TEs. A Beginner's Primer
Comments
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Hi BethL, I've had this twice: both with the BMX and the Exchange. For me, it didn't poke through the incision, it was something to do with the way my PS closes off his stitches.
I was given the same instruction: don't pick at it. I didn't pick at it, but it did start to catch on my clothes and washcloths. At my 5 week post EX check up I asked if it could be removed (b/c my next appointment was 2 months after that). PS said that nurse could cut it off. When the nurse went to pull it out a little, so it could be flush with the skin, the stitch came out on its own. So it had already dissolved inside and was hanging by the incision scar.
Another former breastfeeding mom. My children nursed 24, 18, and 13 months. Each weaned themselves when ready.
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had my first fill today, 50cc, and they removed 50cc air from each which was placed during surgery. I'm over the muscle and found it to be painless aside from feeling the needle poke on my left side.
Funny, just that little amount is noticeable. Made me a little rounder rather than lumpy!
I'll go back in a week for another similar fill and then every 2 weeks until I'm done. I don't think that will be long as for sure with next weeks fill I'll be bigger than I was before surgery!
Hope everyone is doing well
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Congrats on your first fill, Jessie!
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Hi ladies! I'm considering delayed reconstruction, and tissue expanders scare me! Can any of you tell me about how long after your tissue expanders were inserted that you could resume normal activity? Is there any special things you had to avoid doing? Have any of you had fat grafting before hand? Thanks so much for the help! Xoxoxo
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littleblue. . .my story probably won't equal since the recovery from delayed reconstruction is different from BMx with immediate recon which I had. I was not cleared for any exercise until after I went back to work. About 12 weeks then I was allowed to start getting on a 'treadmill and hiking. No lifting for about 4 Mos total then working up from light weights. I had my TEs for almost 8 Mos so that I could conveniently schedule my EX. After erchange. . .no exercise for 4 weeks and no lifting for 8 weeks. I am now almost 8 Mos post EX. I walk, hike and lift light weights. Not as far along as I would like but working on it. Also in PT to get back my ROM.
Good luck
Scottie
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littleblue - My BMX was Aug 13 last year. I started my reconstruction journey on February 3 when my TEs were placed. I have not had prior fat grafting. I had a relatively easy time with the BMX. Even though I was tired, sore and emotional, I was back to work in 2.5 weeks. By the 4 week mark I was working out, lifting weights and feeling better than great (except for the occasional emotional stuff) I did not have to follow up with chemo, radiation or HT. Other than a pesky seroma that had to be drained twice, my recovery was pretty smooth. I was off prescription meds after a week and then quickly weened off Tylenol and Ibuprofen. From my research about the TEs, I knew it was going to be a longer recovery and more uncomfortable but I very much underestimated it. Thus far I haven't had any complications other than some weird scar tissue and really dry peeling skin. As of today I am 7 weeks out and I'm finally starting to feel sort of like myself again. I am constantly aware of the TEs but I can't really say they are causing me pain or discomfort (atleast not during the day). But let me assure you, I have not regretted my decision for a single minute! The first week I remember thinking, "What have I don't to myself!" but after that subsided and by my first fill at week 3, I was giddy over my little mounds! That day I realized just how much I really wanted reconstruction. To see some silhouette of breasts made me smile. I think each fill keeps me going because I'm excited to see the progress and thinking about what is to come. Now, I do cringe with each fill. I don't find them painful. The first one was a little weird and I felt the needle insert into the port but that was it. All subsequent fills I have felt very little if anything. I usually feel really great for the rest of the day and then in the evening I start feeling sore as if I tried to do 500 pushups! I usually have trouble sleeping the night after a fill and I'm pretty sore the next day but nothing I can't work through - I just whine a little. I have found gently massaging helps, especially at night. So in between fills, the tightness subsides and I start feeling less sore. Thankfully I had 10 days since the last fill and that has given me a nice break. I still find it most comfortable to sleep in my recliner. Sleep is difficult and I need my sleep. I took narcotic pain meds regularly for 3 1/2 weeks. At that point I cut back during the day because I returned to work. My first week back at work I was worthless but it didn't help that we were moving offices and I couldn't move or lift. At that point I took the narcotics and muscle relaxers at night when I knew I wasn't working or driving. I then took Ibuprofen during the day. Last week I finally started taking Melatonin SRT, Valium and Ibuprofen at night and that has been the trick to a good night's sleep. My only issues now are waking up! Once I'm up and showered I'm fine but the first 30 minutes or so feels like I've over worked out or been beat! The rest of the day, I plug along and most often forget to take the Ibuprofen. I started PT about 4 weeks post op and pretty quickly got most of my range of motion back. I'm still stiff but I can get there. For the first few weeks I was limited to about 10 pounds of weight (gallon of milk) By week 4 I was released from any restrictions other than "if it hurts, don't do it" and "don't over do it" I've been slowly getting back to my yoga practice and was thrilled last week to do a down dog with no pain! I This week I can actually hold a plank for a little while. I just can't lower down as if I'm doing a push up! That's just too much! I'm amazed at how much strength just evaporated. I don't know if all this info is helpful. Short answer to your question, By week 5 I felt partially normal. By week 7 I feel like a very weak version of my normal self!
