TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!
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An unexpected hazard of physical therapy is the snake den in the middle of the parking lot lol.
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Sitti, I had the direct to implant placement pre pectoral after my bmx. My bmx was nipple and skin sparing. I am overall pleased. My implants are smaller than what I had wanted but due to previous radiation, my skin wouldn't stretch but so much.
I think that surgery is a great choice if you want to be the same size or smaller.
Hope things go well for you. Pm me if you want more information.
Alli
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Wow, am over 30 PS on the list who do Prepectoral Implant Reconstruction!
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Thanks for the comments everyone and for the info littleblueflowers. If any of you get additional info from your PS, please let me know. I'm going to try to get ahold of mine this week. I am feeling worried now about all this and how I don't want to increase my risks of a secondary cancer down the road! I chose this route (prepectoral) to lessen complications/problems. Now beginning to consider just no reconstruction- sigh.
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dcdrogers, thank you for your update. Have your surgeons given you any information about how/if node status would impact the over the pectoral muscle reconstruction? If expanders were required, would they still be over and not under the muscle? Your notes are helpful to me.
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- Alli, dcdrogers, thank you for the information. As it turns out my PS wasn't able to do the direct to implant, he said my skin & tissue were too thin or something. (I also had a N&SS BMX) Suburbs, my PS did place the TE'S over pectoral muscle.
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@Suburbs - The PS didn't mention anything regarding being node position. I have at least 1 positive node (biopsied) and assume she was aware of this when we came up with my game plan. I attend a breast care center at GWU so all of my doctor's have access to my records. I'll remember to ask during out next meeting before surgery. The plan right now is to go with direct-to-implants. The PS will be bringing both the implants and the tissue expanders into the OR. If my breast skin is to thin (as mentioned by Sitti) we will have to go the TE route. Either way the plan is to go above the muscle.
My PS also discussed possibly being able to spare my nipple, but I read somewhere that HER2's should not have nipple sparing surgery. Not sure how true that is, but I brought it up to my MO last week and she said it really depends on how close the cancer is to the nipple and not necessarily the type of cancer one has. Right now I'm still undecided on whether or not I want to keep my nipple if it is an option.
~Dee
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Hi ladies who have completed their reconstruction, a question: My PS sent me home from exchange surgery in a surgical sports bra type thing. He didn't really give many post op instructions, so I'm wondering if its ok to switch out periodically to a sports bra for a while, like when laundering the surgical bra? Or....will my foobs immediatly make a run for it? I know every surgeon is different, but looking for experiences here. Thanks!
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Sitti, I'm sorry I didn't post this a couple of days ago! I had a nipple and skin sparing unilateral mastectomy at the end of January with direct to implant reconstruction using a Mentor shaped implant (gummy) above the muscle. (I had extensive DCIS in my right breast.) Honestly, I had very little pain. I took two prescription pain pills at home, and after that was fine with extra strength Tylenol. The worst part of the recovery for me was the darn drain. I was so happy when that came out! Now, two months later, I am very happy with the way the implant looks (very natural) and even with the way it feels (although it does take a little getting used to). One recommendation I have is to get some comfortable supportive bras. My PS recommended wearing a bra 24/7 for the first three months, which I have been doing. I had good luck finding bras both at Nordstrom's (Natori brand) and at a cancer boutique in a nearby hospital. Best of luck with your recovery!
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Sitti, I didn't realize your surgery was so soon. Hope you are doing well with your recovery and that your pain will be less due to the TE being pre pec. Please keep us posted.
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Hi littleblueflowers, in regards to your question about switching bras, basically it should be ok if the other bra is supportive of your newly created bosom in a similar way. So long as it minimizes movement of healing sutures/incisions, it shouldn't be too much of a problem. That is what my PS told me.
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Hi Ajzs, if you want, I can post your PS on the list if you let me know. Glad your NS direct to implant reconstruction went so well. That’s just marvelous!
