TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!
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So, it has been almost 2 months since my exchange surgery following a BMX, and I appear to be healing well. (That is the good news!) Also good news: the implants are even, I look normal in clothes, and when sittiing/standing up, they look kinda normal (a little rippling, but for the most part, I can deal with it.)
The bad news is that I really don't like the way I look when I am lying flat on my back (supine.) I have smooth round implants with moderate projection, and when I lay flat, the implants shift to the side (fortunately, not under the pits!) creating a large, flat area between my breasts (aka the landing strip!) I This landing strip is wider than the width of my hand. The outline of the implants, particularly in the area closest my "cleavage," is particularly visible.
Has anyone else had this problem? More of an issue for pre-pec?
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I haven't heard of this particular problem, but it sounds like the implants are either not wide enough, or were placed too far apart for your chest. I am sorry, but I don't know if anything besides another surgery could fix that. I really hate to say that to any woman, I know how miserable it is to want to be done. I had 15 reconstruction surgeries, including the 5 Fat Grafting procedures that only worked slightly because the PS's (plural) I had didn't really know how to do the procedure right.
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I am almost 4 weeks post surgery and although I have extensive cording in my left arm and a hematoma in my armpit, the one thing that overrides everything is NERVE PAIN. Has anyone else had this? I'm going on 2 weeks of it now: feels like an intense sunburn/hypersensitivity on various parts of my chest and anything touching it feels like sandpaper. When I left a message about this, the PS wouldn't prescribe me anything for nerve pain, saying the one medication I mentioned can be addictive, but I will see him on Friday and we're gonna iron this issue out because it is making me miserable. I think he's a good surgeon but lousy at office visits and providing a live person to talk to when there is an issue. My father was a surgeon and my uncle and his wife were plastic surgeons, so I have a good idea of what it means to care for patients after surgery. I'm frustrated.
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Hi Ready, I did have a fair amount of nerve pain for the first month. I assume you are going to PT? It helped me a lot. After stretching and exercises she would massage the area. I would massage in the warm shower and it helped. My burning was not across my chest but from left upper pec to armpit area. I still have some now but not nearly as bad. I'm sorry you are so miserable. I hope it gets better soon
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Ready - ME ME ME! I know exactly what you mean. It feels like you've worn a wet sandy bathing suit waaaay too long. I could (and still can) feel the outline of my TEs inside my chest. If I wasn't sitting on the couch perfectly still so I wouldn't go bonkers I was walking around holding my shirt out so it wouldn't touch my chest. Forget bras. It took a while to get my Drs to take me seriously since “everyone hates their tissue expanders." I think most ppl do but maybe not as much as we do!
I finally got an Rx for Gabapentin/Neurontin. I ended up at 900 mg. It helped nerve pain in my chest and feet. It does make you sleepy so you can take more of your daily dosage at night (it builds up in your system). Lyrica is a more expensive option. I've recently switched to Cymbalta in lieu of Gab and Zoloft, and that works (enough) now.
Another help was getting fills - I didn't do any until after radiation. That helped pull in the hard edges and tabs - the TEs are less painful sitting tighter in my chest. I added 150 cc. Now with the passage of time (10 months), more healing and the fills, the pain is “just" discomfort but I occasionally take 200 mg of Gab in late afternoon to get through the evening. It still impacts me daily.
I found some very soft tank tops at my big one stop shop store ($12 Genie brand) that I could tolerate during the day and at night. If you can stand them a little snug they also work for under-boob skin-on-skim discomfort, and can be worn easily as a barrier with other shirts.
A topical that helps is (yes) vasigel (thanks Lula73!). Other numbing creams would too.
I'm so sorry you are going through this - it is awful and makes recovery that much harder. Keep at your Dr. If he/she won't help, try one of your others. I got my Gab Rx from my radiologist. I’m so implant adverse now I’ve decided to switch to DIEP.
Lanne
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I, too, had that horrible sun-burned feeling.
My PT suggested that it is often related to the nerves that have been cut or irritated during the surgery sort of waking up and recovering. She recommended "re-training" the nerves to respond appropriately by using various textures of fabric to purposely touch the affected areas. I used everything from super soft items with very gentle pressure to more rough ones with increased friction. I found that a handheld showerhead with multiple settings also helped.
It seems counter-intuitive when pain is involved, but it really did help.
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Shadie,
i have the same issue.they are far apart even when i am upright.might go for a revision to go smaller and pull them nearer.PS will cut off some skin..
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Seriously bummed....I am supposed to be in surgery right now to swap out my pre-pec 440s for 300s and fill the difference with fat. Would probably have needed a 2nd or even 3rd fg session to fill the void. But my PCP who did my pre-op clearance did not clear me because she mis-read my stress test. Called me at the last minute, day before yesterday to give me the news even though my test was done June 4th!! Sent me to a cardiologist who told me there is nothing wrong with my heart (yay). But I had to give up my surgery date, and when I called PS to get back on the schedule the coordinator told me she is booking 6 weeks out. Worse than that, she will no longer be participating with my insurance after 30 days.
