TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!
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klgnyc, I started out with pre-pec so my case is a bit different, but I have one radiated and one non-radiated breast. I have had my fair share of complications on the rads side, so I would recommend finding a PS with a LOT of experience with pre-pec implants - my PS has been doing it for a while; was one of the first, and even with all his experience I've had my issues. If I had to do it over again, though, I'd still opt for pre-pectorals, even knowing the complications I'd have. Despite all of them, I'm very close to finally getting my final implants.
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List of OVER 40 PS's doing Prepectoral Implant Reconstruction across the US
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Bumping this up again to see if anyone who had radiation and then pre-pectoral reconstruction/revision can chime in. That's the one thing holding me up...would love to move the implants from under to over the muscle, but I'm concerned about infection, wound not healing, etc.
Going to see RO next week and breast surgeon the week after, but I either get docs who say forget having any surgery or surgeons who say sure, why not?
Thanks.
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Hi there! Me! I have had recon after radiation. It's been a struggle, but it's happening and they look great! A bit bigger than I thought, but over all healing nicely. I waited over a year though...and still had complications.
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thanks for your response, littkeblueflowers. What kind of complications, if I may ask? Happy to go to PM if you'd rather.
K
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klgnyc, as I noted before, I'm doing recon after radiation but I did not go from sub-pectoral to pre-pectoral, which if I recall was your original question. Have also had complications, starting with an infection. Had to have original TE removed, then replaced again nearly a year later. Docs thought I was having another infection and threatened to remove TE again but I'm not "clinically" sick - just have a weird redness that will not go away so I refused to let them remove it. I'm moving forward with my final exchange hopefully at the beginning of September.
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klgnyc, I had implant reconstruction under the muscle after radiation. Several years later I developed painful muscle spasms and my plastic surgeon offered the revision, moving the implant to the pre-pectoral position. I did this in late 2015 and it went well, and felt much better. The muscle spasms completely resolved. Unfortunately about 8 months later I developed necrosis and an infection on the original mastectomy scar and had to have the implant removed and had latissimus dorsi flap reconstruction to replace it. My plastic surgeon did not think that this was due to the revision but hard to say for sure. He did tell me upfront that the radiation put me at higher risk for infection, but risk was still small. I also ignored the symptoms for weeks and week, so maybe something could have been done if I had dealt with it sooner.
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Thanks, raven. I understand your situation is different, and I appreciate your input. I am indeed asking two questions, with the most concerning being how folks are healing from surgery post radiation. My husband sees patients who don't heal, though I understand each person brings an entirely new set of variables. I think the moving of implants to pre-pectoral makes logical sense to me, especially based on my pain.
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klgnyc, I think extra care should be planned into how women who had rads are reconstructed. It is a well know fact that microvascular circulation is impaired to a certain, inevitable degree, thus impacting wound healing and risks of infection. The 2 severe infections I suffered occured when I did no extra measures after surgeries, and just, naively hoped for the best. I finally suceeded in my reconstruction efforts by being aggressively proactive in planning out treatments like Fat Grafting, Hyperbaric Oxygen Therapy (HBOT) concurrently after surgeries, as well as high dose IV Vitamin C, and Pentoxifylline and Vitamin E. I may sound unnecessarily grim, but the point of my creating this thread is to hopefully light a working path to reconstruction sucess, whereby people can learn by my mistakes.
That is why so many women fail implant reconstruction after radiation. They and their PS are not working within a realistic framework, ie ...permanently impaired microvascular circulation. Circulation is everything from the perspective of wound healing. That impaired circulation does not ever revert to normal without extra efforts being taken. I really feel that for the majority of irradiated patients, planning implant reconstruction, the risks of delayed healing and infection can and should be substantially reduced by the above therapies that improve blood flow, or in the case of IV Vitamin C actively kill pathogenic bacteria, even Pseudomonas, without harming healthy cells.
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Here on a lighter note is a photo from the Bedroom window of the B&B in Kenmare, Country Kerry that we stayed at. Took my girls to see the house my maternal grandfather grew up in, before he emigrated to New York.
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what a wonderfull trip it must have been!
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not everone is using hyperbaric oxygen. How did you access it? What health care professional helped with it? Did insurance cover it?
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I'm schedule for surgery August 22nd (pre-pec with Dr. Salzberg in NYC) and I don't know yet if I will need radiation. Is there anything I should do prior to help prepare?
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rokel, good luck! Before Every surgery I have had I try to exercise as much as I am able, to build up my endurance, and super hydrate before. I send positive energy for a quick recovery.
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Great pic, macb04! So pretty! Thanks for sharing.
rokel, I second what 2FUN said - exercise, hydrate. You may also want to look into high dose Vitamin C as prep to ward off infection.
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I would also stay away from inflammatory foods. You can Google anti inflammation diet. Basically I have (tried) to change to a no sugar, no processed food diet. I try to stay away from anything made an a factory/plant. That's not always possible, but I try.