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Hi, ladies. Had my right TE replaced last Friday after original had to be removed due to infection last year. After PS said that a new implant had to go under the muscle I insisted on FG back in October to repair damage from infection so that we could re-try pre-pectoral and I'm happy to report.............success!!! Had the new pre-pec TE inserted last Friday. Had a little bit more pain this time than ever before but still completely manageable. Had my f/up appointment with PS today and things are going just great. No problems except a little redness under some mesh "glue" stuff they used over the incision but nothing major - PS thought it might just be a mild allergic reaction. No itching or anything. He filled me with 150 CCs of saline on the way to 750 to match the left side which has a 650 cc TE filled to 750, so I'm still pretty flat on one side. No pain or feeling on the fill at all, though, so that's cool. If he does 100-150 CCs each week I'll be there in no time. He did say they couldn't fill it up much during the surgery because they had to remove a lot of scar tissue this time which probably explains the post-op pain. The bad news is that he left in the EFFING drain. God, I hate the damn thing and I have a long, sordid history with them - had drains after my original bmx last year for seven weeks. Guh! I refuse to take a shower while I have it in there - trust me, once you've been hit with an infection you'll take ZERO chances on getting another one - and sponge baths get really old, really fast. Oh, well. I'll deal with it and hopefully it will come out next week. Appointment with ob/gyn also went well following bilateral salpingo-oophorectemy done at the same time. Only one more f/up appointment with him and then I'm done there.
I did discuss the textured implant/rare cancer thing with him and he indicated that, at first, it was on a specific brand of implant that seemed to have the most issue, but they're now finding cases with other brands as well. But he says it's just so super rare and the texture theory is just that - a theory. We discussed having f/up MRIs and he says he's all for them for women whose original diagnosis was very high grade, meaning a very aggressive cancer, which is not my case. Still, he says, MRIs are never a bad idea but thought that I could wait another year before I start them. I will be having them, though, if only for my own peace of mind.
So glad I held my ground and insisted on the FG. I'm beyond thrilled that I was able to stick with pre-pec.
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Hooray for your new pre-pec implant raven4mi!!
Jen - I was told any sports/(compressive/supportive) bra would be fine. I used the surgical post-op bra 24/7 until I was allowed to shower, which was 48 hrs later. Once allowed to shower I used my own bras and form-fitting/spandex-y tank tops. I did not sleep in any type of bra by day 10.
Trying not to stress about the lymphoma possibility with textured implants. There's enough stress thinking about chemo and radiation induced leukemia which could hit in 5-10 years. It just sucks that the treatment for cancer can cause another type of cancer. I'm trying to enjoy the life I have now as much as I can, and not lose/waste today worrying too much about tomorrow....which is out of most of my control.
- xo
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hi everyone. Thanks for keeping this thread going and the flow of information. I met with the plastic surgeon today and was deemed to not be a good candidate for over the muscle placement due to current status. Chemo first, horrible skin rash from TCHP, steroids holding back (barely) skin rash, two biopsies with skin not healed, no saving or sparing with multi focal disease and possible radiation. The totality of those factors were the reasons for conservatively going with the slower, expanders under the muscle to be exchanged later, measured procedure. The surgeon stated that this newer technique needed good skin intact in order to be successful. This made sense to me. Of course, I would be happy to hear any opinions about this. I was so risk adverse last week that i had talked myself out of any reconstruction. I think i am ok with it now having gained confidence in the surgeons. I am very happy for others for whom he newer model works.
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Raven, congrats on the new implant!!!! Andra, good to know about the bras. Keeping a single surgical bra on 24/7 seemed like a bit of a tall order. Um.... Hygiene??? Also, yes. Lymphoma risk. Im still curious if ADM was used in any of the cases. I mean....my implants are totally wrapped in the stuff, as i bet most of ours are. Therefore, how does this extra ingredient, as it were, affect our chances of developing implant lymphoma. Less, becUse whatever is pissing our bodies of about the implant is not actually in contact with our tissue? Or more, for some other reason. Yah, i think we are more likely to die from radiation or chemo induced cancers. Wheeeeeeeeeeeeeeeee!
