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

kae_md99

thanks 2FUN! if you dont mind my asking what is your implant and how big is it? thanks again

kae_md99

raven,

you are so right!!!! they should listen to

us!!!

rokel

I just had my surgery a few days ago. When the anesthesiologist went over the pain management plan with me, I mentioned that I was having over-pectoral placement he said it was unusual and then cut out half my pain meds since he said I wouldn't need them. I thought that was a good sign and wanted to share!

kae_md99

thanks for sharing rokel! how are you feeling now,painwise? also is there any tightness post op

macb04

kae_md99, welcome to the OverPectoral( Prepectoral) Reconstruction thread. I think I felt the TE much more than my current implant. By the very nature of a TE, it is a structurally sturdier piece of "equipment ", as it is expected to be poked with a needle and expanded in the volume of saline it contains over the couse of several months. I wouldn't actually expect a TE to ever feel "comfortable". So what you feel sounds completely normal to me. It will get much better with the exchange.

Congrats Rokel! How are you feeling today?

rokel

I'm feeling good. Not a lot of pain or tightness. I'm only 3 days out so well aee

macb04

Here is a reminder about Viamin C effects in creating new collagen after surgery.

Healing the wounds or having surgery? Don't forget the Vitamin C!

Dr Rath Research Institute,
Santa Clara, California, USA

Many ugly malformations of scar tissues or prolonged and complicated recoveries from surgical procedures can be avoided by the simple measure of taking the right vitamins.

This is not new knowledge however. As long ago as 1937, Harvard Medical School surgeons observed the importance of vitamin C for wound healing in patients recovering from surgeries [1]. These physicians noted that "spontaneous breakdown of a surgical wound in the absence of infection occurs with relative frequency in patients with the cachexia of cancer, in debilitated individuals, and in young patients; notably those who have some congenital anomaly of the gastro-intestinal tract." Therefore, their recommendation for the administration of vitamin C was based on their subsequent observations that wound healing becomes faulty with low vitamin C, and that vitamin C levels were low in their patients.

While such information remains pertinent today, it may be omitted in medical practice as routine protocols take precedent in the clinic. Recently we have received reports from nurses and practitioners whose patients' wounds will not heal despite the lack of complications. These practitioners even speculated that it may be a vitamin C deficiency or other malnutrition that is responsible for the slow wound healing. However, they admitted that some of their patients, frightened by the media vitamin scares, were hesitant to take supplements without scientific evidence of their beneficial effects.

Therefore, it should benefit medical practitioners, their patients and the public at large to revisit these dusty old papers and new data explaining the role of vitamin C and nutrition in wound healing.

Collagen – a fabric of our body

When wounds heal, the body's metabolic requirements increase. In the first few days following a major injury or surgery, the body's vitamin C may fall to dramatically low levels. In one hospital study, the vitamin C levels of critically injured patients were uniformly at severe scurvy levels [2]. Only high doses (multi-gram) of vitamin C, but not milligram amounts, were effective in restoring blood levels for this vitamin back to normal. Why is it so important to re-supplement vitamin C?

Without an additional supply of vitamin C, the formation of new replacement connective tissue between cells is hindered and the new tissue formed to close the wound may be fragile, defective, or missing altogether. The majority of this connective tissue is collagen, which is comprised of the amino acids lysine, proline, and glycine assembled together in molecular cables and sheets. These collagen cables and sheets are the structural beams, walls, and scaffolding of the body's cells that must be repaired and rebuilt in the case of an injury. Even the seemingly inorganic bones of the body are comprised of a finely organized structure of collagen cables between which mineral is laid down. The enzymes critical to forming these cables of collagen between our cells cannot function without its co-factor vitamin C [3].

Likewise, lysine and proline are necessary structural elements of collagen that are required to a higher degree at the site of wound healing. Lysine is an essential amino acid that humans cannot produce and it must be supplied by the diet. While humans can manufacture their own proline, the rate at which they make it may decrease under illness. A wound patient may utilize as much as 100 grams of protein a day, and their requirements for supplemental amino acids such as lysine and proline may be very high [4]. It follows that a deficiency of lysine or proline would also prevent proper wound healing as these are the raw materials for making connective tissue.

