TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!
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Hi Kmahalick, how are you feeling? Getting stretching sounds good. How does it look? I think I look better with my bigger implant, not perfect, but lalot less like two womans breasts on one person. Planning nipple tattooing this summer.
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Hi, all. Just coming back to report on my PS visit last week. Unfortunately for me, he's moving to Florida in June and since that's way out of network for me, I'm going to have to switch to another PS. For now I plan to stay with the same practice, but I'll see how that goes/who that is.
However, I did ask him about fat grafting and he was more confident about its success than he was a year ago when I first discussed it with him. He said that in my situation, because I did not have any gaps or poles above the implant, its primary benefit would be to melt away (my term) some of the internal rads scars, which can increase flexibility.
He also confirmed that yes, indeed, even a radiated muscle will snap back into its original place if the under-the-muscle implant is removed, and without any compromise to upper body strength.
Unfortunately, he would not recommend over-the-muscle for me unless I am willing to remove my remaining breast (for symmetry) to recon and go smaller than I already am (I am now a D, which is smaller than my original equipment).
Thanks to everyone for the education!
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MMeJ, sorry to hear your PS is leaving. I didn't want to take off my other breast for symmetry. I don't even now have perfect symmetry, even after switching to a larger implant. It is kind of close, enough that I will be able to live with it. I am still always glad to have my implant OVER my pectoral, everything is a devil's bargain anyway, so comfort wise it is better. Good luck with whatever you decide to do.
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Wow, so much activity in this thread since I was last here. Glad for the company, I was feeling a bit like the odd person out, except for macb04.
My PS suggested this procedure for me. He is very forward thinking and loves using new techniques. Lucky me! I was happy to go along with his suggestions. The thought of the intense pain that comes with the "normal" method was not appealing. Also, my BMX was intended to be prophylactic, although they did wind up finding cancer (DCIS).
He placed my TEs immediately following my BMX, using an alloderm sling. I did have more pain afterwards than I expected, but that was primarily due to the alloderm being stitched all around to the muscle. I also had 2 nodes removed, and seemed to have more pain on that side in the armpit area. Fortunately, I had no complications or issues with healing other than side effects from the anesthesia.
My TEs were filled to 300cc at insertion, and I only had 2 additional fills of 50cc each. I felt a bit of tightness each time, but no pain to speak of. I can feel the edges of the TEs with my fingers, and depending on my position can sometimes see ripples, edges, and even a stitch. I am confident that won't be a problem when the permanent implants are in. PS plans on doing fat grafting to fill in bare areas and help cover the implants.
My exchange and fat grafting are scheduled for next Wednesday, April 13th. I will be sure to keep you all updated with my progress and results.
Good luck to everyone else going through this.
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Hi MrsGreenJeans,
Good luck with your upcoming implant exchange! Fat grafting can leave you a bit sore, I think that might have been the worst of it. I had my smaller 420cc implant Mentor Anatomic Silicone implant replaced with a larger 495cc cc Mentor Anatomic Implant on March 3rd. I am planning to have 3d nipple tattooing with Vinnie Myers in California in June/July, unless he wants me to wait longer because of my surgery being recent, although my last incision only touched the outside bottom edge of where my areola will go with the tattooing.
I will be hoping for easy exchange with minimal pain and fast healing.
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Lucky you MrsGreenJeans! Best wishes for a quick and successful surgery next week! Please post here if you are feeling up to it. How long did you go from your original surgery to your implant surgery? I'll try to find your original post after this - maybe it has the detail. Also, I'm wondering if you know what size/style of implants you maybe be getting.
You seem lucky in that you had your TEs filled quite a bit at your initial surgery. I'm a little envious! I had only a little air in mine and now I have to have several small fills to get my TEs filled. Currently I've only had 2 fills for a total of 100cc in each (my TEs are 300cc).
I'm much more comfortable this week (at the 5 week mark now), but I've also begun doing the exercises to get my range of motion back. My PS and the NP both told me not to do the range of motion exercises during the healing period which I thought was odd yet somewhat understood. Because of the above the muscle placement and the alloderm, I think they were concerned that this needed to heal fully before putting any stress on that area.