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Oh, no! I hate the stupid insurance stuff! It seems like they should only be able to "participate" or not at the beginning of the year or something.
Can they put you on a wait list in case something opens up?
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@Brave...no, the coordinator told me when I had to postpone she filled my spot with 4 office visit appts. Apparently my PS is a rising star in the community and in high demand. I asked about a cancellation list but was told it would be pointless as there are others already on the list. She gave me the name of another surgeon in the area. I called and spoke to his nurse. He doesn't believe in pre-pec for one, and not in extensive fat grafting either.
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@shoregirl.. I feel aweful for you. First off, I would be angry at your PCP. Second, I would call back PS and tell them you need more names because the one they provided will not work. Good luck!
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@JoniB, thank you. Yes, I am not happy with the PCP. She is young, I would guess about 29. I haven't let her know yet what has transpired. But I did just send an email to the PS telling her of my dismay. I asked why she couldn't finish the cases she had accepted and just not accept any new cases since she is terminating particpation. Trust me, there was more to the email, I just don't want to get into it here
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shoregirl, I'm so sorry. Be sure you take this to the office manager..unless the coordinator is that person. I work in pre-op and it's so frustrating. Be sure you get your own copy of the cardiac clearance too. In Ohio those are good for 6 months but unfortunately the pcp visit is usually only good 30 days. Your pcp definitely dropped the ball on this. Fingers crossed that your email to the PS may change things for you. Hang in there.
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Hi ReadyAbout, I had Cording and came up with something that helped. First I thought about what cording actually is, kind of solidified high protein fluid buildup in Lymph Channels due to lymph stagnation after removal of lymph nodes. Then I though that sound waves are used to break up things like kidney stones ( Shock Wave Lithotrypsy). Then I thought about my Sonicare Toothbrush which uses sound waves produced by high frequency oscillations to break up plaque on my teeth. Sonicare also makes an Face/Body version called Mia. Long story short, I had been seeing the Oncology Trained PT for the cording, to almost no improvement so I told her my reasoning and that I was going to try it. She cautioned me against it, no studies proving it is safe, ect. I bought the Mia, used it doing MLD in the shower, initally for a short time daily, and then for a more thorough session of it when nothing bad happened. When I went back to the PT 2 weeks later the cording was almost completely gone. I am not sure how the cording I had compared with what you had, but I did get a considerable improvement, something traditional PT was unable to provide after weeks of effort.
Shoregirl, that sucks big time. Do you want me to take your coldhearted, unhelpful PS off my List of PS's doing Prepectoral Implant Reconstruction? I certainly don't want to give any free advertising to an big headed stronzo like that. How does (he) fit through doors with a head that large? Just say the word.
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@DebAl, thank you. I didn't think to get a copy of the cardiac clearance for myself, but I am calling right now to request one. I felt good getting everything off my chest in the email, I really did. But I am a non confrontational person and after I sent the email I took my two little doggies for a nice walk. When I came back, I started to feel bad for sending it.
@Macb04, I appreciate your position, I really do!! It is HER big head though lol!! Let's wait and see if I get any response to the email....
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Hi!
I am having a skin/(hopefully nipple)sparing BMX with prepectoral reconstruction (with TE's) August 28th. My PS is Dr Philip Sonderman from Greater Milwaukee Plastic Surgeons. He did abdomnioplasty on me 18 years ago!!! I had children very young....it left me with loose, hanging skin and split abs for years no matter what I did or how much I worked out! I saved up some money and had the surgery later when I was 30......He is wonderful. I was so excited to find out he was in my network!!!! He even remembered me!!!!
I feel like I am in excellent hands. I am a little nervous and feel a bit anxious waiting until the end of August but the tissue in my right breast is LCIS and my oncologist feels like I can wait. I am a dancer and we have our 10 year anniversary show coming up. I am one of 12 in our troupe and really don't want to miss it or let anyone down. That being said I would have my procedure immediately if my oncologist felt it was necessary. I am happy to have read Sunrisefish's results as I too have had radiation on one breast already. Gives me hope!!!!! 0 -
Dr anne. My doctor said "this isn't an emergency", so take your time to make your decisions.
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One thing I learned for myself over the years (mostly from ortho visits/surgeries) is that (IMO) putting up w/ less-than-great office/admin is sometimes worth it for the right clinician/surgeon.
