TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!
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Hi macb04 - no, my BS nixed the idea of over the pecs, so mine are under. She was afraid it would interfere with maintaining good blood flow to the skin and nipple. But I think over the pecs is the "wave of the future" and I am very happy to see the success stories here!0
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All all happy 4th of July! - I am 2 weeks out from secondary reconstruction, converted to prepectoral with new & much smaller implants tear drop naturalle 410 from mentor round silicone/gel 550 under muscle. New pocket made with alloderm under entire skin flap. Surgery complex, some skin tissue refused to be separated from muscle so a chunk of skin and muscle removed together, so I have a small 2" horizontal incision healing with the original mx vertical incisions & around the areolas. Lasting scar will be minimal, not worried at all. But like all reconstructions there can be complications. Since I have a history of skin necrosis after 1st recon (both vertical incisions necrosis + lost 1 nipple), bi-lat breast cellulitis spring 2015 and LE (arm & chest) summer 2015. PS put wound vacs on both breasts in addition to the standard 2 drains. While the wound vacs were a pain in the butt, heavy, clumpy for 8 days - they were amazing at helping incisions heal faster, cleaner and no infection or necrosis. If you are high risk for infection, ask your PS for wound vacs (they can be expensive & have to be approved by insurance). Note that my PS only does prepectoral reconstructions for secondary or later reconstructions. The outcome too risky for first timers.
I was totally off pain meds and back to work after 10 days. Wound vacs out 8th day, drains out on 11th day. On the pain scale this surgery was more like TE's to implants, not bad at all. My chest feels so much lighter, love not having have muscle up front anymore, I love smaller tear drop shape, much, much more natural looking. My areolas & 1 nip are darker in color which means they were too stretched out before. The pau' de orange left over from cellulitis event is completely gone. LE still present in right arm but truncal LE feels gone, although it's too early tell if it truly is, LE is so unpredictable. I look forward to see how this all heals up, settles in, feels months down the road. PS initially said, 2 step process with fat grafting being the 2nd. I still have restrictions, no exercise. as it increases blood flow and fluids to chest area that is still healing. I can gently message around the breasts but that's all. Estimated 4-6 weeks of total healing. Jury still out on how the pec muscles will do back home, I don't expect pre-bmx performance from them but should be remarkably improved from a forward muscle.....hello swimming once again!
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Hi, welcome jill47, glad you have joined us here at the OVER pectoral (prepectoral ) implant reconstruction. Sorry you had such a difficult path to get done, but it sounds like you are nearly done. Marvelous!
I, like you, found this to be much, much more comfortable over pectoral. I had it done both ways, so I speak from personal experience. My pectoral is back to 95% of normal flexibility and strength. Can do pushups and take a Rowing class without problems.
It is great they are now just doing OVER Pectoral Implant placement right at the beginning, not making women suffer first through having their pectoral demolished and disrupted. It is definitely the wave of the future for the majority of women unfortunate like us to need reconstruction.
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Hi Macb04! I read your previous posts from the start of this tread you started, thanks for doing so
. There is relief for those who are suffering from pain from muscle forward. I didn't mention but when dx w/ bc in 2012 I was a serious ultra runner, distance trail running was a huge part of my life, prior to then Ironman athlete, point here is that my pec muscles were well developed and firm, definitely not supple and well rested; slicing them forward was excruciating painful and my they never recovered. So good to hear you have 95% back of your flex & strength,....that is awesome! I hope prepectoral is the wave of the future for 1st time recon, and God I hope this will eventually happen, no need to suffer further after a br ca dx. But like nsbmx, it too was experimental at one time and not all PS are skilled or trained to perform them. It may take years for prepectoral to be the standard for most women vs. under pecs, TE's, to implants. Have to keep in mind too not all women tolerate ADM's, as some get or suffer from necrosis from the material. Have a great day everyone, I'm off to work with no drains! Jill0 -
Good news, littleblueflowers!
jill47, so glad to read that your new process is going well for you. Rest up and don't do too much too soon - let the healing process do its thing!
