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TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!

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Comments

  • raven4mi
    raven4mi Member Posts: 215

    Thanks for the info Andra. Yeah, the PS said the location where the graft is going won't be painful at all, it's the site of the lipo that I'm worried about. My surgery is on a Tuesday and I'm taking the rest of the week off and through the week-end, so hoping that's sufficient. Then again, I'm lucky to be able to work from home so it's not like I have to worry about traveling anywhere or going into an office. I can work from my La-Z-Boy if I have to!

  • macb04
    macb04 Member Posts: 756

    raven4mi, I agree with Andraxo, I recovered well from fat grafting, although I didn't get my heart rate up to an athletic pace for a month after each fat grafting procedure. I had been told by my first PS that it was helpful to go slowly initially in order to let the grafted fat have less competition for circulation, versus muscles. I was sore, and going slowly was kind of a drag, but I did have some fat grafting sucess, despite severe fibrosis, so maybe that did help. Who knows?

  • JessieJake
    JessieJake Member Posts: 170

    HI Raven, Did you PS say where he would harvest the fat from? I wasn't sure if you mentioned that.

    I had mine taken from my butt. No real other way to say that :) They also tried down the back upper part of my thighs, but she told me she found more in my butt. I'm not quite 4 weeks out and I have no pain left from those areas. The bruises are really what hurt, but nothing I couldn't handle. The first week or so if I sat too long I'd want to start shifting as thought I was sitting on a very uncomfortable chair. Pulling the spanx I'm wearing up and down was uncomfortable as it scraped over the bruising. The pain I experienced was what you'd expect from a large bruise if that helps describe it.

    I also recall being fairly stiff getting in/out of the car for maybe the first week or a little longer.

    I think it depends on where they are taking the fat from. I would imagine the stomach may be more painful as you are always using those muscles.

    Good luck next Tuesday! Hope it's easy and comfortable.

    I have my 1 month post op for my exchange with fat grafting next week. I'm planning that we will be scheduling a 2nd round of fat grafting, and I can say in all honesty, I have no worries about it at all - just that I hope she gets enough fat to help finish my look the way I hope!



  • littleblueflowers
    littleblueflowers Member Posts: 391

    Hi ladies, just wondering how you all are screened for reoccurance, since the over pec implant hides the chest wall and pec muscles from a manual exam? I know i feel my chest constantly right now looking for lumps. Im scheduled for TE installation on oct 27 but i wqnt to be sure my PS and MO have a screening regime laid out for me befor that, just to ease my paranoid mind!

  • KentRunner
    KentRunner Member Posts: 7

    Want to add another Seattle area PS to your list who do over pectoral implant reconstruction. Dr. Mark Tseng with Multicare in Auburn. Had mine done 4 weeks ago and am healing extremely well. He's an artist! I went to a special boutique for mastectomy bras and prosthetics, and the lady helping me was amazed at what a great job he did!

  • raven4mi
    raven4mi Member Posts: 215

    Jessie, thanks for the info. He's planning to take it from my stomach - I'm not obese by any means, but certainly have plenty of post-baby, perimenopausal excess to choose from there, that's for sure. The procedure to do the fat grafting isn't until 10/25 - I'll be getting in a few more high dose vitamin C IVs before then (and another immediately after the surgery.) The first two at 1/4 and 1/2 dose, plus a boost of glutathione went well with no adverse effects, I'm happy to say.

    Interesting question, littleblueflowers! I'm interested to know that myself.

  • macb04
    macb04 Member Posts: 756

    Hi KentRunner, welcome, and thanks for the info about your PS. I am always glad to add the name of another smart, progressive PS. If I counted right, the list is now up to 19, all across the US. Finally getting outof The Dark Ages,just a little bit.

    Hey raven4mi, aren't you a smart cookie getting all that connective tissue strengthening IV Vitamin C before and after your next surgery. I will keep my fingers crossed, that October 25th is a great, successful day for you.

