TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!
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Thanks, macb04, I'll see what I can find out. To answer your question, though, no - subsequent to the radiation 8 years ago there was never any marked difference in the skin on the radiated breast once the initial redness of the radiation went away. No change in the feel of the skin or lasting effects of any kind. Even now, the skin on that side - while puckered and withered looking due to the excess of skin without a TE in there - still feels soft and supple even after the infection on that side. I may have a bit of an uphill climb, but I'm not giving up yet.
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Hi over the muscle ladies,
I had my exchange on Wednesday so I'm 2 days out. Feeling quite good and taking only tylenol for pain now (though I don't really know if or how much that even helps). While I'm sitting here i have 0 pain. If I cough or reach for something I can feel some discomfort, but its tolerable. Sitting up from lying down also causes a shift that is a little painful just for a few seconds as things shift.
I also had fat harvested from my thighs and maybe my butt so bruising there. I have a girdle to wear for 4-5 weeks.
Back to sleeping only my back which is difficult because I had been able to sleep on my side for some time with the TEs.
No drains which is a bonus and probably also aiding in my feeling better more quickly.
Curious to find out which implants my PS used. I'll find out next week or if they post my surgical notes online.
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Hi everyone,
Just an update for those of you who may be interested in the pre-pectoral reconstruction with air-filled tissue expander process. And a question for you ladies about air travel with TEs generally and air-filled TE's specifically.
Went in today to have my second drain removed. PS is using air (not saline) in TEs more and more often for pre-pectoral surgeries because it weighs less than saline. This is important because although the Alloderm that the PS sutures onto the pec is strong, it is also healing. The pec muscle isn't there to add structural support for the TE. For these reasons, air-fills are coming into practice for pre-pec TEs. I don't really understand what all of the measuring units mean yet, but I know some of you are interested in them. So, we added another 50 cc's to the TE today, bringing it up to 400 cc's. Water and air cc's are the same in volume, different in weight.
My nurse told me today that some women are reporting that air travel with air-filled TEs creates discomfort as the cabin pressurizes and de-pressurizes. PS recommends swapping air for saline prior to travel just to be on the safe side. Has anyone had any experience flying with air-filled TEs over the pec muscle?
Gotta say that although I've shed quite a few tears through this process, today was the first time that I lost it outside of the house. For some reason, it was just too much information about decisions that I didn't need to make this morning coming at me. I only wanted the drains out and to know whether we can fly for vacation, but somehow I found myself overwhelmed when the conversation shifted to DIEP vs implants and surgery on the healthy breast to provide a lift. Oh well, all better now.
Not sure how the following detail compares to sub-pec TE recovery, but I'm including it in case it's interesting as a comparison to others.
- Surgery was on August 17th. First drain stayed in for just over two weeks. Second drain stayed in for just over three weeks.
- Nurse said my range of motion was fantastic and mentioned that the pre-pec TE might have something to do with that.
- Restrictions on lifting above 90-degrees remain for the next three or four days.
- Then I'm to start the wall exercises. I'll be allowed to lift up to 15 pounds and start yoga so long as I don't do anything that requires me to push or pull with my upper body. I won't be able to swim until the incisions are fully healed. Even I know that I won't be running anytime soon.
- I'm cleared to start wearing a bra or camisole, but it should be one size larger than normal to avoid pressure.
Thanks everyone!!
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Hi Raven4mi, that is really good that you don't have fibrosis. That does simplify reconstruction considerably. Then the fight you have is to make sure the PS you choose does the Prepectoral (Over Pectoral ), that they decide that is the way to go. Can youswitch PS's? Or go out of state? I had two bad infections with fat grafting, had 300cc's of pus taken off my chest each time, and after that I had an adhesion of my skin to my chest. The PS I had then who was doing the Fat Grafting told me I needed a DIEP, as I had too much scar tissue after my last infection for him to do any further reconstruction. I decided to find a new PS, which I did, who listened to what I wanted and did Prepectoral reconstruction, first with the TE, and then my implant.
So, while I get scar tissue makes things complicated, it shouldn't be impossible to fix in the hands of the right PS.
Hey JessieJake, soooo very glad that your exchange went well and you are feeling pretty good. What kind of implants did you get? Keep us up to date, ok?
Ida-w, I can imagine that flying's associated pressure changes might feel a bit odd with air filled TE, the expansion /contraction process affects my ears too, so why not a TE? It can be overwhelming at times, trying to fit a bit of normal life into the recreation of our breasts. I know that I just wanted it all to be done. Now that it is mostly finished I am thinking aboutsomeminor cosmetic stuff, like getting the hyperpigmentation and petichia removed with lasers. I did that before, it got a lot better, but they said one more time would get my skin to look closer to complete normal, so that you can't tell which side had anything done when I am in low cut clothes or a bathing suit. That's my goal, erase as much as I can, so I don't have to be reminded all the time.
