TEs. A Beginner's Primer
Comments
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BethL: I have implants under the muscle and all of my doctors (BS, PS, and GYN) have said that breast exams (self and clinical) consists of checking the remaining tissue between the skin and the muscle.
Lunderwood, I don't know about TE's not working. Some women have had to have smaller reconstructions because of their skin integrity, some women have had set-backs with infections. Not to scare you, truly. Keep open communication with your PS: they would rather deal with possible problems early.
Good luck, Madelyn
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Thanks Beth and Madelyn for the advice and encouragement. As much a I would like to hurry and get through the tissue expander phase I know you are absolutely right that I need to take it slowly. Its good to hear the skin will compensate if given time. This is just all so new right now... I am so glad I can turn to this group for advice.
Laurie
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Lunderwood, I have similar size TEs - 300cc and had only 50cc of air added during surgery. I had to go slowly through fills because of tight skin. The biggest fills I ever had was 50cc of saline and even went as low as 30cc. The longest I waited between fills was 3 weeks which was suggested due to the skin tightness. The PA doing the fills would test to make sure there was adequate blood flow when she would do the fills and stop when she felt going further would be problematic. As it is I have spots where I have little red capillaries that burst during expansion, but my skin is healthy. I only filled to 200cc although the TEs can hold 300.
So, I would think they will just go more slowly and small amounts as long as your skin responds well.
I went over the muscle with similar concerns as your PS might have had. I had debated quite a bit and it was a last minute choice with my PS to go over. I have no padding really between the TE and my skin so every edge of the TE is visible right now. Hopefully some fat grafting will minimize that when exchange time comes. If you are similar in build to me I know I wasn't ever meant to have a large chest so I'll be satisfied with the petite result I'll end up with!
I do use shea butter lotion and bio oil on my scars. I mentioned that at my fills and they agreed it sounded find but never indicated that doing that or anything else would help my skin aside from spacing out the low and slow fills.
Good luck!
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lunderwood - if your skin is thin and you are petite under the muscle would be a better choice because your pectoral can help support. I had to have my initial expander removed due to healing issues and I also have very thin skin - my BS did a very, very thorough job in removing tissue down to the skin. When my expander was replaced I had very low volume fills - 25ccs at a time. This worked very well for me and I did not have pain or need any meds at fills. I would recommend applying an emollient cream - I used cocoa butter, but shea butter and coconut oil are also good. This helps with skin pliability, but don't massage firmly, just smooth on and gently rub in, as it can inhibit the allograft incorporation process.
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I just had my exchange surgery today and man does it feel good to be rid of theseTEs! Hang in there ladies...I was worried that I would always be uncomfortable and the implants would feel similar, but they're so much better.
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Thank you for all the good advice! I am petite 4'11" and under 100lbs. Before surgery I wore a 34b bra but without the padding I would have been more in the A range. Not a problem to me - so I will be happy with whatever size reconstruction can offer me, especially since it will be matching my remaining breast. I am absolutely fine with progressing slowly. Does anyone have brands of shea butter or cocoa butter they recommend? My PS recommends using silicone gel sheeting and Bio-Oil for scar healing. I am willing to do whatever is needed to help the skin with pliability and healing. Any thoughts on supplements or vitamins?
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lunderwood - I used Palmer's Cocoa Butter, the kind in the tub - used it during two pregnancies and had zero stretch marks - I am also petite and had average sized kiddos. Organic coconut oil is also great, you can buy it in the grocery store. If you keep it in the fridge it will firm up. For supplements and diet - try to eat 100g of protein, and maybe try some zinc and bromelaine, which you can also get from pineapple.
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lunderwood I usecoconut oil and take vitamin c supplements for skin healing
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Wow, I had another fill today and wow I am hurting. I'm now at 510cc hoping to get to atleast 600. From 200 to 450 (60cc fill each week) were very easy and I didn't have hardly any discomfort. At my last fill I had quit a bit of pain that night but by the next day it was tolerable without meds. This time I have already taken advil and a muscle relaxer. This is the most pain I've felt since right after surgery. this is the quickest I've had pain after the fill. I have a feeling tonight is going to be a really hard night. I always have my most discomfort in the mornings after laying day all night
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Alex- my last fill was hard, especially on the right side and mornings are hard. Reminds me of after my bmx. I'm getting 50cc this Wednesday for a total of 670 and then I'm done. Exchange scheduled for August 2. Hope I can make it that long!
Paulinek-so happy for you! Gives me hope that this pain will soon be over
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I took 10mg of my muscle relaxer (max dose for me) and Advil before bed and I made it through the night ok. I did wake up a couple times in some discomfort but it was only when I moved and I was able to go back to sleep fairly quick. I'm still feeling some pain today and I've already taken Advil this morning. Overall the night was better than I expected and hope my final two fills are too much torture. I'm ready to get these things out!!
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Just 2.5 weeks post MX, 2nd drain came out today...still so new at this. Still hoping to consistently find a way to sleep.
Had 300cc at time of surgery, 50cc 2 weeks out and another 50cc planned for end of this week (3 weeks out)...think I'll take a break for a week after that.
