TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!
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How are you doing Rachecarter35?
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Thank you for asking mac04 I'm going to have a follow up ultrasound at the end of this week to check if everything is healed up. I feel fine but I had no signs before the day I had to go to the emergency so I'm just being thorough.
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Just was to say extra thanks to macb04 for starting this group. I'm 8 months post bilat. mastectomy. 2 months post exchange from sub pec tissue expanders to pre pec implants. The muscle spasms were awful. I don't think I would have known about the option of pre pectoral implants if I hadn't found this group.
The exchange surgery wasn't as simple as just switching out to sub pec would have been, since this required allodern, then drains. But it was well worth it.
I had no post op complications and I'm really pleased with the aesthetics. No ripples. No fat grafting necessary.
I was left with awful neuropathic pain after my mastectomy, but I've found the appropriate dose of lyrica to make me nearly pain free. So since I had my switch to pre pec to resolve my muscle spasms and now the right dose of lyrica to take care of the neuropathy, it's a whole new world. And I like it!
Thanks again to this group.
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So good to hear of good outcomes for you Bcbc. Your story is why I started this thread, to get the word out. We have all suffered long enough, every little thing that makes our misery lighter should be done. Prepectoral is infinitely more comfortable than subpectoral. No contest.
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Shoregirl, thank you so much for your response. I really appreciate you sharing your personal experience! It is very scary making such body and life alternating decisions. HUGS!
Friends, I met with my plastic surgeon and she said I was a candidate for prepec. We scheduled surgery for April 26. She did say that it would feel more comfortable, but that the results may not look better than what I have with subpec. She also said that there is little known about how well the alloderm holds up and warned that over time she couldn't guarantee I'd be happy. She also warned that insurance companies are reeling back on what they cover for reconstruction revisions. As I have shared, she is very difficult to communicate with and she wouldn't even discuss the new implant size. She said we would discuss it at my presurgery appointment early April. She gets irritated when I tell her what I want, which is super frustrating. It is like she just wants to know what I don't like and want to achieve and then she will decide what to do. She also will only select one implant to bring to surgery. I think she has a huge ego who believes only she knows best. She agreed to do fat grafting after the revision but refused to do it until 3 months after. She said that it takes that long to be able to see where the fat needs to go. When I mentioned that I wanted the new prepec with alloderm procedure, she got weird and insisted it wasn't a “new" procedure. So bizarre! I had brought in one of the studies Mac has posted and she wouldn't even look at it. I really don't know how to communicate well with her because we are so different in how we think and interact. I plan to follow up asking if she will wrap the whole implant in alloderm because she mentioned that some surgeons do and others partially wrap. I want a full wrap. I hope she supports my request because if not, we will butt heads, which is not fun with her. Since I have a few months before the surgery, I may seek a second opinion if I can find a surgeon who will do a prepec revision (nipple sparing) in Utah. I asked about the recovery and she said it will be somewhere in between the mastectomies with tissue expanders and the subpec exchange. I will have drains for 1-2 weeks. She will also tack the muscle back into place. If anyone has advice on how to communicate with such an ego maniac, please share. I will say that she is a very skilled surgeon who is a perfectionist. She cares very much about her work
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I would run, not walk to another surgeon. The red flags are whipping like crazy with this one. Measure twice, cut once!
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I'm 20 days post DMx with expander on top of pec surgery. How long will I be dealing with the pain/pressure/burning from the expander, mainly in my armpit? I am off pain meds, just alternating motrin/tylenol. I have 1 more drain to get rid of (hopefully Fri), 3rd fill on Fri and plan to start PT. Expander to implant surgery is 5/8. I cannot imagine dealing with this pain until then.
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Bird-of-light I personally would also seek another opinion (or 2). I consulted with an egotistical female surgeon at Hopkins who was so rude and condescending I couldn't bare the thought of her touching me no matter how talented she was purported to be. IMO, we need to have a comfortable rapport with these docs. The intimate nature of these procedures and the vulnerability it places on us warrants a compassionate team!! For me, my sensitive nature really makes a good rapport necessary. Don't get me wrong, bc has def toughened me up. But the incredible emotional and physical trauma of msx and reconstruction really is a lot to bear and these physicians need to put themselves in our place and treat us the way they or their family members would want to be treated! 3 months after implants is not unreasonable for fg, but I wouldn't want to wait any longer.
