Revision from subpectoral to prepectoral.
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Bird-o-Light, I hope this answers some questions. I will update my progress tomorrow.
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Thanks. I’d love to hear if you are pleased with the results.0
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Bird-of-Light,
I'm glad that I did the revision to prepec. I have no animation deformity and my breasts seem a bit lower which is more naturel. Another unexpected plus is they bounce a bit... not that anyone else would notice. (That just feels more natural.)
I can shave my underarms now. For some reason that was harder with my chest muscles interfered with. The shape of my breasts is softening as the alloderm is stretching a little. I guess, because it comes in flat sheets, there is a slight flatness to certain areas... that is diminishing slowly. My plastic surgeon showed me a photograph of my implants wrapped in alloderm before he inserted them into place. Imagine wrapping a round gift with a flat piece of paper! I do have a few bumps that are showing through the skin near the top of my breast toward the center. These are the knots from, as yet, undissolved sutures. Apparently they can take quite a while to dissolve.
As I've said before my dual-plane subpectoral reconstruction was excellent and in several situations... once while getting a bra fitted and twice when my plastic surgeon had residents with him to show off his handiwork my dual-plane subpectoral reconstruction was mistaken for an augmentation. UNTIL I FLEXED!!!! Then it was a freak show.
Going for pre-pec right out of the gate has got to be easier than the revision surgery, which is more complicated because your skin has healed against your pectoral muscles and then must be separated for the revision. So I would caution anyone doing this revision to be very careful with themselves and do everything that they can to avoid infection and be very gentle with their upper bodies for a couple of months anyway.
And although I have the same size implants they do seem a bit larger in the prepectoral position and other people have had the same experience so I'm guessing that's a thing to expect or to take into consideration and make allowances for.
Long day... going to crash early. Cheers.
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Hi, so glad I found this topic. I went direct to implant after mastectomy and wasn't aware of pre or sub pectoral. The outcome looks good, no odd animation, but I'm not getting used to all the muscle movement that comes with sub-pectoral as I go about my day. It just feels weird though not visible. It is great to know that there is an option to change to pre-pectoral! I'll give it another year and see how it goes. Just recovering from radiation now and starting hormonal therapy. Need a break from pains...
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Yaniza, thank you for your posting about this topic. I’m seriously considering the switch, and knowing how your surgery has gone is very helpful. Are you now wearing supportive bras? And will that continue? One of the few benefits I have experienced with sub pec expanders is that they do. not. move. so no external support is needed, and backless and strapless clothes are now a real option.
On the other hand, while the girls look ok in clothing, I do have some animation when I flex, and the constant “iron bra” sensation.
But ... prepectoral implants obscure the chest wall for recurrence monitoring, so there isn’t an obvious best choice. I plan to talk to my MO about maybe doing an MRI on a schedule for that purpose. She did say that it would be a significant milestone if I make it to next June (4 years post treatment) without local recurrence, so maybe with MRI, that’s more of an option. Otherwise, I may just go flat - I had better function and less discomfort before I put all this volume under my pectoral muscles.
Thanks again for your updates.
Avmom
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Hi All,
I started the Prepectoral Implant Reconstruction thread specifically because I converted from subpectoral to Prepectoral. Several women on the thread also converted from subpectoral to Prepectoral.
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Topic: TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!
Forum: Breast Reconstruction — Is it right for you? Discuss timing and various procedures and techniques.
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Macb04,
I started this thread so that I could get feedback from people who have been through actual revision surgery, thereby making this information more easily accessible. I've read extensively about prepectoral reconstruction but revisions to prepectoral are quite different and it's harder to get specific information
Unfortunately, when people talk about "exchange" surgeries I think there is some confusion. This is definitely about revision surgery where you've already healed from subpectoral or dual plane subpectoral and the next step would be a more complicated surgery, if one were to feel the need to change.
I'm not promoting prepectoral over subpectoral although I obviously thought it was the best choice for me.
It's definitely a different experience.
Palesa,
waiting a year sounds like a good plan. There will be more surgeons experienced in revision to prepectoral as time goes by and you are still in early days. I did find as time went by,(with my dual plane subpectoral recon) that although my breasts still looked good, (when I was not flexing), the space between my breasts increased slightly. I think this was the muscles over the implants pushing them towards my armpits.
Avmom,
I've always wondered why it isn't mentioned that in the dual plane subpectoral position only a small portion of the implant is under the muscle therefore there it is only a small advantage, (if it is an advantage) to viewing the chest wall. I have an appointment on the 29 with my surgeon. I will straight up ask him to explain that one!