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Hi Macb
I'm not completely sure which implants my PS used, I do know they r anatomicals in the 295-330cc size range.
I have a concern to talk to my PS about next week. She apparently told my husband I had scar tissue that needed to be removed. hat may be why one of my TEs was a little lower then the other. She can't guarantee it won't come back, but these implants are textured and I believe that is supposed to reduce that risk, I just need to talk with her about that.
One other thing is that my left nipple is "on" but my right isn't. My right nipple had issues from BMX so I don't think there's anything that can be done.
Noticed more swelling last night. I feel kind of big which is very odd for me. I'm liking the look. I hope it stays close to the same after healing (and healing well!)
Girdle is so tight over my abdomen. I didn't have any fat harvested there so I've unzipped and unhooked the sides of the girdle to let my organs relax. The girdle is very high waisted, I'm going to go shopping today for a lower waisted one but with thigh/butt compression.
Feeling good this morning, no pain Meds at all! Even fat harvesting area is better.
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Thanks for sharing ida-w! Funny that air travel is on my list of questions for PS visit on Monday. I assumed the fill would be affected by altitude/pressure changes. Of course, I may still need another round of fat grafting before recon...which I would do ASAP.
I wish I could make a decision about recon/implants. It's either stay flat (though nipple sparing) or get pre-pec implants. Those are my options. It's so hard to choose surgery when I don't have any pain (aside from a little pec tightness when at max stretch), have pretty much full motion and strength, and can do all my sports. Surgery would open the door for pain and complications. ugh. Most surgeries are about weighing the risks vs benefits. Recon has no physical benefits, only psychological/mental/emotional ones. Are the physical risks worth it? I have not decided yet. You know how some days you are very acutely aware of not having breasts...and what you have lost (from everything)? I'm not sure that would change with recon. I think with implants I'd be just as aware. It's all a reminder of cancer. It would be even more of a reminder if I had chronic pain from implants or the surgery to get them.
Got engaged two weeks ago (yay!), so now there is wedding planning which affects timelines for recon too. Either start the recon process in January and exchange for implants by May or wait until after the mid June wedding.
PS told me last time that I'd be allowed to run and lift weights with TE and implants when the drains are out or two weeks, whichever is later. Hope that is true - will ask again. He also said TEs to implants would only be about 3 months since I want small breasts like I had before mastectomy. That is all assuming no complications.
Thanks for letting me vent tonight.
Thank you all for sharing your pre-pec stories, concerns, and updates. It helps me tremendously since that is where I may be headed soon.
- xo
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Congrats Andraxo! Wow, a wedding in the offing, Cool! Yes, a hard decision. I didn't feel I had a choice, lopsided just wouldn't work for me. I amglad I had it done. I can wear what I want again, hated having to find things to cover up. Even with breast prosthetic it looked odd in some clothes and am glad I don't have to worry if I look lopsided anymore. I used to be kind of freaked out that the fake boob would shift, look strange, and I wouldn't realize it. Unlike under pectoral reconstruction, I recovered my strength very quickly after PrePectoral surgery. So Andraxo, I think your PS is telling the truth what happens for most women. So you just have to decide what will make you happier. You can even put off the decision and take a break, just enjoy all those good things coming your way.
JessieJake, when you say your left nipple is "on" and your right isn't, what do you mean exactly? I wondered if you meant they aren't at the same levels? Could you explain more? I also had lots of scar tissue. Every surgery causes some scar tissue. It doesn't necessarily mean problems with our implants. It is a foreign body, after all. I tell my body to accept my Silicone Implant, that now it is mine forever. At least I say that sometimes. I Gotta try.
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Hi Macb, I don't think my explanation about my nipples was very clear! What I meant is that my left nipple can get much more erect than the right one. So, one side looks more excited that the other. It has to be from the nipple sparing surgery. My right side had issues during surgery and was treated with nitro-bid to encourage blood flow. It did work to save my nipple, but it's just more flat than the left side. I know it's kind of TMI, but I was chilled yesterday and both nipples reacted. It's just that the left is more prominent then the right. Does that explain it better?
Oh, I had a little conversation with my chest last night and said please hold on to that fat transfer. I really like it. We'll see if my chest agrees with me or not.
