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Revision from subpectoral to prepectoral.

Yaniza
Yaniza Member Posts: 83
edited January 2021 in Breast Reconstruction

I'm interested in hearing from anyone else who had revision surgery from subpectoral reconstruction to prepectoral reconstruction.

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Comments

  • meadow
    meadow Member Posts: 998

    Yaniza, I have not had this surgery, but I am bumping your question to the top of the active threads so more people may respond. Hoping you are healing and are comfortable. Be gentle with yourself! Let us know how you are doing

  • Yaniza
    Yaniza Member Posts: 83

    Thank you Meadow,

    I do feel that I'm a bit of a rare bird. I know there are more prepectoral reconstructions out there but there don't seem to be many revisions from subpectoral. I'm still a bit nervous about infections with these 4 drains, but I do have an appointment on Monday when hopefully they'll all get removed.

    I'm so grateful to have my muscles back where they belong.

  • veggal
    veggal Member Posts: 261

    I had the switch in September of '17. I like the pre-pecs much better. I also had two rounds of fat grafting. 

    Hope your recovery continues without incident!

  • avmom
    avmom Member Posts: 45

    Yaniza, this is very interesting to me, as I have subject expanders right now (they are a bit different from the usual extenders, in that they can be permanent also), I have been delaying exchange for a while, as DH has had some health issues that needed to be taken care of. However, I am not convinced that I will do an exchange, but might instead just have them removed. They just aren’t that comfortable, and my pecs still aren’t “happy”. Originally, I thought 8 would just go flat, but did a reconstruction consult, and my very wonderful PS suggested that I could get a good reconstruction result.

    Would you be prepared to share your reasons for choosing this option?

    I will be thinking of you as you recover. Have someone you love give you a gentle hug.

    Avmom

  • Yaniza
    Yaniza Member Posts: 83

    Avmom,

    I have had all under the muscle saline implants. It was suggested to me that I could keep them to complete a reconstruction. They were ridiculous and horribly uncomfortable and the animation deformity was out of this world. My plastic surgeon then used them as tissue expanders and did an exchange "dual-plane " surgery which required releasing some of the lower edge of the muscles from my sternum. The results of that surgery were aesthetically very good unless I flexed my muscles in any way. My plastic surgeon does regular follow-ups and during one of these follow-ups it was suggested that since the animation deformity was still an issue and I felt I was losing upper body strength that repositioning the implants on top of the muscle and returning my muscles to my chest wall might be good idea.

    Every surgery has its risks. If nothing goes wrong I will be very glad for the opportunity to get my upper body strength back My post-op appointment is Monday.

    Cheers

  • aisling
    aisling Member Posts: 10

    I'd love to hear responses to this as well. Sending lots of good thoughts your way Yaniza!

  • avmom
    avmom Member Posts: 45

    thanks, Yaniza. I have animation as well, and my PS has raised the possibility of partially releasing the pectoral muscle from the sternum, in part to get the implants closer to the centreline of my chest, and I’m concerned about loss of function. I had both good range of motion and function before implant placement, but somewhat less so now. I look ok in clothes, though I see the upper pole as fuller than “normal”.

    I will look forward to hearing how your recovery progresses.

    Avmo

  • Goldfish4884
    Goldfish4884 Member Posts: 57

    I am switching from under the muscle to over the muscle in two weeks. I am wondering if going over the muscle also helps with the implants pushing out under the armpits. My PS says I should go with a little smaller implant from 700 to 605 or 650 and not as wide. He also said being under the muscle holds the implants down So by going with a smaller implant on top of the muscle I shouldn't notice any size difference. Anyone have experience with this and recovery time

  • veggal
    veggal Member Posts: 261

    I think you'll notice the size difference. 100 cc's is a lot!  I went up in size when I converted to pre-prec from subs. I also got a more narrow implant with maximum projection. And yes, it's easier to achieve less armpit boob with pre-pecs. The surgeon just has to reinforce the outer pocket. 

  • Yaniza
    Yaniza Member Posts: 83

    Hi,

    Although it is early days I already notice that the space between my breasts is more natural looking. My pec muscles were definitely pushing my breasts apart.

    The implants used in the revision from dual-plane subpectoral to prepectoral are exactly the same in my case... Mentor Smooth High Round.

