TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!
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Please add Dr Elizabeth Kim in Los Angeles to the list of prepec surgeons. She's said a year ago 90% of her recons were subpec . Now, 90% are prepec!!
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I met with RO today and I am going to opt for mastectomy - too many strikes against me to do radiation. ): When I met with the PS, he said he does the pre-pec reconstruction over the chest muscle. I will be going from a C cup to a B cup. (I'm a runner and would rather downsize.) What do you wish you had known about this kind of reconstruction before you did it? What advice do you have? From what I understand, it's one of the newer types of reconstruction so I haven't met any local women who have had it. The PS surgeon made it sound like recovery wouldn't be too bad, but I've spent enough time on the mastectomy forums to be skeptical. Thanks in advance for any advice!
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ReadyAbout - This surgery was easy breezy for me. I have tissue expanders and I was surprised how hard they are around the edges... like a hard plastic sticking into me all the time. I haven't had exchange yet so can't speak to that, but I will be happy to have the expanders out. That being said, I only needed maybe 5, at the most, prescription pain pills post surgery. Also had a few Tylenol, but that was it. It really was super easy for me. In the beginning I was scared I would never be able to sleep normally again but that has worked itself out and I am able to sleep on my sides quite normally.
I'm sure others who have done the exchange will pipe in.
Rebekah
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I wish I had known that anatomical (shaped) implants can rotate out of position, even with Alloderm. And that they give you sort of a "humped" look - although that would maybe be improved with fat grafting. I think that this kind of reconstruction probably always needs fat grafting afterwards.
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I didn't doubt my PS even tho I did not feel like he listened to me. He matched my native side to the implant. Made them look pretty close to the same middle aged breasts
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ReadyAbout, I agree that the surgery and post-recovery are very easy for pre-pec. The fact that you're already starting with breasts that have never been damaged by radiation is a huge help. I went through tissue expanders and have now had final implants for a little over six months. From what I've read on these forums about the muscle pain that comes with sub-pec implants I'm so very relieved that my surgeon did over the muscle. The TEs aren't what I'd call "comfortable" but they weren't painful either and are only temporary. The final implants are much better.
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ReadyAbout, I too trusted my PS when he told me recovery was so much easier w/pre pec than sub pec. That and the avoidance of the awful distortion of implants (sub pec) with flexion was enough to get me on board. It was a very easy recovery. The only thing I would have done different would be to do as you are planning and downsizing. I am a natural D/DD and the 470cc implants he put in to keep me at that size are very heavy to me. So I am going to have another procedure probably in the Fall to downsize and decrease profile of implants as well, and add more fat grafting. I think you should expect to have fat grafting at a later date if your ps does not do it during exchange. The fat helps to cushion the edges of the implants since they are right beneath your skin sometimes it is not a good feeling. The fat also takes care of visible rippling and just makes the implants so much more comfy and warm!!
Best wishes!
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I had no fat grafting, and have no edges and rippling etc. My implant is 495 and if my natural side was smaller I would have had a smaller implant ( in retrospect lol)
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Thanks ReneeCA, I just added Dr Kim and the list of Prepectoral Plastic Surgeon's is over 50 in the US, coast to coast.
ReadyAbout, I agree with all of the women here, in that Prepectoral is infinitely more comfortable, with a greatly shortened recovery time for most women. I had a TE subpectoral, and just HATED it. It was awful having my poor tortured Pectoral muscle cut and stuffed with that hard TE. People gain and loose weight, so skin is built to stretch. Not so muscles. My pectoral was INSANELY TIGHT. I couldn't stand it. Also my strength was gone. I couldn't open a bag of chips. I took it out.
It was a world of difference having a TE and then Implant Prepectorally. My recovery was very easy. I was off pain meds by the second day Post -Op. I just had to get through the time of lifting restrictions (around 3 to 4 wk, can't remember), while waiting for the incision to heal.
I got IV Vitamin C (50grams) to help speed my recovery, and reduce my risks of infections. I had 2 nasty infection when I had surgery, and couldn't afford the IV Vitamin C. Now if I couldn't get IV Vitamin C, I would get Liposomal Vitamin C, which is almost as good. You CAN NOT OVERDOSE ON Vitamin C (if you have normal Kidney and Bowel function) Surgery is known to deplete Vitamin C. Vitamin C is CRUCIAL to making strong collagen and optimal wound healing. The poor women on these boards who have incisions open up are probably horribly Vitamin C deficient. None of the doctors ever mentioned Vitamin C to me or other women, they don't get much nutrition education during medical school. Vitamin C is safe to take the day of surgery, doesn't affect bleeding/Anesthesia. I have posts above about wound healing and about Vitamin C. You can get this one on Amazon.com.