The exercises are irritating my chest wall/muscles anew. I assume this is because the TEs are moving around (or the muscle is sliding around under the TEs) and the rubbing is irritating. At least my skin hypersensitivity from the nerves is settling down. I rarely think about that now.
I am also so happy I went above the muscle thus far. As you mentioned, I can see the edges of my TES, spots where they are still folded a little because they are not filled and corners are sticking out like a stick. I feel I could actually lift up around the edges of my TEs. When I lay in certain positions it pushes my TEs up and off my chest wall (or so it feels like) and that can actually be kind of nice.
Good luck next week!
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Hi Jessie Jake, MrsGreenJeans, we might be in the minority now for above the muscle placement, but I think eventually that will become the considerably more common method of implant reconstruction.
As I mentioned, I am just 5 weeks post op from having a larger implant put in . Went from 420cc , moderate profile to 495cc, high profile, Mentor Anatomic silicone implant. PS put in silk mesh to support my implant and reinforce my skin, he even balled it up under the nipple he reconstructed in December, so that it would be a little more " pointy "., so it matched my other breast better. He liked the silk mesh more than the Alloderm or Stratice because he said it sets up a minor inflammatory reaction which over a couple of years causes your body to make new collagen to help support your implant. Between the silk mesh (called Seri) and my prior fat grafting I can not see my implant edges at all.
Will hope you have an easy recovery MrsGreenJeans, keep us posted.
http://www.theplasticsurgerychannel.com/silk-mesh-gives-awesome-results-internal-bra/
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Ohhh collagen!!! I want that!!! I want this in various spots all over my body
I'm so curious to ask my PS about the silk mesh when I see her. It sounds like a great product. I hope that the alloderm will suffice for me since that is what I'm currently stuck with.
It's funny when I think back to the beginning. I had no idea that one method was more common. I went in blind and the PS offered up both. I wish I could say it was with deep deliberation and research that I made my decision, but it boiled down to comfort and reassurance from my PS.
macb04, can I ask how big your TEs were or how full they were? As I get closer to my implant surgery I'm going to have to research a little on what size I might be. I know I've said it already, but filling my TEs to their full 300 cc makes me think I might look like Dolly Parton. Yet, there's this little part of me that's thinking, "hmmmm, let's see what I'll look like....."
Thanks for the info!
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Hi JessieJake, yes, who wouldn't like a nice bit of collagen. My TE was filled to 600cc. Which was bigger than my 36 D real right breast. He goofed and put in a 420cc moderate profile implant, too small. It looked wide enough looking down on it, but looked like a teenage girl breast compared to my R side, even after my lift. Finally couldn't stand it so, March 1st had him put in a high profile 495cc. Still don't match 100%, I would only give it a 90% matching vote. Some days when in a bad mood I would only give it a 80 to 85 % match to my right side. This is as good as it gets. Lucky your doctor was a forward thinker. The one thing I would say is that because of either my fat grafted fat that survived, or my silk mesh, or a combination of both I can not see or feel my implant at all.
How big were you before? Going a little bigger, in my opinion can help make up a little bit for the flattened shape that even anatomical implants give. Basically it is all camouflage, to give the best illusion of balanced, symmetrical? breasts that we can possibly have at this point. Also think about high profile versus moderate profile if getting anatomical implants. That can also make a difference in how real they look. The companies that make implants don't seem to make any specifically for reconstruction patients, as far as I know. Seems they are all for augmentation, which doesn't really help us when all our breast tissue is gone. Some day, there will be 3D tissue printing to make us a breast implant made from our own tissue, grown in a lab. Here's a link about it. Right now this company is looking to make a nipple/areola complex grown from a woman's fat/skin through 3d printing, but mark my words, growing cell by cell an exact breast shaped for an living implant will be on the horizon. Unless this implant I have now is all still wonderful in a few years, I will plan on that.http://3dprintingindustry.com/2014/08/27/tevido-extends-breast-tissue-bioprinting-research-nipple-grafts/
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Hi Jessie, my original surgery was on 12/02/15. Finished fills about mid January. My PS likes to wait a minimum of 6 weeks after last fill for exchange barring no complications. I could have done the exchange sooner, but I delayed it about a month to make it easier on my work. Another employee is able to work extra during my absence so they won't be short a body. I stand and do a lot of reaching, bending, and lifting at work, so I plan on being off for at least 2 weeks.