  • Goldfish4884
    Goldfish4884 Member Posts: 57

    Thanks for the info. I am a bit confused about sizing. I am 5' 5", weigh 155, rib cage measures 36 inches. I have 700 cc implants and wear 36DD bras. Wouldn't mind going a little smaller to 36C or 36D, do you think going from under the muscle to over the muscle I should stay with 700cc. The PS said the over the muscle implants would look bigger which I sure don't want, my main complaint is the under the armpit rubbing and the animation of the muscle. Thanks

  • veggal
    veggal Member Posts: 261

    A lot depends on the width of your chest. My subs were too wide and my arms were always knocking into them. My new ones are a mere half a cm more narrow and all is well. I am 5' 11" and have 615 cc and am a 34 DD. 

  • Goldfish4884
    Goldfish4884 Member Posts: 57

    I am having the sub removed and replaced with pre pectoral in 2 weeks, was wondering if you were having trouble with the muscle animation or the under the arm rubbing or why you decided to have a redo. Did you noticed after releasing from under the muscle do they seem bigger or higher. I am contemplating going a little smaller to help with the under arm rubbing. Also, are your chest muscles healing OK, I heard the chest muscle contract or cramp up after taking the implants out. Thanks for any advice, just don't want to go thru this a third time

  • veggal
    veggal Member Posts: 261

    I had a re-do for many reasons:  1. I hated my anatomical implants from the second I woke up after surgery. 2. Implants were too wide and appeared  flat. 3.  I had asymmetry. 4.  I was concerned about the risk of ALCL with textured implants. 5. I was developing capsular contracture. 6. Animation deformity. 

    I was given Valium for any post surgical spasms, but I really didn't have many problems. The chest muscles healed very fast. 

    Hope this helps. 

  • Goldfish4884
    Goldfish4884 Member Posts: 57

    Thanks VegGal for your response. My under the muscle implants don't look much different than the tissue expanders did, flat and wide. Hope my over the muscle implants work better for me, hate the animation deformity. My PS doesn't use Alloderm, says it's a bigger risk for infection. He did say I have really good skin so doesn't think I will have a problem with rippling. It's all so nerve wracking, hope I'm making the right decisions.

  • veggal
    veggal Member Posts: 261

    That no use of Alloderm is a big red flag to me. I had it, plus Strattice and I still rippled like crazy with the subs. I mean, it was absolutely awful. Now with the pre-pecs I have no rippling at all, but have also had two rounds of fat grafting.  If I didn't have the Alloderm in the lower poles, I'm not sure the fat would have been enough to cover. 

    My .02 worth. 

  • hapa
    hapa Member Posts: 613

    Goldfish - I didn't have alloderm either, PS said we could rev with alloderm if the rippling is terrible but I had fat skin so she thought it would be ok, and yes there is a higher risk of infection since it can't be completely sterilized.

  • Goldfish4884
    Goldfish4884 Member Posts: 57

    Thanks for the replies. I don't have any rippling now with the sub pectoral implants so guess I will take my chances, sure don't want to get any infection. My PS says the muscle is holding the implants down so he thinks I should get a little smaller implant with the over the muscle implant, anyone else do that or did you just go with the same size, I do want to go with a narrower size so I don't have this under the arm rubbing. Any thoughts, thanks

  • veggal
    veggal Member Posts: 261

    Yay for fat skin!  Hope it works for you. I had thin-skinned, droopy menopause boobs. 

    I went slighter larger and more narrow when I revised. Much better, lots of projection. 

  • Yaniza
    Yaniza Member Posts: 83

    I definitely wanted my implants wrapped in ADM because of my thin skin and lack of fat so the slight increased risk of infection was worth it. I am on prophylactic oral antibiotics for the first 10 days.

    I just about never take antibiotics but in this case I'm taking them every 6 hours like clockwork and doing everything I can to rest and eat healthily. So far so good.


  • Goldfish4884
    Goldfish4884 Member Posts: 57

    I am having my under the muscle implants switched to over the muscle implants a week from Friday. I have met with my PS twice to discuss the muscle animation and that I feel the implants are too far out to my armpits. Now I hear that I need to have a lateral capsulorrhaphy. Has anyone had this revision done and is this standard procedurewhen you have a revision. Since my implants are under the muscle now, will I need whole new pockets, I didn't discuss this with the PS, should I call the office and make sure this is what he is planning to do or is this standard procedure. Thanks for any info.

  • Yaniza
    Yaniza Member Posts: 83

    Hi Goldfish,

    it's just a fancy way of saying they're going to use sutures or ADM or both to properly position your implants with a pocket that does the job. When he uses the adjective "lateral" he just means to change the position sideways not vertically. Does your plastic surgeon typically not use plain language?