Andraxo, I'm not sure if this will help your decision making or not, but I was completely back to full activity with my TEs after the doc's recommended healing period. I felt ready to return before they said I could, but I did wait. When I did return I had very little discomfort from my TEs and eventually none. I did everything I wanted (except lay flat on my chest like when boogie boarding, though I think I did a few times just because it happened without thought). I'm pretty small so the TEs didn't get in the way. I really never thought about them. Now with my implants, I am going to have a hard time waiting for the activity restriction to end. I feel almost perfectly fine. Some itchiness, but no problems with range of motion as I did with the BMX. I've been walking quite a bit which is what they said I could do right now. Congrats on being engaged!
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Congrats Andra! Only 2 weekw activity restriction, huh? I like that! I just wish i could predict a 2 week run of bad weather lol. Sigh.
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Hi!
I have did not have my TE over my muscle. I can feel my muscle squeeze my implant as I do things. It annoys me. I want to find a PS that will put my implant over the muscle. I expect to add fat grafts over the implant as well. How are your implants? Does it feel somewhat "normal" or "natural?"
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Hi 8thgradeteacher,
I've had my over the muscle implants for 5 full days now (not very long, but a big hurdle!). They feel even better than my TEs did and I felt like my TEs were very comfortable by the time my exchange surgery came. I have anatomical implants and they are held in place using an alloderm sling. I have restricted activity for 4 weeks while they heal in place.
They are very comfortable even now. With the more rigid TEs I was not able to even shave my armpits very well. I can easily do it with the implants. The implants are silicone so I guess not as soft as a natural breast but they feel fine to me. I had fat grafting to hide the edges of the implant around the top (with over the muscle you can see the edges more easily as there is only skin on top of the implants). Right now I think it all looks great! Well, I do have a lot bruising still from surgery and I'm sure some swelling. Stats say that up to 50% of the fat will die or get reabsorbed but I will keep my fingers crossed on that. I'm very happy right now. I can even sleep on my side already, although I'm not going to truly do that until after my 4 weeks of restriction are up.
I had smaller implants and am quite thin on top. My implants are only about 300ccs. My PS was concerned about being successful hiding the edges of the implant with my think skin, but so far it's looking good! (fingers crossed).
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Hi 8thgradeteacher, Where do live? Do any of the PS's on my list work for you? My implant is always noticeable to a certain degree, although it has gotten less noticeable as time has gone by since March 2016. It is not painful,just feels a little tight sometimes, although nowhere nearly as tight as it did when I had a TE under my pectoral. Hated that. I cannot see or feel implant edges, and have ZERO animation defect when I flex my arm/chest muscles. I have a 495cc Mentor high profile Anatomic textured silicone implant. When it bugs me a little bit, I just rub it/shift itaround a little, and the annoying sensations go away.
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Hi Macb04, So you can "shift" your implant to some degree? I was wondering how much movement there could be. This might be a dumb question but what do you mean the implant is noticeable? Not the edges?
I'm annoyed this morning because I was making breakfast for my kids and I got a pulling/dull pain under my right implant. It's the same spot where I had a really sharp pain following the placement of the TEs and my PS attributed to a stitch placed there. Do you know if there would be a stitch in that spot now? I guess I'm just worried I pulled on the alloderm or possibly the base of the implant. I have no idea. It's funny that I would get it in the same spot. I guess I use my right side more and maybe that would have something to do with it. I don't think I'm overdoing it with lifting or anything. I'll see if it disappears this morning. I find if I slouch (which I've done just while sitting here) I'll get that dull pain.
I find it harder this time around to not do as much because I feel so good. At least I can walk easily!
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Thanks everyone! - appreciate the congrats, and hearing positive reflections/accounts about your implants...healing and activity. It does help! I met with the surgeon yesterday. He doesn't think I need another round of fat grafting and could start recon any time. He took more pictures (I had pictures taken before mastectomy) and they used the pics today in a software program that can show me what size I'd look like with different types and sizes of implants. We've tentatively decided to move forward with TE placement early November. Of course I didn't sleep much last night though (worse than my usual), and want to talk to him again so I just scheduled another appt for October. It was helpful to see it with that software for sure, but I still think everything they showed me was too full - didn't realize until I got home that his nurse wasn't showing me or choosing the lower projection series only the full projection for the gummy bears. I want smaller. He also has no concerns about my flying with TEs in. If I go with November I wouldn't even start filling until 7 or 8 weeks later after a trip out of the country in December.
Happy Tuesday! xo
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Firni - I did remember to ask my PS about PS in Denver area that does fat grafting and over/pre-pec implants. He told me he had to look up the person in a group he did some training with. He even left me a voicemail an hour ago saying it was a Dr Bateman (was hard to hear on my cell message), but he was going to call that surgeon personally/directly to confirm he is doing those procedures and get back to be about it. I will let you know as soon as I hear from him again...and I will ask for the contact info/what group he is with etc.
