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

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Comments

  • raven4mi
    raven4mi Member Posts: 215

    Cool, thanks, macb04. I just noticed you have the list at the top of this thread as well. Just FYI, you spelled my doc's name wrong - it's Chau not Cha. And I figured I'd better give you his office city, just in case anyone's trying to locate him - it's in Berkley, MI (which is more suburban Detroit - we just always tend to say Detroit to people who aren't from here!)

  • macb04
    macb04 Member Posts: 756

    Oops raven4mi, sorry, I will correct that in both places.

  • Robins_Mess
    Robins_Mess Member Posts: 8

    Have any of you over-the-pec ladies had radiation?

  • raven4mi
    raven4mi Member Posts: 215

    Robins_Mess, yes, I had radiation, right side only, back in 2008.

  • Robins_Mess
    Robins_Mess Member Posts: 8

    Raven4mi did Dr. Chau do fat grafting for the radiation first, and if so, how many and how far apart? How bad was your skin from radiation? How was your recovery from each procedure (I'd be flying in from Denver so wondering how long I'd have to stay for each procedure). Dr. Chau is actually an in-network doctor on my husband's insurance, so I can get on his plan in December. But I'd be willing to fly out to do the initial consultation before I switch insurance. I'm just excited that I might be able to get the procedure I truly want!

  • Robins_Mess
    Robins_Mess Member Posts: 8

    Thanks macb04. I used your list of doctors doing this procedure and found a few that are under my husbands insurance. I can get on his insurance in December, so I'll hold off for another 6 months. Thanks for starting this thread! I'm excited!

  • macb04
    macb04 Member Posts: 756

    Great Robins_Mess, so glad this has been of help to you. That's why I started this thread, and the list of PS'S who are at the cutting edge of Reconstruction, sothat we can all find out helpful things BEFORE getting possibly irreversibly damaging procedures done. Knowing the safe, effective alternatives, like OVER pectoral, versus under pectoral (which is a strength disrupting , painful disaster for many, many, woman), are crucial for our recovery.

  • raven4mi
    raven4mi Member Posts: 215

    Robins_Mess, I need to clarify....

    First, Dr. Chau does not do direct-to-implant. I have tissue expanders. He had a reason why he doesn't do direct which I don't recall off the top of my head - I can ask again if you want me to. I happen to have an appointment today. But if you're going to be flying in from Denver I didn't want to give you the impression that this would be a 1- or 2-visit kind of deal.

    Secondly, he has not done, nor even yet mentioned, the possibility of fat grafting. It's also on my list of questions, but I was waiting until we get closer to the exchange date to ask him about it.

    Lastly, regarding the effects of radiation - my skin was virtually unaffected by my radiation treatments. At the time (8 years ago) I had very minimal burning/redness - not even as bad as the worse sunburn I've had. Now, however, I am having minor complications and only in the breast that was radiated - I'm assuming that's why. First, I lost part of the nipple/areola due to necrosis (which they warned me might happen) and then, after the drain was removed on that side I had extremely painful fluid build up and they had to go back in and put in a new drain. As I said, in my opinion these complications are due to the radiation and are not in any way related to the over-the-chest placement.

    Please let me know if you have any other questions!

  • JessieJake
    JessieJake Member Posts: 170

    Top o' the morning to you (Lame, I know but it just came to me)

    I've been applauding myself lately for my last minute change to go with over the muscle reconstruction. Today, though, a bump in the road. Do not get me wrong, I simply can't imagine the grief I think I would have dealt with physically with the other option. How do I know this? Well, even with the only thing stretching being my skin, I'm quite limited on how much I can expand - I think I'm at 200cc (crazy that this morning I can't recall exactly) in my 300 cc expanders and that was pushing it. I think I would be nowhere near this if I had to include muscle stretching. Plus, and this is the odd thing that probably is similar to what under the muscle people are experiencing, I got pain up by my left shoulder blade in my back when I went to bed last night. I shifted and tried a few positions and thought it was all good this morning. Then I went for a bike ride. Something I've been doing lots and lots of finally in our decent weather. No issues until half way through my ride. I got this pain near my sternum and then it radiates to my back. It's the pain from last night. I tried stretching which relieved it for a few seconds but then it's back. Even though I know perfectly well it's the TE, having pain near my sternum is concerning. I have been issue free for several weeks - doing all normal activities and forgetting about these things. Stretching fully each morning is so satisfying! Anyway, I have no idea what I could have done to irritate things. I had this pain once before after a fill so I'm sure it will subside. Ugh, I feel it now just sitting her - to the left of my sternum and near my shoulder blade.

