TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!
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hapa, we could try to keep the peace and cognitively reframe your husband giving you grief about your next revision, say it is only because he is worried. It could be that AND he is just being a selfish pain in the butt if he is at all like my dh. . My husband used to give me grief with every reconstruction procedure because it meant he would be expected to take care of the house and the kids for a while. No support there for me unfortunately. I hope your dh is better for you than mine, and that you have a safe, sucessful revision.
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Thanks mac. He's not better than yours; possibly worse. We don't even have kids, and after my last revision we road tripped to Santa Fe literally the morning after, I had so few problems with recovery. He's just complaining out of some moral distaste for plastic surgery and concern that I'll "never be happy", which is entirely possible. Though back before my BMX, when I floated the idea of no reconstruction at all, he didn't like that either. I guess a shitty looking reconstruction was his idea of an optimal outcome? It is going to be very tense in our house for the next few days, at least.
Andra - do you know how much fat (how many ccs) your PS removed when you had fat grafting? Mine is saying he wants 100-200 ccs, which seems like a LOT to put on my 210cc implants. He's expecting 50-60% to "take".
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Hi Macb4, may I ask if you have scars on the reconstruction? I am kind of hiding in changing rooms because my reconstructed boobs have big scars that they cannot get ride of. ….How are yours?
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hapa - no idea how much fat CCs were taken last time. It was 3 years ago. I do recall PS saying it was hard to get though (he tried lower abdomen and couldn't get anything, ultimately took it from my hip area which is crazy because I have boyish hips). I also oddly tend to lose a few pounds every fall so my weight is down now. I'd have more fat in the spring when I oddly gain it back (all without changing my habits) so maybe I could fat graft later. 100-200 ccs isn't much when you consider the area that is it spread out over. My recon looks great in clothing and I know nothing will really make it look good naked (i.e. natural). That's OK. It's mostly about my ability to be active, and also low maintenance. I'd be fine flat. Funny you road tripped to Santa Fe right after surgery. I'm in Santa Fe! - at least on weekends. Are you in the area? I work in AZ weekdays on the Navajo Indian Reservation and my spouse lives and works in Santa Fe, so I guess that is home. I like the commuter marriage since I have a very high need for alone time and I'm simply too busy and then drained on workdays to want to even talk to another person when I'm done.
So sorry hapa and mAcb04 that your SOs aren't as supportive as you'd like them to be. With all the other crap you have to deal with it just sucks to add that as another layer. *sigh*
- xo
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hapa, I do wish I could give your dh a figurative slap up side the head for being a selfish horse's ass. Sorry if that is too frank, but that kind of nonsense makes my blood boil.
Can you go stay at a friend's house for the next few days leading up to surgery? I certainly wouldn't have hung around with the lack of empathy I experienced before and after my many, many, many surgeries if I didn't have kids to consider. We need caring and compassion at home, as surely as competence in the OR. Lack of caring and the distress it causes harms us, and impedes our ability to heal. We deserve better.
Reconstruction has absolutely nothing whatsoever to do with your dh. His opinion doesn't count in the slightest, only yours counts.
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Hey tibet 1, I do have scars which I put Embrace Scar therapy for existing scars or other Silicon scar strips on. I have also had some real improvement with getting Pulsed Dye laser treatment at my Dermatologist. I have left the scar strips on for months at a time, which seems to be the only way to get the scars to fade appreciably. See a Derm, with specific experience in dealing with improving scars. They can improve the situation, although this is unfortunately not covered by insurance.
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Mac - thanks. I don't plan to take his opinion into consideration at this point. He spent my whole treatment year playing video games instead of helping me research or make decisions, I consider it too late for him to jump in with an opinion now. He's been complaining about things I do a lot lately. I'm not sure how this is going to play out, but I think it is just a symptom of a bigger problem -- this experience has changed my priorities, my tolerance for risk, and my philosophy on life in general and he is not on board with those changes.
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I feel much the same about my own dh, that since he didn't have my back, wasn't supportive when I most desperately needed it, he has forfeited the right to be a priority in my personal decision making.
Well I hope you find support from other areas or people in your life. We are all here for you as well.
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Oh yeah, you guys are the best!
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Hi Ladies, I’m new to posting but have been reading. I have a question regarding revision from sub to pre pec implant - I currently have the tissue expanders under the pec. I’m done with the fills. Is it possible to place the implant pre pec during the exchange even though the pockets are under? The chest area is very tight and when I flex there’s animation. I just wish I was more informed of the options before going into surgery. I want to make it right this time and avoid having to have the revision after the implants are in
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Hi, sunshine -
Great question! I would think that if you're a candidate for pre-pec reconstruction you could opt for it now and have the expanders removed and the pre-pectoral implants placed at the same time.