Andra xo
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Andraxo, that's pretty cool they have a program where they can show you what you would look like with different implants. I've never heard of that, but, wow, it sure makes sense and would be so helpful to avoid confusion or disappointment in the end result.
Good luck on getting info on the new PS in Denver!
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Andra, how many rounds of fat grafting did you get? I had 2, my surgeon said he usually does 3, but i really dont want more surgery. He said my skin looked fine to go ahead, but im interested on others experiences.
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Hi JessieJake, yes I can shift my breast/and implant in all directions, similar to my real one, about 60% of the same movement. I mean it is noticeable just in how it is a sensation of an implant sitting on my chest. I notice it sometimes when I am just walking along. Then I move it around a little bit, and then stop being consious of it. My PS used some program using a photo of me to try matching my real right with my implant size. I wound up too small compared to my right, I told him it was too small, right after I had the surgery. So I had to redo it, he hated to admit his computer program was really wrong,but he eventually did. That mistake cost me an extra 1200 dollars out of pocket and plenty of misery, while I tried to live with a very poor match. I wish I could have had the manufacturer of that damn Computer program pay for the redo, since it was their screw up that caused the problem. So what I would say, is trust your instincts. Make sure you agree with the size recommended by your PS and the computer, because you are going to be stuck with it for a very long time.
Adraxo please PM me the name of that PS when you get confirmation, so that I can add it to the list.
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I had my 1 week post-exchange follow up. Everything is healing well and the bruising and swelling is subsiding. She used the Allergan 410LX 290grams silicone anatomicals. The smallest of the 3 sizes she brought into surgery.
A couple of surprises for me - She recommended I wear an underwire to prevent either implant from falling while it heals as she had to adjust both sides to make them even (left down a little, right up a little). She said to use some gauze to cushion the incision line from the pressure. She prefaced this with, "I would almost never recommend this but...." I was so looking forward to not ever wearing one again. She did say also if I can't find one, or it is too irritating, a sports bra with a good band around would suffice.
I have a follow up on Oct. 5th to see how the fat grafting looks, but she talked about the possibility of doing more, and if so, it would be in 3 months. What she did do now looks very good. It hid my visible ribs and padded the top edges nicely (please stay fat!).
And, I mentioned here that one of my nipples is flatter than the other. She said she could correct that by making the one that is more prominent a little flatter, but she said to wait and see what happens over the next few months.
She was quite firm on no vigorous activity for 4 weeks (bouncing, running, swinging arms).
So, all in all, so far so good. Comfort level great and healing well.
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Congrats, Andra, on the upcoming wedding! Glad you're doing well post-exchange. I'm insanely jealous; really can't wait to be at that point.
I have an e-mail out to my PS with the list of prophylactic things I want to try to see if he'll agree to any of them. I explained how anxious I was about his pessimistic outlook on the success of trying the implant again and that I felt like I was brushed off with my concern about not wanting to go sub-pectoral If he won't approve any of the prophylactic measures I'll consider seeking a second opinion. I also have an appointment with a holistic center on Monday night to see if I can get at least one round of IV Vitamin C in (plus whatever else they recommend) before my next scheduled surgery date. If I have to postpone I will, but I'm so anxious to get this done and over with that I feel like I'm stuck in a Catch-22. My brain has been consumed with this 24x7 since my appointment with my PS last week and it's starting to impact my life - I feel like it's the only thing I can focus on, you know? And unfortunately all I can focus on is the PS's pessimistic view, when I should be focusing all my thought energy to a positive outcome!
*sigh* This reconstruction business is not for the feint of heart, that's for sure.
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Hi raven4mi, that is great, about planning to get the IV Vitamin C. See if you can get a IV Vitamin C infusion 1 or 2 days after your surgery if you are worried about possible infections. When I did get 50 grams IV Vitamin C, I had no problems, but when I didn't get it, was the times I had two horrific infections on the rads affected side. I even got them to give me 10 grams of Vitamin C in my IV during the surgery. My Naturopath gave my PS a letter detailing the correct amounts of Vitamin C per liter of diluent such as D5W or Normal Saline. I have shown the study info before, but surgery is known to lower tissue levels of Vitamin C.
I hope you get a good response from your PS so you can go forward.
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Thanks, macb04. I really can't thank you enough - all your advice has been invaluable.