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Did I read someone asked about brushing from fills? I didn't address that issue yet. But the answer is yes it can happen. It's kind of bad luck. Sometimes a vein is tucked under the skin and cant be seen readily and the PS hits it. A BIG bruise can occur. It doesn't really hurt but looks scary. My PS hit one on me and said "oh. That's going to leave a nasty bruise!" LOL. He said he tells his patients if he knows he hit it because he doesn't want them to freak when it shows up. It usually bleeds a lot in the office when it happens and the PS wipes up the blood couple of times. That's your clue! LOL. Normally only one swipe per stick. LOL and I will say, if he hadn't told me I would have freaked because the bruise 6 inches across. LOL
Much love
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Moonflwr - that was me asking about the bruising! Thank you for your response. Thankfully I've had 10 days since my last fill and all my accumulated bruising has gone away! About 2 fills ago, I think the PS hit a good and juicy vein! It was quite ugly! Glad to know that too is normal!
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Littleblue, returning to normal activity was gradual. I had the BMX with TE insertion all at once. I had nipple-sparing, skin-sparing BMX. First two weeks were hard, and I limited my lifting and range of motion activity per PS, although I started walking the day after surgery, per BS. I gradually added grocery shopping in the third week, careful nothing heavy, and I made sure the cashier packed the bags lightly. By 5 weeks I was lifting more weight, to about almost normal at week 8. That started all over again for TE to implant exchange.
Your experience may be different. You'll be recovering from "just" TEs, which may be easier than the BMX. I saw "just" because you may have less recovery or more recovery, such as skin stretching depending on how much skin was left from your BMX. You can ask PS to go slowly with the fills.
I was very lucky, I didn't have any bruising from fills, just from the BMX.
Yeah for everyone's progress!!
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Thanks for sharing ladies! It helps to hear peoples experiences so much! Xoxoxo
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Hello - I had a double skin sparing mastectomy on March 14 with tissue expanders placed over the pec (my plastic surgeon said I had a lot of extra skin to make a pocket). 2 days ago I noticed some seepage and dark color along the lower part of one breast. He prescribed silver sulfadiazine cream to help promote blood flow/healing. My surgeon said he's not worried, so I'm trying not to be. Has anyone had this complication? How long did it take to resolve? I live alone and just need to know there are better days (and pretty boobs) ahead. Thank you!
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Chicago - I used (Silvadene) for some necrotic areas after BMX, and it did help. This is a problem that can take some time to resolve so watch it closely but don't be too alarmed if it takes a while.
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I had my 5th fill today. When I put on my shirt I actually said "WOW" out loud! I am so fascinated by this process and how much difference 60 cc at a time can make! My surgeons next clinic is Monday. They scheduled me for another fill then. Has anyone had two fills so close together? I'm a little nervous. They said if I can cancel if I don't feel up to it. Just curious if it will feel any different/ wors
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ringelle, if you're not in pain from your last fill it should not be a problem.
Now I'll say my usual piece. TEs, by their nature project out much farther than the implants will. We get used to our huge TEs and are disappointed when we exchange. Just so you realize that you WILL lose some projection after the squishies are in. The TEs have a hard back to push out skin and muscle. The implants will settle into the nooks and crannies of your chest.. The degree of this, of course, varies for each person. Most PS will try to give you what you want. Most PS will tell you what they can't do and why. So you will have to ask how close they can come to your hopes and dreams.
