TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!
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Hi calidancer, yes, I have some tightness, annoying, but not terrible. Did you have Rads? I had terrible rads fibrosis. I got improvement in that with fat grafting/Hyperbaric Oxygen Therapy and now continue daily with Pentoxifylline and Vitamin E. Some women have used Accolate to treat Capsular Contracture. I even read about using a special type of Ultrasound, with specialized massage called the Aspen Ultrasound Therapy, which is used for breast augmentation . There is a trial ongoing about the technique for cosmetic breast augmentation related CC.
Also, there is info on using Low Level Laser Therapy as a non surgical treatment of Capsular Contracture.
The American Journal of Cosmetic Surgery
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 March1, 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 th 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.
References
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World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–2194. Google Scholar Crossref, Medline 7. RianCorp. Products. Available at: http://www.riancorp.com/Products/low-level-laser-therapy-lllt.html. Accessed May 28, 2013. Google Scholar 8. Lawenda BD, Mondry TE, Johnstone PA. Lymphedema: A primer on the identification and management of a chronic condition in oncologic treatment. CA Cancer J Clin. 2009;59:8–24. Google Scholar Crossref, Medline 9. Carati CJ, Anderson SN, Gannon BJ, Piller NB. Treatment of postmastectomy lymphedema with low-level laser therapy: A double blind, placebo-controlled trial. Cancer. 2003;98(6):1114–1122. Google Scholar Crossref, Medline 10. Stergioulas A, Stergioula M, Aarskog R, Lopes-Martins RA, Bjordal JM. Effects of low-level laser therapy and eccentric exercises in the treatment of recreational athletes with chronic Achilles tendinopathy. Am J Sports Med. 2008;36:881–887. Google Scholar Link 11. Caetano KS, Frade MA, Minatel DG, Santana LA, Enwemeka CS. Phototherapy improves healing of chronic venous ulcers. Photomed Laser Surg. 2009;27: 111–118. Google Scholar Crossref, Medline 12. Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: A systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet. 2009;374:1897–1908. Google Scholar Crossref, Medline 13. Huang YY, Chen AC, Carroll JD, Hamblin MR. Biphasic dose response in low level light therapy. Dose Response. 2009;7:358–383. Google Scholar Link 14. Society of Photo-Optical Instrumentation Engineers (SPIE). Biomedical optics and medical imaging. In: Huang YY, Hamblin M, Chen AC. Low-Level Laser Therapy: An Emerging Clinical Paradigm. Available at: http://spie.org/x35504.xml. Accessed May 28, 2013. Google Scholar 15. Brown SA, Rohrich RJ, Kenkel J, Young VL, Hoopman J, Coimbra M. Effect of low-level laser therapy on abdominal adipocytes before lipoplasty procedures. Plast Reconstr Surg. 2004;113:1796–1804. Google Scholar Crossref, Medline 16. Schlager A, Oehler K, Huebner KU, Schuth M, Spoetl L. Healing of burns after treatment with 670-nanometer low-power laser light. Plast Reconstr Surg. 2000;105:1635–1639. Google Scholar Crossref, Medline 17. Kozanoglu E, Basaran S, Paydas S, Sarpel T. Efficacy of pneumatic compression and low-level laser therapy in the treatment of postmastectomy lymphoedema: A randomized controlled trial. Clin Rehabil. 2009;23:117–124. Google Scholar Link 18. Omar MT, Shaheen AA, Zafar H. A systematic review of the effect of low-level laser therapy in the management of breast cancer-related lymphedema. Support Care Cancer. 2012;20:2977–2984. Google Scholar Crossref, Medline 19. Dirican A, Andacoglu O, Johnson R, McGuire K, Mager L, Soran A. The short-term effects of low-level laser therapy in the management of breast cancer-related lymphedema. Support Care Cancer. 2011;19: 685–690. Google Scholar Crossref, Medline 20. Jackson RF, Roche G, Mangione T. Low-level laser therapy effectiveness for reducing pain after breast augmentation. Am J Cosmet Surg. 2009;26:144–148. Google Scholar Link 21. Jackson RF, Dedo DD, Roche GC, Turok DI, Maloney RJ. Low-level laser therapy as a non-invasive approach for body contouring: A randomized, controlled study. Lasers Surg Med. 2009;41:799–809. Google Scholar Crossref, Medline 22. Jackson RF, Stern FA, Neira R, Ortiz-Neira CL, Maloney J. Application of low-level laser therapy for noninvasive body contouring. Lasers Surg Med. 2012; 44:211–217. Google ScholarCrossref, Medline 23. Nestor MS, Zarraga MB, Park H. Effect of 635nm low-level laser therapy on upper arm circumference reduction: A double-blind, randomized, sham-controlled trial. J Clin Aesthet Dermatol. 2012;5:42–48. Google Scholar Medline 24. Freitas CP, Melo C, Alexandrino AM, Noites A. Efficacy of low-level laser therapy on scar tissue. J Cosmet Laser Ther. 2013;15:171–176. Google Scholar Crossref, Medline 25. American Society for Photobiology. Photobiological Sciences Online. Mechanisms of low level light therapy. Available at: http://photobiology.info/Hamblin.html. Accessed May 28, 2013. Google Schola 0 -
Calidancer:
You could check with your surgeon to see if he is on with you doing Lymphatic drainage massage by someone that specializes in oncology/breast reconstruction. It has been so helpful for the tightness and discomfort after BMX and every time I have a fill in my TE. Its very light and gentle but feels so comforting, and it always feels better after! Fingers crossed for your smooth healing!