My PS called me last night; he felt so bad that I had left his office in such an anxious state. He's agreed to prescribe Singulair, which he isn't sure will help but certainly won't hurt, and he's also agreed to discuss fat grafting. That, along with the IV Vitamin C, makes me feel that at least I'm being proactive on trying to get a good outcome. He still warns me that because this is the rads side and because of the prior infection that there still may be the possibility he has to go sub-pectoral, and he won't know until he gets in there, but at least I feel like I'm taking control and doing as much as I can to get a good result.
Truly, thank you again and again and again!
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Just back from a therapy conference in DC...catching up on BCO.
Little blue flowers - I only had one round of fat grafting. Thought for sure I'd need another round, but PS said I was ready to roll for TEs if I move forward. I know I'll need fat grafting after implants and don't have much fat to work with so I'm happy to save it for after implants. I'm tentative for Nov 9th to get TES placed. whew. When are you slated for TEs? Was hoping you were ahead of me for them!
I'm hoping that I don't spend the next 6 months super stressed because of surgery and the recon process overlapping with wedding plans. My sleep is so awful now (thanks tamoxifen and my usual busy brain). I'd elope or have a super small simple wedding if that was an option, but he wants a BIG wedding. I'll get on board with it!
- xo
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Andra, wow! Im glad to hear your experiences! I think we will be surgery and recon buddies- im thinking of scheduling my TE installation for the first week of November and just hoping the field season has ended by then! Are you doing anything special to help your skin?
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Looks like we'll all be close together, surgery-date wise - I've finally landed on 10/25 for my new attempt at re-inserting TE on the right. I'm doing as much as I can to ensure pre-pectoral. Fingers crossed I come out of surgery with good news!
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littleblueflowers - I just moisturize my skin daily with lotion (have a couple that I like) and I'm mobilizing the skin and soft tissue regularly. I saw a PT specialist 9 times since the fat grafting, and also a couple of short sessions with one of my staff PTs, and of course what I work on myself one handed (I'm a PT). It has made a tremendous different in the chest wall mobility. I won't be able to start filling until early January - 8 weeks later even though he said he usually starts at 5 weeks s/p TE placement. I only want to be an A or B cup so there won't be much to expand anyway. Not sure when the exchange for the pre-pec implants would be...March??
Glad you have a date scheduled raven4mi - hope it goes just as planned for pre-pec!
Yesterday morning I took my annual military fitness test. I achieved "maximum" for my 45-49 age group. yay! Managed to rock out 40 push-ups! (90 sit-ups in 2 minutes and a 1.5 mile run in 10:45) I'm very happy with that given they year I just had. Wonder if I'll be able to do that after recon. My sternum is pretty sore today. My left pec is always a little sore and tight.
Did anyone get any type of scan (MRI, US) before recon with implants?
- xo
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Andra, thats good to know. I was wondering how long befor fills started, if one had radiated skin. It all became real to me today when i got my pre surgery packet in the mail. What a suprise! Im scheduled in for Oct. 27! It wasnt what i planned, but eh- ill just pray for snow and an early stop to the field season, i guess. Although...getting over the pass to my PS will be difficult if we have an early bad winter. Sigh. So many factors.
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Just added a PS from Colorado thanks to Andraxo. The list of progressive PS is now up to 18!
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Had an appointment with my PS today to discuss fat grafting to see if that will help ensure a pre-pectoral implant on my re-try post-infection. The short answer was "It can't hurt." I'm likely going to go for it even though I'll have to wait another six months to get the TE replaced in order to give it a chance to work.
So, just wondering for those of you who had fat grafting, what was the recovery like for that? Obviously he said it would depend on how much fat he needed to take, but just wanted to get a feel for recovery.
Thanks, all.
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raven4mi - I had fat grafting mid June this year. While only my cancer side (left) was radiated, he grafted fat bilaterally and anterior to my sternum. I was told to restrict my activity for 2 weeks - no running, no weight lifting. I walked, hiked, road biked. There's no way I would've run even if allowed to...was too sore in my torso. It helped to wear compression garments on both the donor and recipient sites (compression shorts, spanx-like tank top). The fat was taken from my sides/hips. He also tried at my lower abdomen but couldn't get anything there and that spot resulted in significant adherent scar tissue. I was able to work through the scar tissue over a few months. I was sore from the places fat was harvested, more than where it was placed. The procedure was done on a Wednesday so I took Wed-Friday off work, but was back at work full time Monday (I'm a physical therapist). After 3 months (Mid Sept) he thought my skin/tissue was improved enough for TE placement anytime. I chose November to give me more time to mentally digest getting recon (vs staying flat). That's a tough battle in my head! We are meeting again in October to review it all one more time.
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