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2FUN, I got Hyperbaric Oxygen Therapy (HBOT) at a Wound Care Center. I found out about it after I had those severe infections as a way to help irradiated skin. Most women who have had rads have some degree of fibrosis, which is a thickening, or stiffness of radiated skin. Sometimes it is termed as "woody in texture". The diagnostic code for radiation fibrosis is " SOFT TISSUE RADIONECROSIS " . Once you have had rads and have even a little bit of rad fibrosis, even Medicare is required to pay for HBOT. I credit the HBOT, along with Fat grafting , and Pentoxifylline and Vitamin E, with helping me sucessfully complete reconstruction, and with helping to reverse the severe fibrosis I had. My skin was not pliable the way the rest of my normal skin is. It was thick and woody, like boot leather. Now my skin is supple and flexible. Even doctors can't tell that I had rads.
Yes all, just got back all. I was ready to come home, but at the same time wished I could have stayed. It was the best family trip I ever had there. Usually my dh and I get into at least one argument, which we mostly skipped this time. The Fish was from the Guiness Brewery Museum tour in Dublin, an advertising logo.
The close up church is Christ Church , Dublin
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rokel, at a minimum, have extra amounts of oral Vitamin C,. Look at this link, and read the entire article. Excellent nutrition helps with wound healing and formation of strong, new collagen.
https://www.ncbi.nlm.nih.gov/pubmed/14653765
Nutritional support for wound healing.
Author information
Abstract
Healing of wounds, whether from accidental injury or surgical intervention, involves the activity of an intricate network of blood cells, tissue types, cytokines, and growth factors. This results in increased cellular activity, which causes an intensified metabolic demand for nutrients. Nutritional deficiencies can impede wound healing, and several nutritional factors required for wound repair may improve healing time and wound outcome. Vitamin A is required for epithelial and bone formation, cellular differentiation, and immune function. Vitamin C is necessary for collagen formation, proper immune function, and as a tissue antioxidant. Vitamin E is the major lipid-soluble antioxidant in the skin; however, the effect of vitamin E on surgical wounds is inconclusive. Bromelain reduces edema, bruising, pain, and healing time following trauma and surgical procedures. Glucosamine appears to be the rate-limiting substrate for hyaluronic acid production in the wound. Adequate dietary protein is absolutely essential for proper wound healing, and tissue levels of the amino acids arginine and glutamine may influence wound repair and immune function. The botanical medicines Centella asiatica and Aloe vera have been used for decades, both topically and internally, to enhance wound repair, and scientific studies are now beginning to validate efficacy and explore mechanisms of action for these botanicals. To promote wound healing in the shortest time possible, with minimal pain, discomfort, and scarring to the patient, it is important to explore nutritional and botanical influences on wound outcome.
- PMID:
- 14653765
- [Indexed for MEDLINE]
Free full text
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My first surgeon (Sloan Kettering) told me no supplements a week before surgery. The new surgeon hasn't mentioned it. Were you told something similar?
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both my PS and BS said no vitamins and other supplements 2 weeks before surgery
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Hi rokel,
Some preoperative supplements can possibly increase the risks of operative, or postoperative bleeding, or interfere with anesthesia. Just to be caustious, most PS recommend stopping all supplements 10 days to 2 weeks before surgery for the reasons I mentioned.
Here is what I posted about the topic of postop use of supplements. I will add it up to the start as well.
Hi, NotVeryBrave, because of the risks of bleeding, or interference with the anesthetic, it is a good idea to follow that recommendation to stop all supplements before surgery. I am only talking about taking additional nutritional supplements AFTER, a few days to a week afterwards. Here is what I said regarding this from another post about the post op period:
The only contraindications I know of regarding herbs/supplements after surgery is the increased risk of bleeding that can occur in the early PostOp period, usually the first 3 to 7 days. Blood clots are a very small risk in the PostOp period (for nonorthopedic procedures), but one that is not much affected by use of herbs/supplements, except a few that interfere with the effectiveness of Warfarin/Coumadin anticlotting medications, like CoQ10, Goldenseal, or St John's Wort. .
Certain herbs are known to increase the risk of blood thinning,
Herbal Medicines
- Garlic: inhibits platelet aggregation (organosulfur), discontinue for seven days
- Ginkgo: inhibits platelet activating factor (terpenoids, flavonoids), discontinue for thirty six hours
- Ginseng: inhibits platelet aggregation and lowers blood glucose(ginsensosides [mimic steroids]). Check PT/PTT/glucose, d/c for 24 hours (preferably seven days)
- Saw Palmetto: associated with excessive intraoperative bleeding(mechanism unknown, likely multiple), in the absence of pharmacokinetic data, no recommendations re: preoperative continuation can be made
Herbal medicines that increase the risk of bleeding:
- Black Cohosh: Claims to be useful for menopausal symptoms. Contains small amounts of anti-inflammatory compounds, including salicylic acid. Theoretically could have intrinsic/additive antiplatelet activity.
- Chamomile: Claims to reduce inflammation and fever, to be a mild sedative, relieve stomach cramps. Increases risk of bleeding because it contains phytocoumarins, which have additive effects with warfarin.
- Feverfew: Claims to prevent migraines. Increases the risk of bleeding because it individually inhibits platelet aggregation, has additive effects with other antiplatelet drugs. Also additive effects with warfarin.