  • Andraxo
    Andraxo Member Posts: 168

    Hey littleblueflowers - I asked the same thing at my last visit with med onc. Since I have only a 1% risk of recurrence in the next 5 years, what needs to be monitored? MRI? I know if my risk was higher there would be MRI. Initially she thought I needed MRI before TE placement, but after reviewing my case with the interventional radiologist, they don't think it is needed. Nothing is. I had clear margins, and did both chemo and rads. My tumor was not aggressive. They never did oncotype, but did mammaprint instead and it put my tumor as "low risk luminal A" which is the best prognosis. Now I want to know what happens at/after 5 years? MRI then? I'll push for it because if I have to wait until I'm symptomatic for a recurrence that would be too late....I'd likely be stage 4. Had a boatload of cancer in my lymph nodes and was in the best shape on my life - running my fastest races. I'm already freaked out that my weight is down even though I usually lose a few pounds for no reason (no change in food consumption or activity) when the cooler temps hit.

    I was just put on alert for deployment for Hurricane Matthew. I'm on-call for October. Of course it's bad timing with plastic surg follow up next week to review recon again, but medical appt can be rescheduled.

    - xo

  • littleblueflowers
    littleblueflowers Member Posts: 391

    Hi Andra! You do have a good prognosis! Mine, not so much. 2 positive nodes and an extremely agressive cancer. Booooo! I wonder if MRI is the gold standard for monitoring with this type of recon? Anyone else care to share? Hey good luck if you go out on the Hurricane. Do you go out with FEMA? Thanks for responding!

  • Andraxo
    Andraxo Member Posts: 168

    I do think MRI is the way they monitor in our circumstances. I had 3 (or 4?) positive nodes out of 5, but my tumor itself was small. I think I had more cancer in my nodes. Still wish I knew my oncotype because my ki67 (which they just did...a year later...good thing they keep the tumor samples for a while) came back as intermediate, yet med onc says I'm very low risk for recurrence because of what the mammaprint said and what I did for tx (mastectomy, chemo, rads - the who shebang!) I wish I felt better about my prognosis. You know...that little voice that makes you worry they didn't kill it all and it is thriving somewhere in my body.

    I'm a commissioned officer in USPHS (public health service) - we deploy for domestic disasters...flooding, hurricanes etc - especially if nursing home patients get evacuated and we need to set up a medical shelter. I usually end up doing almost all wound care and not much regular PT. I've also gone as a liaison (Hurricane Katrina) and a field medic (last presidential inauguration). Sometimes it seems odd to be pulled from my current duty station with the Indian Health Service because we are so underserved to begin with. Fingers crossed this hurricane turns into a big dud when it hits the US.

    - xo

  • littleblueflowers
    littleblueflowers Member Posts: 391

    Ha! As an archeologist, Im on a disaster response team list as well. How funny. I most recently went out as a division on hurricane Sandy. Not going available for this one, though. You be safe out there!

    On a more scary note, its good to hear MRI are the gold standard. I wonder how I can get those scheduled into a survivorship plan? Do they have any nasty side effects, or are they reletivly safe? I hear you about the fear. Now unless i can get a monitoring plan in place, im scared and considering remaining flat! I know thats the rout my onc prefers. I threw the book at cancer too, but being TN- well part of me says screw it, im going to die of mets anyway, i may as well go with a nice rack lol. So many questions! Im going to start a pannel discussion with my doctors and post the answers. Ugh.

  • Andraxo
    Andraxo Member Posts: 168

    I don't think MRI are the gold standard or are routinely ordered. My med onc said MRI or US could be used, but never said anything about the need or frequency of getting any testing. Seems there is no standard. I've spoken with 2 others who have implants (had cancer tx within the past couple of years) and they said it's all physical exam (and one gets labs), no scans yet. I have a f/u with med onc scheduled for 2 days after TE placement and I will be asking a lot of questions about what happens down the road for monitoring because physical exam does not seem like it is enough. I wonder if different implant types and placement affect physical exam? One woman told me she can move hers around a bit and check the margins well. hmmm.

    That's sweet you're on a disaster response team littleblue! I'm still on alert for this hurricane. They confirmed the travel roster and my gear is all laid out ready to packed tonight. Now it's just wait and see if we are activated.

    - xo

  • littleblueflowers
    littleblueflowers Member Posts: 391

    Be safe out there Andra!

