TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!
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The nightmare indecision continues.... finally realized I want to go with Dr Rogers direct to implant prepectoral. However, my BS "cores" the nipple where I've heard other BS' who leave 5mm or 3mm beneath and aren't as inclined to go up as high on the chest, which one BS referred to as "hallowing you out". The more aggressive you are I think the higher the risk of complications and necrosis/the thinner the flaps, but, obviously don't want to ever have cancer again so pros and cons... As a thin patient I also worry an aggressive BS will make the prepectoral outcome a little more iffy cosmetically regardless of the PS since apparently thicker flaps are ideal for this technique?
For those who did prepectoral, I would love to hear from those who went straight to implant and how it went!! And, for everyone, if you happen to know if you BS cored the nipple, or... ?
I really love the BS who is aggressive, and I really want to go with Dr. Rogers. I'm just scared to pair them together as what if that leads to complications. My BS doesn't believe in direct to implant or prepectoral... But I don't think I have the time or ability to switch to a different BS that's in the same facility. Help!
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Good morning Aisling,
I certainly didn't go straight to implant. My route to prepectoral as you know was circuitous. But at five foot seven and 114 pounds and having had an aggressive surgical oncologist working with my plastic surgeon I was hollowed out all right! My initial surgery was skin and nipple sparing. (I have both) My incisions are underneath my breasts.
There is a pre-surgery surgery that can be done behind the nipples. I didn't get this done because my initial surgery was moved up because of a cancellation but it sounds like a good idea. The plastic surgeon will take tissue from behind your nipple and then when the pathology report comes back clear they don't have to go so close and there's less chance of necrosis with the nipple. I was lucky but I always thought that the surgery sounded like a good idea.
As for thin skin,which is an issue with me, my plastic surgeon used a heavier kind of alloderm. I should perhaps be writing this after my appointment at noon today but I will try to remember to ask him specifically what kind.
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I have a friend who did direct-to-implant prepectoral and did fine; no big issues with recovery. I also have another friend who did nipple-sparing bmx last fall and now has cancerous cells in the nipple. ): No matter how carefully we research and the number of precautions we take, we simply aren't immune to recurrence.
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Hi everyone!!! My surgery is tomorrow!! Skin/nipple sparing, prepectoral, bilateral mastectomy with tissue expanders!!!
Wish me luck
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Good Luck, Druanne!!!!
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Good luck Druanne. I had mine five days ago and so far recovery has been a breeze. I was most worried about the feeling of having two large foreign objects lodged in my chest (which is why I insisted on pre-pec to begin with) and so far I don't notice the implants at all.
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Many well wishes, Druanne!
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Best wishes Druanne!. Keep us posted on how you are doing!
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Good luck Druanne!! You will do fabulous!!
Here is a question for you pre-pec ladies. I have my 2nd set of smooth rounds in, installed pre-pec last Nov. On the right one, upper pole about 11 o'clock position there is a linear crease/fold that angles down toward outer 9 o'clock position. It was really bothering me (painful) earlier this year. I had it checked by ultrasound in Feb and thats when I found out it was a fold and I was told it was nothing to worry about. But now it is hurting again, and the pain comes in waves like a uterine contraction if that makes sense. It will hurt, a real sharp needle like pain for about 30 seconds, then go away and a few minutes later repeat the cycle. It doesn't happen every day though! So weird. I am thinking along the lines of when I had my real breasts, if I had too much caffeine I would get some pains like that. Any one else have issues with folded implants causing pain? I did read that if there is a crease/fold it can lead to rupture...ugh!!
I am supposed to have a revision (yes, another one) anyway so it will be coming out eventually. However, I am the one that had the PS quit participating with my insurance mid case. She had planned a staged revision and only done the 1st stage, then quit, leaving me with one side 2" lower than the other (didn't add more Alloderm to that side) and this creased implant on the other side. She referred me to a friend of hers who is PAR to finish the case. I met the new PS July 5 for a consult. She said she would call the referring PS and discuss my case before we proceed as we were not all on the same page. I never heard from her again, here it is 7 weeks later! I have left 3 messages, and am feeling like she just doesn't want to take my case but doesn't want to come out and say it.