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For those who have gone through your exchange: did your PS put limits on you raising your arms after the exchange surgery? i am scheduled for next Thurs, and have not gotten a clear answer on this.
For my BMX, since I was over pecs, I had no restrictions on arm movements after the drains came out, just weight restrictoins for a month or so. Since there are no drains anticipated for the exchange, I am trying to figure out if the limitations (or lack thereof) would be the same. The only info I have received is about the weight restrictions.
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Thanks everyone for your responses - they have been very encouraging! I told someone at work that this forum has essentially become my new social media - and I assume the Russians aren't interested in this data, LOL. One more question: my cancer navigator sent me a bunch of stuff on mastectomy and reconstruction. Among the materials was a pamphlet for Pretty in Pink, a boutique for specialty bras and mastectomy camisoles. This led me to wonder: in terms of bras/camisoles, etc., what do I need post-surgery to keep my breasts afloat? Are there certain items that you found especially helpful? I think I read somewhere that underwire bras don't work after mastectomy, and I think I've worn underwire since birthing my second child. What about sports bras? What did you like to wear in the weeks after surgery? Any dos/don'ts? Thanks so much!
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I think I was not supposed to raise my arms over my shoulders, for a week and I had weight restrictions of no more than 10 lbs for 2 weeks
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how can I see the list of pre pectoral plastic breast surgeons? Thanks
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gkbuser - The list of surgeons is in the first post of this thread.
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They usually put a surgical bra on you right after the operation. I used that for probably a week, but felt like it didn't do much. I had bought some sports bras that zipped up the front, but they had too much compression. I ended up ordering a three pack of bras from Amazon called "Vermillion Sky" or something like that. They had almost no compression and were soft and came down far enough that they didn't rub on my incisions.
After about six weeks, my PS told me that I could wear whatever bra I wanted. I tried on a bunch at various stores and ordered more online with no luck. I ended up going to a boutique to be fitted around 12 weeks post op. I bought a couple of bras there and a few more with the bra fit people at Macy's. I had worn underwire styles forever and these are as well - although vastly different sizing.
I used to wear a 36B bra. I now realize it was probably the wrong size, but - while I had asked to stay the same - I now wear a 32DDD. I look about the same in clothes (the projection is similar), but these implants are much wider
It's funny how some PS's have pages of rules and are very specific about everything and others are quite vague.
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My PS did not want me wearing a bra at all for the first three months. I had nipple sparing do that may have been part of it. He did not want any compromise of blood flow. He still prefers a light cami or soft/stretchy bra but I can wear anything except underwire. I just buy regular bras at stores and they are pretty much the same size as before. I am pretty small but definitely don’t need a bra for support. These babies aren’t going anywhere.
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Legomaster, how many cc's are your implants? mine are 415cc each and i wonder if its okay not to use a bra,just camis...
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Mine are 235cc. I am 5'5" and weigh about 110. I have always been thin and athletic, it's just my body type. I know must people have opposite issues but it is just as frustrating trying to gain weight as it is to lose it if your body has different ideas. I dropped to 100 pounds right after diagnosis and it took over a year to gain that back. It's scary when you don't have a small reserve before going in for chemo or surgery when's you know you won't be eating as much
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I think the bra question is mostly a personal one. It seems like some women never wear a bra again and others practically never take theirs off - wearing to bed, etc. I sleep without one and usually don't put one on until I'm getting ready for the day.
Some of it is comfort - does it feel better with or without? Some is appearance - does the bra help with position or shape? But gravity can affect all of us over time so I think a bra when upright is probably a good idea.
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WOW Thank you!! I will refer back to your post frequently I'm sure! I had pre-pectoral TE placed with my bilat mastectomy last February. I was "fortunate" to have nipple sparing mastectomy due to location of my cancer, smaller breasts, and nipple trajectory. Incisions are inframmary and are not visible. Zero pain as far as the expanders go and my fills were completed before I started chemo with no discomfort. (My PS will not fill during chemo, i didn't see him on your list but will look again..he is awesome). If chemo stays on schedule I will have perm implants in July/fat grafting if needed. Cutting the pec didn't appeal to me personally due to animation deformity. My PS said "let's put your implants in the natural place where your breast tissue was" so here I sit completely "full" waiting to get thru chemo. Even with the expanders I can still wear tank tops etc. It looks natural enough that I can wear what I did before I am just stretched out a little bigger. I am more than willing to answer any questions. I feel very fortunate with this part of my journey. 100%. Thank you for bringing this option to the forefront!!