    Well i talked to my BS and he said he didnt think over the muscle implants were a bad idea. He quoted stastics at me, said he felt it was very easy to skin the breast tissue off the pec muscle but harder to get the skin cleanly defleshed. Therefore, he felt that over muscle implants were safe in my case, and would make it easier to detect reocurrance in the skin. He will continue with exams every year, and i asked him to try to get me an MRI every year. His concern is surgical trauma after radiation and weather the implants would heal. Who knows? My concern is staying alive (90%) and looking good (10%). I still will worry about the part of my chest hidden behind the implant.

  • JessieJake
    JessieJake Member Posts: 170

    Hi LittleBlue, I'm smiling for you. I completely understand having worry and that you may still carry that around, but boy, over the muscle is so easy. I do hope that works out for you!

    I have had my implants now for 4 weeks and seriously, I feel so normal. I am smaller (my implants are only 290cc which puts me in a 30D or 32C bra size) and I think that helps, too. There isn't a lot of heaviness to support.

    My issues were on my chest wall, but as crazy as it sounds, I'm not worried. It might be just the way I am, but the BS say I wouldn't need any more mammos or anything, and I just nodded along.....

    Good luck and hope all goes well!

  • littleblueflowers
    littleblueflowers Member Posts: 391

    Thanks for the imput Jessie! I guess the worry is normal. Im so glad you are happy with yours. Did you wear any kind of bra or camisol while your tissue expanders were healing? Wondering if i need to buy something befor i head into surgery?

  • JessieJake
    JessieJake Member Posts: 170

    yes, LittleBlue, I did wear a seamless bralette while I had my TEs. I also had a sport bra that was seamless, too, that worked. They were just enough support to make me a little more comfortable. The few times I wore nothing due to clothing style I eventually got an achy feeling like they were weighing my chest down. I also wore it for modesty, too. I think some women don't wear anything, but this worked well for me.

    I actually found mine buried in the back of my bra drawer after surgery. I lucked out on that but I'm sure I bought the 2 I wore the most as a 2-pack from tjmaxx or marshals for maybe $10.

    Hope that is helpful

  • Lillypoppy
    Lillypoppy Member Posts: 55

    Hi everyone - I'm looking for any advice you can give me. I'm from the UK and in September 2013 had bilateral subcutaneous mastectomies with one step immediate implant reconstruction sub pectoral. I had seri structure at the time but had inflammatory responses to it. I've always been happy with the cosmetic result with scars in the inframammary fold however since my surgery I've suffered with shoulder pain (treated for bilateral frozen shoulders) and more recently had a constant pulling tight sensation across both breasts. I developed a lump which thankfully on core biopsy was benign (granuloma). At this consultation myself and the surgeon discussed the animation deformity I have and the lack of strength I have in my arms and upper body and more importantly the pain I have and he has offered me pre-pectoral implants with full cover ADM and lipomodelling

    I am looking forward to be free of discomfort and the animation deformity but I am nervous of having it done. He is one of the UKs leading surgeons and has done this before. However I am asking for any tips or advice you can offer. I am also unsure of what shape implants I should opt for. At the time of my original surgery I had tear drop (as they matched my natural breast at the time) however I now feel I need more fullness at the top. I'm booked in for surgery in November and am seeing him in 2 weeks to choose implants. Any advice would be gratefully received :-)

    Thank you so much

    Lilly x

  • JessieJake
    JessieJake Member Posts: 170

    Hi Lilly, I think you will eventually be so much more comfortable with above the muscle. You listed so many things that should go away with this.

    I don't know that I can answer your questions very well. There also might be other forums that would be useful although above the muscle is the exception not the rule.

    I've had my anatomicals above the muscle for 5 weeks now. Easy, easy, comfortable. With above the muscle you maybe be concerned with hiding the edges of the implants as they will not have as much coverage. Perhaps that's why your PS is using full ADM and lipomodeling (which I assume is what I call fat grafting).

    I had fat grafting but I think a lot if it simply reabsorbed. I also think anatomicals work only for some from what I've read here. I'm quite thin and small on top so they worked best for me. My implants are only 290cc.

    If there's anything else I can share, let me know! Good luck - it's a good route you're taking!

