TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!
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Thanks for the quick response, 2FUN. I have large pre-pecs as well (over 600 cc) and while I have no discomfort from them, I do feel better keeping them in a bra of some sort 24/7. I have a large Alloderm sling on each side as well.
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Thanks 2Fun,
I appreciate hearing your experience.. ugh. I guess it’s a trade off, natural squishies that move but need a bra or iron bra boobs that don’t move or require a bra..
Lots of decisions as 1/10/18 is fast approaching..
Mimi
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Mimi68
Which implants do you have?
Im having my pre-pec TE swap Jan 9th and still on the fence about round or anatomical implants. MY PS suggested the anatomicals but Im worried about them being too firm.
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Hi amtreb,
I have Mentor 650cc HP round silicone. I love the implant and will keep the same, just smaller, likely 450cc.
My main issue with current sub muscular implants is muscular deformity with exercise and hand and arm weakness. Size is the main reason for this exchange but my PS proposed it.
Mimi68
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reneeCA, congrats on the wonderful outcome! So happy for you.
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Hi KBee,
Thanks for your post, we actually exchanged a few posts regarding reoccurring cancer detection. Mine was deemed benign lymph node by US. So far it's not grown at all so I feel reassured. I'm in the process of considering cancelling my pre- pec on 1/10 and just having him downsize me that day as I am, sub pec with pretty great outcome the first time. An FYI for all.. Insurancee will pay for an MRI to check for silicone leaks 3 years post implant and every two years after, it's an FDA mandate but no more frequently than that. It's concerning. I had aggressive grade 3 comedo necrosis DCIS triple negative. I don't want to be kicking myself for vanity if I miss a chest wall recurrence that gets advanced silently and quickly. (I'm a nurse so I'm naturalky skeptical of new things.) the large out of pocket may be the final decision deal breaker. I wanted everyone to know what I found out about covered recurrencesurveillance.
Mimi
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Mimi thanks for the MRI info. I had trip neg aggressive grade 3 dcis as well. I am coming up on 1 year for my bmx and feel forgotten by my breast surgeon. I guess I have to call them, I don't know what made me think they would be monitoring me.
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shoregirl. I was told by my BS that my.MO would be responsible for monitoring me.
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Hi Shoregirl,
I saw a MO the first one year and after that was told to see my BS annually for an exam. No planned imaging surveillance is part of the BS plan. My PS ordered the MRI at year 3 which happened to coincide with my lump in my axilla. He said he is happy to order an MRI every two years to "look for leaks" which gives me peace of mind and yay, its covered by insurance.
I want to sincerely thank all the women on here who are sharing their Pre-pec experience. After a lengthy discussion with my PS yesterday, I decided to simply downsize and stay sub pectoral on 1/10. We decided that if I was truly unhappy with the result (besides size), in pain, experiencing extreme poor side effects form sub-pectoral placement, then I wouldn't have to think twice about going to pre-pectoral. In other words, if it's not broken, don't fix it. For so many of you, this new technique is a God send. I just don't think I'm a candidate who needs it. I wish all of you well as you continue to recover and I will happily update you on my exchange.
Mimi
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Just discovered this forum. Thanks so much! Having surgery after chemo, so some time to decide. My hospital (a major cancer center) doesn't really do pre-pecs yet. There's a doc on the list above that I could try to see here, but before I go down that road, are there specific criteria that make someone a good candidate for pre-pecs? From what I understand, I am not a candidate for nipple-sparing mx in the affected breast. Also, I had a bilateral breast reduction about 25 years ago.
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red332, I’m glad you asked that question because I was kinda wondering the same. I’m thin with a small frame and it seems like the people who are most happy have had a lot of fat grafting done. Please any of you ladies correct me if needed. Im just worried that it will look and feel like plastic under my skin. I go back to the PS in February to discuss starting recon. I know so much more to ask and discuss than the first time thanks to all the ladies here
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I did not have nipple sparing mx. Just a regular mx with an expander. I am perfectly happy without fat grafting. For reference, I am 55. Very active, use my body for my work as a physical therapist.