For the right surgeon, crappy admins/grumpy nurses & other staff who are less-skilled communicators, are just nuisances... like traffic jams, running out of toilet paper at the wrong time, parking tickets etc... The surgeries are more important to me than someone behaving crappily... Can always let PS about support staff being unsupportive later.0 -
@Druanne that is so cool that your surgeon is your surgeon from 18 yrs ago. That should really help put you more at ease!! I was told the same thing w/my DCIS. It wasn't a hurry and rush situation. I didn't even find out about the DX for 6 weeks as I was out of state and had changed my cell #. Got back home and the letter was in the mail! Good luck to you
I did get a reply by email from my PS. She said she was so sorry. She knew my surg had been cancelled due to cardiac clearance, but had no idea what my insurance is-its generally not something she is involved in or aware of. Said the decision to not accept my insur was made by the practice admin due to the overall needs of the practice and surgery center. That apparantely its not possible for only one physician in a multi-physician practice to par with a particular insurance company and so it wasn't possible for her to remain par when it didn't work for the rest of the practice/surgery center. And she cc'd the admin on the email so she knows my individual situation and she can reach out to discuss w/me. Said she knows the intent when she made the decision to no longer participate was certainly not to leave patients without appropriate follow up or care.
I wrote back and said I am the one who is sorry. Being confrontational is so out of character for me. My emotions were just all over the place from all that had transpired in a matter of 2 days. I told her I really value the rapport we have and look fwd to hearing from the admin as to the next steps. I really feel it was the coordinator's lack of sensitivity in the way she broke the news to me and trying to justify the provider becoming non-par because the plan didn't pay enough that really set me off. So hopefully by networking here in various threads I can get some recommendations for PS that are on board with extensive fg done in stages.
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Thank you so much for your replies 2FUN and Shoregirl
I went in and got fitted for my postoperative bras this morning. August will be here before I know it!
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Yes it will Druanne!! In the meantime, knock em dead in your upcoming dance production!
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Wow, the list is now up to 65 PS doing Prepectoral Implant Reconstruction in the US with the addition of Druanne's PS. Thanks Druanne!
You are right Shoregirl, by mistake about your PS being a she. There are a few other Prepectoral Implant Reconstruction Plastic Surgeons on the list for MD. None of them InNetwork, or close enough to home?
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@macb04, I had a call from the office admin this morning. She was so empathetic and apologetic. Said if she had heard as a patient what I heard from the patient coordinator she would have felt like the doctor didn't care. So I am sure this is going to be a training tool at that office on patient relations! At any rate, she and the PS discussed my case this morn. Said they came up w/a couple options for me. I could come in to her surgical suite Thurs, and she could swap out my implants and fg. BUT, Alloderm is not covered in an office surgical setting (must be OR) and implants would be out of pocket for the same reason. So option 2 is she would refer me to her dear, close personal friend and colleague. She is an Asst. Director of PS at Johns Hopkins. Hopkins is 83 miles from me, but that is do-able. Heck my current PS was 50 miles from me. Anyway, she has complete confidence in the Hopkins PS and said if she ever needed surgery this would be the woman to do it. She will walk her through all we had planned and be there for any questions. I feel so much better!! I would say, leave her on the list! Empathetic, compassionate female PS are somewhat of a rarity.
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@shoregirl so happy for you. Love to hear stories like this and glad you are going into weekend with things worked out.
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That's great Shoregirl. Do let me know your new PS's name if you wind up pleased with her care.
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Thanks ladies! Lets all have a wonderful Father's Day weekend!
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curious... has the cording come back? Did you use Mia still to keep at cording atbay?
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A few questions on your experience with reconstruction: 1. Did your PS give you any oral instructions or handouts on what to expect with tissue expanders/fills/general timeline of reconstruction? Did she/he sit down with you and map out how things would probably go? 2. Did you have to take an antibiotic before and after each fill? 3. With prepectoral, what is the general waiting time before the last fill and exchange surgery? 4. Did any of you have fat graft and/or lift done at time of exchange?
I now realize that my PS is probably technically proficient, perhaps even gifted, in the operating room, but his organizational skills with office visits are terrible. He reminds me of students I've taught who had 140 IQs but couldn't hold on to a piece of homework to save their lives. He wouldn't do my first fill on Friday because I didn't take an antibiotic beforehand and he refused to admit that no one in his office ever told me about it. He went on to refuse my third request for medication to treat nerve pain, saying that he didn't know where I got the "myth" that gabapentin is helpful, but that it would only make me high. If "high" means "sleepy", then perhaps he has a point. He said that since I'm very active and a distance runner, I must be "kinesthetically aware" of pain more than most people. I told him my father was a surgeon and the worst sin in our family was complaining about illness unless we were coughing up blood. (I had a heart attack at 41 and waited a WEEK before going to see the doctor.) Anyway, my PS left a message on my voicemail yesterday checking in and saying that he wants to talk about last week, so I imagine he is either going to offer a tepid apology or fire me as his patient. Either way, I am too tired to care.
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honestly Ready, you should fire HIM. You deserve so much better than this nutjob. Go see one of your other docs for the gab Rx if you have to. Lanne
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Hi ready, I did not get any instructions or handouts about tissue expanders or fills, the only timeline we’ve talked about is an estimated time of exchange (sometime in August/sept). The only antibiotic I took was for 10 day right after surgery, finished them well before my fills started. And since I’m right there with you going through this I unfortunately can’t answer the last two questions. I do know I am waiting until well after surgery to think about needing or wanting fat grafting
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