At the moment I can't speak definitively to how much support I am going to need after I heal completely but things seem pretty much as secure as they did before. This is probably a feature of the alloderm being sutured and healing into place. I'm getting to be quite an expert at modifying bras. Ever since I started this process... from all under the muscle, to dual plane subpectoral, to prepectoral... I have been working on bras that support without having their own built in shape. The problem with the molded cups seems to be that they are never quite in agreement with my reconstructed breasts.
I also hope to occasionally go without a bra in the summer as I was able to before the revision.My implants are 325 ccs, so not heavy. Smaller naturally helps allow for going without support.
Cheers, Yaniza
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Thank you for taking the time to post this information. Can you explain what dual-plane means? Did your muscles get reattached
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So glad I found this thread.
My short story is original BMX 6/17 with subpec tissue expanders. Exchange to subpec round gummies 9/17. Those flipped front to back, not upside down, so that what should have been the front of my implants faced my chest wall. My right implant also displaced laterally. My pockets were revised 11/17. My implants, still subpec continued to flip. In July of this year, a new surgeon revised the pockets yet again and changed the implants, but left them subpec. That surgery did not work either. My left implant continues to flip, my right implant flipped, the reinforced area on the right did not hold and the implant moved back to being to lateral.
I have found a new surgeon (in Florida - I am in Colorado) who has successfully repaired the flipping implant issues for two other women. Both had prepec implants to begin with. Although I would love the added benefit of getting rid of the animation deformity and the tight, unnatural feeling, the only reason I plan to have another revision is my need to have implants that don't flip backwards and stay where they are supposed to. His plan is to wrap them in alloderm, move them prepec, use drains again, and fat grafting down the road for any rippling. Can any of you who have had or have plans to move your implants sub to pre please answer some questions for me ASAP?
-was your ADM/alloderm wrapped around the implant bf placement or was it stitched together, placed in the new prepec pocket and then the implant placed in that area?
-I have heard reattaching the pec to the chest wall can be quite painful. Was your sx done inpatient or outpatient and how did it compare to your original mastectomy and subpec te placement as far as the discomfort?
-did your surgeon use gummies or saline? Do you know if the implants were more or less cohesive?
-how long were your drains in?
-any other suggestions for what worked or didn't work for you, as well as any questions you can suggest I ask my surgeon.
Thank you all so much!!
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Hi Yaniza,
I know of several women who have had revision from Subpectoral to Prepectoral Implant Reconstruction, including myself. They have posted on the Prepectoral thread.
I don't know if there is much in the way of research about the revision process, but it would be a good topic of study.
Discouraged- I had things done in stages. First the Subpectoral TE was removed. Then did Fat Grafting multiple only slightly sucessful procedures. When the PS took out the TE he didn't stitch my Pectoral into place, said he just placed it into the right position and left it. I later decided to get a Prepectoral Implant with Seri Silk Mesh ADM from a different PS. My pectoral healed about 95 plus percent of what it was before all these surgeries began. I am back up to strength and can work out without problems.
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Just had a consultation with a Stanford plastic surgeon last week. He thinks I'm a good candidate for revision to pre pec at the time of my exchange surgery next month. He uses alloderm and will place four drains. The revision surgery is not as simple as just replacing TEs with implants, but I can't wait to get rid of these sub pec TEs. The frequent muscle spasms are not fun. Wish me luck!
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Bcbc, wishing you the very best luck. Please baby yourself.
You are right about this being a more complex surgery, there is a lot going on. For instance, I didn't realize that my surgeon anchored the alloderm so that there are sutures above the nipple halfway to my center line.
At about "2 o'clock", on my right breast there is a suture that is refusing to disolve so my ps will make a small incision to remove it this Thursday. Just a local anesthetic so not a big deal, but weird... never could have imagined it.
The main thing is give all the surgical adjustments, that are required for this revision, time to heal.
Cheers, Yaniza
Macb04,
It's good to know your muscle function is so good. I'm still going to be careful but shoveling snow is in my future. I look forward to not having that weird, tight, cramping sensation.
Yaniza
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Hello Discouraged,
My implants are high smooth round mentor (325 cc), saw my surgeon on the 29th and reviewed the photos from my surgery... just a couple of the implants wrapped in alloderm before placement. I woke up with 4 drains, two were removed after one week and the remaining two at 10 days. My revision surgery was on the 21st of August.