PRides, everyone is different but for me the expanders started feeling better at 1 month and continually got better as time went on. I think with filling it helps get rid of sharp creases and edges and so becomes more bearable. I had my msx 1/29/17 and expanders placed then. They were swapped for implants 3 months later. The recovery for the exchange was infinitely easier than the msx. I hope you feel better soon!!
I got the call today from my ps office. My next procedure to "release" the left implant so it can sit down in the pocket more laterally is scheduled for Feb 4. I have pre-op with the ps this Friday. Since I am only getting a local and he will not be putting me under I don't have to go get bloodwork or pre-op clearance from pcp. I will know more Friday but the plan if all goes well is to let this heal for a month, then round 1 of fg. He anticipates 2-3 rounds, done in his office surgical suite. I will find out if he plans to put me under for fg. Yikes!!!
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Cool Shoregirl if you can get something done under a local. I had FG 5 times, and really, you probably want to be out for the whole thing. Just my opinion.
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PRides, TEs can be very uncomfortable, but your description of your burning armpit pain makes me wonder if you are experiencing nerve pain (neuropathy) also. I wish I'd realized earlier that this was my biggest problem post op. Neuropathy can be treated with different non narcotic drugs. Gabapentin or lyrica may work vey well. Over the counter meds often don't touch it. Gabapentin was a life changer for me. Your surgeon can prescribe it, but you will likely have to suggest it.
I also found that the TEs became more comfortable as they were expanded. The "lumps" smooth out as they are filled.
Warm wishes for more comfort.
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my expanders became more bearable once I started fills (and mine were already filled to 500cc when I left BMX surgery). Felt like a chest harness made of sandpaper or broken glass. Gabapentin helped keep me sane. Be vocal about your pain so you will get what you need . The pain can last a long time. It gradually gets better but in my case it was almost a year before I wasn't constantly aware of it.
Lanne
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Yes PRides, just like Lanne said, be gocal if you are not getting some relief of your pain/discomfort. Don't be afraid to speak up. They should be ASKING You about how you are feeling.
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macb04, saw ps yesterday for my pre-op. I asked if he planned to put me under for fg and he said they don't typically. He and his pa both said all the women do fine. I told him I am pretty nervous about it and he said we could do it in the hospital under gen asth if I want, or the outpatient surgery center. I have some time to think about it. Fg won't be for another 6 weeks. Were any of your fg under just a local?
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prides- I had terrible nerve pain after my expander placement. Turns out my drain was pushing on a nerve. The pain went away when that drain came out, thankfully! It is the first time in my life I took pain meds and they barely touched it. I hope your drain came out and you experience the same relief.
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Shoregirl,
I had FG both under a local, and under general anesthesia, as I had it done 5 times. I found it really hard to be awake for it. It depends on you, and it also depends on how extensive the FG is to be. I do remember waking up in alot of pain. Where I had it done was in my 2nd PS's outpatient surgery center. They wanted me up and out of there, so they didn't give me enough pain meds. I woke up hearing someone moaning. Remember thinking they should help that person, and when I fully awoke, realized the person moaning was me. Not saying that to scare you, but just to bring to mind discussing how much pain to expect, and how they were going to take care of it is so important. I switched places/PS's for subsequent procedures and never had it that bad again.
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macb04, thanks for sharing your experience. That is a sad story! Did you just have the fg under local once? When I woke in recovery for the last revision, they couldn't get my pain under control on the left side (the one I am having released on Feb 4). He had put stitches in the muscle and new alloderm. Finally I lied to the nurse that my pain was under a 5 so I could get to the next revovery phase. Once I got there, they switched me to oral pain med and surprisingly it worked! After 4 -5 doses of IV Dilaudid hadn't helped.
Anyway, since he did give me the option for gen/an for the fg I think I will prob request it. I had to stay 5 days in the hospital after msx because they couldn't get my pain controlled. Supposedly I have Fibromyalgia and possible Lymes disease so I am always in pain anyway. I have read that if you have chronic pain you become more sensitive to pain. I used to be so tough. Had my 9lb 14 1/2 oz son completely natural. Now I feel wimpy.
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Bird of light find another PS. I love my PS, he always takes his time and is very supportive. He even gave me his cell phone number in case I ever need to ask him anything. I text him anytime I have a question and he always gets back to me quickly.
I’ve had 5 surgeries with three different surgeons. Surgeon #1 was wonderful but left the practice and moved out of state, surgeon #2 was awful. No bed side manner. Rushed me every time I saw her. She even told me that sometimes Breast cancer goes away by itself! Head Breast surgeon at University of Penn. Surgeon #3 was wonderful, thoughtful and compassionate.