I'm not sure which implants I'll be getting. My TEs are the Allergan style 133mx anatomicals. I am pretty sure he'll be using the Allergan Natrelle 410 cohesive gel anatomicals as the two are designed to work together. My PS is a perfectionist, and I have faith that he will choose the right style for me. He did a great job with my sister's reconstruction.
macb04, I agree with you that this procedure will soon be much more common than it is now. So much less invasive than the under the muscle method. I have had no complications thus far, and am hopeful that trend will continue!
Continued best wishes to all. I will update you after my procedure.
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Hi Ladies,
It looks like I might be joining the implant over muscle group! I just found a PS I like, who offered this style of recon, and I'm cautiously excited. It doesn't look like there are too many of us here yet, and it sounds like a fairly new proceedure, am I right? I've been reading all I can on people's experiences, just to get ready. How are you all liking yours so far? Thanks!
Xoxoxox
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Welcome to above the muscle
if that's the route you choose.All I can say thus far is the fills are easy. I'm a ways out from exchange. I think I'll be having several more small fills before I'm done.
My PS said she wants to wait 6 months from surgery to do exchange. I'm not seeing that most are waiting that long, but a lot varies on personal situations.
Good luck!
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Thanks for the reply! I think I do choose to go this route. My PS said that considering my lifestyle, this was really my best option. I'm glad the TE isn't too painful-under muscle it sounded horrific. He is suggesting 3 rounds of fat grafting befor TE installation, then expand for 2 to 3 months, then rest, then install textured implants wrapped in an all derm matrix. Does this sound about right?
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Hi littleblueflowers, Welcome to the over the pectoral page! I started this thread because I wanted to get info about this cutting edge reconstruction method out there. I had a TE under my pectoral initially and just hated it. Some women go through the whole misery of reconstruction with implants and just hate it and some even take the implant out and go flat because they are so uncomfortable. What a terrible shame, when OVER the pectoral is available and considerably more comfortable. I had fat grafting before I got the over pectoral TE, got to an A cup. Then went on to get an over pectoral TE and then exchanged to an 495cc high profile Anatomic MENTOR implant. My PS used Seri Silk Mesh to reinforce and cover my implant. It is supposed to spur your body over a couple of years into making more collagen.http://www.prnewswire.com/news-releases/clinical-study-improved-breast-reconstruction-outcomes-with-seri-scaffold-300028806.html
Between the silk mesh and my fat grafted fat I can not see or feel my implant at all. Sounds like a good plan for you. Good luck with everything.
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Hi littleblueflowers! So far I have no complaints about having had this procedure. My situation is different than yours since I did not require radiation. My PS was able to place my TEs at the same time as my BMX, using the alloderm matrix. My fills were no big deal at all. I only needed to wait 6 weeks after last fill for exchange since I didn't have any skin damage as you probably do.
My exchange is this Wednesday. I will also be having fat grafting at the same time. Will let you all know how it goes.
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Oh, I WISH I had been able to go this route! Prior to BMX, I was a 40/42DDD, and they hung sadly to my waist.
I got 180 ccs in my TEs during BMX, then fills to 635 ccs. At that point we stopped, because I was in a weight loss program. After dropping 60 pounds, the TEs looked like stripper boobs!
At exchange, the PS had to do additional surgery (lateral capsulorraphies) to make the pockets smaller, as neither one of us had predicted how much smaller I would be down the line.
I ended up with 700cc high profile saline implants. Ironically, they fit perfectly with my body size, and I can still wear some of my old bras!
But all the surgical cutting and suturing has taken its toll on my pecs and anterior serratus muscles. It was a long, painful process, and I still have lingering pain and weakness.