Wound healing requires a team effort

Not only are vitamin C, lysine, and proline essential to the rebuilding of damaged tissues, but also a variety of macro- and micro-nutrients that supply bio-energy, building blocks, and enzymatic cofactors needed by the cells to maintain all their normal tasks. As the rebuilding process involves the immune system to clear out damaged debris and infectious agents, new cells divide and move in to replace lost cells. All cells then work together in forming a bed of collagen, fibronectin, laminin, proteoglycans, and other extracellular matrix molecules that give a functional form and structure, without which the tissues of the body would disintegrate. All of these processes involve an intricate cascade of interdependent biochemical events within each and every cell, and each of these processes has a different nutritional requirement.

Although there is not much economic interest in funding studies with micronutrients in wound healing, there is enough clinical evidence in support of micronutrient supplementation. The clinical study developed and sponsored by Dr Rath Research Institute demonstrated that daily supplementation with the collagen building nutrients such as vitamin C, lysine and proline, significantly accelerated healing of bone fractures [5]. This study confirmed the critical role of bone collagen for faster bone healing since these patients were not taking calcium supplements, commonly recommended in bone health. Healthy bone metabolism requires both collagen building micronutrients and minerals. Also, our laboratory data have proven that synergy of vitamin C, lysine, proline, green tea extract, arginine and other micronutrients aids in healing skin wounds and reduces scar tissue (unpublished).

Therefore, the keen observation of today's bedside caregivers that wounds may be slow to heal because of micronutrient deficiencies and malnutrition is correct and applies not only to patients in developing countries, but to patients in hospitals in Berlin, Paris, Warsaw, or San Francisco. Micronutrients deficiencies are still common and affect both young and old. Therefore, a simple measure like taking nutritional supplements can help in mending our cuts, wounds, burns, broken bones and surgically damaged tissues without health risks. At what cost? Less than the price of the cup of coffee you buy at Starbucks every day.

References:

[1] Lanman, T.H., Ingalls, T.H. (1937) Vitamin C deficiency and wound healing: an experimental and clinical study. Annals of Surgery 105(4): 616-625.

[2] Long, C.L., Maull K.I., et al. (2003) Ascorbic acid dynamics in the seriously ill and injured. J Surg Res 109(2): 144-148.

[3] Berg, R.A., Steinmann, B., et al. (1983) Ascorbate deficiency results in decreased collagen production: under-hydroxylation of proline leads to increased intracellular degradation. Arch Biochem Biophys 226(2): 681-686.

[4] Russell L. (2001) The importance of patients' nutritional status in wound healing. Br J Nurs 10(6 Suppl):S42, S44-S49

[5] J. Jamdar, B.Rao, et al (2004), Reduction in Tibial Shaft Fracture Healing Time with Essential Nutrient Supplementation Containing Ascorbic Acid, Lysine and Proline, Journal of Alternative and Complementary Medicine, 10, 915-916.

123meesha

Thanks so much for your research Macb! I've been looking into HBOT.. i find it frustrating that this is not a first line treatment and that insurance will only cover it once you have solid evidence of a serious problem. I bought some liposomal C to use before and after surgery. This is also really helpful info about the lysine and proline. I have been trying to find a go-to for HBOT treatments in case i need them after surger. Regarding vit C, I am hoping the liposomal C will do the trick for me, but maybe I should be ready to invest in IV C just in case I get an infection.

macb04

I agree it should be offered to every woman who has had trouble healing, infections or radiation fibrosis. I think I would not have gotten through reconstruction without HBOT, as I they had damaged me quite severely with radiation fibrosis. It really contributed to my reversal of the radiation fibrosis, along with the Fat Grafting and the Pentoxifylline and Vitamin E. I got the HBOT at the Wound Care Center at Northwest Hospital, part of University of Washington, Seattle, WA. I had to fight, fight, fight to get my insurance to pay for it, which they did.