From what I’ve read, Prepectoral is considered to be a better option as it much less painful and much faster recovery. Not all surgeons bother to keep up with newer technologies. I'm 4 weeks out from prepectoral TE to implant and feel great. Also, I only had tissue expanders in for 7 weeks. They were uncomfortable but not unbearable. And I’m 58, no spring chicken.
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PRides, I only had three fills in my TE then had them replaced 3 weeks after. Total of 7 weeks. Once filled to the capacity my skin would handle, they were very uncomfortable (felt like baseballs in my chest) until they were replaced. My 4 drains all came out the first week, they were also very uncomfortable. Can you move up your replacement surgery? Four months seems like a long stretch to have them in.
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Right now, the plan is about 8 fills, then 8-10 weeks rest b4 surgery. Just had my 3rd fill, holy crap the pressure. I'm seeing a pt tomorrow, praying for some relief.
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I've been associated with two plastic surgeons during reconstruction. They both wouldn't consider doing exchange until 3 months post final expansion. All surgeons are different,
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Shoregirl, ironically, the time I mentioned awakening in agony, I had a general anesthetic. I got very pushy and particular with future PS'S to make sure I didn't wake in terrible pain. Part of the problem was they were in a rush to get me up and out of their in office surgery center. They had a jam packed schedule( I didn't know that when I was doing the PreOp visit), so literally time was money. Not good care. Just part of the many instances of crap medical care I have had associated with the bc industry.
Ideally the fills are done slow enough to allow stretching and growth of new skin. If you have had rads damage, that pace will be much slower, than a nonrads damaged skin. I am forgetting exactly, but think I had the TE the second time with the Prepectoral method for 5 months or so, before implant exchange.
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crap. just developed cellulitis in my cancer side reconstruction. WTF? My last surgery was April 2017 and I had ZERO problems post-op or since then. On Abx now, but taking lots of C orally (I can't get IV Vit C in this area - work on a Native American Indian reservation hundreds of miles from a real city). Also need to get a skin biopsy but that is more of following protocol than my oncologist actually suspected anything otherwise. Onset of erythema and mild edema was Wednesday last week and I just happened to have Onc f/u Friday to discuss my time off Tamoxifen (which was nearly 6 weeks and I will not be going back on it because I hate it as an athlete). She ordered stat MRI which showed everything was fine with the implant (she suspected possible tear in it and the redness was irritation being exposed to silicone despite mine being cohesive gel and not able to "leak" out), but the report came back as skin thickening and swelling, suspect cellulitis, with recommendation for skin biopsy to rule out any cancer in the skin given my hx of cancer, radiation etc. Coordinating my cancer related care/appts 300 miles from here is a real pain. Thankful I can get the skin biopsy done by a general surgeon friend at the medical facility I work at instead of driving back to get it.
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Oh Andra, that is so, so messed up. Please order ASAP Liposomal Vitamin C. You can get a much higher amount into your body orally that way than with regular Ascorbic acid. There's a study somewhere about that. Also consider Oregano Oil extract/Olive Oil extract/Oregon Grape extract/Silver. They work synergistically with antibioics to help kill all those bacteria. Look at the studies I have at the start of the thread. Also consider stuff like Bromelain/Nattokinase/Serapeptase to break up bacterial biofilm.
Keep us in the loop. We all hope you get well quickly.
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Thanks Macb04! Is there a liposomal you recommend? I just went on-line for it and there are soooooo many to choose from! I may just wait and see what is available this Friday when I'm home/where my spouse lives. Nothing would be delivered here (work location) before Friday even if I ordered tonight express mail because everything takes at least 2 days...and I head back in 2 days. I'm pretty isolated. Same for getting any extracts. Wish I remember to buy stuff before I left the city yesterday after oncology and drove 300 miles. I was just so eager to get back to see my own patients after having to reschedule people yesterday! Really hate the hassle of chasing down new crap!
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Hi Andra,
Some people really love the Liv On Labs Liposomal Vitamin C, I tried it. Very thick and not super palatable. I like the Aurora Vitamin C much more. I have tried a few other brands, and those are so far my favorites. HerbPharm makes some great Alcohol based Extracts. I use their Oregano and other tinctures. .
