TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!
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I'm still pretty miserable. Spent some time in the ER the Friday before last. This nerve pain from the right paravertebral block site is awful. I would seriously go through 6 more rounds of chemo as trade for taking this pain away. I'm loaded up on amitriptyline and gabapentin - they make me functional and take away most of the pain (thankfully), but taking meds for this is not a long term solution and that is what concerns me the most. We are all hoping the nerve root heals over a few months. Add to that, my left surgical side appears infected (red and hot) and I'm back on antibiotics as of yesterday. Hopefully it will clear it. Would be incredibly disappointed if I can't go on the trip to Israel which is 10 days away, but I will do whatever is necessary. My chest wall/surgical sites feel OK. I lifted weights this morning as best I could and I have been running (ran several days in a row once I hit the 2 week post-op mark). The nerve will be a problem whether I exercise or not, so I always choose exercise. So happy these expanders are on top of my pecs and I can already lift weights. Realized that I don't want to bigger than these expanders, so I'm hoping we can size down but that would mean sizing down the footprint and I'm not sure if that can be done if the pocket is already bigger.
- xo
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Oh jeeze Andra- sorry you are in so much pain. Thats aweful. Im sitting here waiting on my second fill- my radiated side is definitly redder than my other side. Hoping antibiotics do the trick for you! This ish is for the birds, huh.
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hi Mcb.
Any over the muscle ps in the Boston area? I'm intrigued by this. I have unders and find that the animation is bothering me during exercise and things like opening jars and doors , etc. thx.
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Update 12/2 - Thanks for people's helpful comments to my post - surgery date is 12/9; I'll let everyone know how it went. My PS has agreed to this method after his research with other PS, manufacturers, and medical research. I'm optimistic & relieved because upper body strength is so essential to my happiness.
Hi everyone! I'm new to this topic and the whole process. I really appreciate the forum and have learned from everyone's posts.
My PS says he's seen 1 pair of reconstructed breasts over the pectorals (post mastectomy), & they looked good! But he hasn't done the procedure, and he's concerned that something could go wrong later...not leaving enough skin to do a repair. He would like to review any medical studies about the process with risks and rewards.
I found this one: https://www.ncbi.nlm.nih.gov/pubmed/25455288 I'm also going to give him the list of doctors you've collected on this thread - thank you so much!
Has anyone here seen any medically documented studies to share? Surgery date 12/9/16. Thanks in advance!
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Hi MacB04 - I did some research for my PS today & thought I'd share contact info with the group.
Dr Reid Mueller - OSHU, Portland, OR (503) 494-6687 www.reidmueller.com/
Dr Kamakshi Zeidler - Campbell, CA (408) 559-7177 zeidlerplasticsurgery.com
Dr Karen Horton--San Francisco, CA (415) 923-3067 drkarenhorton.com
Dr. Michael Halls--La Jolla, CA (619) 286-6446 or (858) 458-0100 lajollabreast.com
Dr. John G. Apostolides - San Diego 619-222-3339. defyprs.com
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So disheartened not to see a New York doc on the list! We better step it up!!! I'll certainly ask the plastic surgeon(s) when I get my nerve up to have a consultation!
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Hi dandelion. Only have it done by someone who does it all day long. If getting over the muscle is what you want then u might have to travel to get an experienced doc. it will be worth it in the long ru
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There are likely many more surgeons performing over the pec implants, and Macb04 adds to list when people (on this blog) report those surgeons. I've watched the list grow significantly over the past few months. Most surgeons do not do this often (not as often as under the pec), but have several under their belts. My surgeon has done several and he was the one who told me he recommends it for me (before I had done any research) because I am so active.
- xo
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Hi everyone:
This is my first post here although I've tried to read almost all of the pages.. So grateful for this thread! I don't know anyone in Real Life with over the muscle reconstruction so it's great to see you all here.
I had a single mastectomy in June with immediate saline implant placement. I'm scheduled for exchange to silicone on 12/28. Just trying to get a better feel for what lies ahead and find out what questions to ask before I see my PS for the pre-op on 12/14.
For those of you who are further along in this process, how are you feeling about your final implants? I'm worried about contracture because that has started up in the last few months. (I had surgery in July and chemo from Aug-Nov). It seemed like it got worse with chemo, if that makes any sense. Maybe it's just coincidental. For the first couple of months I didn't have any at all so this more recent development is disappointing. I got some serious grief from some of the PS consults I had when I was first diagnosed who told me not to do over the muscle. They thought I had too little body fat/skin but the PS I selected was confident and had done a lot of surgeries on people with similar frames/body types. I'm glad I did it. I mean I think I'm glad. Right now I'm not ecstatic over this one bionic boob - the projection is a tad much! Really hoping the exchange will fix this issue.