  • macb04
    macb04 Member Posts: 756

    Hi Lilly, welcome to the PrePectoral Implant Reconstruction site. I am so glad you are getting a chance fora do over that will likely fix many of the complaints you are experiencing, like tightness, animation deformity and loss of strength. Those same problems bothered me enormously, that is whyI bugged my PS to put 4he TE/Implants over my muscle. So very much better. I have to admit I still have some residual shoulder tightness from severe Radiation Fibrosis damage. I can only imagine it would all be horribly worse with an implant under my muscle. SHUDDER............

    So now to your question,I had Fat Grafting first several times, and then had the TE put in, anda few months later got the Mentor Anatomic High Profile 495cc Silicone Implant. I actually had a 420cc Mentor Moderate Profile Anatomic implant first. It was too flat/small to match my real right C cup breast I tried to live with it, didn't want to do another damn surgery. Just couldn't take it. Made me cry still looking so lopsided, after all this misery. So did the final surgery to get a better size match. Still not perfect, but considering how chopped up I had been in the past, I can live with it ok enough now. It made a big difference to my satisfaction going from Moderate Profile to a High Profile Anatomic. The Moderate profile was made for women doing augmentation who had their own breast tissue to pad things out. After a mx, that bit of padding is gone, obviously, and fat grafting helps, but you can't count on great success with that, as JessieJake said. Quite a high percentage of grafted fat can get reabsorbed even with the most experienced PS. So with the High Profile I gained a normal looking slope to my breast that matches up with my real right in low cut tops and bathing suits, and not too badly when naked. I wouldn't look down at myself when I would shower for about 3 years. Too awful to see, didn't look in the mirror either. Now I look briefly to reassure myself every day, in the mirror and in the shower. I even change in the locker room again at the gym.

    Hope this helps, Good Luck.

  • Lillypoppy
    Lillypoppy Member Posts: 55

    Thank you JessieJake and Macb04 for your really helpful replies.

    JessieJake - I'm happy you are pleased with your result. Thank you for telling me about the fat grafting. Did the fat come from your tummy? Did you have any issues with that and is it just a small slit scar? Sorry for all the questions! I know you said it was reabsorbed - did that happen quite quickly?

    Macb04 - I have read all of the posts on the pre-pectoral site - thank you for starting it - its great. I had never heard of pre-pectoral and I thought I was a pretty well informed person - and finding information, particularly people's experiences was pretty non-existent. I'm so pleased I found this forum.

    Macb04 - how long was it before you felt better symptom wise? This pain and discomfort was something I thought I would just have to live with and really got me down. We sound in a similar boat having lived with it for 3 years. Part of me happy I survived cancer and feeling ungrateful that I had a good result but knowing living with the symptoms and pain rendered me unable to do so many things. I hope you get some more improvement in your shoulders - I know how debilitating it is. I am really hoping my shoulders gain some normality. Interestingly my surgeon says there's not any real research about shoulder pain/ frozen shoulder and subpec implants but I absolutely know it's connected for me.

    Thank you for the information on high profile anatomicals. Am I right in thinking the anatomicals are still the "tear drop" shape but with more filling at the top? I'm a c/d cup at the moment - happy with size but not overall shape. Feel empty at the top in certain clothes or swimsuit etc. So like you - high profile anatomical or did you consider round? I don't want to have the "glamour" look though!

    Thank you to you both for all your help. It's much appreciated

    Lilly

  • JessieJake
    JessieJake Member Posts: 170

    Hi again Lilly,

    My fat was taken from my butt. I had been forewarned that this would be the worst of my surgery. To be honest, it wasn't that bad. I found myself shifting while sitting for the first few weeks and it was uncomfortable pulling my spanx up/down as they scraped against the bruising. However, it was quite tolerable and I didn't take pain meds or anything for that. If I have a leftover scar from where they inserted the cannula to take the fat, I cannot see it (partly because it's on my butt!). Even the spot where they injected the fat isn't noticeable to me at this point. Very small incisions for those. They did snip out a stitch on each of these spots at my 1 week post op, but they healed well.

    I do think the fat disappeared fairly quickly or possibly it was also some swelling that subsided. My PS did say we would know at my 1 month post-op how that went. I would agree I could tell at that point there was some reduction in the fullness I had at the top.

