn't always so up front and center in your mind, it sure has for me...you'll get there too! :-)
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I had lump and rads and am at high risk for local reocurrance so I am choosing to do a BMX with immediate reconstruction to eleviate the every six month mammo's and MRI's. Because I have already been radiated it is an issue. I have interview 3 PS's and decided on the one I am going to use and feel so good about it. He is the only one that felt that he could save my radiated nipple and he said if it does fail he feels that he can match my existing nipple which the other 2 PS did not feel they could do because I have rather large nipples for my small breast. I am also very small and thin. I won't be having it until March because they wanted to wait until I was one year post rads and then my boss will be gone. So 2012 will be year of crossing the finish line with BC. I feel a huge weight off of my shoulders know that I can reduce my local reocurrance rate down to 2%. My distance recorrance rate is 14%, but I figure I can live with these numbers and not think a BC all the time. Am excitied to have made my decision but now for the wait.
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LISAMG- My incisions are in the same position as yours but have had no return of sensation 18 months later. Not sure why some of us do and some of us don't.
fire-dancer- My ultimate goal is 100% fat grafting some day as well. "Awkwardness" and "fakeness" describe the implants perfectly. I feel the weight of the implants, too. (What's interesting is I read a study where the majority of BC patients perceived implants as weighing much more than breast tissue. Yet, about 85-90% of plastic surgeons say there is no difference.) It's definitely gotten a whole lot better with just one round of fat grafting, though- night and day.
Sherry- Since you've got time you might want to research fat grafting for recon as well- either as an adjunct to the implants or total fat grafting. Research shows that the stem cells in fat grafting can actually help repair radiated skin. Unfortunately, the majority of PS's aren't trained in fat grafting so it can be tricky to find one in your area but it might be worth checking out depending on how much rads damage you have.
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As far as returned sensation, I have a remarkable amount, considering I assumed I'd be numb all over forever...I would guess I can feel @ 40-50% in areas around the breast. As far as the nipples go I have sensation, but it is completely not enjoyable, if you know what I mean
. Actually, it can be painful, like when I take a shower I don't let the water hit my nipples directly, it hurts in a wierd way. I am super-grateful for my nipples, but am not crazy about the type of sensation that is a result.Kate - I only had a small amount of FG, like 25 cc's each side. I wear some kind of bra pretty much 24/7 and that part is a drag, but without it I feel the weight of the implant. Also in conjunction with the return of more sensation (?) I just notice the awkwardness more I think, not sure if that's it, but I can "almost" feel them in a bra - hard to explain but I think you get what I'm saying ;-) I'm thankful for no pain issues/CC issues, so I'll stick it out for a while and keep following the FG trends, I am hopeful though that I will replace these someday, and am looking forward to that day, but for now I can live with it...I must say your experience is remarkable and very exciting for me to read about, you really research and educate yourself (as well as others :-) on FG, so Thank You!!!
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Kate yes my PS is going to do quiet a bit of fat grafting he also said that if my radiated tissue is healing slow he will send me for hyperbaric treatments to promote healing. I feel really good about him and have heard really good things.
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If we find that the implants are uncomfortable will our insurance pay to have them removed and then do fg? Can it be half and half? Once you have the fg done can you later add to it with fg? I don't want to be large, just a size b so I'm hoping I won't feel the weight of fake breast.
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fire-dancer- I also wear a bra 24/7 otherwise it's too uncomfortable. I've got almost 100% sensation return around the diameter outside the breast, about 20% on the breast itself and nothing on the nipple other than that almost painful feeling you describe in the shower.
Sherry- That's great that your PS is open to, and trained in, fat grafting. Most are not so lucky you for having one in your area! Good luck with everything!
evebarry- I'm sure every insurance company is different when it comes to the fat grafting. I have United Healthcare and they covered removing the implants, replacing them with smaller ones and a round of fat grafting over the top. If you do end up doing this I would say your implants are painful rather than just uncomfortable but, yes, insurance companies are supposed to pay for all revisions, too. Also, yes, you can always add to the fat grafting and you can do half and half. Some women do not have enough fat for entire breasts. I just had a consult with a PS in Beverly Hills, Dr. Lawrence Koplin and he said he actually prefers to do it this way- implant + FG. He said otherwise it can take too many procedures plus having to use the BRAVA system and this is too much for a lot of women. The majority of PS just use FG to fill in divots and such. More now are using it to supplement implants in BC patients who don't have any breast tissue. There can be issues with the implants being right under the skin. And now a handful of PS are creating entire breasts using just fat. So depending on what you want to have done you have to ask your PS which they do.
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firedancer - I have cleavage too - I think when I press in the middle that it is flat, but I do think the implants must be a bit close. I do have the 450's and a small chest wall. I think I will just leave it be, but am also thinking if I ever have to get these replaced I will go a bit smaller, it has taken some time to get used to them
I too have a weird, not pleasurable sensation when nipple is touched, it's like I can feel the pressure - oh well. Happy Thanksgiving!!0 -
I just found something interesting on a PS website. It addresses cleavage determinants for augmentation patients, but it seems it would apply to reconstruction as well. Helps to explain why chest/ribcage/sternum configuration dictates the amount of cleavage we might end up with after surgery.
http://www.advanced-art.com/Breast-Aug-Cleavage.htm
(I am posting this on a few of my threads so forgive the repeat...)
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