Had second drain pulled today but was still collecting 45-50cc a day...have the kind of TE that has 2 ports...one to fill and one to remove any fluid build up around the TE.
Have been trying to research the surgery for swapping for implant but don't feel I have found a good source so far...have others? One big question I have (since I just got rid of the drains...) are drains part of the swap surgery??? Should I expect another 2-3 weeks of drains at that time ....and thus plan for a time I can either be on light work duty or simply take time off???
Sorry for the simple questions, it seems like for all my research, I find I still don't know more than I know.
DX DCIS Oct 2015
Lumpectomy Dec 2015, Jan 2016
Arimedex Jan 2016
L Mastectomy June 3, 2016
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I think a lot if patients get drains after the change. But my doctor says he doesn't use them for the exchange. depends on your surgeon.
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TrmTab I had my exchange surgery yesterday and no drains. I have heard some PS use them for the exchange. I only had my mastectomy drains for 9 days, so maybe that was a determining factor? I would ask you PS at your next fill appt.
Also there is a forum on this site called exchange city...some good info there
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Forgive me if this question has already come up, but I was wondering if the volume of the final implant is the same as the volume of the TE. If not, does anyone know how the volume of the final implant is determined?0
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grandma3x my expanders were filled to 400cc and my implants are 395cc. I think they can fit a larger implant even if the TE was smaller and vice versa, but it seems to be within 100cc one way or another from what I've read.
My implants seem very small compared to the expanders. I started out barely filling 34b and the expanders filled a 34c. Now I look to be smaller, but I just had exchange yesterday. I'm trying to have realistic expectations I just don't want to have gone through all of this and be disappointed
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Paulinek
If I read this correctly you have already had the swap 2.5 months after the mastectomy...wow...that seems fast.
I had gotten the impression that I could have the TE from a June 3rd surgery until Nov/Dec...but at your rate, I should plan more for Aug/Sept (I know everyone is different and I need to speak to my PS, but wow!)
Was the swap surgery in hospital or just the PS office/surgical suite? Are you back to limited duty/no more than 5lb lifting for a month? You seem like you are doing great!
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TrmTab I had nipple sparing BMX so I think it went a little faster because I had more skin that someone with a straight mastectomy. I was filled to 190cc at the time of surgery and only went to 400cc. My PS only waits 4 weeks from last fill to exchange. The exchange was outpatient in a surgical center. No lifting or exercise for 4 weeks. I am going to work a few days next week, but I'm a guidance counselor and school is out so I can make my own hours
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trmtab - some plastic surgeons use drains for exchange surgery, but it is usually dependent on several things. They are sometimes used for "gummy bear" anatomical implants so that the pocket does not fill with fluid and cause rotation of the implant - it is important for anatomicals to be really snug in the pocket. Drains may also be used with exchange for patients who kept their drains for a prolonged period at the time of mastectomy - if patients have that type of history their docs may use drains. Another reason may be for those who have extensive pocket work done to conform the pocket created by the expander to more closely meet the desired size, shape and position of the final implant.
grandmax3 - I would agree with paulinek - implants are generally within 100cc of your final fill volume (not necessarily the expander volume), and they can be larger or smaller. It is very important to note that implants almost always look smaller, sometimes up to 50% smaller, than an equally sized expander. This is one reason I cringe when I hear that plastic surgeons say they will stop fills when the patients likes their size - your implant will appear smaller, and the potential for disappointment is high.
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SpecialK, do you have any knowledge of fill volume vs implant volume with over the muscle implants? I am really curious about this as my PS does over the muscle.
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Nice to see this thread very active again after the recent lull!
Laurie/Lunderwood: glad to hear you're going to take it slow. Best wishes.
Paulinek: welcome to the squishy side.
Alex276: my worst pain was usually mornings and when I got the shivers (Nov-Jan); in both cases it was muscle tightness and spasms.
TrnTab: drains vary by PS, although drains are usually in for a shorter time than MX. My PS uses them for anatomicals to lessen fluid buildup which can cause rotation. My exchange was at the Center for Outpatient Surgery. You will find more information on the Exchange City thread.
Grandma3x: hello again, January surgery sister. My Ps filled 420 at BMx, which was plenty of volume for me. He did one more fill of 60 to make sure the pocket was large enough. He removed more tissue from right at exchange. My PS orders several size implants and then uses sizers to check the final implant size. My implants are L-450 and R-495, and look evenly matched.
Grandma and HuskerFan: Have you seen the Breast Implant Sizing thread by Whippetmom? She guides ladies on implant sizing based on a series of questions. Read the original post and then answer the questions in your post. She'll give an excellent estimate for your implants. Also, talk with your PS. What would you like to look like? Bigger, smaller, rounded, or a natural drop (anatomical)?
I believe links to Exchange City and Breast Implant Sizing are at the top of the page.
Much love. to all,
Madelyn.
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Thank you, everyone for your responses to my questions. Whippetmom recommended 430cc ultra high or >375 high profile rounds, which is why I was wondering how much I would need to overfill my little 275 cc TEs. Right now I'm filled to 210 cc's and I am bigger than I was before my MX. I guess I'll just keep going with the fills - low and slow - until I'm sure I've had enough or the PS tells me I have to stop.