- Fish Oil: Claims to prevent/treat atherosclerotic CV disease (800-1500mg/day). Also used to decrease triglycerides (>4g/day). Dose dependent bleeding risk increases with dose >3g/day.
- Garlic, Ginger, Ginko, Ginseng: Increases bleeding risk by interacting with antiplatelet drugs to inhibit platelet aggregation and inhibit fibrinolysis. Also augments warfarin
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My PS prescribed 10,000 units of Vitamin A. I was given this because I am on Prednisone which can impact wound healing. I was instructed to begin the Vitamin A 3 to 4 days before surgery and continued to take it until the prescription ran out. So for a total of 30 days. My PS did not want me taking it longer than 30 days as Vitamin A can become toxic.
I was not allowed to take any other supplements or NSAID etc...2 weeks prior to surgery and for 2 weeks after surgery.
~Dee
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Hi Dee, welcome. Did you have a Prepectoral Implant Reconstruction, or Subpectoral? If you did Prepectoral, do you want me to add your PS's name to the list?
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Hi Macb,
You've already added my plastic surgeon to the list
I saw Dr. Lennert in Washington, DC.Thanks
~Dee
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Thanks, MacB.
I saw my RO on Tuesday and she thinks I'm in pretty good shape for a revision - I have very little radiation fibrosis - and stunned me when she said she thought I should have the surgery. She pointed out that radiation has changed markedly in the past 20 years, and the risks are fewer, though of course not non-existent. I did mention hyperbaric and high dose C to her as well, and she seemed to think I was in better condition than most and would be okay without those things ahead of time.
Seeing breast surgeon next week so she can weigh in, too.
In the meantime, I saw a pain management doc today and he suggested spinal epidurals versus the intercostal epidural I had some months back that did nothing. I may try that in the interim since I can't schedule the surgery until November, but I want to fix the issue as best I can, not just treat this for the next 40 years. I don't expect to be 100% ever again, but I'd settle for 40 - 50%at this point
Also, the surgeon I'm seeing now is Dr. Troy Pittman out of Georgetown. He's done one pre-pec revision I've seen (it was gorgeous, especially compared to my Frankenboobs) and has performed the standard implant surgery/revision on two of my friends who are very happy with the results.
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Hey KLG- I have been pretty successful as you asked, but I have dept with very slow healing of surgical wounds, which at one point led to a staph infection. I had to get emergency surgery with that and IV antibiotics. I have also been on oral antibiotics for going on 3 months. My breast is almost healed- just one tiny scab at this point. It has taken almost 3 months to heal! Just something to be aware of!
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Ugh, that's what I'm afraid of. I actually had an open wound for nearly five months after the mastectomy as I started chemo four weeks from surgery and one section didn't heal fully. PS had to stitch that closed when she swapped in permanent implants before radiation. Luckily, there was no infection, it was just super slow to heal and I packed it with Silvadene every day.
And yet, when I spoke to my RO, she wasn't worried about infection...she seemed to think the risk was really low given how well I healed from radiation.
I know it's always a crapshoot...just trying to eliminate as much risk as possible.
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klgnyc, I just want to bring up that the Wound Care Center I went to explained to me that use of Silvadene, when there is no infection, or large burden of bacteria, has been shown in some studies to cause delayed wound healing. I found information about the fact that it can be toxic to keratocytes and other cells responsible for creating new tissue. Just thought you might not have been aware of these cautions regarding silver and wound healing.
Oh, so the skin where you were irradiated is just the same as your non irradiated skin..? Wow, that is great. Then I guess you shouldn't have too much worries of poor perfusion. Doctors tend to dismiss things like IV Vitamin C because they don't have much experience with it, yet even they would have to admit the amount of resistance to antibiotics is increasing in a very scary way. I just hear so much about infection, that I wanted to make sure you knew about IV Vitamin C, just in case. Good Luck, and keep us posted. I really hope you get much more relief than just 40 -50%.
http://woundeducators.com/silver-dressings/
Precautions
There are a number of situations in which silver dressings should not be used. These include:
- Surgical wounds that are low risk for infection
- Pregnant or lactating women
- Patients who are sensitive or allergic to silver or metals
- Wounds being treated with an enzymatic debridement agent
- Wounds in which there are no signs and symptoms of infection present, whether localized or systemic
- Chronic wounds that are healing as expected
- In, on, or near sites that are being or have been treated with radiotherapy
- Small, acute wounds that are unlikely to become infected
- Wounds in which slough or necrotic tissue is present
- Wounds colonized with multiple organisms or biofilms
Silver dressings can be very effective for wounds that are infected, or wounds harboring large numbers of bacteria that have stalled in the healing process. There are numerous silver dressings available on the market. When used appropriately, silver dressings are cost-effective and safe to use and can significantly reduce wound bioburden.
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The list of Prepectoral Plastic Sugeons in the US is up to 46.
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Hi Ladies, just chiming in. I had radiation in 2014. Just had a double mastectomy with Alloderm and direct implants over the muscle on May 17th. Almost 3 months out now. I have had no issues healing and have full feeling in the skin of both breasts. I plan to do fat grafting in November.
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