I'm wondering about what type of implant to use and whether there are many options. I see some of you had computer aided graphics - my PS doesn't do that. She's a good listener but also pretty opinionated (as you would expect). I know she'll do what she thinks is best but I'd like to be a little more educated than I was at the first surgery. She mentioned she would perhaps use use a high-fill and/or textured implant. I'm small with an A cup (maybe B+ back in the day
and I'm not crazy about doing a lift on the "good" side. I see from some of the earlier posts there are high and low profile implants. Anything else to know? I'm a small chested person and am looking to stay small and really natural (read almost flat!). Not exactly a PS' dream, I'm sure. Hope you all have a good night. Take care
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Hi Willa216!
I was approx B- cup before cancer and bilateral mastectomy. I currently have expanders in and no real fill yet, just the air my PS fills with a little at time of placement (uses air instead of water until it is time for the 'real' fills) which is supposedly around the size of an A cup...but feels bigger to me because of the projection on the upper edge. Even with a little air in them they already seem big enough. I think it is because they don't compress like real breasts. When I wear a sports bra with a thin foam layer for nipple concealment (that would have flattened my real breasts) they seem pretty big now. The expanders are ugly and can almost hook my fingers underneath them at some of the visible edges, but at least I can get a little idea of how it will be to have some form of breasts again. I call them "frankenboobs".
I don't want any 'cleavage' and want small natural looking breasts so we are going with gummy bear/cohesive gel implants, specifically he uses the Allergan Natrelle 410s. Google them....see if they are shaped like your natural breast on the other side. They come in low, medium and full HEIGHT, and low, medium, full, and extra full PROJECTION. We decided on the lowest projection I could get for the footprint (width) needed for the size of my body. Height will be determined in the OR and either medium or full (I am 5'5" but have a long torso). My PS said the upper pole may be visible through my skin (I am very lean and muscular/athletic) but he would do some fat grafting if needed to help conceal the upper pole. I think the expanders are a little wider than I'd like so I'm hoping we might be able to go even smaller if we size down the footprint/width, but it might be too late because the expanders creates the size of the pocket (and you don't want the implant to be loose in the pocket or it can rotate). My PS has been great through it all and supportive of me wanting small natural breasts that would work with my very athletic lifestyle.
Anyway...I hope that helps!!
other update: my L side infection finally seems to be improving and I was just given the OK to go to Israel/Jordan on Friday with my fiance (still not used to that word!) as long as I stay on antibiotics the entire time (that will be a month of abx not including the first 2 weeks I took them post-op - yikes!). Of course I'll still be on gabapentin and amitriptyline for the nerve injury sustained by the anesthesiologist when the R paravertebral block went awry. Might have to be on those meds for a few months while the nerve hopefully heals. At least it helps the pain well enough that I ran 12 miles on Saturday and 6 miles today. Found out yesterday that weight lifting exacerbates the nerve pain so I need to back off that. Gained a few pounds from post-op decreased activity (and probably holiday food), but that just put me closer to my pre-cancer weight.
Hope all of you have wonderful holidays!! Big love and hugs!!
- xo
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Hi ladies- Hope everyone is doing well! A question: did any of you find that your saline filled tissue expanders got really cold outside in the winter? Did any of you come up with a great idea to keep the baby sweater kittens warm without compressing/compromising bloodflow? Went skiing yesterday, mindful that my PS warned against frost bite, and dang if they didn't get chilly, even under all my layers. Another question- Symmastia. I'm afraid I'm getting it a bit- the clevage skin seems to be lifting in one spot. My PS says not to worry, all will be corrected at exchange, but ugh. I think its due to my radiated side not wanting to stretch. Any suggestions? And a final question- it looks like the scar on my radiated side may have some tiny openings in it. PS said its probably from stitches disolving. ITs freaking me out though. Can you recommend anything that worked for you to strengthen a scar and help with healing while preventing infection? Thanks!
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DandelionWishes, come join us on the December surgery thread.
I had my surgery yesterday and it was direct to implant over the muscle. My PS does that all the time now, unless there's a compelling reason not to. I was able to come home the same day, and everything is going well. I'll let you know how it looks once the swelling goes down. My PS inserted Natrelle 410 FF 740 cc.
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Has anyone noticed a pinching like an underwire bra with their over pec implant. Just wondering.
