TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!
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I tried Embrace at my surgeon's suggestion after my initial BMX with DTI reconstruction.
Unfortunately, I think because I was doing chemo, my skin was extremely fragile and removing the strips ended up tearing the skin. I switched to paper tape and the scars looked pretty good within about 6 months, despite the chemo.
I just had revision surgery to switch from shaped textured implants (which were causing air pockets due to the texture against the Alloderm) to smooth round, with some fat grafting. Pretty sure I will stay with paper tape again.
My wonderful oncoplastic surgeon is Anne Peled, MD - San Francisco, CA
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Hi Magari, I could see how delicate skin could be harmed by the Embrace. You have to know the health of your skin, you are the best judge.
If skin is fragile, have more Vitamin C. There is no upward limit of toxicity if you have normal kidney and bowel function. After surgery, I had 6 to 9 grams of Vitamin C per day, and didn't even get diarrhea, because my body needed it to make strong healthy new collagen.
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UGH! NY Times article a couple days ago about FDA recalling the textured implants. Apparently they have already been banned in Europe since last year. Mine went in April 2017. The FDA recommendation is to leave them alone if no symptoms, but surgeons are not allowed to use them anymore in the US. Just wanted to share in case some of you have these implants.
#$%^! I have been having symptoms (a little swelling and fluid collection around R implant which is not my cancer side). Need to get checked.
- xo
Breast implant maker Allergan Inc. issued a worldwide recall Wednesday for certain textured models after regulators alerted the company to a heightened cancer risk with the devices.
https://www.nytimes.com/aponline/2019/07/24/us/politics/ap-us-breast-implants-safety-recall.html
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I’m sure this has been answered, but there’s so many pages to sort through. What is the exchange recovery like? I just got my surgery date scheduled, and while it’s outpatient, I’d like to know what to expect and how long to plan for childcare.
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Andraxo, I am so sorry to hear you are having problems, and then the recall on top of that as a worry for you and all of us. I get pretty angry about every last bit of the whole bc industry crap. I don't even know what to say. I also have a textured implant. I'm good, but I know it will be messing with the heads of so many women in our situation.
Hey Fritzmylove, good to hear you are getting your exchange done. For many of us, the exchange was not as bad as the initial mx. It was that way for me. I would say light activity for the first week, then gradually doing a bit more, but still no lifting over 5 to 10 lbs for the first 2 wks for most PS's.
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Andraxo, Learned this week that I also have one of the recalled T/E's. Plastic surgeon would not have mentioned this -- but I asked specifically. Now I understand why I'm being pressured to do "exchange surgery" ASAP.
Won't be able to schedule surgery for five months; I'm just now planning my "new normal" life for September !!
Feeling weary of being treated like a product on a conveyor belt. I don't blame doctors & health care practitioners -- but it's sad to be treated in a cold & impersonal manner as one endeavors to go through BC treatment.
Can't tell whether rude "attitude" is due to ageism....or the new healthcare business model ??
Roseanne7
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Roseanne, I feel sad to hear of shoddy care, of vulnerable people, by people who ought to know better. I think bad care in healthcare is the norm for many encounters. Doesn't matter how many surveys they have us complete.
We deserve to be treated with competence and considerstion.
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Thanks macb04,
Yes, it's tough to know how to approach these situations! Several of my current Dr.'s are working Moms (plastic surgeon, med onc, PCP, etc.) For years, I've cut them a lot of slack... knowing they are "overtaxed" & wearing many hats.
However, NYC healthcare has reached a point where most doctors (except onc surgeon) don't know my medical history & waste appointment time writing frivolous "problem lists" to upcode medical billing. None of these so-called problems have anything to do w/ cancer treatment & prevention, not to mention help dealing w/ side effects of cancer tx. No awareness or compassion
As you've stated: Cancer patients deserve competent & considerate care !!
Roseanne7
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I’m having double mastectomy on Monday . Please add my plastic surgeon to the list for DC, Virginia and Maryland are- https://www.medstarhealth.org/doctor/dr-david-habin-song-md-mba/
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Hey Askmissa, sorry to hear you are joining us, but thanks for the name of your PS. I added him to the list.
Come back and let us know if you think your doctor did a good job. I am trying to restrict the list to doctors where women say they have had a good experience.
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Hi All:
I had subpectoral implants during my double mastectomy back in 2017--didn't know about prepectoral back then. I have ripples and animation (the latter is what drives me crazy). I have Kaiser insurance and have had consultations with two separate PSs within Kaiser who do pre pec. One of them (Dr. Hornik)--PS whom my friend went to--advised that he could swap out my subpectoral for prepec in one surgery and be done with it. My friend liked him, but I had a red flag raised b/c he still was using textured implants (among other options) as of last year and downplaying their risks. I told him I would not use textured implants.