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Hi amtreb, good suggestion about getting someone to do massage after TE fills. Anything that can make the process more comfortable should be used.
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Hi ladies, I will be having direct to implant above the muscle implants placed at the time of my mastectomy on 1/22. I see the most everyone has had tissue expanders. So now I am wondering why I don’t need them. Or Im also wondering if I misunderstood my PS (my first meeting was with her today). She definitely said implant at the time of mastectomy and did not use the term tissue expander. Why do most people need tissue expanders?
Thanks for answering my questions, I’m sure there will be more. I’m nervous about my implant side matching up with my natural side, and I did mention that to PS, but of course that is her goal as well.
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I’m not sure what your doc is going to do to be honest. Mine said that for immediate construction they would place expanders first. However I was not able to my nipple or skin. The expanders are to stretch the skin back out.
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Some cases they are able to go straight to implant. my PS and I had discussed this possibility. The day of surgery when I saw him before I told him I was 100% ok w TEs rather than risk anything by going straight to implant. He assured me he would not take any risks, if the tissue looked like it could take the implant he would, it something I don't think they know for sure until they get in there. Based on the blood perfusion to the skin. My number 1 concern (after the cancer) was keeping my nipples and having adequate blood supply.
I woke up w TE not inflated at all, that meant zero, flat boobs. It was hard to look at but now 5 weeks out I am SO glad he made that choice. I feel like I have so much more control and idea of what I want the final outcome to look like. The huge advantage of straight to implant is 1 surgery, but that may have to be followed by fat grafting anyway.
Id just say discuss the range of possibilities and if you really like the surgeon you can trust their decision if you are good either way.
-a
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rdeesides,
my PS was going to to do direct implant when I had my BMX but cautioned me he wouldn't know until he was actually in surgery whether he could or not. Turns out he could not go to direct plant (I never even asked why but trusted his judgement either way). There are ladies on the forum that have had direct to implant and from what I'm remembering they've all been pleased. I wonder if you posted under "Breast Reconstruction" for imput from those who have had the procedure, you could get some feedback that may help you.
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Thanks for replying so quickly! I am doing skin/nipple sparing mastectomy so I guess that is why she says she can go direct to implant. She never mentioned that there could be a possibility that wouldn’t work out so I will ask her what could happen that she wouldn’t be able to do that and would have to put TEs. I am ok with TEs if she has to do that to prevent other issues, but I would love to go direct if it is reasonable.
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Hi rdeesides, I hope that direct to implant works out for you. That is the least traumatic way to get reconstructed, to wake up looking mostly normal. Good Luck, and keep us up to date on your progress.
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I was also told beforehand that the plan was to place the implants, but that TE's would be used if it looked like too much stress was going to be on the tissues or incisions. I was very happy to wake up with the implants. Not that everything will look normal - there's a lot of swelling and some weird shape issues in the beginning.
I think it also has to do with size. If you are staying about the same size then the skin should be able to safely close over the implants. If you want to be bigger then you more likely will need TE's to gradually stretch the skin.