    In the meantime I cut my ride short because it was pretty uncomfortable (now enjoying coffee and breakfast). Coincidence I see my PS today to discuss if my exchange will be on 6/24 or not. I can't wait to ask her about how she will adjust the implants so they are level. My right TE is quite noticeably lower than the left. In the early stages of fill it wasn't as obvious, but now that I have these weird softballs sitting on my chest, it's glaring. Despite that, I'm hoping she will say I can wait until end of summer for surgery. In clothes I don't think anyone will notice my lopsidedness.

    Another lady from my area is undergoing over the muscle TE placement with her BMX today. So glad that wound up being her decision. She has a different PS than me but same clinic. She knew of my choice but I certainly didn't push it. She made her decision based on the conversation with PS.

    I just wanted to share my experience thus far. I know my clinic is doing a blind study comparing over/under and I was thinking about how this discomfort I'm having would be relevant data (although I'm not part of the study, it started after my surgery).

    Hope everyone else is doing well today!

  • littleblueflowers
    littleblueflowers Member Posts: 391

    Hi ladies!

    My PS is Dr. Hardy at Northwest Plastic Surgery Associates in Missoula MT. He is doing fat grafting before installing tissue expanders to help heal my skin from radiation. So far so good!

  • JessieJake
    JessieJake Member Posts: 170

    Saw my PS today and she said there is no rush to do my exchange surgery. The pressure spot caused by the right TE did not cause the issues she thought it might. Yeah, June surgery would seriously impact my summer plans so I'll happily deal with my lopsided softballs until September.

    She said I will have to do anatomical implants for sure. It is a simple fact that I am nothing but rib cage on top - you can see every part of the TE from the tabs used to "tack" it into place to the pointy spot where the TE didn't smooth out all the way from fills, and my ribs show, too. She said the anatomical will not show the edges as much as the round style, but I will still most likely be able to see some amount of outline. She'll do some fat grafting but she isn't sure she will get much. She said to eat a lot between now and then so there will some fat to harvest. I simply can't not be active in this great weather! I carry my weight lower so there may be a little more than she realizes by looking at my "freaky small" chest (her words! but we are comfortable with that speak at this point!) - wish I could gain more padding around my upper body, but it's not in my cards (or genes).

    As for the crookedness of my TEs, she explained that it is all TE. The incisions are level and that would correspond with the alloderm inside. She said during exchange surgery should she find that there is some asymmetry between the sides she can fix it by either adding stitches to the side that is too low or cutting through some of the scar tissue on the side that is too high. I left feeling confident with that info.

    So, three and half more months of these TEs. I think I'll be just fine :)

  • raven4mi
    raven4mi Member Posts: 215

    macb04, I had an appointment with my PS today and told him I added his name to this board. He said I should mention that one of the pioneers in this and a physician who does a lot of them is Dr. Jacobson at the Mayo Clinic. I don't have any further info on Dr. Jacobson - maybe someone else will chime in on this or the other board.

    He also said that the over-the-chest implants were being done quite a lot in Chicago but gave no details. Sorry I didn't press him for more information but I was dealing with my own stuff during the visit.

    Robins_Mess, I asked him about fat grafting, and he referred to it as "icing on the cake" that would come after the exchange and at the end of the process to smooth out any imperfections - "kind of like spackling a wall" were his exact words. He cracks me up.

  • macb04
    macb04 Member Posts: 756

    Woo hoo! With the addition of Dr Jacobson, there are 9 Plastic Surgeon's on the list who are doing this cutting edge Over Pectoral Implant Reconstruction. I will add him here, and on the other Listing thread. Thanks raven4mi.

  • JessieJake
    JessieJake Member Posts: 170

    The plastic surgeon I mentioned in my earlier post today was Dr. Jacobson from Mayo Clinic. Another board member had her BMX and tissue expander placement today with him as her plastic surgeon. He did describe himself as the pioneer of the process when she spoke with him.

    http://www.mayoclinic.org/biographies/jacobson-steven-r-m-d/bio-20055115

  • raven4mi
    raven4mi Member Posts: 215

    Awesome; great link, JessieJake. My PS used the word "pioneer" to describe him as well.