The second PS option (Dr. Jacobs) I have is much more patient centered, a great listeners, is a much longer drive from my house (about 2 hours with traffic), but the main disadvantage with him is that he wants to start me over with TEs, fill them up slowly, and then do a 2nd surgery to exchange them for permanent implants. He says that b/c of fat grafting needed, etc, that he hasn't found a way to do reconstruction without 2 surgeries, so he thinks best to start with TEs. The thought of two surgeries, and going through the whole TE expansion and wait for exchange makes me sick to my stomach. On the other hand, he was a great listener and was very focused on what my concerns were, whereas Dr. Hornik seemed almost flippant.
Thoughts? Have any of you had sub-pecs replaced with pre-pecs? If so, did you go straight to implant with the replacement, or did you go back to TEs first?
Thanks in advance for your feedback.
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Go with option 1. He can no longer use textured implants. Period. Number 2 doesn’t seem to know how to utilize the already stretched skin in a different plane, which seems absurd.
Another option is to keep visiting surgeons until you find a fit that’s *just* right.
Good luck.
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IME, surgeon 2 is right that you're probably going to need fat grafting anyway, which will be a second procedure. If you have rippling it will probably be even worse when you go pre-pec.
But VegGal is right about surgeon 1. If you really don't want TEs, which I understand because I hear they are quite uncomfortable, go with surgeon 1. Or talk to surgeon 2 about doing direct to implants with your revision. At least make him explain why that's necessary when the skin is already stretched.
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Please keep in mind that not everyone is a good candidate for direct to implant. Many factors such as vascularity and skin thickness can make Alloderm with expanders the way to go. I went prepectoral right away in two stages. Tissue expanders and Alloderm, then exchange and fat grafting. For me, the exchange surgery/fat grafting was Super easy. I am thin with no upper body fat, super active, and have no rippling to mention. Good luck on your journey! I hope you make a decision you feel comfortable with and have great results!
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VegGal--Thanks--your comment makes sense! I think the textured implants (even though I would have insisted on not using them even before the recall) was more a kind of an indicator that he didn't seem very patient-centered and it made me worried that he may not make the decisions that would be best for his patients given the research; that it is more about how it looks than the health of his patients. But I also agree that it seems absurd that the 2nd guy can't swap implants and needs to go back to TEs. It doesn't make logical sense to me. As for searching further, there is only one more PS I can use with my Kaiser insurance and he is really too far away.
Hapa--all he said was that he couldn't figure out a way to make it look good with just one surgery. I pushed him on it, but he insisted on the TEs. I don't want to go back to them not only b/c of the discomfort (and I understand they are not as uncomfortable over the pec), but b/c it means going back to square one with being flat and then all the slowness of the fills and then waiting for the exchange and then having the exchange surgery before I look halfway normal again. That was awful. Once was OK--i could handle it. But I can't imagine doing it all over again.
SimoneRC--It wouldn't be direct to implant. I already have implants (have had since Nov 2017), but they are under the pec. So it doesn't make sense to me why they need to go back to square one and start over with TEs again.
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Hi MinuteAtATime,
I think they need to lift that skin to create the new prepectoral pocket that holds the implant. Your current pocket is under the muscle, right? That skin is not just floating around unattached. So I think when they create the new prepectoral pocket you are faced with the same issues for making sure you do not wind up with necrosis.
My fills were super quick. Many women wake up with the expanders already partially filled. My time from expander to exchange was three months and I woke up flat from my mastectomy. I had super thin skin FWIW.
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Hi ladies! I am set for surgery 9/20 to replace Allergen 410 textured implants. I decided today after speaking with my PS to try pre-pectoral after having under the muscle since 2011. To say I am nervous about the outcome is an understatement. I have had considerable animation deformity for years as well as neck, scapula pain since my mastectomy. If this new surgery can relieve this, I'd be thrilled. I know there an increased risk of infection, but fingers crossed this wont be an issue!
I want to add him to the list as he has been doing these for a number of years. Dr. Sameer Patel at Fox Chase in Philadelphia.
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hi Randi64!
I made the switch from subpec to prepec and truly I couldn't be happier. I had grotesque animation deformity and one implant was being clenched so tightly by my pecs so it never dropped. I had shooting pains going down my upper, inner arms that my onc thought was a lymph node issue! Nope. It was subpec implants messing with my pecs
Three + months out from surgery, I keep looking at my breasts because they look real again. They jiggle. They're squishy. They even sag a little. She put in 520s from 400s (both sets rounds, not textured) They're beautiful.