But not all surgeons do pre-pec implants, or yours may have had reasons for choosing sub-pectoral reconstruction in your case.
Ask your surgeon, and if s/he says no, ask why not. If you don't like the answer, get a second opinion. And let us know the outcome!
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Hi Margari, thank you for your response. I was bleeding a lot from surgery so I had the BM first and a week later had the expanders put in. The surgeon was worried about necrosis so he placed the expanders under the muscle. I really don’t want to have to go through more surgeries after the exchange surgery so I wanted to see if anyone here had a similar situation. I have an appointment with the PS in a few weeks and will see if he’s willing to do this and will report back so it will be informative for others going through this difficult time.
thank you again.0 -
Hi Sunshine39, welcome. I know what you mean about wanting to minimize more surgeries. I wonder if there would be enough loose skin over your pectoral to fit in an Prepectoral Implant of the size you might want. That is the real determining factor. I see you said your chest was tight. I worry you might need a Prepectoral TE before you can have Prepectoral Reconstruction done. I hope not, but want to say this is a possibility and feel it's best to discuss it here for you and others. I had a subpectoral TE initially, and then a Prepectoral TE before my Prepectoral Implant Reconstruction myself, as the subpectoral didn't make Prepectoral possible.
By all means get a couple of opinions. So you are making the best informed choice for yourself. Let us know what they all say, and what you decide to do.
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Hi macb04, thank you for your response and this wonderful thread you created! My chest is tight but I think it’s the upper pole where the muscle is being stretched above the TE as my nurse said I can get at least 2 more fills (120cc) if I really wanted. I was a 34b prior to BM and don’t really want anything bigger. Just want to feel as natural and comfortable as possible..That being said, I think my skin would be ok for some Morestretching pre pec? I will definitely ask the question when I see the surgeon. I don’t mind having the TE until I find the best solution so I appreciate everyone / anyone’s input here. Happy Sunday!
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I had sub pec TE and exchanged for pre pec implant. They just have to repair the pec muscle. It’s all done in one surgery.
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Hi Amy, thank you so much for responding to me! May I ask how you feel about the exchange surgery overall? I.e. recovery specifically related to the pec and what made you so sure that a pre pec exchange would be a better choice considering you didn’t have the sub pec implant yet at the time of your decision. I had raised my discomfort and concerns to the surgeon a week after my surgery and Mentioned again last time I saw him. Both times he said that I would feel better after the exchange surgery. We all know that is true though I just don’t know how much better and I hate to have to revisit and make a correction later. May I ask how you came to making that decision?
Thanks again!
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Hi All!
Surgery was Nov 6th. Plan A was to remove my nipples and exchange my pre-pec textured anatomics for smooth rounds - as long as they didn't look worse (in terms of edges etc) than the current ones or if any concerns about blood supply on radiated side etc. Plan B was go flat even though he wasn't sure I could really be flat because of the extra alloderm on radiated side (it would be visible edges all around). Well, the smooth rounds looked worse and surgeon said all the OR staff groaned when he tested one out. He took a picture and came out to talk with my spouse explaining to him that I would not be happy. My spouse agreed. I saw the picture later and yes, worse (edges even more prominent and warped/rippled). Even if I had enough fat for one round of grafting it wouldn't come close to helping that. Surgeon spent hours meticulously teasing out some of the extra alloderm so I wouldn't have edges. He did a great job, but I'm a bit sad to be flat. It will be an adjustment - feels like mastectomy all over again and I find my self emotional about on and off. My spouse is adjusting as well but just like everything else he says we will get through this together. I do like it more when I'm naked - would much rather look at scars than look at those implant edges of fake breasts - but bummed because my implants looked really awesome in clothes with or without a bra (aside from nipple issues). They were only 250cc and the smooth rounds were even smaller at 220 cc since the pocket was smaller after removing nipples, but it just wasn't meant to be. Flat is where I will remain unless in the future someone develops better implants or other technology for pre-pec breasts where there can't be fat grafting to blend the edges and ripples.
Thanks for all your support on this thread! I hope you all get the results you want!
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Sunshine39, sounds like you are doing a good job gathering as much info as possible, that will make whatever way you go easier to live with. I hope you get a result you are happy with. Like OCD Amy said, people do switch from subpectoral to Prepectoral fairly often since it has become an option thanks to ADM stuff like Alloderm and Strattice. I will say that my Pectoral recovered almost completely back to normal after the subpectoral TE was removed. He didn't stitch it back into place, just put it back into the right spot and it seems to have healed well all on its own. I have 98% of function and strength I had before first being chopped up.