(I'm curious - how do your muscles feel once the over-the-pecs implants have replaced the old ones? After all, the original resecting and suturing of the underlying muscles hasn't changed.)
Also, I am highly sensitive to autoimmune and inflammatory issues, and over-the-pecs implants, while sounding like a dream, would probably not work for me.
The Alloderm, or whichever kind of mesh sling they used, could potentially cause problems, and with such big, heavy implants, I can just see them migrating all the way down to my lady parts.
But kudos to those who can have this procedure done!!!!
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You know, I was worried about the implants migrating too! My PS said that just the scar tissue capsules that for would be enough to hold the implant in place, and the alloderm sling is an added layer of protection for the implant which is stitched in place.
Mac, do you overall like how yours look? How was recovery from the fat grafting proceedures?
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Hi again, yeah, someone else also asked me how the implant stays in place. There is some suturing of the implant to my pectoral of the Seri silk scaffolding. I can feel it when I stretch, or if I bend over on rare occasions I will have those muscles nearby on my lower ribs have a brief, painful spasm, until I straighten up.
I had a 420cc moderate profile implant initially, that was too small so 5 plus wks ago got a 495cc high profile Anatomic silicone implant by Mentor. It is better, about 85% sizewise compared to my right breast when I am naked. In clothes it is a very good match and I have nice cleavage. I wish it could look better, but I have reached the end of what I can do. I am worn down, and know I will never be one of those women who get a really excellent, symmetrical reconstruction. I am not lucky that way. I got really bad infections 2 times out of the 5 times I did fat grafting. I still wish I could have afforded to see Dr Khouri down at the Miami Breast Center for Fat grafting, then I would probably have had much better success than I managed to have with the inexperienced PS I was able to find here in Seattle, in my insurance plan. Except for those infections, I was sore from the fat grafting but I was usually up and around, albeit slowly, the next day. I was sore for weeks, but only when I would move a certain way, not constantly thank goodness.
Hi Blessings2011, sorry if you don't think you could get this style of Over pectoral implant reconstruction. It isn't a perfect solution for everybody, but I think a less invasive surgery like this that avoids disturbing major muscles like your pectorals should be on offer for everybody. My pectoral was not sewn back down when the TE was removed, as at that time I wasn't planning an exchange, but was going to go forward doing fat grafting instead. My pectoral healed just fine. I have almost fully normal strength. I can kayak, or do chores or push ups without any problems.
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MrsGreenJeans, good luck Wednesday! I know I said that already but I'm excited for you. Hopefully all the surgery aspects will be easy, too. I am so looking forward to the end of this road with my own exchange surgery but a little leery about the surgery process as I was soooo sick afterwards from all the anesthesia and various meds. I know more now so hopefully we can better choices to minimize that part.
I am just accumulating so many questions! I'm hoping the NP I see for my fill tomorrow might have some info for my questions. I'm going to ask about the silk mesh, fat grafting before exchange (my PS talked about doing it when I get the implants), and I better make a list for my other questions!
macb04, I think I can relate to those pains you described when bending over or stretching. Now that I'm off restriction I am moving so much more and so much more comfortably. However, there's no getting around that I have these TEs in my chest and they remind me when I do things without thinking. Like yesterday when I tired to grab one of our cats as she was trying to escape me. I squeezed my TEs together and stretched way out in front of me. Oops! Some of my feelings I know are from my TEs and chest wall just moving against each other. The one I feel the most that I think is from the alloderm being stitched to my chest wall is on my lower right. After surgery I had a horrid pain there that the PS attributed to a stitch she placed in that spot. That thankfully went away, but when I stretch I can feel a pull all the way down my right side in the front. It's not terrible, but is a clear reminder that I had something done in there.
I haven't gotten to the point of trying a push up but I have added back a few of my PT exercises from a previous shoulder issue and they are going well. They don't really use my pec muscles anyway. You have some great experience to share in that you had the below muscle and how your pecs healed. That's wonderful!
Blessings2011, that's so great you ended up with such a fabulous looking result! Despite the issues leading up to your final result, I hope you are enjoying the heck out of how you look now!