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Hi red332, welcome. I don't think there are any particular criteria for having the much more comfortable, faster healing and no animation deformity/ loss of hand/arm strength Prepectoral versus Subpectoral Implant Reconstruction. I don't know why anyone would want subpectoral implants. It's a mystery to me. On this thread there are women of all shapes and sizes who have Prepectoral Implant Reconstruction. Having had a TE subpectoral and also Prepectoral, I clearly know what I prefer. It is No contest. Prepectoral is infinitely superior for comfort. Any PS who tells you that cutting and displacing the Pectoral muscles has no effect on comfort/ arm and muscle strength is clearly either deluded, or self seving. By self serving, I mean that they don't want to learn a new, better, for the patient technique, and instead want you to be satisfied with a further deforming type of procedure like subpectoral implants reconstruction.
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Amen to that macb04! My PS actually said "no one uses their pectoral muscles" REALLY??? do you feed yourself, comb your hair, do dishes , hold a baby, wipe your...... My PS told me the day before surgery he was going to do a pre-pectoral. My research review mentions that some people are not as good of a pre-pectoral candidate depending on the extensibility and thickness of your skin. Radiation damage may affect pre-pectoral placement. I am surprised how many "famous" cancer centers do not have doctors doing pre-pectoral implants.
When I was looking for a plastic surgeon, I found that if PS 1 was good at technique A, they recommended surgery A, if PS #2 was good at technique B, then that is what they recommend. I saw a PS that was good in 3-4 different approaches, then I saw another PS that was good at 3-4 different approaches. Then I chose PS.
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I agree with 2FUN about the thickness and extensibility of your skin, which is affected by rads damage. However I had terrible rads damage, very severe fibrosis that was enormously helped by Fat Grafting, so even that is no longer an absolute limiting factor. Admittedly I had to have extra procedures, which was not easy, but still, I got to an ok result in the end.
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Mimi & 2FUN, thanks for the info. I didn't have an MO though. My BS told me since I was non-invasive and trip neg I would not need chemo, so no MO. The nurse nav told me I would be checked at 6 months, which did happen, and 1 year. The "New Patient Guide" they gave me when dxd says I am to have clinical exams every 4 months after surgery for 24 months, rotating visits with treating providers. That hasn't happened. After 24 months, according to their guide, I am to see a provider every 6 months, until 5 yrs. After 5 yrs, see a provider annually. MRIs "ordered as needed by the breast team if clinically indicated." Maybe since I left the ps that was on my bs team I have fallen through the cracks. I will call Monday and get an appt.
Red, my ps told me he hoped I would be a candidate for the pre-pec, which he would be able to tell when expanders were placed (in my case same day as msx). He didn't tell me what the criteria were, but that the recovery is so much easier, the pain level is much lower, no animation deformity when using pecs. I would think criteria is skin integrity. I, too had a bilat breast reduction and lift back in 1993. BS used same old incisions, called the Wise pattern (anchor shape) which really gave me a nice, natural slightly cone-like breast shape with the round implants.
Cpeachy, my pre-pec implants never looked or felt like plastic under my skin. But they DID feel like an unheated waterbed mattress when I touched them, cold and clammy during the summer in the AC. Once I had the fg though, that went away. The fg also cushions the implants so you don't feel them under your skin and hides ripples. I am slim too but they don't need a lot of fat, and can take it from various areas if needed. Almost everyone has at least some fat in the love handle/muffin top area. I have heard of it being taken from around the knees, the bra band, thighs...wherever they can get it! At one point, before my revision, I asked my 1st ps if he should switch my implants to sub pec to make them more comfortable to me. He said an emphatic NO!! Mine were uncomfortable it turns out, because he chose an implant that was too narrow. They were sliding around in there and actually flipped over backwards. So the constant rubbing of the edges was hurting the back side of my skin. Then when my new ps opened me up to swap my implants, she found that the 1st ps had only put a postage stamp size piece of Alloderm on the right side, yet the left one was encased as it should have been. She was puzzled! Since my revision, I am very happy, much more comfortable and no longer question whether sub-pec would have been better.