I got the IV Vitamin C at the Infusion Clinic of my Naturopath, Natural Family Medicine of Seattle. Before I was able to get IVC I had to have a blood test for Glucose 6 Phosphate Dehydrogenase ( G6PD) Deficiency, which is an extremely rare contraindication. I know that out of my many, many surgeries, I only got 2 infections when I didn't get the Intravenous High Dose Vitamin C. It should be offered as a standard of care, as it is broadly antiseptic, without any bacterial resistance ever detected, more than can be said for any antibiotic. It is also proven to kill cancer cells, so it is a win, win from any standpoint.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1405876/

CMAJ : Canadian Medical Association Journal

Canadian Medical Association

Intravenously administered vitamin C as cancer therapy: three cases

Sebastian J. Padayatty, Hugh D. Riordan, [...], and Mark Levine

Additional article information

Abstract

Early clinical studies showed that high-dose vitamin C, given by intravenous and oral routes, may improve symptoms and prolong life in patients with terminal cancer. Double-blind placebo-controlled studies of oral vitamin C therapy showed no benefit. Recent evidence shows that oral administration of the maximum tolerated dose of vitamin C (18 g/d) produces peak plasma concentrations of only 220 μmol/L, whereas intravenous administration of the same dose produces plasma concentrations about 25-fold higher. Larger doses (50–100 g) given intravenously may result in plasma concentrations of about 14 000 μmol/L. At concentrations above 1000 μmol/L, vitamin C is toxic to some cancer cells but not to normal cells in vitro. We found 3 well-documented cases of advanced cancers, confirmed by histopathologic review, where patients had unexpectedly long survival times after receiving high-dose intravenous vitamin C therapy. We examined clinical details of each case in accordance with National Cancer Institute (NCI) Best Case Series guidelines. Tumour pathology was verified by pathologists at the NCI who were unaware of diagnosis or treatment. In light of recent clinical pharmacokinetic findings and in vitro evidence of anti-tumour mechanisms, these case reports indicate that the role of high-dose intravenous vitamin C therapy in cancer treatment should be reassessed.

Flygirl12

hey guys, my PS is very willing to do over the muscle TE and implants, I'm just curious about what your doctors have said with reoccurence? With the muscle under the implants, are they suggesting more imaging? I know the rate of reoccurence is small, I'm just wondering what you have gotten from your PS and BS

rokel

flygirl- that was a concern of my surgeons. He only likes to do over-pec if the surgery is preventative because in theory you could have a reoccurrence on the pec wall that would be undetectable. But when we asked him for numbers he admitted that hehad never heard of this actually happening, just a theoretical risk. I was willing to take it and in the end the cancer was not right up to the chest wall so I felt ok with the risk

klgnyc

Thank you all for your comments...thought I'd posted this earlier, but don't see it so sending another thank you.

Sunrisefish and PugsMama, you give me so much hope, and PugsMama, you look fantastic.

Both RO and breast surgeon agree this is the best option after 2.5 years of pain and no relief, so I'm scheduling surgery for November/December. I'd do it at surgeon's first available in early October, but I'm hosting a major charity fundraiser later that month and can't take the risk I'll be out of commission.

Considering a spinal epidural next week to tide me over, even though intercostal nerve block and Botox did nothing. Anyone tried the epidural?

macb04

Hey klgnyc, I don't know about the epidural, other than generally with surgery, but have you tried Lidocaine patches as a temporary pain fix?

klgnyc

I've done Butrans patches. They take the edge off, but don't come close to eliminating the pain and are only good for a week or so. New pain doc thought the epidural could be a decent stopgap till I can have these awful implants removed.

Now that I know I want to have this above the muscle revision, it can't come fast enough..

SouthernGinger

I received Allergan Natrelle Inspira SCM-445 silicone implants in same operation as BMX and (3) auxil node dissection. No TE. I was a 36C before surgery and told my PS I wanted to remain the same but have slightly fuller breasts. I wish I'd known about all the different options in silicone implants but guess my surgeon chose this particular brand & style based on what I had said. I am hoping that I can get used to these implants over time. I am only 2 weeks post-op and maybe what I am feeling right now (tightness, some pain) is normal. My PS said she puts implants on top of pec muscle which is what I wanted also. Would love to hear from anyone who has the Natrelle SCM implants also. Thanks!