    Also, just as an FYI, my PS, Dr. Chau, has been doing these for two years now. He says it's the wave of the future and the PS community is really moving that way. I explained to him how difficult it was for us lay people to find docs to do it though, which is why I added his name to the list. He was fine with that. So, hopefully, some time in the not too distant future, it won't be so difficult to find a PS to do this!

  • Robins_Mess
    Robins_Mess Member Posts: 8

    Apparently Colorado is a black hole for forward thinking PS's. I have literally called every doctor under both my and my husbands insurance and none of them are even willing to do fat grafting + implant on my radiated side, let alone above the muscle. Traveling worries me after surgery, but I just don't see another way. I think my next plan is to see if a doctor here would work with a doctor out of state for doing fills and minor things like that, but travel for the actual surgeries.

  • macb04
    macb04 Member Posts: 756

    Oh Robins_Mess, that just sucks, to have to jump through hoops to get what you need. Try picking your out of state doctor and then ask them if they would call and speak with a local PS helping you out. Are you talking about for the TE fills locally or what? A doctor will always be more willing to talk with another doctor, than with a patient. Your local doctors don't like exposing their ignorance of newer procedures, so you might need to pick the youngest one of your local bunch and see who (PS wise, out of state) will speak to them on your behalf.

    Good luck, definitely an uphill battle at times, but I begged and pleaded and got my over pectoral procedures, which was a first for my PS, so it can be done. Also, my PS is kind of young, so not as intrenched in "no". If it will help, I am willing to ask my PS to talk to someone for you. Remember, I am a train wreck of Radiation damage, yet I am doing Ok with an over pectoral implant.

  • besa
    besa Member Posts: 289


    Just saw this published article in pubmed and thought it sounded relevant. It is a very small study...


    http://www.ncbi.nlm.nih.gov/pubmed/25455288#

    Prepectoral implant placement and complete coverage with porcine acellular dermal matrix: a new technique for direct-to-implant breast reconstruction after nipple-sparing mastectomy.

    Reitsamer R1, Peintinger F2.

    Abstract

    BACKGROUND:

    Nipple-sparing mastectomy (NSM) and implant-based breast reconstruction are increasingly replacing conventional mastectomy for risk-reducing purposes in high-risk patients as well as for therapeutic purposes inbreast cancer patients. For implant-based breast reconstruction, generally, subpectoral implant placement with partial detachment of the pectoralis major muscle (PMM) is recommended. The advantage of a potentially better cosmetic result has to be balanced with the disadvantages, such as partial injury of the PMM with subsequent muscular deficit, breast animation, and postoperative pain. We hypothesize that prepectoral implant placement and complete coverage with a porcine acellular dermal matrix (ADM) may provide an alternative to subpectoral implant placement with an excellent cosmetic result, avoiding the disadvantages of subpectoral implant placement.

    METHODS:

    In a total of 22 breasts in 13 patients (nine bilateral and four unilateral), NSM and immediate direct-to-implantbreast reconstruction were performed with prepectoral implant placement. The implant was completely covered by a porcine ADM, which was sutured to the fascia of the PMM and the inframammary fold to keep the implant in place.

    RESULTS:

    The cosmetic results were excellent and patients were fully satisfied at a median follow-up of 6 months.Breast animation and implant dislocation could not be observed. Implant rims were not visible, and capsular contractures grade III and IV could not be observed. The complications comprised minimal nipple necrosis in two patients and hemorrhage with evacuation in one patient.

    CONCLUSION:

    Prepectoral implant placement and complete coverage with porcine ADM represents a novel approach and a feasible alternative to subpectoral implant placement after NSM and implant-based breast reconstruction for patients who prefer their PMM to be left intact.

    Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

    KEYWORDS:

    Acellular dermal matrix; Direct-to-implant Breast reconstruction; Implant-based breast reconstruction; Nipple-sparing mastectomy

  • macb04
    macb04 Member Posts: 756

    Hi besa, welcome to the OVER pectoral implant reconstruction thread. I had read that study and thought it was great, gave me hope when I chose to go OVER pectoral with my implant reconstruction last year. It has been a long road with lots of awful misery involved, wrong turns and setbacks, but I am nearly at the end. On June 9th I fly to California to get my nipple tattooing done. Crossing my fingers it all goes well.