I thank my lucky stars EVERY DAY that I just happened to stumble across a PS who would do the prepectoral implants from the beginning. I realize now how lucky I am!
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Hi Raven....yes, you are very, very fortunate! Thank you for the well wishes, feeling better every day.
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You can add my PS to your list of docs who will do over the muscle: Kamakshi Zeidler in Campbell, CA (near San Jose). She also highly recommends doing fat grafting to fix any imperfections.
I love my PS. *She* told *me* about the option of putting the TE/implants over the muscle. She said women have been unhappy with the implants under the muscle and were coming in to have them removed and put over the muscle, so why not try to perfect it the first time. She said I was a good candidate (was having nipple sparing mastectomy, had thick skin, and she said my breast surgeon was excellent and was always very gentle with the skin). Knowing I had a toddler to keep up with, she also mentioned it would be less painful and the recovery would be easier. She left it up to me to decide what I wanted to do - so happy I chose over the muscle.
During my mastectomy surgery, my PS put in the expanders and added Alloderm for extra support. I've had 3 fills so far and while I've had discomfort just from having the TEs in there, I'm sure it's nothing like the pain I'd be in if they were under the muscle. My PS has also been supportive of my decision to use saline rather than silicone implants (silicone seems to be every doctor's preference). She said she would use a smaller implant and do more fat grafting so there would be a thick layer of fat around the implant and it would have a more natural look/feel, wouldn't be able to see rippling, etc.
I also want to mention that there is a new option to the saline expanders. My PS is involved in a clinical study for AirXpanders. It's a different kind of TE - instead of going into the office to have saline injected into your TEs, you get a remote control so you can add air to the expanders yourself at home (there are measures to prevent you from overexpanding). Supposedly this is less uncomfortable because you can add a little at a time, several times a day (vs. one big fill). I didn't end up doing this because I didn't meet all of the requirements, but it sounded pretty interesting. I believe at this time, though, you can only do this if your PS is one of the doctors participating in the clinical trial for AirXpanders.
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Hi Jodiann, welcome to Breastcancer.org, and thank you for sharing your experience with the expanders. We're sure it will be of help to others who are undergoing similar procedures or trying to make the best decision on reconstruction.
Please feel free to private message if you have questions for us. We're here for you!Best,
The Mods
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jodiann, I've read about those AirXpanders.....what a great concept! I am 6 weeks out from my over the muscle BMX. I only had one fill, 540 cc, and had very little discomfort. So glad your PS was willing to go over the muscle...it's a wonderful thing
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Hi, jodiann. Those AirXpanders sound quite interesting. When my PS initially put in the TEs he filled them with air, then removed the air and started filling with saline. I kind of wondered at the time why he just didn't stick with the air, so that's interesting that this new experimental product is available. I'll have to mention it to him the next time I see him in September.
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raven4mi - my PS filled me with air too during surgery. I think maybe the reason they don't just do that is because the air gradually deflates (like a balloon, as my PS says). Just when I would start to feel comfortable because it wasn't as tight, it was time to go in and get another fill. That's interesting that your doc removed the air before your fills. My doc seems like she's adding more saline as the air starts to deflate. Eventually, it'll get to the point where I have no air and am all saline, but until then, I can hear it sloshing around when I move, haha! I'm guessing I don't have too many more fills to go, though, since my surgery to swap for the real implants is on Sept 1 and she likes to have you "rest" about a month after the last fill.
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I think maybe it's because saline is heavy so there's better chance for ptosis.
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Well, that's what he said he did during the procedure when he had to go back to clean up some minor areas of necrosis around the nipples. But I had the same sloshing thing going on afterward, which I must say was rather disconcerting at first! I was walking somewhere and I heard a funny noise and was thinking "what the heck is that sloshing sound?" and then realized it was me! That made me laugh.
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Hi jodiann808, welcome. Glad you had a smart, forward thinking PS. I have added your PS to the list. I am going to have to better organize the list by regions.
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Hi to all. Away on vacation, but through the marvels of modern technology am able to post here as if I was home. Happy Summer.