Andra, that is so hard. I know appearances are important, but comfort is equally, if not more so. I know you will find a way to be pleased with how you look without the implants, just will take some time, as you said. I will let you know if something amazing come to fruition, like 3d implants made to order using our own cells. I am ever hopeful about that one being part of the future of reconstruction.
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Thanks Macb04! My surgeon said many years ago he was working with a Chinese scientist on a type of hydrogel that would fill the space to create a breast mound. It sounded similar to wound care many years ago when patients have deep wounds and you needed to fill the space while the body granulated tissue (which is now assisted by wound vacs). He said it worked great in mice and was a substance that had zero toxicity. He said there wasn't much interest though in developing it more because of how much the implant industry has grown and dominates. It reminded me of lobby groups owning our democracy. Dang! As someone who used to perform a lot of wound care in PT, it sounded great!
I'm doing well functionally flat, as I did with pre-pecs. 3 days post-op I hiked 9 miles at 10k elevation with a drain. 8 days post-op I ran 8 miles. I started weight lifting again too and made sure to get in extra push-ups. Without breasts I need better pecs!
- xo
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Andra, very interesting to hear about Hydrogel Breast Implants. Theses studies are about the ones called Monobloc Hydrogel Implants. It sounds pretty good, anI will definitely start reading up on it.
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Here is one about a really cool idea where these French Researchers made a lattice from a Bioabsorbable material, and then grow a patients own Fat Cells on it, which is absorbed over 6 months to creatr a more natural, and safe "breast.
Here is an Israeli company also creating an better breast implant, of your own Fat tissues in a 3D collagen scaffold.
https://www.3dprintingmedia.network/collplant-bioprinted-tissue-breast-implants/
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Not ready for Prime Time yet, but will keep you all informed.
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Human clinical trials for technology aiming to improve the quality of life after breast reconstruction to begin later this year
14 November 2019
11:36
Evonik, a specialist in biomaterials for implantable medical devices has signed an agreement for the use of a Resomer bioresorbable polymer for innovative breast implant technology with BellaSeno, a developer of 3D printed absorbable scaffolds.
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BellaSeno will use Resomer in its Senella breast scaffold products with a proprietary additive manufacturing process. They are designed to be implanted after breast reconstruction, augmentation or revision surgery. The Resomer polymer features mechanical properties and a degradation profile that allows the scaffold to safely absorb at a rate that matches the formation of the patient's own tissue. These scaffolds will be available in different sizes and shapes to match the patients' needs.
The process avoids the use of silicone implants which are often associated with clinical risks such as capsular contracture and device complications such as rupture and deflation.
The first-in-human clinical trials of the Senella scaffolds with Resomer are scheduled to begin in Germany this quarter. Evonik will supply its Resomer polymer for clinical and commercial use under the agreement.
Jean-Luc Herbeaux, SVP and general manager of the health care business line of Evonik commented: "Evonik is pleased to be partnering with BellaSeno in the clinical development and commercialisation of their innovative, 3D printed breast implant technology.
"Senella breast implant scaffolds can potentially enhance the quality of life of millions of patients worldwide who undertake surgical procedures each year. This agreement underlines the ability of Evonik to leverage the safety and versatility of Resomer polymers, together with our advanced application technology services, to support customers in the commercialisation of innovative medical devices."
Simon Champ, co-founder and chief executive officer of BellaSeno said: "BellaSeno is very excited to be working together with Evonik in this collaboration.
"The level of support provided by Evonik has been excellent."
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It is only a matter of time before we have better technology in this area! I fully expect the advances to come from Europe or Israel given their history of leading when it comes to breast cancer related research. I imagine the question will be if some of us will want to bother with surgery again by the time it is truly available.
- xo
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Sunshine, sorry for the delay in response. My story is a little complicated. I had planned at first to have BMX and implants. My PS at the time didn't even mention pre pec so my TEs were placed under the pec muscle. After chemo and rads I decided that I might want to get DIEP and my PS did not do that procedure and referred me to a college who does. I was going to have DIEP on both breasts but one of my arteries wasn't great and they were afraid they would have to do a TRAM flap and I didn't want that so I settled with DIEP on cancer/rads side and implant on the other breast. This new PS said he mostly just does pre pec now and that was what he suggested. It feels WAY MORE comfortable than the sub pec TE. I had noticed a little more rippling and the implant dropped some and was not even with DIEP breast so I had another surgery to raise it and had fat grafting and I am very pleased with the resutls.