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I went direct to implants as well after my skin/nipple sparring BMX. I was/am small busted though. I wonder if that makes a difference too? If I had chosen to reconstruct to a larger size maybe expanders would be necessary. Regardless, I am happy to have done all in one surgery. I think they look great, pretty much like my real boobs except the nippesare slightly moved to the outside. It looks fine and only I would notice the difference though.
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Hi Legomaster, I am glad to hear it worked out so well for you. Hearing a good outcome, that no one could even tell but you, that is super encouraging for lots of women who read these boards.
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Hi, all. Thought I'd pop in with a quick update.
Had my 8-week post-op from final exchange surgery with my PS today. After finally browbeating him into prescribing the pentoxyfillene (both oral and topical) and being on it for a couple of weeks (with zero side effects that he was so worried about) he was impressed with how much the post-infection redness has improved, so I got to do a little bit of an "I told you so" to him. He said he was happy to learn something new from me.
He believes we can do another lift on the left to get them more evenly matched by simply cutting and tightening the skin – the implant would not be touched or impacted in any way. I told him I wanted to give the pentoxyfillene a chance to work first and that I would call him if/when I decide to move forward with any further repairs. But at this point I don't see that happening any time soon. With a little bit of smoke and mirrors I can make myself look good enough in clothes for now that I'm no longer self-concious simply walking around and at this point I'm just happy to be cancer- and infection-free and have everything far enough behind me prior to our trip to Europe in December/January.
I can't thank you all enough for all of the love, support, and advice that I've gotten from this thread. I hope you're all doing well.
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Yay Raven!!! That is great news!
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Goid need Raven! Now start packing for that trip
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WooHoo Raven! I am so glad you have had some improvement, so you feel comfortable enough to no be self conscious. We all deserve that. It's great you have no side effects with the Pentoxifylline and Vitamin E topical and oral. It is pretty well tolerated by most people, so it is really good that your PS is starting to have an open mind. Your hard work will pave the way for someone else to have Pentoxifylline more easily prescribed as an option.
I especially think the prescription Pentoxifylline and Vitamin E (5%/1%) Compounded Cream is an option that should have research done. Because it has topical absorption it may be much better tolerated than the oral form for some women. Ideally it could be prescribed for all women undergoing radiation prophylactically, because tightening of skin and underlying tissues is almost a guarantee. It's really just a matter of degree, some women have very minimal tightening of skin and soft tissues secondary to rads, and many others are like me, with terrible painful radiation fibrosis. I am sure it is easier to prevent fibrosis than to reverse it.
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That is wonderful news Raven! What a great thing to have a doctor learn something from all the wisdom gleaned from these boards!! I am so happy you were persistent with him and it is paying off for you! This site and the ladies here have been such a blessing to us on so many levels. Reports like the one you just shared are so uplifting!! Enjoy your trip!!
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to add to all the other well wishes raven, not only have you taught your doctor, but your dr will be able to help others
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to add to all the other well wishes raven, not only have you taught your doctor, but your dr will be able to help others
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Hi,
I am new on this thread and have been reading all of your wealth of information! I am located in australia and am so grateful to have found this thread as this type of prepectoral procedure is very new here and its so hard to find any information or ps with photos from this type of placement.
I had a bilateral mastectomy and T/E placed under the pec muscle in 2015. The tissue expanders were exchanged for Silimed anatomical tear drop implants with a round base that were placed under the muscle. (silimed 410cc 3extra high projection -12.3cm diameter x 6.6cm projection)
The projection is great but unfortunately they are smaller than my original breasts and the skin envelope is a little big. I also have rippling and bad animation deformity when I use my pec muscles.
I am seeing my plastic surgeon tomorrow and going back into surgery in 2 weeks time to get the current implants removed and new ones placed prepectoral above the muscle. They are going to make them larger to fill the envelope better but unfortunately the silimed implant brand has been discontinued in australia so i cant just go up a size.
I am only small - 5'2' tall, 50kg, small build, but have always had quite a large sized breast 10D. I am hoping to achieve a breast similar to this. I would like the best projection possible and hopefully have a good cleavage but not look unnatural. I do not want them to be wide or flat on my body.
I am not sure whether to go with Mentor CPG series anatomical memory shape 495 cc - 13cm width x 12.2cm height x 6.5cm projection, a polytech replicon anatomical shape 535cc with a round base 13cm diameter x 6.3 cm projection or try a round shape? allergan inspira?
I would be really appreciative if anyone here could let me know their thoughts on these options from their experience with prepectoral implants.