My left TE sits about a half inch above my incision. I think the PS will need to pull my expanded skin down to the incision site to make it even with the right side during exchange. Has anyone had this done? Should I have an extra fill on the left to make sure there is enough extra skin for coverage?
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husker - I have zero experience with over the muscle expanders/implants - I would never have been a candidate as my BS was exceedingly thorough with the mastectomy on both sides and I have skin like tissue paper, I can actually feel seams and bubbles in my implant through the allograft, muscle and skin. I think I actually just saw a post by whippetmom saying she also has limited experience, although I don't think the size physics would be all that different. What you are less likely to have, I think, is the flatness that can come with sub-pectoral implant shortly after exchange. It is possible that your PS can achieve the same look with slightly less volume since the implant will not be as constricted by the layer of muscle. It will be beneficial for you to post about your experience after exchange as subcutaneous expander/implant placement for reconstruction is relatively new. As more surgeons use this method on select patients there will be more questions that arise about these details, so any info you can provide will be useful for those who come after you in the process.
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Just back from my second fill. Surgery was three weeks ago tomorrow(!) and I am already at 450! ...300 at surgery, +50 2 weeks out, and then +100 today (only 5 days after last fill up - due to scheduling shifts on Dr's side)
I was very surprised by today's 100 fill....thought we would be doing 50 given the first experience and the fact that I've been having some pain....
I am 5'8" 200 lbs and was a 40D before surgery. I have a TE that is sized for 600-720cc...at this rate I will be at full TE expansion 5/6 weeks post surgery...is that anywhere near normal?
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trmtab - that is very fast, and no, I don't think that is the common experience. A lot depends on your skin envelope and pectoral laxity as to whether or not you can handle this volume and frequency of fills. Keep in mind that you have very new incisions and you need to keep a close eye on them. They should not look stretched this early, so examine them regularly. Also, make sure you are keeping your skin hydrated and pliable with an emollient cream or oil. If you are experiencing pain it is important for you to voice that and indicate you are unwilling to maintain the current pace and volume of fills. A lot of patients leave this to their plastic surgeons, but it is not their body - or even really, their choice - you are the decision maker. It is also unfortunate that many plastic surgeons rush the fill process because they are not charging office visits for fills - that process is usually tied to your surgical charge. Fill appointments could be given to patients who are generating income, so consequently some docs move too quickly to get the process over with. I am not saying this is what your doctor is doing, but it is important to understand that this is a possibility.
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SpecialK, thanks for your thoughts! I will definitely post more about my experiences along the way. The interesting thing so far is that I had 450cc at my first fill with no pain whatsoever. I had a nipple/skin sparing BMX and my PS was able to preserve a lot of skin. I guess I had a lot to work with too as I was fairly large busted (36dd) before BMX. I need to post on the implant 101 thread to see if Whippetmom has much insight on the over the muscle procedure.
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Huskerfan, my fills on my last try were 100 right up to the last fill. Then he went down to 75. I had 300 or so in at TE placement. I was going for 900 in Saline rounds, but ended up with 750 overfilled to 850 at my last exchange. The 900 were too wide for my chest, as were the 800. I am a C cup now. Was a C cup before BMX. All in all happy just to have finally finished. Every oneis so different. My first 2 tries were fairly similar but infections were my downfall. I had my drains in for 5 weeks .each and every time.
Trmtab, what SK said. It is up to you.
Grandmax3, your PS should let you know. So make sure to ask.
Paulinek, welcome to the squishy side! Always glad when it goes well.
BTW, are there any more links we need to add? Are the ones on top working? Please let me know.
Also, i am doing ok right now. LOL
Much love to all
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Well, a TE newbie update...I was in pain/discomfort from my 100 fill last Thursday (three weeks post surgery and at 450 total), painful to touch, awkward to simply have my arm resting on the outer chest wall (simply having hands at side/not actually doing anything). When I got into bed on Sunday, just lying in bed and trying to move a couple of inches from the edge of the bed into the center, I had a sharp and very painful spasm...actually yelped out loud and had to concentrate on breathing until the pain settled down.
Well...weird/funny thing is, yesterday, Monday it occurred to me that in fact the TE wasn't actually bothering me and today, still it is okay...
So, was it resting on a nerve and the sloshing of the fill getting into bed moved it off the nerve?
My view of the TE in its half full state is very wide across my chest to my underarm area, but not very full in projection.
I see the doc on Thursday morning, and am still trying to decide if I should continuing filling or wait, but after the "pain spasm" it has been...okay...
Thoughts?
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trmtab - this is common, often recently installed expanders rest on nerves and as they are filled and lift outward and upward they lift off of those nerves. If I were in your boots I would ask for a smaller fill next time and see what happens regarding pain or discomfort, 100cc fills are large, particularly that soon after surgery.
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Thanks SpecialK
I had been thinking of taking a week off, but when the pain relieved itself...I think I can move forward, but do want to go to a 50 fill.
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