Much love to all.
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Chicagogal39, I hope your medicine is helping by now. Although, I'm curious. What do you mean by "seepage"? and what color was the dark color? Did PS suspect it was the beginning of an infection or something else? Or, SpecialK, is it to prevent possible necrosis?
I had to use nitro paste after surgery to promote blood flow in my right nipple as they found during my nipple-sparing BMX that it wasn't getting much. That paste is horrid, but it worked and my nipple is healthy now. Although, I need to ask at my next appointment if there is an concern that continued stretching might have any effect on it. I'd hate to jeopardize that after what I went through using that paste to save it. I wonder what they believe causes necrosis to start??? Or infection??
FYI, I also had my TEs placed over the muscle.
Ringelle, I'm seriously looking forward to my next fill (only my 2nd one) in hopes it will get rid of some of the ripples and divots I still have from them being under expanded. So, I'll have 2 fills 1 week apart and then she told me I'll go every 2 weeks. Obviously you are further along, but I have read others getting fills as close as you are mentioning. One woman did 2 the same week because of a seroma she had.
Good luck!
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I have a surgical date- April 19th! I am having a double mastectomy even though only my left breast has been diagnosed with DCIS. They will be doing reconstruction during my surgery. I will not need TEs because my previous implants created pockets. I am happy about that - one good thing came out of those implants!😉 This pass Thursday my PS drained my previous implants to allow for the skin to shrink. I am actually happy with the way I look in clothes! I think my friends and co- workers will be a little shocked! I thought about trying to stuff my bra so it wasn't so drastic but screw it! This is me working through my process. Its a journey and my faith is guiding me throughit.
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So, Heathet, you'll just wake up with new implants and be done with it?!?! How lucky is that!!!!
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I know! I'm pretty excited about that! It's kinda like my silver lining right now!
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Yeah! That's AWESOME.
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Staceysue, did I read you have another drain? If so, that just sucks. No pun intended. Or wait. Maybe I did intend that one. LOL. Hugs.
Heathet, awesome to here you are going straight to implants. That's great. I too did a double (BMX) with only DCIS. But the IDC was hiding in the side i had removed prophylactically. So it was a good idea for me.
Jessie, I'm really surprised to read all of the ladies who had implants put over the muscle. Are they using any interior supports, like Alloderm? Just curious to see if this is something new.
Chicagogal I hope improvement in your skin issues is imminent.
To all, much love.
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Thanks for the good thoughts, everyone. Some parts of the skin are a dark blue/blackish color, and the discharge is a rust color. They put the nitroglycerin paste on after my surgery, but I still have the issue. It's hard to tell if the cream is working, but the PS said it's healing from the inside out and we need to wait to see where the demarcation is. The PS said I had a lot of extra skin and so he created an extra pocket for the TE to rest on top of the muscle. It's less common, but it makes me feel a bit better that there's extra skin underneath. I've been told the best thing I can do is to take a daily shower, keep it clean, and apply cream (and ABD pads or maxi pads) twice a day. I'm trying to stay positive, even though it looks gross, my PS isn't concerned and so I'm trying to be patient. I have another follow-up on Tuesday to hopefully get the remaining 2 drains (from my bilateral mastectomy on 3/14) out, as well as find out how the skin is healing. Thank you for the support.
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jessiejake - necrosis occurs generally when the skin dies from lack of blood supply. When the breast tissue is removed, particularly when the removal is very thorough, the surgeon has removed all of the previous vascularity with the tissue and the skin must form a new network of blood vessels to stay alive. Necrosis is more common with a skin sparing procedure such as in immediate placement of expanders or implants. Necrosis can form if there is too much pressure because of the tautness of the TE, not enough pressure, and sometimes it is just an anomaly of the surgery and the individual patient - it can happen up to 20% of the time. I don't know of anything specifically that can prevent it, but some surgeons now use a machine that tells them when they have hit the sweet spot of skin tension. I am curious whether the necrosis rate is higher with expanders/implants placed over the muscle because you are cutting down the available source of blood supply - which is usually the pectoral muscle. Infection happens just because of the exposure to bacteria and each patient's immune situation at the time, and happens quite often even with the sterile precautions taken during surgery.