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Hi All:
Appreciate all of the great info you are providing as well as the support.
First,
Raven, congratulations on your pre-pec implant! Good to hear that it seems like everything is going to work out for you despite a complicated situation.
Sitti - Best wishes to you as well on your surgery.
I'm wondering if I could get some feedback. I had a single mastectomy - nipple sparing and skin sparing with an over the muscle implant in July. I got contracture and had to do a capsulectomy in Feb and a new silicone implant was placed. I'm wondering about a few issues:
I had a lot of swelling until this week - I'm about 7 weeks out from surgery.Now the swelling has gone down but I can't move the implant around much in the pocket anymore (PS had me moving it about/massaging) and the implant seems harder. For those with implants already, did this happen to you as well? Or did the softness of your implant and the size of the pocket remain static as you healed? I just don't know what to expect. When you have implants should you expect them to be soft or are they going to end up being hard no matter what? I was so hopeful the implant would remain soft like my natural breast (I know it's not the implant itself getting harder but rather the scar tissue that is affecting the implant, but you know what I mean
I'm concerned about contracture again and I can't gauge what's normal. Two weeks ago my PS said everything looked good. But now something different is happening. For those who have implants, did your PS use Alloderm? Mine doesn't use it typically but she said she might if I had continued issues with contracture. I'm not excited about it in the least but from what I've read it is often used - esp with pre-pec.
Has anyone done physical therapy to soften scar tissue and keep the implant softer during healing ? My friend is a PT and suggested this but my PS isn't impressed with the idea.
Lastly, with this talk of additional cancer arising due to implants, I think my head may just blow off. I realize there have been only a small number of cases (potentially) but still... And now I am doubting my decision to do over the muscle because of contracture issues and because any reocurrance is apparently difficult to catch. I had an aggressive HER2+ tumor so I wish I would have had the brainpower to address this upfront with my BS/PS.
Thanks everyone. I wish this worrying would end. Despite my efforts to live in the moment - yoga, meditation, daily exercise, I seem to have done a face plant today. Can't stand the thought of more surgery after chemo and ongoing Herceptin. This reconstruction process is more than I realized it would be. Sometimes it seems like it will never end. And I've never been more negative. Sorry!
Take good care. Happy weekend everyone!
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Aaaaaak! A whole month of not being allowed to get my heart rate up???!!!!!!!!! Thats 3 more weeks of slow walking!!!!!! Fu@#! Im gonna turn into jabba the hut 😲 This blows.
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Jen - that is crazy to me! So sorry you cannot push yourself cardiovascularly. That simple sucks! I have never understood the HR restrictions from your surgeon - it just doesn't make sense to me unless you have some cardiac damage from chemo. ugh. Did he/she give you rationale for that restriction?
willa216 - I have implants that are completely enveloped with alloderm, just like Jen. I think the majority of surgeons just use it at the base to make a sling-like support, but some surgeons wrap the entire tissue expander in it. Your skin becomes one with the alloderm over time. The more supportive pocket remains for when the TE is exchanged for implant. I'm also a PT, have had therapy myself by someone who specializes in this stuff, and also treat my own patients s/p mastectomy etc. Yes therapy for the scar can help free it up and soften it (you could easily be taught how to do it yourself, but having someone else do it can help even more), but nothing softens the actual implant. I have never heard there is less risk of contracture by going under the muscle. My implant on the radiated side feels more locked into the pocket than the non-radiated side (which is more mobile) but that is to be expected given even mild radiation fibrosis.