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Andraxo: Thank you! I'll check out the gummy bears/Natrelle. I think we are thinking along the same lines. I, too, am hopeful that the final implant can be a bit smaller than the original but I have the same concerns you do. As an aside, that's interesting about the air expansion. I feel like I'm learning so much these days about everything I never wanted to know anything about..
Hope you're doing okay with your infection and the nerve pain. Ugh. Sending good thoughts your way. Fingers crossed you get to make your trip with your fiance
LittleBlue: I have saline and I actually notice that my implant feels hot! That said, I'm in CA and have not had an opportunity to test in snow. It was in the 30s last night though. When I was outside for about an hour I didn't notice any coldness. Hmm. My aunt has gel implants and she says they are like ice all the time (hers are under muscle). Sorry for your skin/rad issues. I wish I had something intelligent to say to offer help on that front but I didn't have rads. I hope you feel better soon.
Myjourneys: Hope your recovery is going well!
kmahalick: I do get pinching sometimes - it comes and goes. I'm about 5 months out from initial implant placement so I was thinking it was just healing nerves? I have a lot of very strange sensations. I hear that complaint a lot though from people who have over and under the pec implants.
Take good care, everyone.
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Hi all. Sorry to just jump in, but I have a question for you. I had a left mastectomy on 11/22 and had a TE placed over the muscle. My PS has been doing it this way for ~1 year and highly prefers over compared to under the muscle. From his point of view: drastically better recovery, less invasive, etc. The resistance came from my BS, and I had to make sure the RO was on board in case I needed radiation, but they investigated and said it's safe.
I'm happy with my decision but still nervous about detecting possible recurrence on the chest wall, which is now under the TE (and will be under the implant). This was my BS's initial concern, but the PS said he doesn't "buy it" that it's concerning. I will ask him again why he's so confident that it's not a problem, but do any of you worry about this? I had close margins (<1mm) from the mastectomy, and while the invasive cells were close to the front and side skin (I had 3 small tumors), there was DCIS close to the chest wall. True, DCIS is less concerning than the IDC, but will I be relying on MRI to detect something there? I'm curious about the guidance you all received about followup after TE/implant placed over your muscle.
Thank you.
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Kat104, funny you should ask this as I just had a 6 month follow-up appointment with my MO yesterday and I asked about the recommended on-going testing. His opinion was that all of the breast tissue has been removed at this point and that while, yes, it does recur in a very small percentage of patients, the incidence of false-positives from on-going testing is high which can then lead to unnecessary procedures which carry their own risks for infection, etc.
I'm still mulling all that over in my head so don't have an opinion. Just sharing what my MO told me.
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Thank you, Raven. That's also my concern about relying on MRIs (false positives and more procedures), but I'm a little scared of missing something now with the chest wall "buried" under an implant. Thanks for sharing your MO's opinion.
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Kat104 and Raven4mi: I'm really interested in this discussion about accurate follow ups for over the muscle implants. Nobody (not BS, PS or MO) ever mentioned any issues with recurrance detection with over the muscle implant. I'm a little nervous about this now. I guess I was so anxious and upset at initial diagnosis that I didn't even ask the question. I sure wish it would have been brought up or I would have had my head screwed on to ask. Raven, I'm somewhat comforted by your MO's comments but, I don't know, there are so many things to worry about that I would maybe have liked to take this off the list. As far as false positives - I hope this doesn't sound negative - but I would much rather go through false positive anxiety rather than have something be missed and end up with a really serious situation. I have dense breasts and cancer was missed for what was likely years on mammos/ultrasounds and even 3D mammos. All that to say that after an MRI I did have to have a surgical biopsy on the "good" breast at time of mastectomy of my "bad" breast because an MRI did light up with a very small spot in the "good breast". It was a benign fibroadenoma. While I wasn't happy to have a second surgery I'm glad the spot was found. Anyway, I have an appointment with my PS next week so I'll ask her and let you know her opinion, although I think BS or MO would be more likely to know. I see BS in January for 6 month f/u.
Have a great weekend!
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I originally followed this thread because I have issues post radiation, and wondered if this would ever be an option; looking at all options. It is not an option for me, but I wanted to comment on the detection of a local recurrence. I had a local recurrence and was able to detect it because it was between my pec muscle and the skin. The issue a few of you mention about this is an important one, and I think you should have a discussion with all of your doctors about how to detect a local recurrence if they do not plan to do MRIs. Simply saying local recurrence is not much of a risk after mastectomy is easy to say when they aren't the ones who have to face the consequences of an undiagnosed recurrence that spreads. Don't be afraid to advocate for yourself. At the end of the day, you need to decide which is more concerning for you, a potential false positive, or a potential undetected positive
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I didn't mean to scare anyone, and I'm sorry if I did. It was the biggest factor that made over-vs-under a hard decision for me, and I really struggled with it before coming to the conclusion to go ahead and go over the muscle. And what helped me get there is that my BS consulted other surgeons in other parts of the country who have over-the-muscle implant patients, and the consensus is that it is safe to proceed. Also before surgery the RO assured me that radiation would work just fine with the muscle under the TE. I guess I'm just scared now with close margins and looking for feedback from others in the same boat.