What on earth should I do? I am considering going back to my 1st PS that was on my BS team and see if he will take me back!
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Really Hapa??? That's awesome and has been my concern too! I have to have the tissue expanders for 3 months ish and am thinking about the same thing, having foreign objects stuffed in my chest. I have heard the TE's are kinda uncomfortable though. I am so happy to hear you are doing well!
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Thank you Shoregirl! I hope you get some answers! That sounds like it can be scary & annoying!!
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Thanks VeGal & DebAl!!!! I will keep you posted!!!
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Thanks SimoneRC!!!!
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Found out today I will also have Alloderm support for my tissue expanders. One layer.
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Aisling - I had BMX with skin and nipple sparing, direct to implant. My BS took tissue from behind each nipple that was sent to pathology, but I recently learned that she left a "disc" of tissue behind to support the nipple and areola. I'm pretty sure that every other scrap of breast tissue was removed - high on chest and around the sides. They do tend to take even more on the cancer side.
I did have an infection on the cancer side 5 weeks post op that required 3 days of IV antibiotics in the hospital followed by 2 more weeks by mouth. I've had some concerns about an area behind the areola on the cancer side, but nothing shows on mammogram, US, or MRI. I had finally decided to just have it removed, but circumstances delayed that and now I'm back to "not sure" on what to do.
Early on I had concerns about my choice of surgery. I was worried the implants were too wide, too flat, and there was rippling. However - as time has passed - I'm much happier about my appearance. I don't know if I'll ever do fat grafting. The rippling seems less obvious anymore.
I wouldn't worry too much about how your doctors will work together. If you're happy with each - I think you'll do fine!
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Shoregirl - Boy, have you had a run! I think I'd maybe call the last PS again and see if they have any other (better) recommendations. It seems really unprofessional for them to not return your calls. You could also maybe see if there's an office manager or someone who could follow up for you.
Going through all of this is hard enough without extra stumbling blocks. I hope you get a plan with a timeline soon.
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I wish you the best of Luck Druanne with your upcoming surgery. Remember to increase your Vitamin C intake. Vitamin C is absolutely crucial for surgical incisions and other wounds to heal with strong collagen, lowers the risks of incisions opening up. Vitamin C also helps with strong immune function. It is a known fact that surgical procedures lower the body's store of Vitamin C.
Impossible to overdose on Vitamin C if you have normal Kidney and Bowel function. Only thing that will happen if you have more Vitamin C than your body needs is some loose stools. I used to get high dose IV Vitamin C after most of my surgeries. I only had infections following surgeries where I did not get the Vitamin C.
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NotVeryBrave- Thank you! Strangely both of my sides are the cancer side in a way - I had DCIS on the left 2 years ago and a lumpectomy, now I have DCIS on the right, so at 39 and considering a history of other cancer (Hodgkins Lymphoma stage 4B when I was 19)... I've been deemed too high risk for boobs (that probably wasn't the medical explanation for why I should have a mastectomy).
ReadyAbout - you are right. My therapist told me today that there was no 'wrong choice' - that things could go wrong no matter which method or who I choose. Comforting in a noncomforting way. The BS at Cedars called me this morning and said he had spoken to the PS I wanted to go with... said he didn't "core" the nipple after all but he was going to remove all that he could/get as close as possible as his concern was not for aesthetics but for the next 40 years of my life/not having a recurrence, and that as I was thin so it was a difficult surgery but if I wanted the thicker flaps the PS was requesting he may not be the surgeon for me... but he managed to say all of that in a very, very kind and non defensive way. When I asked him if he could be the one to perform the surgery (vs. one of his fellows in training) he said yes dear in a way that only he could say. That was my other big concern as I've had my fair share of intern and fellow surgical errors many moons ago. So I see the PS again tomorrow with my husband and best friend in tow and am going to ask if he still thinks direct to implant is recommended given this info and we'll see.