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Hi, macb04. Hope you're someplace fun! Ahhh, the marvels of modern technology!
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raven4mi, am over visiting the inlaws in Dublin, Ireland. Will come home on Friday. Here is the view from O'Connell Bridge looking out towards the River Liffey.
Had some gorgeous weather the first week, now merely a bit overcast. 0 -
Sweet! What a beautiful picture. Have a great time!
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macb04, thank you, thank you for starting this thread!
I had BMX 8 years ago. Under pec TE and mentor round silicone 500 implants. Left side was ILC and right side was prophylactic. Left side did great but right side developed deep scarring at the incision line making that breast look almost square. I have been told by a couple PS that more surgery to correct the scarring would only result in more scarring. In the summer of 2015, with my second recurrance, I did 6 weeks of rads which included 5 boosts to my entire left upper quadrant including my axila and clavicle. My skin actually healed very nicely. It is soft and supple. Very minimal discoloration 9 months post. The implant capsule however, has contracted severely. Very hard, migrating to the very upper boundary of the pocket and absolutely no movement. The skin over my original incision line seemed stuck to the tissue underneath. After I saw a PS a few weeks ago who told me to live with it, that nothing can be done with irradiated skin, I just stared massaging that breast every time I had a chance. Which is a lot. I can now move the implant ever so slightly in the pocket from top to bottom but not side to side. My skin feels less stuck. I know this is not a total fix.
I am obsessed now with the idea of fat grafting and over the pec implants. Do you know if there are any pictures posted on the forum?
How much fat is needed for grafting? I don't have a lot.
Could this be a solution to the scarring on the square right side?
The most important question: How do I find a PS who will consider this procedure without a making consult appts and interviewing them? I'm with Kaiser in the Denver metro area so my options are pretty limited.
I'm so glad your on an absolutely fabulous vacation! It looks beautiful there.
Thank you again for starting this thread and giving me hope!
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Hi Firni!
So sorry you've had painful scarring and contracture.
not sure if this helps you but...
They don't use much fat all for grafting to help improve radiated tissue. I'm about a month s/p fat grafting to help my radiated L side (had BMX 11 months ago, 6 rounds of chemo, then radiation which ended late April). He said he is having great results with it and now being able to use TE/implants in radiated tissue - and he hadn't recommended TE/implants in radiated tissue in previous years because of the complication/failure rate (30%). The areas my PS took the fat from look the same - can't really tell anything was taken. I may need another round, but not sure where he can take from - I'm athletic, lean, and muscular. He will ONLY consider over pec implants for me due to my lifestyle and that is still dependent on how well my radiated skin recovers. I may stay flat anyway, still on the fence.
MY PS is in Santa Fe NM (W Dougherty at Christus St Vincent) - maybe 5 hours from Denver?? Might be worth a trip for a second opinion, even if the opinion is out of pocket. I see him again Aug15th. I will try to remember to ask if he knows any PS in Denver area who also do fat grafting and over pec implants. I'm a PT and work closely with fantastic ortho-hand surgeons and find that surgeons tend to know other great surgeons all over the country. I also see an awesome PT who specializes in this stuff (since I can't treat my own chest wall that well) - she is making a HUGE difference in getting my radiated tissue more mobile as well as on the non-radiated side (which has areas of adherent scar tissue).
I travel 4.5 hours each way to Santa Fe from the Navajo Rez in AZ to get my all my cancer care (there is no cancer care on the Rez and the facilities in SF were in network for my insurance...and boyfriend lives there too).
- Andra xo
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Hi Andraxo.
Thanks for answering some of my questions. Sante Fe is not that far from Denver and I have family in Albuqueque. We try to go every few months to see my MIL who is getting on in years. A detour thru Sante Fe is not out of the question. Certainly a PS in the Denver Mtero area and in network would be preferable. However, sometimes a girl has to do what a girl has to do.
I'm happy to hear that as a lean muscular and active woman, you were able to have the fat grafting done. I used to be lean and muscular. Now I'm just thin and rather soft. LOL.