Does anyone have photos they would be ok to share with me via pm of anatomical vs round implants over the muscle please...I am trying to understand the difference in appearance between the two when placed over the muscle, especially on a smaller sized person, like me.
Also, I am wondering if the shapes of the implants look different/ bigger /fuller when placed over the muscle because they don't have the pec muscle pushing them down? do the round ones look more round? or do they do they sit the same as a tear drop when standing?
Thanks again for sharing all your stories and information. I just feel so grateful for finding this information. It really helps knowing your not the only one going through it!
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Lalala1
Im in the same boat of trying to decide on implants and having a VERY hard time finding pics of pre-pec implants w anatomical vs round implants. I'll be curious to see if you find any, I haven't found any thru this forum and have requested access to the photos section but have not heard back.
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I don't have photos, but my PS lifted my natural side so it looks like a saggy 45 yo boob instead of 55 years old. Then he used an anatomical pre-pectoral implant ( even tho he said he would use a round) and it is a pretty close match. Now that my swelling has gone down, it is obvious to me that they are not a perfect match, but part of that is now I have no nipple. HTH
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lalal1 and amtreb - I could send you private messages with pics of my reconstruction with pre-pec implants but I'm not sure if it would be helpful. Please just let me know! I am 48 y.o, 5'5" approx. 123# lean/muscular. I wanted the lowest projection breasts that worked with my frame/build that I could get since I was barely a B before bilateral mastectomy and I'm so active (they cannot get in the way of any sports). I also didn't want any cleavage. I had nipple sparing, but the nipples are kind of in new time zones now....a bit off to the side. My implants are cohesive gel anatomic (Natrelle 410, full height, low projection at 3.4cm, 250cc) and they are VERY visible under the skin, with rippling too. I will not have fat grafting because I just don't want to spare the fat I have (saving it for other purposes as research progresses with stem cell harvesting and use). My breasts don't look any better than tissue expanders when I'm naked, but look just like my old natural breasts in clothes - which I am very happy about - YAY! I just have to be careful with necklines because the top edges are so visible. From what I read/hear, people who get fat grafting or have more body fat than I do look better/more natural and conceal the edges. It's been 6.5 months since these implants were placed. They were initially bigger (woke up from surgery bigger than discussed - 310cc and 4.4 projection) and had them exchanged to smaller weeks later. If you think it would be helpful to see my small/low projection implants, just let me know and I'll snap a few new pics.
- xo
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Hi Andraxo,
Thanks for your information re your breast implants. Glad to hear hat you are happy with your size now. I'd be interested to see how visible they are over the pec muscle without FG. My ps doesnt do FG at the initial surgery when he puts them in but will do some when he does the nipple recon. It would be really helpful if you could please private message me some photos - thank you for offering. I am also quite small and lean in size and am trying to understand the difference in look between the anatomicals and rounds when placed over the muscle - so it would be great to see what the anatomicals look like - thank you!
ps: when you mention you are saving fat for other purposes as research progresses with stem cell harvesting and use.... is this new research in breast cancer treatments? (....I read it and just got kind of hopeful...!!!)
2FUN - thank you for your information re your implants. When you say that it looks less like a match now that the swelling has gone down - is it that the implant now looks different in size? or does it not fall like a natural breast? did you get high profile ones? I dont have a nipple yet either and I have been told that it makes a big difference to how matched they look...
Amtreb - i totally understand how hard it is to find information and pictures of anatomical vs round impalnts placed over the msucle. I am in australia and the procedure is even rarer over here - so i cant find anyone here who's had it done at all!
Fortunately I found this amazing site!.... and Andraxo has offered to private message some photos of her anatomicals (see her post above) and 2FUN has also posted her experience with pre pec anatomicals (see her post above). Also HuskerFan has messaged me information of her experience of anatomicals vs rounds (both pre pec) and VegGal private messaged me some photos of her anatomicals (sub pec) and rounds (pre pec). Try messaging them directly, they have been so incredibly helpful to me!
Thanks everyone for your help & sending lots of good wishes your way.....If you have any questions that i can help with, feel free to ask.
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lalala1 - I tried to take a few chest area selfies last night and it was a big fail (not good with my iphone - kept making shadows or the wrong angle etc). It also sucked to see how 'off' my nipples are - dang it! They're like wandering eyes! I'll see if my husband will take some better pictures this weekend that I can send privately.