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One thing I do notice that is by the end of the day I don’t want anything tight on my chest. Not abra, not a tight shirt, just something loose and not clingy. It is more just a matter of comfort at that point for me. The rest of the day I don’t really have an issue.
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legomaster,
that is me,at the end of th day ,i dont want anything tight.. i am still in the process of seeing what works for me but at the end of the day, i cant wear anymore bralette/camisole. wish i was 250 ccs too:)
notverybrave,
i do worry about gravity.. will ask my PS when i see him next month although i recall him telling me that i dont need to wear a bra again...i dont know if its just me but now that the implants have settled,i feel more discomfort...
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Please add Dr. Mark Gaon in Newport Beach to the list of plastic surgeons who do prepectoral implants.
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Dear OCAtty,
Thanks for the information. Welcome to the community. We hope that you will share more of your story and stay connected here. We look foward to seeing you around the boards. The MOds
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Hi OCAtty, welcome to my Prepectoral Thread. I just added your PS to the list and alphabetized a bit better. If you have any questions, there is a great group of supportive women who have gone through this already.
Take Care,
Macb04
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Just wanted to jump in and give an update on my pre-pec implants!
Im a bit over 3 months out from my exchange (Jan 9th) and things are over all pretty good. I have pre-pec Naturel Inspira Rounds 420cc's (pretty much exactly what whippetmom on the sizing page suggested!) They fit my frame great and the recovery was really pretty smooth. They look great in a bathing suit and bears, and Ive ben back to yoga and strength training with no issues. My nipples (spared) ended up not quite level just due to how they were before, but I'm the only one that would notice that.
I just had a second round of fat grafting (first one done at the exchange surgery) to cover some rippling. OMG this round of grating SUCKS! WOW! the first time was inner thighs and belly and they were sore but this time is my flanks and outer thighs. It is so much more uncomfortable and painful with certain movements.
Any feedback from those who have had grafting done there? I am wearing spanks but I don't know if they need to be tighter if that would help? Just don't want to end up dented and all jacked up from the lipo!
You'd think taking fat from your saddle bags and adding it to your boobs would be the best thing ever LOL! I knew it was too good to be true HA
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I am meeting with PS tomorrow to talk about this procedure. I'm scheduled for bilateral mx and reconstruction in 3 weeks. I don't recall him mentioning fat grafting when we first met - I think he mentioned Alloderm?
I've read about this procedure and Googled "What to ask PS before breast reconstruction" but I'm all ears if anyone has additional suggestions.
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I did not have fat grafting at the time of my BMX/reconstruction. I am on the small side so maybe that is why. They still look good and I don’t see rippling yet. The alloderm was described to me like an internal bikini. I think it’s a pretty good amount too
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Amtreb, I hope you heal quickly and get some relief from pain. Did you ever hear about eating lots of pineapple to help speed healing? My mother's plastic surgeon mentioned it to her after her arm lift so I have been employing that strategy for all my surgeries eating lots of fresh pineapple before and after surgery. I have healed very quickly with my procedures. I am having a second round of fat grafting and a revision in June. Will be downsizing my pre Pec 440s 2 about half that size and filling with fat to make up the difference. She will be taking fat from my muffin top area on sides and toward back. So I'm a little nervous because I have heard that that is a very sensitive area. My first round of fg was taken from my abdomen. I did wear my compression Spanx for 5 weeks and would have continued longer but had shoulder tendonitis and couldn't pull them up. Another member here Special K told me to massage the donor sites even though it hurts like hell. This prevents fluid building up in the tunnels left from the cannula.
Would you mind messaging me with your experience and progress over the next few weeks?
Readyabout, a lot of pre Pec get fg at a later time, not at surgery. Some don't get it at all. It really depends on how your implants settle, integrity of your skin, and many variables. I got my 1st round 7 months post exchange to hide ripples. I'm getting more all over the surface to add warmth and softness. Best wishes to you!
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I live in Carlsbad and also go to Scripps La Jolla. Dr. Wilde is fantastic! My oncologist is Dr. Ali and I like her so much. Luckily Dr. Shimizu said I didn’t need radiation after my “complete pathological response” following surgery so I felt great about skipping that. I only needed lumpectomy but due to a discovery of PALB2 mutation, I opted for double mastectomy on March 13. Dr. Apostolides will do final implants in July. I’m stil getting Herceptin/Perjeta infusions every three weeks until October. Good tip on bras at Free People.
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