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Hi Macb04, thank you for the encouragement. I will ask the surgeon If he can do pre pec exchange first and go from there. My gut feeling tells me he will say no but let’s see.
Hi Amy, no worries and thank you for the response! Yes, I am concerned with the rippling but I think I take comfort over that rather. I’m glad to hear you are doing well and very happy with the results!I will post again after I meet with my surgeon. Hope everyone get to enjoy the holiday season despite what we are going / went through! X
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Ok, so I had my revision with fat grafting yesterday. It seems it was a waste of anethesia, the surgeon was only able to get 30ccs out of me. I'll post in a few weeks once the swelling is down and I know what they look like. So far it seems like he smoothed out the area between the implant and my armpits, which was by far the worst looking part of my recon. You could even tell in clothes that I had fake boobs because of the divot there. Crossing my fingers that all of this fat takes because I don't think I have enough to do a second round.
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Dang, hapa. Hope the fat takes too. Best of luck with recovery from surgery.
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hapa,
Eek. I hope it looks better than you seem to be anticipating.
I have a follow up with my PS at end of January and plan to schedule fat grafting. I definitely have a few more ripples with these smooth rounds than I did with the 410s. Do not regret as I prefer shape and feel, but I could not do fat grafting before due to lack of body fat (which is why I switched to 410s to address rippling in first place..). Hope my doctor can find some more this time to fill in a couple areas.
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Hi everyone:
I have some questions about capsular contracture and pre-pec revisions.
I've tried twice with pre-pec implants (single mx). Each time I have developed grade IV capsular contracture within a few months of surgery. I am going to have to do something different. My current implant is very deformed and painful.
My original PS says that diep would be the best option. I've thought about this for a year and cannot get in a comfortable place with it for a variety of reasons and risks particular to my case.
I've sought additional opinions. Usually I hear that I sub pec would be required to get any luck avoiding subsequent contracture. I don't want to do that. My latest consult who has a stellar reputation does diep but says he can also do a pre-pec using alloderm or some other mesh. The Alloderm worries me as it is another foreign substance for my body to disagree with. This PS says he has no trouble with Alloderm. My original PS says Alloderm causes all sorts of issues and she won't touch it. Bleh.
So I have 2 questions really:
Has anybody had a successful pre-pec revision to fix capsular contracture?
Do you have Alloderm and has it caused any issues?
Thanks so much. Grateful to be able to come here when my husband and friends do not want to think about or discuss all of this.
Sending love and good vibes to all.
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I have Alloderm and pre-pecs. No issues.
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I had Alloderm initially with a Subpectoral TE. Had that removed and then got Seri Silk mesh when I switched to Prepectoral TE, the Silicone implant.
That is very tricky for you if you have tried Prepectoral twice, with CC developing each time. I was at increased risk of CC due to Rads Fibrosis, so I was on Pentoxfylline ( a prescription medication) and Vitamin E OTC twice per day for about 2 years.
I have often wondered if Pentoxfylline and Vitamin E can help prevent CC in women without Rad Fibrosis. Weirdly there seems to be no studies on that.
I have often read several hypotheses over how CC develops. One is the potential low level bacterial infection from biofilm adhereing to the implant shell and causing an inflammatory process. Or, of course, that an implant is a foreign body that our body encapsulates to wall off a potential danger from the rest of the body. Could be a bit of both. No firm understanding has yet to come to light.
It has been shown in studies that Pentoxfylline and Vitamin E do seem to decrease risks of CC for Rads Fibrosis, so maybe there is some problem related to blood flow which the Pentoxfylline fixes. Pentoxfylline is used on label for an issue called Intermittent Claudication, whereby it causes red blood cells to be more easily distorted so they can fit into abnormally narrowed blood vessels and improve tissue oxygenation.
I also got IV Vitamin C (50 grams) at my Naturopath the day after each surgery to put in the TE, otherwise then I got infections. Perhaps if the low level bacterial thing is true,, then the IV Vitamin C would have killed any bacterial at the high dose I took. High dose IV Vitamin C produces Hydrogen Peroxide in the tissues which kills most bacteria.
So my thought is if you wanted to take another Prepectoral Implant chance, then you would have to do stuff like Pentoxfylline and Vitamin E, and or IV Vitamin C in conjunction to see if it could work out. I had severe Radiation Fibrosis, really awful, and had an extremely high risk of CC, so I feel these extra steps were crucial to my sucess.
Also wondering if you read the articles on treatment of CC with Low Level Laser Therapy.
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