There is a lot of research now for using stem cells for many things medically, one being joint injections for joint pain/arthritis/loss of articular cartilage. As an athlete, I know my joints will need something eventually and I'm hoping for some promising results from the research. Fat serves as a primary source for harvesting stem cells - they are spun out of it. I had one small round fat grafting after radiation just to bring stem cells into the area to help heal the radiation fibrosis. It worked well enough that I did not need hyperbaric oxygen or Pentoxifylline in order to proceed with reconstruction. Most fat that is grafted doesn't "take"... at least that's what others report as well as my own experience (no noticeable change in tissue thickness), but the stem cells still did their job and that was the entire point for me. I'm not very optimistic that fat grafting to conceal my implants edges and rippling would actual make a big difference in my case.
Sub-pec was never an option for me, my surgeon knew from the start that I was way to active (at work and recreation) for anything under my pec. I also couldn't have any other type of flap or muscle graft given my body type and activity level. Pre-pec was my ONLY option for reconstruction. If these implants ever fail, I would simple go back to being flat.
- xo
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lalala. The real difference now that swelling is fow, is that there is a very small amount of subtle concavity at the center, near my sternum. I needed extra tissue removed b/c I had close margins. The implants would have been perfect but taking the tissue changed a bit of the curve. Ideally if I had abut a centimeter of roundness at the area where my nipple is, it would be perfect.
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I agree with Andraxo, but we are both in the same profession (do I remember right, you are a PT too?). I can't imagine how it would be without theSE pre pectoral implants. The only thing that is less than ideal is that my implant is a 695, and I feel like I need to wear a bra all the time, as it feels like gravity is pulling on my implant. I always wore a bra in public, but now I wear one at all times and sleeping. I don't mind not having a nipple. I'm a conservative dresser.
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2FUN - yes PT too!
I am CHT (I know...odd for a PT but I also manage a hand surgery clinic on the Navajo Indian Reservation that is staffed by visiting volunteer hand surgeons) and my entire caseload is upper extremity for almost the last 15 years. Even I saw a PT though after B mastectomy because I had cording/axillary web syndrome and couldn't effectively perform manual therapy well enough on myself. Wow 695 - I can't even imagine! I'm only 250cc implants and only really need a bra when running or to conceal nipples....just like pre-cancer/mastectomy. Do you have any problems keeping the breast/implants warm? Even my little ones become cold easily. I have to be careful in winter sports season because I can't feel that they are cold unless I touch them. Sometimes I also wish I did not have nipple sparing. - xo
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CHT is not odd. I am working schools right now and I said I would never do that. I want to be certified in Feldendkrais method some day.I am a total manual therapist, and I do not know if I will ever get back into that work.
My BIL is a hand surgeon, just not in your area. He does volunteer work for Schriner's hospitals and a clinic in Peru.You will need to give me splint ideas for unstable CMC thumb joints, LOL
Where/which town is the Navajo Clinic. My son was in Klagatoh working for a few weeks 2 summers ago. Looks like an Amazing place.
My chest definitely gets cold. This is my first winter with the implant. I can't believe my breast is that big, but I am a chubby person, so it doesn;t seem that big (40C before and 42 B now)
I have decided that I really need to get on with the exercise and regaining my immune system. Even if I lose a ton of weight I will probably be fine with my implant, since i have been a 38-40 C all my life.
Re-reading this I have decided that my standards for the written word is incredibly low. Man, this disease has lowered my standards on everythign !!!
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I'm so glad to hear raven and macb are doing well.
I had my revision on 10/25; swapped out under the pec implants (which had rotated and probably explained at least a bit of the chronic pain) for over the pec implants. The surgery was meant to correct the pain issue - 2.5 years of intense "iron bra" not helped at all by botox, nerve blocks, acupuncture or oral meds - but I'm pleased to say the foobs look 100% better. I also did high dose vitamin C and have been lucky enough to have no complications.
All of that said, it doesn't really FEEL all that different and I still have that "iron bra" tight sensation. I'm not even a month out and I'm still wearing my compression bras so that's probably part of it. I've spoken to the surgeon/nurse and they want me to give it more time so the swelling can go down, etc.
I met one of my surgeon's prior patients and she (and others) swore their pain went away or was greatly diminished.
For those who have done this swap, how long did it take for you to feel better? I don't want to get ahead of myself (I probably already am), but I'm a bit nervous this was all for nothing.
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