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Hi Kbeee! I know you and I talked about potential reocurrance in the soft tissue quite a bit. Before I went ahead with pre pec recon, I asked my surgeon and MO for a care.plan. They said that it would includ.manual exams, an annul MRI, and ultrasounds. Its a calculated risk, but I went for it. KAT, im with you, id much rather a false positive than a false negative!
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I definitely would not hesitate if I knew they would do ultrasounds and MRIs to monitor for recurrence
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Willa216, thanks for your response, I can't figure out the exact movement that causes it but after 11 months I am wondering if it is the way the implants adheres to the tissue.
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I just saw my PS regarding this issue again today. I have had multiple attempts to correct the riding up of my pectoral muscle due to the implant being placed under the muscle. He finally said he would be willing to do it this way...apparently this is becoming the new method, but he does not have experience with it. I have endured 11 years of torture with these things under my muscle. Unfortunately it will be a fairly invasive surgery to try and repair and reattach my muscles to where they should be. But as it stands now, I would rather have nothing than continue with this discomfort. I am very interested in hearing more about this reconstruction method.
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calkat, I would strongly recommend that you find a surgeon who has been doing the pre-pectoral implants for a couple of years; you sure as heck don't want to be your PS's first experiment! Please see macb04's list at the top of this page. Even if you had to travel a little bit it would be worth working with an experienced surgeon. Would any of the surgeon's on the list be an option for you?
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I had a mastectomy last week, with the implant placed over the muscle. For some reason, a small part of my skin at the incision didn't get enough blood flow and they had to go back in, cut the dead skin away. Now I have a TE under the muscle because they felt the muscle would be able to promote/nourish blood flow to the skin. Right now it's feeling tight, and I can't extend my arm as much as before, but my pain killers are handling any pain.
Just wanted to share with those who are considering an over-the-muscle implant. My BS does these exclusively, so she was experienced. It just wasn't the best option for me.
Will the tight feeling go away after a while? (I'm assuming it'll take time for the muscle to relax, but don't know what the usual timeframe is.)
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MyJourneys, you mean a week after they did pre-pectoral they took you back in and put the TE in under the muscle?
Sorry, I can't speak to the tightness you're experiencing with under the muscle as I've only ever had pre-pectoral, though some on this thread used to have under the muscle so hopefully they can help you out. You may also want to consider posting on the December surgery thread (I'm assuming there is one - there's usually a thread for each month) as the majority of others from those threads have under the muscle since pre-pec is so rare.
Good luck!
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Raven, you asked:
<<MyJourneys, you mean a week after they did pre-pectoral they took you back in and put the TE in under the muscle?>> Yes. the pre-pec didn't work out. We have a December surgery thread going and it's been very helpful.0 -
Hi all, I just had a revision surgery for my above muscle implants. It was just fat grafting. My ps said that some of the fat she grafted during my exchange did stay but I needed more to fix a few thing. In certain positions my implants had some ripples and the top edges were more visible than I liked.
I am hoping the grafted fat may stay better this time as I certainly have more sensation in the area, and blood flow is good.
This surgery was very easy in comparison to others. I believe they started at 8 and I was being wheeled back to my room at 10 something.
But wow does my butt hurt. This is the area where she took fat. My foobs are swollen and bruised around the top where she injectef the fat. I've had more discomfort from this than when I got the implants. I wonder if it's from nerve regrowth. I've had itchiness, some stabs of pain. The itchiness is baffling as what do I scratch?
My ps said they look good and nobody's perfect so I believe after healing things still won't be even, but hopefully top edges well be hidden better.
I'm still completely confident in my choice to go above. So comfortable!
Hope everyone else is doing well!
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JessieJake, I had fat grafting done back in October and the recovery for it sucked worse than any of the other surgeries I had! I wasn't prepared for that. I even told my PS that, while I realize that's his bread and butter, I can't imagine why anyone in their right mind would do this procedure on purpose. And he agreed!
The itchiness is a very common after-effect of FG. My abdomen was my donor site and wearing the binders/girdles they recommended helped tremendously with the pain. It took weeks for me to feel back to normal. Hang in there - it will get better eventually!
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