    And yes, technically, I had that procedure when my implant position was changed from dual plane subpectoral to prepectoral 10 days ago.

    I just got the last 2 of my 4 drains removed this morning. It feels great and I am so looking forward to sleeping in a position that isn't just on my back propped up with pillows!!

    Good luck with your revision. I will be looking out for news of how you are doing.

    Cheers


  • Goldfish4884
    Goldfish4884 Member Posts: 57

    Hi Yanzia: Thanks for the info. My PS is an older guy, doesn't talk much, just kinda says "Oh you will be fine". I on the other hand want to know all the details to make sure he knows what and why. I am just nervous because I don't want to go thru with the surgery sub pectoral to pre pectoral and not be happy. I know I will get rid of the muscle animation but I also want to make sure The implants are closer together, not under my arms rubbing when I move my arms. I currently have 700 cc implants and I think I will go with 650 cc Natrelle Inspiration cohesive, the PS said if I go a little smaller it will help with the underarm problem. He also doesn't use Alloderm so I assume he will stitch the sides to hold the implants in place. So glad to hear you got your drains out and hope you get some good sleep tonight. Do you have to keep your arms at your sides still or are you able to drive and blow dry your hair. Take care

  • Yaniza
    Yaniza Member Posts: 83

    Hi Goldfish,

    two nights without drains has been restorative! I have driven some but I'm still wary of doing or lifting too much because I really want this to take... naturally.

    I have another appointment with my plastic surgeon on Wednesday. I have a few sore spots. I know that is to be expected but I will feel better when I point them out. Things are slowly looking better as time goes by. My dual plane was so good aesthetically that it's hard to make comparisons. Still wouldn't trade the animation deformity and the weakness for breasts that only looked good when I was totally and absolutely not using my chest muscles.

    I am washing and blow-drying my hair but carefully. I'm not making any fast stretching movements yet.

    I would never have consented to this procedure without ADM. My skin is in good shape but it is thin. Have you asked your surgeon how many of these revisions he has done? I'm going to guess that there are a lot more surgeons who have done straight up prepectoral than surgeons who have done revisions from dual-plane subpectoral. My surgeon had only done four revisions like mine.

    Yaniza

  • Goldfish4884
    Goldfish4884 Member Posts: 57

    Hi Hapa: I am having my surgery on Friday to switch the implants from under the muscle to over the muscle and you were one of the few that replied that you had over the muscle implants without Alloderm. Most people seem to have Alloderm and fat grafting butMy PS does not use Alloderm due to increased risk of infection and I am wondering how happy you are with your results. Have you noticed any rippling, how do they feel, do they seem too high. My PS said I have plenty of good skin to cover them but I would like to know how yours turned out. Do you notice any size difference with overs compared to unders. Thanks for your hep.

  • hapa
    hapa Member Posts: 613

    Goldfish - I didn't have revision, I went straight to prepec. I had my surgery about a week and a half ago and there's no ripples. You can see the upper poles a bit, moreso on the right which is still a bit swollen. The swelling in the left side seems to have gone down a bit. I don't see any ripples now but I'm told you don't really see them until all the swelling is gone, a couple months down the road. If both boobs look as good as my left side does right now, I think I'm good. But my PS told me to expect to need some fat grafting to get a good cosmetic result. We shall see. My PS also said my skin flaps were very thick and healthy, and that they just didn't think I needed the alloderm.

  • Goldfish4884
    Goldfish4884 Member Posts: 57

    Hi Hapa: Thanks for the info. Glad to hear you are happy with your surgery outcome so far. My surgery is this Friday so I think I just need to relax and trust my PS. He also said I have really good skin that should cover the implant. Did you have reinforcement on the sides so they don't go out towards the armpit

  • Yaniza
    Yaniza Member Posts: 83

    VegGal,

    I just went back and saw your first response to this thread of mine.

    Really excited to go back through the boards and see your posts.

    Not sure if it is true that this revision from sub to pre pectoral is as rare as it is seeming to me at the moment.

    Cheers, Yaniza

  • veggal
    veggal Member Posts: 261

    It's not terribly rare, IMO. I also think that more women will make the switch when the time for revisions come. 

    Take care. 

  • Yaniza
    Yaniza Member Posts: 83

    Went to the grocery store and did a bit too much lifting. Got one very restless painful night out of it.

    Anyway, things have stopped hurting. Must remember that this revision surgery is different in that reattaching the muscles to the chest wall is something you really don't want to disturb!!