    What are your circumstances, are you getting reconstructed. ?

  • besa
    besa Member Posts: 289

    I try to read all the bc literature and this was just a journal article I came across that I thought was relevant to people on thread.

    ( I had recon a number of years ago - a very problematic DIEP done locally following a multifocal bc diagnosis - I struggled with the DIEP recon --- wrong turns and multiple revisions. And then a number of years later I traveled for a prophylactic contralateral ns sGAP and a skilled revision of my DIEP side at NOLA)

  • HuskerFan
    HuskerFan Member Posts: 26

    Hi ladies....so glad I found this thread! I am the one JesseJake was speaking of upthread; I had my BMX on Thursday. Dr. Steve Jaconson is my PS and we are going over the muscle. During my consult with him, he told me he can't even remember the last time he did implants under the muscle. At first I was a little overwhelmed with the idea of going over the muscle. After all my extensive reading on these boards, I just assumed I'd have TEs and implants under the muscle since that's what seems to be more common. Now I know that the reason over the muscle isn't as common is because there aren't very many PS who do these implants! So far, I am feeling really good after my surgery. My TEs were filled with a little bit of air. Dr Jacobson said I should only need two fills. I was originally a 36DD.....apparently you can fill quicker over the muscle since the muscle isn't needing to be stretched.

  • raven4mi
    raven4mi Member Posts: 215

    Hey there, HuskerFan! Kind of cool that it's you on this thread - kind of feel like I "know" you from the May thread. :)

    The good news is that none of the complications I've been having are directly related to the over the muscle implants, so don't freak out that I'm here. LOL!

  • HuskerFan
    HuskerFan Member Posts: 26

    Hi Raven! I'm really excited to have found more "over" ladies. So glad we have a place to discuss our experiences. Dr Jacobson also talked about fat grafting once we get to that step. I ended up with a nipple sparing BMX....keeping my fingers crossed that I get the desired outcome with that

    Sounds like you've had a rough time lately......hang in there

  • macb04
    macb04 Member Posts: 756

    Hi HuskerFan, welcome to my OVER thread. I will add your PS to the list of docs doing this kind of surgery. I want OVER pectoral implant reconstruction to be as available and common as the traditional under pectoral kind done routinely in the past. I think the choice of OVER versus under should be left up to the patient, all things being equal. I would bet there are very few women, who are anatomically unsuited to OVER pectoral reconstruction. It is certainly more comfortable. No disruption of your Pectoral muscle, a HUGE misery for me and scores of other women. I think it is the saddest thing that women deconstruct because having a big blob of silicine inserted under their pectoral is painful and making them miserable enough to go flat after all that hardship.

    HuskerFan, can you tell me if your PS is Dr Steven R Jacobson from the Mayo Clinic? I want to make sure I have it correctly on the list.

  • HuskerFan
    HuskerFan Member Posts: 26

    macb04, yes that is my PS

  • mshel
    mshel Member Posts: 9

    I have my exchange surgery in two days.  I continue to have some stitches coming up towards the surface of my skin in the cleavage area.

  • JessieJake
    JessieJake Member Posts: 170

    Hi mshel, I remember you having the stitch that poked its way out. I wonder what on earth is causing that to happen? Did you develop an infection or did the antibiotics keep it at bay?

    Also, was wondering if your PS moved up your exchange due to those stitches surfacing. I hope all goes well with the exchange and you have no more issues.

    Best wishes and let us know how you do!

  • macb04
    macb04 Member Posts: 756

    Hi mshel, that is odd that you are still having those stitches show up. I had a problem with one particular type of suture material, and when I told my PS about it he changed the suture he used in mynext surgery and didn't have any more problems. . I hope you have a marvelous result, heal well and quickly. Great, Good Luck to you on your upcoming exchange! .

  • macb04
    macb04 Member Posts: 756

    Hi just home yesterday from seeing Vinnie Myers for my 3D nipple tattooing. Woo hoo! Have matching nipples, pretty good. Amazing that he could so quickly make my breast look real.

  • JessieJake
    JessieJake Member Posts: 170

    Great macb04! Wondering, was it uncomfortable? And how awesome it was a one visit result. Enjoy - too bad you can't just show them off!


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