I do appreciate your checking out the surgeon situation in Denver for me if you remember.
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Hi Firni,
Yes even relatively small amounts of fat can help with soft tissue Radionecrosis, which is what it sounds a little bit like you have. The reason it helps is because the rads damage the tiny little blood vessels, quite severely in many cases. That decrease in blood flow can be seen on doppler studies. The grafted fat produce small amounts of factors that influence growth of new blood vessels to bring back normal blood flow to the surrounding area. This can also be seen in doppler studies as well. Another thing, which I have mentioned before, is the use of the prescription medication Pentoxifylline 400mg three times per day plus Vitamin E 400IU three times per day. The Pentoxifylline was originally used for a medical condition called Itermittent Claudication, whereby someone has poor bloodflow to their legs. It was discovered that it helped improve blood flow in patients who had damage resulting from radiation therapy as well. Improves skin texture/tightness/flexibility and ability to heal after surgery. Look at the following studies, and show them to your provider to have them prescribe the Pentoxifylline. http://www.ncbi.nlm.nih.gov/pubmed/22846413
http://m.jco.ascopubs.org/content/22/11/2207.full
https://www.researchgate.net/publication/13457565_Striking_regression_of_radiation-induced_fibrosis_by_a_combination_of_pentoxifylline_and_tocopherol
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Hello over the muscle ladies, It's been a while since I've been on, but my exchange date is sneaking up on me. I have it scheduled for September 7th. I'm just starting to get a little anxious. I'm mostly concerned about nausea after surgery. I had a horrible time with the mastectomy. I convinced myself originally that it was from the nitro-paste used to save my nipple. However, now that I'm facing it pretty soon I'm starting to doubt it was just that. I know I'll have them place a scopolamine patch before surgery - last time I wasn't smart enough to take it until after when I was suffering so badly. I also know there are certain anti-nausea meds I can't use and that's in my notes.
Any home tips on preparing would certainly be appreciated if you have any!
But, I'll be at 6 months past original surgery when I get the implants. I have to say my experience with TEs has been easy. Aside from a few folds pushing out on my skin, I've had no issues. I have complete ROM and am 99% active at my original level. I decided on our recent vacation that I shouldn't do activities where I lay on my chest. I still don't even lay on my stomach so this seemed inline with that. This meant skipping a ride at a water park where you rode on your stomach. Also their tubes in the lazy river were so tall, I couldn't hang in the middle with my arms over because it made me lay on my chest. I was careful boogie boarding to hold myself up but that got tiring. Does anyone know if this is correct? Should we not be laying on them? What about implants? I never considered that maybe there would be activities I'd avoid because I don't want to smoosh my chest.
Once I get implants and fat grafting it will be interesting to update my story. If I had to say now, I'd definitely recommend over. I can't imagine adding on to the recovery that I did have or the possibility of muscle spasms, iron bra feeling or muscle animation.
Hope everyone else is doing well.
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Hi, JessieJake. Sorry, I'm afraid I don't have any advice on dealing with the nausea, but I just wanted to wish you luck on the upcoming exchange.
I agree whole-heartedly that I can't imagine dealing with the additional pain and issues that would result from a under-the-muscle procedure.
I have an appointment with my PS on 9/8 to get back on the schedule to re-insert the TE on my right side which had to be removed due to infection. I'm hoping to be done with everything by the end of the year so that my deductibles and out-of-pockets don't kick in again!
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Hey JessieJake, longtime no here. Glad you have your exchange soon. Totally get it about getting nervous. I used to get more and more nervous. The scopalamine patches tpapplied before you get any anesthesia is such a big help. You could even ask to get the patch early so that it is in your system for at least an hour or two before you get any other medications. That's what I eventually started to do and that helped immensely with preventing nausea.