- xo
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Andra, he's a fascist. Thats the only possible explanation. Just kidding. Kind of. No, I have no cardiac damage or bleeding issues. He just feels that getting blood pumping could possibly damage healing tissue, or cause a seroma... dunno, Im not a Doctor, but this drives me freaking batnuts. Also no lifting more than 10 pounds or raising my arms. Which makes more sense than the cardio restrictions. 3 more weeks of supposedly no more than gentle walks around the block. Ha! How are you doing? Implants settling in? Wedding planning going full blast? 😁😊😁
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Hey raven4mi, congrats to the MAX! I am so glad you managed to get Prepectoral to work out for you. It is wonderful that you were able to rehab your skin/muscle after that infection, so it worked over your pec. Are you on Bromelain to help decrease bruising/swelling? When I took it, along with increased Vitamin C and Zinc the length of time with the drain was shortened, vs the time I didn't take it.
I am not going to worry too much over the Lymphoma risk with implants. To put it in perspective, the FDA reported 359 cases of the Lymphoma, out of almost 5 million women having procedures with breast implants since 2010. That is a statistic I saw gathered from the Plastic Surgery Annual Statistics, including for Augmentation as well as Reconstruction. I think Andraxo is right, much higher risk of leukemia from rads/chemo poison, so not worth it to worry. We could drive ourselves crazy worrying, and this has all sucked enjoyment out of my life enough already. No more...... I am happy to have two breasts again.
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Hi ladies I'm new to this board and waiting to see a new PS closer to where I live. I have had TE for also most a year not ( chemo, etc) deciding what I want to do next. I hope I can go to the best next step. Don't really want implants or a major surgery w the flaps. Wonder if fat transfer w some type of lipo is out there. To fill the space. (?)
I wanted to see if anyone else heard the news regarding cancer stemming from implants. Specifically textured implants. It was in the Today Show this week. It was a shock since women like us have already have battled the disease and get implants as part of the healing process.
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Hello ladies! It's very late, 4:25 am, and I can't sleep due to discomfort so I won't be addressing all the individual gals as I am so tired, but am answering some questions. Just don't want to keep DH awake with all my tossing in bed so decided to read some BCO posts.
My pre-pec TEs are 450cc, filled to 475 and my skin is stretched as far as it will go. I have my exchange date of May 4. My PS said I WILL have drains, I am thinking due to the fact he has to get rid of the "dog ears" under my arms due to loose skin from 50lb weight loss.
PS had initially planned on using textured ANATOMICALS, but midway through my expansion he told me he is not using them in his practice anymore due to the slight Lymphoma risk. I appreciated his concern even though the risk is small. I don't want to increase my risk period. Even though I had pure DCIS it was tested for HER2 due to high grade and microinvasion seen on biopsy. Turns out I am Triple Neg so I am taking all precautions. PS will be using Natrelle Inspira smooth rounds, high to ultra high profile.
I did well with my fills, until the last 2. PA who did my fills told me to start wearing supportive bra as I am a full D now. Perhaps the constant bra wearing is causing my discomfort. It is mainly on one side just in front of armpit, and just started a week ago. Nurse said it could be nerves waking up. Has anyone had pain start later after several weeks of no pain? Also, has anyone who is filled to capacity experiencing flaky skin? Maybe that is from the bra as well.
As to the Vit C, I have access to IV, stepfather is an MD and holistic.However, I have stage 2 chronic kidney disease and read that kidney impaired should NOT get IV VIT C as it can lead to kidney FAILURE Again, not taking any chances. I do have powdered quality VIT C I got from my stepfather. The scoop it comes with delivers 4000 ius. I take 1/2 scoop 2000 ius every few days. My urine VIT C levels are 100℅.
I am so thankful for this forum and all the love and support here. I would probably have had to go to counseling or get on antidepressants had I not been able to share our stories with each other. Cyber hugs and best wishes to all!!