Yaniza- Thank you and did not know there were different thickness levels of alloderm!! Great thing to ask the PS about tomorrow...
Ok... tomorrow is D day (Decision Day). Otherwise insurance won't clear in time etc.
Good luck tomorrow Druanne!
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Hi everyone! I am out of surgery and home!
I woke up to a "big" surprise! I was supposed to have TE's but woke up with final implants! He was concerned that my left breast, which was previously radiated, would have poor blood flow and skin envelope. He said my tissue and blood flow were great and he decided to do direct to implant. I was very happy and surprised. He put very large implants in me at 790cc. I was a 34DD prior to surgery. He said there was plenty of healthy skin for them and he said the over filled size would most likely not ripple. He doesn't seem to think I will need further surgeries but we will see. So far to me they look smaller than they were (real ones) , albeit rounder!!! I looked up the size and found out that 800cc is the largest. I wanted to be smaller....so far I think I am.....I guess I will have to wait till all the swelling is gone and I am healed to see the final. I can always have them changed to smaller at some point. What do you guys think???? Are they gonna be too big??? I am so very happy and a little concerned at the same time.
I am used to being large so........My fiance says they look a little smaller. It is hard to tell. I did just have surgery on Tuesday.Hope everyone is doing well!
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Congrats Druanne! I hope you're feeling well!
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Congratulations, Druanne! That's great news! I'm sure that your PS would not have placed the implants if there was any concern so try to relax. Things will change somewhat over the next several weeks to months. You may be very happy with the end result! I hope so.
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macb04,
I've been MIA from the boards for a while but have been catching up on past posts and saw your vent posts. First of all, vent away! Don't ever feel bad about expressing your rage in this safe place. You know I have an equally unsatisfactory mutilation so I 100% get where you're coming from. Hugs to you!
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Hey, all. I hope everyone is well. Been MIA from the boards for a while - just needed a break, you know? Welcome to all the new people here. I'm sorry you have to be here but you'll get nothing but great advice and support from this group.
I am less than three weeks shy of the one year anniversary of my final exchange surgery and you're not even going to believe this.....I was feeling kind of sick last night, like maybe I was coming down with something. No temp and decided to go to bed early to sleep it off. Woke up in the middle of the night with excruciating pain in my right implant, the one I had all of the infection issues with. It's not red, but I can see it's swollen and it's extremely painful. Slight temp this a.m. of 100.3. I found some abx left over from when I was taking them post exchange and popped a couple this morning (even though they expired in June - they might not help but i figured they can't hurt.) Also going to start gobbling Vitamin C and take some oregano essential oils.
Why on earth this is happening nearly a full year post-exchange is beyond me. I have had no injuries to the breast or anything like that. I can't even begin to fathom where an infection, if that's what this is, would even come from. I have zero interest in sitting in the E.R. for hours over this holiday week-end and, frankly, I'm kind of willing it to go away! I'm not even sure what to do at this point. My plan for now is to try to tough it out through the week-end, but then I don't even know who to contact next week. PS? ID? The latter will immediately want to remove the implant and there's no way in hell I'm going through all that again.
Why is this happening to me??? ~sigh~
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raven4mi: One year post-exchange and you get an infection?! NO!!! Not fair. Can you call your PS and ask for antibiotics? Some antibiotics are less effective for infection and it would stink for you to be on one that isn't working. I got a second infection in my left side this week, just days before my exchange surgery, so I am on Bactrim and Keflex. Instead of getting the implants on Tues, PS is going to remove both expanders, replace them with new ones, and put an antibiotic plate in the bad side which will stay in for 3-4 weeks. Be careful with your infection! My PS said I would need to go to hospital this weekend if I got a fever over 101, racing heart, a lot of pain, or if it started to spread. I had a fever yesterday and felt so bad that even my students asked if I was ok, lol. The antibiotics kicked in today and I feel so much better. Hope the same for you!