SouthernGinger

Just saw my Drs name on your pre-pectoral list! Dr. Michelle Roughton at UNC Chapel Hill! She is awesome! As is Dr. Gallagher - my BS. I have my first post-op visit with her on 9/11 & hoping the tightness & pain will have subsided by then. Saw Dr. G this past Monday (8/28) and all my aux node biopsies were clean and they were able to get clean margins from the Paget's! Yay!

macb04

Hi SouthernGinger. Welcome and glad to hear you good news. It is good to hear more positive feedback of the PS's that are on the list. I hope the tightness goes away for you too. It has improved significantly for many of us going the Prepectoral Route. GOOD LUCK with you post-op visit. Keep up the good nutrition for best healing.

macb04

If anyone knows PS's doing Prepectoral Implant Reconstruction in other countries besides the US, let me know and I will expand the list. I am sure there must be some doc's doing the procedure overseas.

veggal

My long-awaited revison happened today! I went from subpectoral 595 cc Natrelle 410 FF's to prepectoral Inspira SCX 615 cc on right and 650 on left. I also had fat grafting in the upper poles.

My PS found capsular contracture in both sides. She removed both capsules, which removes my risk for ALCL! She also removed some redundant skin on Righty to help improve symmetry.

All of the fat came from my thighs. She spared my belly in case I need another round in the future. I sure hope not as I had a terrible time with nausea in recovery. They finally ended up giving me Decadron after the Phenergan and Zofran failed to help. I can't use a patch as I have a neuromuscular disease and scopalamine is contraindicated.

So now I wait and see how it all turns out. I have a drain in each side, but the PS placed it below my implants instead of the underarm area and it is MUCH more confortable.

Thanks for reading!

rdeesides

Question for you ladies. Can you have this type of reconstruction at the time of mastectomy if you are going to need rads after?

Thanks!

R

macb04

Hi VegGal. Good for you. I hope you heal well. As you know, good nutrition will help immensely with recovery from surgery.

Yes rdeesides, women have sucessfully gotten Prepectoral Implant Reconstruction as a Direct to Implant Procedure with radiation to follow, although I don't have numbers for you. Perhaps someone eho has done that will respond.

SugarCakes

UGH! Had typed a lengthy response with background and somehow I guess I swiped and it all disappeared 😞

Landed here while searching with key words. I had BMX + TEs. Few weeks later, swapped out TEs for Implants... all under pec muscles. No issues with healing or pain as I had implants prior and already had a "pocket" for the TEs and implants. Then I had radiation.

What I am trying to find out after running across this thread... might a revision to have implants placed above my pec muscle improve the appearance of my radiated, reconstructed breast?? Right now it is higher, harder of course, and dimpled / indented / creased in some areas. Already had a revision once where the implant was replaced, some scar tissue was removed, some fat grafting was done. No real improvement. In fact, in terms of smoothness, I'm thinking it may look worst.

All and all, it isn't BAD. My PS feels and I was inclined to agree that I probably would be satisfied had I not had such beautiful implants prior.

So again, might a revision to have implants placed above my pecs improve the appearance and feel of my radiated reconstructed breast in particular???

Back to reading more of the thread while I wait for a response

legomaster225

Rdeesides, I am currently getting rads and had my implants done at the same timeas my mastectomy. Both PS and RO said they have not had issues doing rads afterwards on pre-pec implants. So far I'm fine but we will see. I can update after I am done if that helps.

SugarCakes

oh wow! Just want you ladies to know that reading through some of this thread has given me life this morning!!! All in all, I have done very well after my treatment. I once LIVED on these boards, but now I just check-in now and then or like today when I'm researching and looking for others with similar experiences. I LOVE these boards. Anyone I know that is diagnosed with BC, I always stress how much the site and the community boards helped me get through that first year! Love you gals!!!

rdeesides

Legomaster, yes, please keep me posted. I'm a way out from surgery but am hopeful I will be able to do this. Want to have as few surgeries as possible.