    I can completely understand what you mean when you write you "feel empty at the top". That was how I felt my whole life (I was seriously pretty flat by nature) and so the teardrop anatomical (you are correct that they are the same thing) and fat grafting actually improved that. I was quite excited immediately following surgery. Given my body description, though, I can understand why many women who had fuller chests prior to this would be let down with the anatomical as it is a flatter slope on top to the fuller bottom. For me, any addition in the top half was more than what I had. Given that, in my completely non-expert opinion, you might want to explore rounds. When you get closer to surgery, look at the Breast implant sizing 101 forum. The woman there is very knowledgeable in her recommendations.

    Lastly, my PS would have done any implant I chose, but she said that given the thin skin, and going above the muscle, anatomicals would be the best best for blending in the edges. Apparently the edges on an anatomical are thinner than on the rounds. The edges of my TEs were very visible and would have looked unnatural to anyone seeing me. That drove me to select the anatomical/tear drop.

    I am supposedly having another round of fat grafting in December. I meet with my PS in November to discuss and I'm very curious to see what she says about my result. She did see me at 1 week post-op but I know things have settled a lot since then. To be honest, I think there is a chance I'll forgo the fat grafting. I actually wonder if either the next height up in the same implant would make more sense or the next size up in implants which is 30cc more would be a solution. Overall, I'm not terribly disappointed but I think there's room for improvement! We shall see - that's unique to me but it's nice to share on here as someone may have good input...

    Again good luck with this and hope that helps some more!

  • raven4mi
    raven4mi Member Posts: 215

    Hi, LillyPoppy. I can't really speak to what an under-the-muscle implant is like as I was lucky enough to find a progressive PS and got pre-pectoral right away, but I can tell you that the recovery from them is super-simple and I had none of the pain or muscle spasms that are often suffered by those who get them under. As for size and shape of implants, I still only have one TE on the left side following infection complications on the right, and I don't have any problems with edges being noticeable, but then again I am pretty large - 750 ccs! Because of dealing with the infection (likely caused by a hospital-acquired infection) we haven't even gotten close to being able to discuss what shape of implant I'll get. The only place the TE looks "weird" is on the top where the port is, but once the implants are in then obviously that goes away. I'm working toward having the TE on the right replaced and am doing everything I can within my resources to ensure I get pre-pectoral again on that side.

    Good luck to you!

  • Lillypoppy
    Lillypoppy Member Posts: 55

    Thank you again JessieJake for all your advice and for sharing your experience. I think I will look at high profile anatomicals as Macb04, and perhaps as you say slightly larger in casefat grafting not enough. Decisions are so hard to make! It really helps listening to others experiences.

    I don't believe there are many UK surgeons doing pre-pectorals so thank you to you ladies for helping.

    Raven - thank you for reassurance about recovery. I had some problems after my initial surgery in 2013 - repeated seromas and skin infections so can appreciate what you have been going through. I am due to take a small internal flight 2 weeks after surgery so hoping I'm not being too optimistic!

    Macb04 - can I ask - after going to pre-pectoral after sub pectoral - did you find you had more droop/movement of the breasts themselves? I'm just trying to prepare myself as currently they feel like two bricks on my chest and I often don't need to wear a bra. Thank you.

    Sorry for all the questions! I appreciate your help everyone. :-)

    Lilly x

  • macb04
    macb04 Member Posts: 756

    Hi Poppy, I don't need a bra on my Left, implant side, but I definitely do for my real right. My Left has some movement possible in all directions, which is great for giving me cleavage. I like that with the anatomical textured implant , the fat grafting and the Seri Silk Mesh I have no sign of implant edges. No animation defect either. I don't have any pain, I had chest pain /muscle spasms right away the entire time I had the TE under my pectoral. When I had the PE changed out and put OVER my pectoral I never had any pain. I have some tightness left in my shoulder and side because of the radiation fibrosis damage was so severe. My rotator cuff is also torn, due to radiation damage. My L breast doesn't bother me,more that I am frequently conscious of the feel of it being different than my real right. As time has gone on, I more and more forget about the implant even being there.

  • Lillypoppy
    Lillypoppy Member Posts: 55

    thanks macb04. Listening to your positive outcome makes me wish the next 4 weeks away... I just cannot wait to be free of the "tight band" feeling across my chest and look forward to my shoulders healing. 10th November is my date... it can't come soon enough. Due to see my surgeon for implant selection 2 weeks today - thanks for all the great advice.