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Ditto , Good Luck from me MrsGreenJeans. Remember to bump up your oral Vitamin C intake on the days leading up to your surgery and for several weeks afterwards. It will improve immune function and help healing because surgery is known to deplete Vitamin C. Increased Vitamin C improves collagen formation, and as a water soluble Vitamin you can't overdose. Also, it will not interfere with surgery and will not increase bleeding risks.
JessieJake, I think that the muscles spasming gets better over time, also it got better when I increased my Magnesium usage. I have a Magnesium Chloride Brine Spray that I bought at Super Supplements. I just love Magnesium, helps with so many things, like muscle spasms /tightness, blood pressure, heart arrhythmias and palpitations, blood sugar issues, anxiety. Thats just a partial list.
Take care All.
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Thanks for the well wishes, ladies. I did some reading up on ways to lessen the anesthesia side effects and flush those toxins out of my body quicker. Vitamin C was on the list. Also, high potency multi vitamins, b-complex, lots of water and foods high in fiber. I will definitely give them a try.
I wish I had done the research sooner, they recommend starting the vitamins and minerals 2 weeks prior to surgery. Better late than never, I hope.
Two more days till surgery. I am equal parts nervous and excited. Can't wait to get rid of that "iron bra" feeling, but a bit anxious about the fat grafting and anesthesia. Gotta take the bad with the good though. I'm not stressing about it!
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Oh, great information on the supplements! I'm going to be on the Vitamin C and looking into the magnesium. I have so many palpitations, if that can help it would be nice.
I had my 3rd fill today. Asked lots of questions and brought DH along on a whim. So glad I did because a lot of things changed today. The NP said my skin was very tight and she wasn't thinking she would be able to add much today; maybe only 25cc. But as she filled she was able to add 40cc and was happy with the results except for one spot under my right foob where the TE is still creased over and creating a pressure point on my skin. I've had it all along but until today it wasn't causing any skin issue. Now it is causing the skin on that point to look white from lack of blood flow. She was concerned enough to bring in my PS. PS thought it really didn't look to be of immediate concern but no longer wants to wait 6 months to do the exchange surgery. She suggested 3 months which would be about June 1st. She scared the beejeezus out of me when we asked what to watch for and she said, "Plastic poking through". WHAT??!?! She said my skin looks pretty thick over that spot but just leaving it for months would probably not be good. And/or they are wondering if another fill will straighten it out. But, they also think I'm pretty much at my max for stretching and how I look. So, the plan is to return next week for a mini-fill of maybe only 10cc in hopes the crease will straighten out. Either way, I'm probably done (not maxing out these 300cc TEs! I am at 140cc now) and I'll be getting my implants a lot sooner.
She said she either puts in the same size or slightly bigger when it comes to implants. We talked briefly about the fat grafting and she said I'd be more sore from that. I said something to the effect of, "Who's going to complain about that?", and they both laughed. Apparently I'm underestimating how painful that will be! I said I had read here from many that it leaves you quite sore, but hard to imagine having never gone through it.
I also asked about the silk mesh since I got to talk to my PS today. She was familiar with it, but didn't think it would apply to me maybe, although she has personally not used it. I was mostly just curious about it but there was a tiny bit of me that was hoping she wasn't going to say she wished she would have used it or something along those lines! I'm stuck with the alloderm for now!They asked again how big I want to be. Ugh, I don't know. I was almost non-existent before (hence the tight skin they keep bringing up) and I was staring to feel a little greedy watching myself grow. I said I really need to rely on others opinions because I don't trust myself. It was nice to have 3 of them tell me today (one being my DH!) that I'm probably where I should be. I tried putting on one of my old padded bras in hopes it would apply pressure to push that point in, but the underwire goes right up the side of my foob. Oh my, they were never like this before!
Learned that the TEs are stitched in place as well as the alloderm. Wondered about that....
Hope you have a peaceful night MrsGreenJeans! Oh, and hope your fat grafting leaves you not too uncomfortable
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Crossing my fingers for you MrsGreenJeans. !!!