Thanks,

macb04

HI SugarCakes, it sounds a bit like radiation fibrosis is affecting your radiated breast/implant. Obvious signs of Fibrosis are a thickened " stiff or woody" texture to the skin. Fibrosis is also associated with Telangectasia (which are small dilated blood vessels) I would suggest reading up on the following info on Pentoxifylline/Vitamin E and Radiation Fibrosis. I know that Radiation Fibrosis is often helped considerably by multiple Fat Grafting procedures. Do you think you could have Radiation Fibrosis? It's important to work on improving the vascularity of your skin following radiation in order to get the best result with any surgery. Overall I think that having an over Pectoral implant can be better for many reasons, including comfort/strength and speed of recovery. It can work out looking really good in the right PS hands, even for women afflicted with rads damage. I had very bad radiation fibrosis. My skin was like boot leather, stiff and woody. I started Pentoxifylline and Vitamin E a few years ago, and still take it orally and also use it as a topical prescription cream. I also had several Fat Grafting procedures as well as Hyperbaric Oxygen Therapy. Between all of that I managed to do what I was told was impossible. Now my skin is soft, and nearly normal in texture and appearance. I hope this helps. Good Luck.

Pentoxifylline and vitamin E treatment for prevention of radiation-induced side-effects in women with breast cancer: a phase two, double-blind, placebo-controlled randomised clinical trial (Ptx-5).

https://www.ncbi.nlm.nih.gov/pubmed/19540105

Randomized, placebo-controlled trial of combined pentoxifylline and tocopherol for regression of superficial radiation-induced fibrosis

https://www.ncbi.nlm.nih.gov/pubmed/22846413

Randomized trial of pentoxifylline and vitamin E vs standard follow-up after breast irradiation to prevent breast fibrosis, evaluated by tissue compliance meter.

Jacobson G1, Bhatia S, Smith BJ, Button AM, Bodeker K, Buatti J.

Author information

Abstract

PURPOSE:

To conduct a randomized clinical trial to determine whether the combination of pentoxifylline (PTX) and vitamin E given for 6 months after breast/chest wall irradiation effectively prevents radiation-induced fibrosis (RIF).

METHODS AND MATERIALS:

Fifty-three breast cancer patients with localized disease were enrolled and randomized to treatment with oral PTX 400 mg 3 times daily and oral vitamin E 400 IU daily for 6 months after radiation (n=26), or standard follow up (n=27). Tissue compliance meter (TCM) measurements were obtained at 18 months to compare tissue compliance in the irradiated and untreated breast/chest wall in treated subjects and controls. Measurements were obtained at 2 mirror image sites on each breast/chest wall, and the average difference in tissue compliance was scored. Differences in TCM measurements were compared using a t test. Subjects were followed a minimum of 2 years for local recurrence, disease-free survival, and overall survival.

RESULTS:

The mean difference in TCM measurements in the 2 groups was 0.88 mm, median of 1.00 mm (treated) and 2.10 mm, median of 2.4 mm (untreated). The difference between the 2 groups was significant (P=.0478). Overall survival (100% treated, 90.6% controls at 5 years) and disease-free survival (96.2% treated, 86.8% controls at 5 years) were not significantly different in the 2 groups.

CONCLUSIONS:

This study of postirradiation breast cancer patients treated with PTX/vitamin E or standard follow-up indicated a significant difference in radiation-induced fibrosis as measured by TCM. There was no observed impact on local control or survival within the first 2 years of follow-up. The treatment was safe and well tolerated. Pentoxifylline/vitamin E may be clinically useful in preventing fibrosis after radiation in high-risk patients.

Copyright © 2013 Elsevier Inc. All rights reserved.

SugarCakes

Hi Macb40,

Thanks for all the information! I am thinking the problem isn't my skin. But I don't know! It feels soft and smooth to me. My radiated boob is hard and appears like a tight out of shape ball compared to the other. Its also too big in the pole. Looks Frankenboobish, especially from the side. I wish I could see pics of other radiated breast reconstructions. I know about the 3rd party photo site. I have been there in the past and it's just too complicated to find and post pics, especially in this day and age.

I considered going for a PS' second opinion. Ran across this thread and didn't realize PS' were doing pre-pec implants now. I am going to call the PS's office in Chapel Hill to schedule a consult. If she seems to think what I have is about the best that can be done, I will move on to my plan B and get a tattoo over it!

macb04

SugarCakes, try pinching up skin on the radiated breast, and on the nonradiated breast and compare how they are.