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Thanks!!! Yes so far I am feeling pretty great!
I will be a patient patient lol.......I know it is only day 3.
I am so grateful I got to skip the tissue expanders. My nipples are looking good so far too! This is hope for others who have had radiation! I had it 7 years ago on my left breast and my PS was so worried about blood flow and nipple sparing. Then to wake up with final implants in!! YAY! 0 -
Hi Raven,
That's so F*cked up! An infection, no f'ing way. Can you get another IV Vitamin C infusion? Slam the Oregano Oil like you mentioned and look into Immune Boosting Mushrooms like AHCC and or Turkey Tail. Can you see an area of redness? Also might be useful to try oral Colloidal Silver, or oral Manuka Honey, which is broadly antibacterial.
I also have used Infrared Light topically for shallow infections. I just picked up an Philip's Infrared Light and an socket/ plug thing at Home Depot. It's cheaper than the ones they sell for pain, but as far as I can tell works the same. Infrared light is shown to have bactericidal effects.
Philips InfraCare and InfraPhil
Pain relief through comfortable infrared warmth
Philips InfraCare and InfraPhil offer a range of pain relief infrared lamps, including different models that can treat either single body parts (such as the neck or knee) in a focused way or provide half-body treatment. InfraCare and InfraPhil feature innovative infrared halogen lamp technology that has been optimised to ensure an evenly distributed warmth over the treatment area.
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I started retaining water last week from my last chemo treatment and there was a chance my implant exchange was going to be delayed but just got the word it's a go! I feel like chemo kicked me in the butt as I was walking out the door. It was frustrating and a little scary. So back to the hopeful stuff: September 13 under the knife hopefully for the last time. I really like my new PS and feel confident he's going to do a good job. He will have to revise one of my pockets and I'll probably have to have drains again. This is the rebuilding part. That makes me happy.
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I had the infected expander removed on Tuesday; back at work today. Long story, but a neighbor came over the day before my surgery to tell me she is an NP in plastic surgery and has a ton of experience in reconstruction. She gave me some helpful advice and texted some surgeons she works with to see if they agreed. Based on what she told me, I decided not to go along with what my PS wanted to do, which was replace expanders on BOTH sides and add an antibiotic plate in the bad side. Instead, I opted to just remove the bad expander, and I spent yesterday visiting two PS because I am leaving the one I've been using. He's been so difficult and disorganized and I couldn't handle it anymore. I met a PS I really like and have an appointment with him next month. The infected side will stay flat for the next two months to make sure the infection is really gone, then PS will reinsert TE, wait 2-3 more months, then implant surgery. The reconstruction will be a little more difficult now because the tissue on my deflated side is going to tighten up. I didn't realize until yesterday how significant a setback it is to lose a TE, both in delay of surgery and the aesthetics. Interestingly, both PS walked into the rooms yesterday saying, "Wow, you have been through a lot." and I guess I hadn't really added up all the complications, which is probably a good thing. If I gave myself time to Rolodex through all the mishaps, I think I would descend into a hopeless mire.
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ReadyAbout - I'm really sorry for all that you've been through. I've had moments like that - where you actually stop to think about what's happened and just about crumble. Sometimes you spend so much time and energy just plodding along, one foot in front of the other. It's how you manage to keep going. But it's okay to stop and feel sorry for yourself and the whole mess once in a while.
I'm glad you've found some hope in a new PS. A light at the end of the tunnel is always welcome!
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ReadyAbout, if you think you need and would like it, you should be able to get insurance to cover a breast form (and a bra) for use during the next few months. I just purchased a partial form to make up for the temporary size difference after my DIEP surgery. You can get an inexpensive foam insert or the more expensive silicone form. This is one thing you don't need to fret about with all the other things you've got going on! You deserve a break!
Lanne
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