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Andraxo- Thank you! I actually saw a massage therapist last night about another issue. She showed me how to do the implant massage so I'll keep that up. I hope I'm remembering correctly but you recently downsized your implants because initially they were too big? I think you did this quite soon after surgery? The reason I ask is that I'm thinking that this latest revision didn't go so well and maybe I should just ask for some changes now rather than trying to wait this out. Also, I hope it's okay to ask so many personal questions? I believe you are small framed with little body fat? Do you have any rippling or are you still swollen? My PS told me the implant was fine if it was mobile in the pocket. I'm not sure it is. It's still rather soft but it is a strange shape when I lie down (ripply/bumpy) which makes me think the edges aren't all free. It moves but I think the movement is just the gel in the implant, if that makes sense. As far as the contracture rates being worse with pre-pec - I got that info from several PS who advised against pre-pec. They also said I'd experience more rippling. However, I have a friend who has been a physical therapist for BC patients for over 20 years and seen a lot of reconstruction. She recommended my surgeon who does pre-pec. My surgeon said that rippling and contracture occur with above and below the pec implants and the rates are similar. Of course, that's not what the other surgeons said. It's hard to know what's true. I wanted to try pre-pec because it seems to yield the most natural results and of course is less invasive. I guess I will go see my PS. In any case, thank you, again! I hope you're doing really well and you're feeling good!
Littleblueflowers - I feel for you on the 4-6 weeks no exercise. It's head-bangingly (word?) frustrating. My PS is the same. She did relent and tell me I could walk 20 minutes at a time but no speed walking. I ended up just walking about 60 minutes at a time and just watching my heart rate. I hope this time goes by quickly for you. Take care.
Shoregirl: I've had two surgeries at this point. Both times I had no pain at all for about two weeks and then kind of shooting nerve pains and sensitivities a few weeks out. My PS said it was the nerves waking up. It did go away both times. Hope it is the same for you.
Meow: Good to see you! I hope you're doing well and life has been good for you. I'm not sure about the fat transfer for reconstruction. I think there is a thread here specific to it. I think it's called BRAVA. If I recall from the cold cap thread, I think Dancetrancer did it? Maybe she can point you in the right direction. I don't think it's very common but it certainly does seem like an appealing option. Hugs.
Have a good weekend, everyone.
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Meow- there are some women doing reconstruction using fat grafting. Check out 'Susan's story: Breast reconstruction with fat transfer' on Youtube. I'm going to talk to my PS about it. I'm scheduled for a pre pectoral exchange in May but having concerns now. Also want to talk about smooth implants over textured (which was what she planned to use). I haven't made a final decision yet......want to get more information.
Best wishes to all the women on this thread! I know we are at various stages of treatment/reconstruction and trying to do what's right for us and it's great to be able to get feedback from everyone :-)
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Thanks, macb94! No, not on Bromelain - never heard of it, in fact. But I read your post while at a school event with my son and stopped on my way home and picked some up. I'll try anything, and you haven't steered me wrong yet, so thanks.
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Willa, thank you! I'm really glad to see you too! I'm trying to hang in there😊I'll look into the BRAVA and Dancetrancer.
Love2 hike thanks!I'll check out the video. Hugs to you ladies we do go through a lot and we deserve to be satisfied.
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Hi raven4mi, hope the Bromelain helps. Remember to take the Bromelain at least an hour away from meals. If you take it with meals, all of its good effects will go towards helping to digest your food instead of working on other problems in your body. Look up this Nutritional Support Full Text article, just copy and paste the full title into Google. It is really well written, discusses the process of wound healing, and what each of the various nutrients do. How much Vitamin C are you having daily now? I found that increasing my Vitamin C levels seemed to correlate almost inversely with how fast the drainage decreased, ie, more Vitamin C= Much less drainage.