Finding the right ps is really key. When we are dxd, we are in panic mode. I did research my ps, and he had excellent credentials, is the director of ps at the hospital and is forward thinking. He is also part of my BS team at the breast center she started at the hospital. I had complete confidence in him. But once I got through the expansion and the exchange, I started to question certain things, and was not happy with the answers I was getting. So I found a new ps to do my revisions. A female. One of the things I had wanted was to keep my nipples. The 1st ps said I couldn't because I had "too great a distance from nipple to collarbone." Then when I said I wanted nip recon, he was adament I not do it, just go with his 3D tats. As it turns out with the new ps, she said I could have saved my nips. She ALWAYS tries to save them unless the margin was too close. She showed me pics of her patients whose "distance" from nip to collabone was much further than mine and she saved them. So my point is, as Macb and 2FUN alluded to, if you have time, get as much info as you can, and really get all your questions and concerns answered. Interview these ps. If they don't do what you want, find one who will! I wish I had asked a ton more questions (and I asked a lot) of my orig ps prior to surgery. I wish I had gotten a 2nd surgical opinion re the nipples prior to msx. But I am very happy that the 1st ps gave me a pre-pec installation. Had he not brought it up, I wouldn't have even known about it. So I am grateful for that.
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shoregirl. I was told the same schedule for checks/exams. I get checked by my PS every 6 months and my MO every 3 months. Funny I never thought about not having a mo!
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I saw my PS this week for a follow up 2 months after my implants. I have pre-pecs and am thrilled with the size, location, etc of my implants (hated the expanders!) But on my cancer side, I have some noticeable ripples that I thought we weren't supposed to have. I didn't get a chance to ask him about that since I had a bunch of other questions. My other side looks great, no ripples at all. Not sure why on one side and not the other. I had some fat grafting on the cancer side too, shouldn't that have filled in anything that was needed? I'll see him again in three months to talk about nipple reconstruction and is this something he can fix at the same time?
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My PS explained that the BS does more aggressive scraping in general on the cancer side, leaving very little tissue and fat. The same happened to me. I'm 10 days out from second round of fat grafting and am pretty sure I've had enough!
Good luck!
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Cpeachy, I am very thin with small breasts (both before and after implants). I’m 5’5” 115 pre chemo. Currently 104 lbs. I love my pre-pecs. I had a skin sparing, nipple sparing BMX and specifically asked to remain the same small B cup size. It just looks right for me and even though this was my opportunity to finally have boobs I just wanted to look like my normal self. I think they look great. My nipples, although not reactive, look normal and are slightly off to the side from where they were. If you were not me (or my husband) you would never know though. I feel that my breasts are slightly wider, starting more under the arm than my real ones but the projection is the same. I could wear the same bras as pre cancer except he doesnt want me wearing underwire so I had to get all new ones. I don’t really have rippling and have not needed fat grafting. I don’t have much fat it would be difficult anyway. I still know they are implants and it still does not feel like “me” but I am very happy with the procedure and the way they look. I’ve had several of my doctors say they look fantastic. Nobody has ever said that in my prior 51 years. Lol.
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Thank you as always for the info! 2fun and Legomaster, I'm glad to hear you are both happy with your implants with no FG, that gives me hope.
Legomaster- we're about the same size, can I ask what size/brand/shape implants you have, just so I can get some perspective? I did have skin sparing mx, so there is some to work with, but also rads, which so far has damaged my lung more than the skin. My PS said he wasn't too worried about working with radiated tissue, so I'm going to have to trust him on that.
Shoregirl- I also didn't even know pre-pec was an option until I went to see the PS and he said that's how he's been doing them. I was very pleased with that option! I have some reservations about the silicone, because I didn't even know they still used silicone in implants anymore until that first visit either. I really have no idea "how much" is needed for fat grafting, but that's why I asked.