I also avoid pressure on my implant by avoiding laying on it. Just doesn't feel comfortable. Sometimes when I geta massage I will lay on a donut shaped cushion to lift me off the implant, to still have access to my back. I know Icanlay on my side, like pregnancy massage, but I have shoulder problems, so that hurts. I rarely sleep on my side anymore.
raven4mi, thinking about your upcoming surgery too. Can you get IV Vitamin C agt a Naturopath? I finally discovered that if I get IV Vitamin C after my surgeries that I was able to avoid infections. I have had 17 surgeries in the past 4 years. So I have learned a thing or two about infections. Had two really nasty infections, counted in the antibiotics to help prevent disaster. They didn't. Antibiotics don't work for me anymore. My last surgery in March I developed fevers, saw an infectious disease specialist who, while nice, wasno help at all. I was on Cipro and Doxycycline and developed rampant diarrhea. Still had fevers. Finally got IV Vitamin C twice in one week, really large doses of 50grams each IV. Then my fevers finally stopped.
I work in healthcare and see poor results from antibiotics all the time, so I am not surprised by this anymore. The problem is that doctors have forgotten the other ways infections were treated sucessfully before antibiotics were invented. That is what they are taught in medical school, which, lets face it, is heavily influenced by the pharmaceutical industry. It is scary to think that eventually there will be no safe antibiotics available to treat infections. That is the scenario that I currently live in, so I am looking for other safe, sucessful options and feel it is important to pass this info on. The same way I want to make sure that women know about OVER pectoral implant reconstruction, in the same way I want to save women from the heartaches of infections that antibiotics can't fix.
Passing along this info means that maybe I can make some positive effects out if all this misery, at least for someone else.
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Thanks, macb04. I've never even heard of IV Vitamin C as an option (unsurprisingly, I assume.) Not sure if it will make a difference by the particular bacteria I had was a fairly rare gram negative bacteria, so I'd have to research if Vitamin C would help in my case. Can't hurt to look!
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Antibiotics are bactericidal for only certain bacteria. Vitamin C is bactericidal for pretty much ALL bacteria. It causes the production of Hydrogen Peroxide in tissues, normal cells can take it, have mechanisms in place to take care of exposures to Hydrogen Peroxide, but bacteria and even cancer cells don't. That is thebeauty of it. At these high Vitamin C doses of 50 grams and up, the Vitamin C acts as a proxident, yet it is safe. Approximately 2 to 5 %of the human population can not metabolize these high doses of Vitamin C, thereis ablood test to check for this. This testis always done before high dose Vitamin C can be administered. The only contraindication I know of is this genetic inability to process high dise Vitamin C and if you have Kidney dysfunction. Otherwise it is very safe then, I have saved myself from infections that way with the Vitamin C infusions a number of times. IV Vitamin C used to be given frequently by doctors before the advent of antibiotics. Look into it. Crucial for health and especially forrecovery from surgery. I have posted about this a number of times. You are welcome to look through my posting tofind all the scientific references.
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WOW, the list is up to 14 PS's and counting who are ahead of the curve, doing PrePectoral Implant Reconstruction. Who would have thought that option would be available even as little as a couple years ago.
Keep giving me those names and I will add them to the list. Can't wait till I can say we have the whole country covered, but I can say we have both coasts and then some.
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Hi Ladies! Well, I had a check up with my PS today, and he thinks it will be OK to go ahead with reconstruction even though I have only had 2 sessions of fat grafting rather than his recommended 3. He says there is no standard for what works best, he just likes to do 3 sessions. Well, I don't at all enjoy surgery so we are compromising, maybe. How many sessions of fat grafting to your radiated chests did you all get before having expanders installed? Thanks!!!!
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I had 5 sessions of fat grafting altogether, but also lost most of it due to 2 bad infections in the midst of it. I would say that when the texture/flexibility of your skin is restored to normal or nearly so, then you have had enough. I had severe radiation fibrosis damage. My skin was like boot leather, thick and woody. Now it is nearly normal. Depends on how damaged your skin is, how much fat grafting to do. I also got HBOT, a large number of sessions in conjunction while doing the fat grafting surgeries and when getting the TE and then after the implant exchange to help healing. Most people are not destroyed by their rad doctors, I had bad care at Seattle Cancer Care Alliance (SCCA ).
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