This research on Low Level Laser Therapy sounds very interesting. For many women with the unwelcome complication of Capsular Contracture, with its attendant hardness of the implant, the only cure has been surgery. Well, before I would go under the knife again, I would certainly be willing to try something pretty painless like Low Level Laser Therapy (LLLT), which is otherwise known as Cold Laser Therapy.

I found only the title and abstract of an article saying laser therapy doesn't work. I wasn't able to access the article, unless I buy it. So I guess everyone will have to make up their own mind, or await further research.

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Laser therapy does not work for capsular contracture: A randomised controlled trial - European Journal of Surgical Oncology

http://journals.sagepub.com/doi/abs/10.5992/AJCS-D-14-00036.1

Low-Level Laser Therapy: An Alternative Treatment for Capsular Contraction

Jason D. Johnson, DO, Paul M. Glat, MD, FACS, William L. Scarlett, DO, FACSFirst Published March 1, 2015 Research Article

Download PDF	Article information

Abstract

Introduction:

Fibrous capsular contracture is the most frequent complication leading to patient dissatisfaction after breast augmentation and breast reconstruction. This multi-factorial phenomenon has been treated both surgically and nonsurgically with mixed results. At the present time, the more severe grades of capsular contracture are treated most successfully by surgical means.

Materials and Methods:

The LTU-904 laser was used on 33 patients with grades III and IV capsular contractures. Patients underwent laser treatments once a week for a period of 6 weeks. They received a 10-minute treatment using the 904-nm laser with a 2-cm square grid pattern with 1 minute of treatment in each area (300 mJ/1 min treatment = 1.5 J/cm²). Patients were administered a posttreatment survey to determine their level of improvement and satisfaction.

Results:

Surgical intervention was avoided in 93.9% of patients with grade III and IV capsular contraction. Of the patients who avoided surgery, the laser improved the stiffness of the breast by 10–95% (average, 43.6%) and an overall improvement in comfort ranging from 10–95% (average, 48.2%).

Conclusions:

Low-level laser therapy is a promising alternative treatment for grades III and IV capsular contracture. In most cases, both the patient and surgeon observed significant tissue softening and improved breast contour after treatment while avoiding surgical intervention.

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Vol 32, Issue 1, 2015

raven4mi

SugarCakes, I'm still in the TE stage (final exchange scheduled for next week) with one radiated and one non-radiated breast and I can tell you that even with pre-pectoral my radiated breast is a mess. Part of that has to do with an infection that I acquired after my initial BMX but a large part of the problem is from the radiation. It's higher, harder and mis-shapen compared to the non-radiated prophylactic side. Unfortunately I couldn't get my RO to consider prescribing Pentoxifylline because I'm 9 years out from radiation treatments so she said it wasn't "indicated" and God forbid they'd think outside the box for even one second. Prior to my BMX the outside appearance of my skin on the radiated side was completely normal - you would never know I even had radiation and the skin was just as soft and supple as the non-BC side. It's the damage on the INSIDE that is the problem. Now, of course, it looks awful but at this point I don't care what it looks like naked, I just want to look good and more symmetrical in clothes. (When I think how low my expectations for a decent outcome have dropped through this process it amazes me. I just have to shake my head.) Sorry I couldn't give you better news but that's been my experience.

macb04

Hey Raven. Glad you are getting finished up next week. You must be looking forwards to getting this over with. Good Luck to you. Any doctor (even a Naturopath) can prescribe the Pentoxifylline and Vitamin E. I had my Primary Care Provider do it since she knows I never go back to the RO anymore. She was also willing to prescribe the topical Compounded Prescription of Pentoxifylline and Vitamin E that I apply to my entire chest/axilla and breast every night. She understood how awful it was to have such severe radiation fibrosis, she empathized and didn't just pass the buck, but instead helped me. So I am on both oral Pentoxifylline and Vitamin E and Topical Pentoxifylline and Vitamin E. I might seem like overkill to take the same medications in two different formats. I would do just anything to prevent the return of that awful radiation fibrosis. I have zero side effects, althouh one woman complained of stomach upset with the Pentoxifylline.

This is a case study of a topical formulamtion of a well researched oral combination. Pentoxifylline and Vitamin E. Worth a try. I wish they would do a large research study on it. I think it has helped me, who knows? I was desperate and I have had a huge improvement, do I will take it