I have some rippling as I have very thin skin but it's not worth it for me to go back under for fat grafting. They're very pretty as they are and I couldn't care less about minor rippling. I felt like Frankenstein before (no offense to anyone with subpec... some look beautiful, mine did not) and now I feel like a natural woman. Love them that much ! Good luck luck to you!! Ps there's a thread here for this type of revision surgery. I'll bump it for you
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MinuteAtATime, that is understandable, not wanting to go through being flat again. I absolutely hated that, being lopsided and always worrying about matching my R side with a prosthetic. But like SimoneRC said, TE's are often partially filled during surgery, so you wouldn't be completely flat most likely. And every week fills would get you closer and closer to the right size.
That being said, I don't know if all women switching from Subpectoral to Prepectoral Implant Reconstruction have had TE's. Perhaps someone will chime in.
Hi Randi64. Welcome and the Best of Luck in converting from subpectoral to Prepectoral. I really hope your pain issues improve greatly. Why do you say there is an increased risk of infection?
I will add Dr Patel to the list.
Hi Cresent5, so happy to hear you have had such a lovely result changing over from subpectoral to Prepectoral Implant Reconstruction. I am sure your story will bring hope of good outcomes to many women.
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I had sub pec TE and switched to a different PS and he suggested pre pec. So he removed sub pec TE, repaired the muscle and put in pre pec. I'm not sure I understand why you would need TE if you already have an implant.
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Minute - My oncoplastic surgeon does prepectoral implants just about exclusively, and direct to implant whenever possible. She is switching my coworker's subpectoral implants to prepectoral, with some nerve grafting at the same time. My coworker wants smaller implants than her originals, and I'm virtually certain there will be no TEs involved.
I had shaped, textured highly cohesive gel implants (Sientra) when I had my nipple-sparing double mastectomy with direct to implant, prepectoral reconstruction a couple of years ago. I had significant rippling on one side, and an air bubble that seemed to be growing which was causing discomfort. So my surgeon switched me to smooth round implants (also Sientra, highly cohesive gel) and did a small amount of fat grafting at the same time, about a month ago. This was done as a single outpatient, 2 hour surgery, and I am very happy with my results.
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Has anyone had pre/pec done a few years ago and still no rippling? I’m trying to find any long-term reliable research on outcome.
I know the immediate results can be quite compelling as my friend just went through the procedure here at hospital I was reconstructed at with a different surgeon, but she’s only a month out and healing.
Even her surgeon who is very qualified surgeon says rippling remains an issue. But my friend was having terrible pain with sub-pecs and this was more the primary issue for her.
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Well, I had the second , larger Silicone implant placed in March 2016, and still no rippling. The PS, mcintyre, put in a 420 for some nutty reason in January 2016. It was way, way, way too small. I knew it was too small the second I woke up. He cut away too much skin, so when I did reconstruction surgery number 15 in March he was only able to fit in a 495cc implant. Still too small. Need a 550cc or 575cc size implant, but the PS screwed up, and left me lopsided unless I want to do ANOTHER breast reduction on my R real side AGAIN. ( Had the R lifted due to insurance issues sooner than I should have)
Anyhow, No ripples 3 years out. I know that is not a huge amount of time gone by. A women I met through the boards had Prepectoral Implant Reconstruction done in England about 10 years ago and was still happy with it, which is what convinced me it was the way to go.
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I’m sure much of outcome besides surgeon’s expertise is what the surgeon is left with skin-wise to work with. And quality of the skin.
I’m going to talk to my surgeon again about pre-pec thoughts and see where she is at on the spectrum. I need to go for nipple and areola revise tmr. I’ll have an hour to bend her ear uninterrupted.
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Mine will be two years old on Thursday. No ripples.
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Ladies, thank you for sharing your info and all of your encouragement. I decided not to settle for the doc who required two surgeries and starting with TEs. I decided that this surgery is important enough for me to try my 3rd option for a PS, which is quite a drive (a few hours). I read his bio and he sounds great. I meet with him next week. Fingers crossed the third one is the charm.
As for ripples, I have them already with my subpec implants, which are saline. But I don't mind the rippling as much as the animation. that's why I want to switch to prepec.
Do any of you have saline implants prepec? I would like to stick with saline--i feel a little safer with them. I worry the silicone ones will leak without me knowing.
Happy first day of fall.
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