Oregano Spirits - 1 fl. oz (30 ml). HerbPharm
Aurora Micro Liposomal Vitamin C 1000 MG - VALENCIA ORANGE (5.4 Ounces Liquid
LivOn Laboratories Lypo-Spheric™ Vitamin C -- 1000 mg - 30 Packets
- Shop all LivOn Laboratories
- SKU #: 858514001002
- Shipping Weight: 0.53 lb
- Servings: 30
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Thanks Macb04!
Are the oregano spirits super strong oregano tasting? I'm probably the only Italian who doesn't like oregano! Ha!
- xo
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PRides- How are you doing? Any relief from pt?
My last little fill -40ccs- left me in so much pain for 2 days. I think either we waited too long between fills or my radiated skin is reaching its limit. My PS wants more room because I’m only at 220cc and the implants I chose start at 220. The 60cc fill before that was fine. His PA gave me the impression after my second fill that she thought I was going to have problems, and that was 100ccs ago. It’s depressing because it’s not like I’m trying to be large!
Any ladies on this thread have that problem with nerve pain after fills or reaching some kind of limit? I’m sure it’s nerve pain because it shoots down my arm right to my fingertips and around to my back. I didn’t expect it with prepectoral.
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Cpeachymom, have you tried any medications specific for nerve pain? I was miserable until I was prescribed gabapentin. Now on lyrica, which is working even better for the nerve pain. I'm two months post revision to prepectoral implants and am finally comfortable all the time. Best wishes for comfort.
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bc bc- No, I’m stupid and stubborn and hate taking meds. I tried some extra strength Tylenol but it didn’t really help. I considered asking for gabapentin. I considered going back and having some saline removed.
I called and asked about splitting my next fill into 2, but she said no. Well, the PA said she would check with the doc and call me back, and then never called back. Sigh. At the time I was too sick and in too much pain and recovering from a different surgery all at the same time and just didn’t have a care to fight.
I’m glad you’re doing well. Are you still taking the Lyrica?
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cpeachymom, irradiation causes Radiation Fibrosis. Period.. Without a doubt, that occurs to every single person who is irradiated. It is just continuum, from very mild and hardly noticable to extremely tight and painful. I don't know why they are not more honest on this point. You should be on Pentoxifylline 400mg three times per day and Vitamin E 400IU per capsule three times per day. You should also consider Pentoxifylline 5%and Vitamin E 1% Specially Compounded Cream. I have posted about this, but will explain what an enormous help this can be. Simply put, it markedly improves blood flow in irradiated skin. It's main medical use is to improve blood flow in a problem called intermittent claudication. There is are a number of research studies showing great improvement tissue health and softness of irradiated skin after consistent use over several months. I have used both the oral and topical Pentoxifylline and Vitamin E together with good effect, and ZERO side effects. Here are the links. Radiation Fibrosis causes skin to become TIGHT. If your skin is having increasing tightness, you will find the stretching required for Skin Expansion with a TE to be painful, and nearly impossible.
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Pentoxifylline and vitamin E treatment for prevention of radiation-induced side-effects in women with breast cancer: a phase two, double-blind, placebo-controlled randomised clinical trial (Ptx-5).
https://www.redjournal.org/article/S0360-3016(04)01838-3/abstracthttps://www.redjournal.org/article/S0360-3016(04)01838-3/abstract
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Pentoxifylline and vitamin E combination improves superficial radiation-induced fibrosis
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Prophylactic use of pentoxifylline (Trental) and vitamin E to prevent capsular contracture after implant reconstruction in patients requiring adjuvant radiation.
Cook M1, Johnson N2, Zegzula HD3, Schray M4, Glissmeyer M5, Sorenson L6.
Author information
Abstract
BACKGROUND:
The combination of pentoxifylline (Trental) and vitamin E has been reported to reverse significant consequences of radiation after mastectomy with immediate reconstruction, such as severe capsular contracture or loss of implants. We questioned whether prophylactic use could prevent these consequences.
METHODS:
Thirty women with implants or tissue expanders after mastectomy that underwent adjuvant radiation were treated with Trental and vitamin E for 180 days. All subjects then entered a 12-month observational phase.
RESULTS:
Of the 26 evaluable subjects, 3 subjects required implant revisions. One due to malposition of the nonradiated breast and 2 were due to contracture (7.7%). There were no implant losses.
CONCLUSIONS:
The combination of Trental and vitamin E can prevent severe contracture and implant losses allowing for immediate reconstruction with implant or tissue expander even if radiation is planned after mastectomy.
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