Hey JessieJake, definitely look into Magnesium. Huge percentage of people are deficient, lots of meds deplete it. You can not overdose on it, kind of like Vitamin C, unless you have bowel obstruction or kidney failure. It can make some people have loose stools, even when you are deficient. Magnesium Oxide has a very strong laxative effect. Oral Magnesium Glycinate, or Mg Threonate is good, with a much less laxative effect. I love to take a bath with Epsom Salts. You know how it always helps with muscle aches? Well that is because it is Magnesium Sulfate. I read that 96% of Mg Oxide is not even absorbed, but strangely enough they sell it as a Magnesium supplement at Costco. Look at these interesting links on Magnesium. Definitely a do no wrong mineral, and do much good. Hope your wrinkled area flattens out and your skin gets a good, well perfused color back.
http://drsircus.com/medicine/magnesium/magnesium-the-ultimate-heart-medicine
https://www.wellbeingjournal.com/magnesium-balances-calcium-and-rescues-the-heart/
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Exchange complete!!! Things went very well yesterday, no problems at all. Got to hospital at 8:30 and was home about 2:40ish.
One of my biggest concerns was the anesthesia effects, but I feel amazingly well compared to the MX surgery. I don't know if it was the shorter duration or the drugs they used this time, but I'm not feeling that brain fog at all. What a relief. I do get a bit dizzy if I stand for too long, so am not doing much of that.
The exchange part was no big deal, I am feeling very little discomfort from that and range of motion is much better than I had anticipated. The belly pain is another story. I don't feel it much when I am just sitting or lying down, but oh boy standing up and sitting down is not fun. The abdominal incisions hurt like the devil when I accidentally touch them against something. Gotta be more careful with that. He took some fat from the inner thighs as well. The upper pole where the fat grafting was put in is somewhat painful, but not too bad. I took norco twice yesterday, but so far today have only had acetaminophen.
I am all bundled up tight in my surgical bra and girdle, so haven't seen the results yet. PS said he thought I would be very pleased. I see him on Monday, so will get a good look then I hope.
I'm just gonna chill for a couple of days. Hope everyone else is well.
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Oh great news MrsGreenJeans! Of all the things I've spent time thinking about it is the effects of the anesthesia so it is great to hear your experience was much improved this time. I hope since you feel better this time around you'll be able to enjoy your convalescence and your stomach area feels better quickly. You sure weren't at the hospital too long! That's great, too.
When you have time - you just had fat grafting, correct? So I was wondering how big the incisions are. I was talking to my husband about this the other day and realized I never even considered what type of incision that requires. I just assumed it was quite small and that it was a root-rooter job. See how little I know?
Will be fun to hear how Monday goes!! Thanks for checking in and continued good healing wishes!
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Hi MrsGreenJeans, Congrats! ! I am glad to hear it all went so well for you. I remember being sore. But every day it got better. I had some residual numbness around the fat grafting donor sites for several months.
JessieJake, the fat grafting was done from a small incision for me, about 1/4inch length or smaller. Sometimes got a stitch and the smaller ones none.
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jessiejake - FG incisions are usually "stab" incisions, just large enough to insert the cannula. Sometimes they are stitched and sometimes glued and/or steri-stripped. I have had FG three times and cannot see the incisions now at all. If the abdomen is used some PS will hide the incision in a fold or put it near the belly button. The thing with FG for purposes of exchange or revision is that usually only the amount of fat needed for the graft is taken, any more than that can cause denial of your claim to insurance as cosmetic instead of reconstruction. Generally, you don't see a big difference in the donor area after this type of lipo, but it is uncomfortable as FG harvesting is pretty rigorous.
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Jessie, I haven't had a good look at the donor site incisions although in the hospital they did appear quite small. I've had the girdle on since discharge (it crotchless!!!) so I haven't looked at them since. Will probably take a look tomorrow.
Otherwise, I am still doing remarkably well. Thanks everyone for the well wishes.
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Congrats on being done with your exchange, Mrs GreenJeans! I can't wait to hear how you like your results.
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There are so many terms/phrases in these replies that someone stumbling on this conversation would most likely be left speechless! Crotchless girdles, rigorous fat harvesting, ... too funny!
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