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Hi Shoregirl,
I only saw the MO once, at my 6 month follow up. After that, I needed to make all follow up appts. for annual screening.
Red332 I agree there is no definitive criteria for doing either approach. I have had no pain and no issue with my sub pectoral muscle, besides muscle deformity under clothing in the gym. My main issue four years post exchange is that they are simply too large and make me look bigger than I am. My PS told me that when Pre-pec is done right out of the gate after BMX, patients more often need FG to fill ripples and reinforce the skin. In my case, I expanded well and am four years out with excellent skin integrity and perfusion, so switching to pre-pecs after sub pec's, need fat grafting less often. My sub pectorals are indeed cold in the winter.
Bottom line is that there are many very good board certified PS's working at academic university hospitals, doing Pre-pec. European outcomes have been promising. Having said that, many of their partners in the same practice, who are also very skilled and forward thinking, won't touch it, until there are years of long term outcomes. Evidenced based medicine is now the gold standard of medical care and it should be. It is also a very expensive surgery. The Alloderm alone bills up to $40,000. This is important for many who have high out of pocket caps. These things all factored in to my decision to stay sub pectoral. I may decide down the road to switch once it's been out there for longer.
It's a very individual decision that requires a lot of consultation and thought. Ask your PS a lot of questions to help you make an informed decision.
Mimi
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Alloderm for $40,000? My whole 4 hour surgery (BMX with immediate reconstruction using implants and Alloderm and an overnight stay) was billed as $50,000. My portion was an outpatient procedure copay of $125.
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Yes, Pre-Pec reconstruction (different than direct to implant BMX) uses an enormous amount of Alloderm to support and impregnate the implant. I checked with insurance who had completed pre-auth and this number was accurate. Bottom line, always ask before hand the estimated cost. It is a much more costly reconstruction.
Back in 2008 some on this board were noticing this in their surgical bills.
https://community.breastcancer.org/forum/44/topics/707164
Mimi
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Cpeachy, I have MENTOR Memory gel, smooth round Moderate Classic profile 235cc. I went direct to implant at the time of my BMX so no expander or additional surgeries. Yes, they are much smaller than most people on these boards but I have always been small breasted. It fits my body. I was a runner/jumper in college, now just coach. I was always happy that my breasts never got in the way. My sister is totally opposite of me and has wanted a reduction for years.
I did have radiation on one side after surgery. My skin, mostly under my arm and where they boosted, did get very red and peeled but has healed up nicely. I still have a darkened square around my breast but it is slowly fading.
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All,
I am having UMX, skin and nipple sparing. It will be pre-pec. Dr said yesterday it will be a call on the day of surgery whether I meed a tissue expander or will be able to put an implant. Either way though, she says I will need a revision surgery. Why would I need a revision if I go direct to implant? She said we would swap the implant out at revision, even if I already have an implant. I’m so confused. Maybe it has to do with how it settles into the alloderm and also she wont do fat grafting until revision.
Any thoughts?
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rdeesides, she may be thinking since it is uni there will be some final tweaking for symmetry once the implant settles into the pocket? Or just fg can be considered a revision I would think. Best wishes on your upcoming surgery
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Hi rdeesides, I understand the idea of revision, but I am as perplexed as you by switching out the implant at revision. I would think she would aim for the right implant sizing with the initial surgery. I guess ask for clarification now is my advice. You could send her an email asking her to explain what she means. I wished I had clarified things more, might have saved me some grief.
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I am 4 weeks out from the switch to pre-pec and still so happy to be rid of those painful sub-pec implants. I also went from textured to smooth and they move around much better. I only had my implants on 1 year and 11 days but there was a lot of gunk on them! Chronic inflammation and lots of "foreign body giant cells". Anyone else have this on exchange pathology?
My harvest sites (abdomen & flanks) from fat graft have lots of hard knots under the skin. One area is particular painful. Wondering when the knots go away?
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reneeCA, Im glad u r feeling better. I don't know about the "gunk" . Maybe someone here will have experience
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