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Ooh, that's interesting. I'd have to look at my surgery notes again but I do know they used a special tool during surgery to verify blood flow which is how they knew the nipple didn't have good (it said "sluggish") blood flow during surgery. I'll have to ask about a machine to check for skin tension. I have very little skin (there's a spot in my surgery notes specifically stating that my small presentation made the surgery more complicated - it makes me laugh as that is the story of my breast life) and the NP told me, "it's very tight" more than once.
It does explain why the PS put very little air in my right TE during surgery.
Chicagogal39, lucky you already have a pocket for the implant! I'm making one, I hope! (ok, two in my case!)
But, by the way, did you have to use that nitro paste for a while? You are the first person I've found that has had to use that. I used it for 9 days total. The first 3-4 days were horrible. I was using too much (at their direction) and it gave me a headache to rival all migraines. I was puking and couldn't even focus my eyes on anything or anyone. I also had heart palpitations. Cutting way, way back on the dosage amount saved me (and my nipple!) but I'm still a little upset about it because I think I was close to overdosing and they were oblivious for a while. While I think it's effect is pretty dramatic it also seems like a pretty dangerous drug if not handled properly. Holy cow is all I can say.Moonflwr912, yes, I have alloderm in place that will eventually hold my implant. My DH remembers the details of our conversations with the PS better but there was plenty of talk about that alloderm, scar tissue, etc.... I will have some fat grafting at implant time to pad around the top edges of the implant to hopefully not make it as obvious through my thin skin.
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jessiejake - same machine/tool, I believe it is an IFR camera - the skin tension affects the blood flow. Nipples are especially problematic.
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jessejake: the cream they have me on is silver sulfadiazine that I apply twice a day. The nitroglycerin was in my bandages when I woke up from surgery and stayed on for several days until the PS removed it. I had the skin sparing bmx, and will have a nipple made at the end of all this. Wishing you continued good healing!
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Love the pun, moonflower
On the subject of ntg paste - when I was working as an ER nurse there was a man who mistook his tube of nitro paste for his tube of preparation H. Good thing his little grandson was there to call 911! He made it....but barely. It's very very strong stuff!
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O....M.....G
What on earth, did he forget to put his glasses on?
I would agree it's not something to play around with or make a mistake with! Geez, lucky he survived and I bet he'll keep those tubes separate from now on!
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A couple of questions for those with or who had TEs.
-did you use any product (lotion or oil) to protect your skin during the stretching process?
-did any of you notice your areolas get bigger also during stretching process?
-did your TEs move or could your doctor's office move the TE at all?
-How about massaging? Not on the TEs maybe, but around edges, is that helpful?
-Not sure if this is TE related or not, but my chest nerves are alive and spastic. Anything resting against my skin makes them scream but I also can't walk around naked on top for more than one reason. I have my second fill tomorrow and I'm wondering if that will agitate my nerves more or if that's unrelated. I plan to talk to them about it. I had similar nerve pain when I had previous biopsy done. I couldn't tolerate anything touching it for a while. They game me lidocaine patches which either worked or my nerves simply settled down on their own during the same time. If I could get this under control I think I'd be a new person.
Thanks!
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jessiejake - I used cocoa butter on the TE area - used this with all pregnancies and did not get stretch marks. Be aware that you can get stretch marks with TE, especially if they are rapidly expanded. Areolas can indeed get larger - they are on the skin that is being stretched, so that makes sense. My TE did not move, and you should not massage the TE if you have had allograft slings as part of your recon - this may disturb the allograft and the end result is that it will not be encompassed by scar (this is what you want), and you can have incomplete coverage over the expander, and later the implant. Just rub moisturizing lotion or cream onto the skin, but don't vigorously rub the TE. You might want to ask about getting some lidocaine cream for the hypersensitive skin.
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So I have a small marble sized lump under my arm on the TE side. It wasn't there in January when I saw my BS. I don't have an aggressive cancer. I don't see MO until May, BS until June and don't have any PS appointments scheduled yet though I definitely need to do so because I want to schedule my surgery. Who do I call? Edited to add I had level l/ll axillary nodes removed.
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