Nutritional Support for Wound Healing - Alternative Medicine Review https://www.ncbi.nlm.nih.gov/pubmed/14653765
Hi Meow0369, I did BRAVA Fat Grafting. I don't think the PS was very experienced, so I wasn't very sucessful. I did 5 BRAVA Fat Grafting Procedures. I had 2 severe infections, and lost most of the grafted fat. I couldn't afford to go somewhere to find a more experienced PS, so I had to give up on Fat Grafting with BRAVA and switched to Prepectoral Implant Reconstruction, which was not my first choice. It has worked out fairly well, though , overall. The small amount of my grafted fat that remained after the infections (which I got, by the way, because I couldn't afford to get IV Vitamin C then, ... sad.......) has cushioned the edges of my implant completely so I have no animation defect. Experience of the PS counts alot with Fat Grafting. PM me if you want to have more detailed info.
I have a textured implant, put in last year before all the latest hoopla about lymphoma. Remember 397 cases of Lymphoma out of 5 million implants since 2010, is not a high number. For those who are looking at future implants, might be a talking point with their PS, but for us women who already have a textured implant, keep in mind the risk is so very low, compared to the Carcinogenic potential of chemo, radiation or tamoxifen. I am done, and refuse to lose what little comfort my improved appearance has given me worrying about what if...
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Thanks, macb04. Yes, will watch the Bromelain intake and mealtimes. Thanks. I'm taking 2,000 mg of Vitamin C a day (one Emergen C packet in the morning and one at night.) I saw your post about lipospheric vitamin C but haven't gotten any. I'll see how things go this week and if the drainage doesn't slow so that the JP comes out on Thursday then I'll look into that and Vitamin E as well.
And I'm with you on not worrying about the textured implants. We could drive ourselves quite insane with all the "what ifs" in our lives. I prefer to just live the day I have.
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willa216 - good memory! yes I did exchange to smaller/less projection. On the right side, I did that just 12 days after the initial implant. We tried for a week later, but the implants did not arrive in time and they only perform surgery 2 days per week so I had to wait another 5 days. The left side wasn't ready because it's my radiated side and still looked a bit angry. The L exchange to less projection/smaller is scheduled for April 21st, which is 2 months after the initial implant. He thinks the tissue would be ready at 6 weeks, but he will be away then. Even after the smaller exchange they will still be a little bigger than I wanted, but I'll be happy. Ok to ask any questions you want! I am not small framed, but don't have much body fat (had initially planned fat grafting via BRAVA for recon but not enough body fat in the places they like to harvest from). I'm muscular with broad shoulders 5'5" about 128#. My swelling is gone and yes I do have rippling - more on the non-radiated side. I have textured anatomic implants (Allergan Natrelle 410 cohesive gel). We talked about possible fat grafting later to help conceal the top edge and for rippling, but he's not sure where he'd get it from (he already took a little from my hips to treat my radiated tissue after radiation), and I'm not sure I care enough. It's not as if a little fat grafting is going to transform these things into looking natural! They are not aesthetically pleasing when naked, but thankfully look great in clothes, and most important of all they are comfortable with all forms of activity/exercise.
Jen - yeah, that actually sounds counterintuitive. Exercise increases circulation, and I know I want good circulation to my healing tissues! So sorry you're stuck with just walking. The lifting restrictions make perfect sense though. I'm doing OK - thanks! Realized this week though that I am not any faster or stronger since finishing chemo/rads a year ago. I think this is what I am stuck with, though thankfully I can still do a lot. I blame that fluorquinolone reaction that was half way through chemo Stupid drug! I don't think my muscles are ever going to fully recover - but I know I came out better than many who react to that drug. The FDA is investigating it more. As for my new implants, even though my breasts seem pretty close in size visually I'm still exchanging out the left implant for smaller. I'm aware of it having a little weight when I run and I don't even want to notice my boobs when participating in sports. My surgeon probably thinks I'm crazy! Hope you are feeling great aside from not being able to exercise much! By now you have likely showered and checked them out - are they close to what you wanted? Hope so!!
- xo
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