    One last question - where the fat grafting is taken from (probably tummy) do i need to wear compression underwear afterwards?

    Thank you. Lilly x

  • Andraxo
    Andraxo Member Posts: 168

    Greetings!

    Back from deployment for Hurricane Matthew - it was uneventful for the team, but good team time for training.

    Met with PS this past Monday for more time on the computer like the "Weird Science" 80's movie when they make the woman. We reviewed my 3D body images with different implants. Decided on low projection - which is the flattest implant one can get. I don't want cleavage or upper projection! I want small natural shaped breasts. The only question is the implant height - medium or full - and that will be determined in the operating room (I have a very long torso so likely full height). Both height sizes have the same projection...just 3.8 cm. It really helped to see the computer images of my body with different sizes, and it helped me feel better about moving forward with surgery. I'm on the schedule for Nov 9th for tissue expander placement over my pecs. Fills would start 8 weeks later and they think I'd need at most 2 fills. Exchange for implants would likely be in late Feb or early March.

    Soooo happy to see some great positive stories of over the pec results on this thread! I'm still nervous/stressed about choosing reconstruction over staying flat, but feeling better about it after the last visit with PS.

    - xo

  • littleblueflowers
    littleblueflowers Member Posts: 391

    Hey Andra, welcome back! I wish my PS showed me computer modeling! He said we would just decide together when things looked right. Well, I go in on Oct 27, so Ill let you know how I fare!

  • raven4mi
    raven4mi Member Posts: 215

    I wish my PS had something so cool, too, Andra. Frankly, I'm pretty OK with how the TE even looks on the one side, and I assume that whatever I end up with will be an improvement on that so not too worried about it. Still, kinda jealous.

  • JessieJake
    JessieJake Member Posts: 170

    Andraxo, Good luck with your TE placement and follow up steps. I think your experience with the 3D imagine piqued a lot of interest here! Oh, that would be a nice thing to have!

    I was thinking of you after your post because you mentioned your long torso. That is my case as well - something I typically don't like, but it has a few benefits, too. I "hid" my pregnancies until at least 20 weeks or more because baby had plenty of room to stretch out and hide in there! The bummer is that I typically can't wear dresses with a waist. The waistline often hits on my ribs rather than my waist and makes my butt look like it's falling down my legs! And forget one piece swimsuits - I either resemble an 80s era Jane Fonda with the high cut thigh or the top is so low my chest all but peaking out the top!

    Anyway, enough on that, I ended up with low height anatomicals. It was a surprise to me but *I think* it looks right. I know my length is in my ribs and waist, maybe not above my chest (??) which is where the extra height of the MX - medium heigh would have gone. Did your PS specifically say that the taller height is good for long torsos? I want to like what I have but now that I've had my implants for 6 weeks, I'm finding a few things that I wish were different. I don't know that it's size related, but I just assumed I was getting the mx height when I went in for exchange. I am so narrow and thin on top, I like to think that she chose the low height as the best for my unique shape. She was so concerned about making the top of the implant as little noticeable as possible though my skin. I had fat grafting but I'm pretty certain it didn't stick up there. However, in comparison to the TEs, where I could clearly see the edges and tabs through my skin, I think the implants are much better - not perfect, but I'd be surprised if anyone would guess they are implants if they saw the tops....

    At the end of the day, though, I'm glad I did go above and with anatomicals. Despite my minor misgivings, this has been relatively easy and quite comfortable! Good luck!

  • Andraxo
    Andraxo Member Posts: 168

    so funny JessieJake! - I have the same problem with some clothes. Yup, the waist on dresses in my size isn't in the right place so I lean toward sheath dresses where the waist is more fluid. I also don't have hips - I'm very planky/rectangular. Feel even more boyish now that my little breasts are gone, but it does kind of suit my frame.

    I think I'll end up with the medium height implants, but he is going to order the full height too. When he tried them on the computer I thought the full height were too tall. It's all about the top edge visibility. I think my implant breasts will be a little higher on my body than they were naturally pre-mastectomy. I had nipple sparing and my nipples seem higher now....which makes my torso look even longer. I was maybe an A+ or B- cup before mastectomy.

    So happy to hear you are doing well with your implants!! yay!! :)