He did reattach my pectoral muscles to my chest wall. That probably did add to the discomfort but at a bit over 2 months out there are only occasional twinges.
The alloderm was anchored in a few places. I am going back Thursday to get a stubborn suture removed that hasn't dissolved.
Things continue to improve and I'm certainly glad I had the revision. It is a more complicated surgery so you have to look after yourself very well while you heal.
Yaniza
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Thanks, Yaniza. I'm two days post op from revision to pre pec. Uncomfortable, but very tolerable. My plastic surgeon told me pre op that he would carefully evaluate my skin flap as he was operating, but there was a chance that I would need TEs again for the pre pec placement. I told him I would rather be flat that have TEs again. He said he understood so would not put in TEs. He assured me that I would not be flat, but might be smaller. I was fine with that. I awoke from surgery with 500cc round gel implants. (TEs were 540cc) I think they're perfect already. 😍 Now to get rid of the four drains! So nice to finally be on the squishy side.
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I am 1 week post op, revision from sub pectoral to pre pectoral implants. Was wondering if some tightness this early on is normal.I had the revision surgery due to the uncomfortable tightness with the implants placed under the muscle. Should I be concerned, even lifting my arms is difficult because it is also tight.
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I appreciate this thread and I am reading it with interest. I am having major challenges swimming and doing any kind of movement rotating with my shoulder. I am even debating just going flat because of the pain caused by my subpectoral implants.
the challenge is I have quite a wide chest so its a very large implant that is in there. Unfortunately I still can not even fill a B cup and use custom prosthetics for the top pull area. I have no volume in my upper poles and did not like the experience of fat grafting. I did one procedure with that and it was enough. I am hoping they will improve the technology so that the alloderm is premolded to the shape of the implant then it should be much smoother underneath the skin. I have a consult with a PS next month to do something different so please update ladies and share your experience. I am even thinking of switching to a DIEP because my implants have severely limited my mobility. I already have neuropathy from chemo and the right implant is pressing on my brachia causing further numbness and limiting my arm rotation.
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Hi Jackson1,
I had swelling after my revision surgery, which is obviously normal. The alloderm does stretch a little and when the swelling goes down that will relieve some tightness too. All that being said I actually do have some tightness that will have to be relieved on my right side. I'm going to have some work done to adjust the size of pocket. My young plastic surgeon is relatively new to prepectoral but I trust him totally to get it perfect in the end.
Are you relatively satisfied with your appearance after the revision?
Yaniza
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Hi Exercise Guru,
Even before my surgery I fantasized about alloderm that could be shaped to fit implants instead of snipped and folded around implants. It's great to know someone's thinking the same thing. Perhaps it won't be that long before that very sensible option is available!
If you're very athletic prepectoral might very well be a better option for you. I was at one time so I still had a lot of muscle memory in my chest that caused quite severe animation deformity. I have to admit though, that when I was not flexed my subpectoral reconstruction looked quite natural. I did notice that as time went on and I became more active my muscles were pushing my implants further apart.
I hope more people share their experiences with this very specific type of surgery. I feel like I'm repeating myself.
Yaniza
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I went from sub pec TEs to pre pec implants 8 weeks ago. Very pleased with the outcome. Nice shape. No rippling, no indications for far grafting. No more muscle spasms. I think that if the implants are below the pectoralis muscles, you have less upper pole fullness.
Surgery was more complex than it would have been if I had just switched to sub pec implants, but it was still in and out.
I'm now 8 months out from my bilateral mastectomy and finally am comfortable again. This is in large part due to the fact that I have my neuropathy under control with the right drugs, but also because these implants are not causing more pain by being under the muscles.
I'm really glad I researched this and found this plastic surgeon that could do this type of exchange for me.
I would recommend doing the research to find an experienced surgeon that does both pre pec and flap surgeries to get a second opinion.
Best of luck to you, exercise guru.
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hi Yaniza,
I am very happy with the new appearance since my original surgery was completely under the muscle. The implants looked like mounds stuck on my chest and they were quite close together. Now with the revision they look and feel much better. I’m happy to hear that the tightness is typical. It just worried me as I went through the revision because of the extreme tightness I felt when they were under the muscle.
Thank
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hi yaniza and jackson1,
I am just one week post op with a revision from sub pec to pre pec. I had my original implants in for 8 years. I had learned to live with the tightness and uncomfortable feeling and had full range of motion, but always hated the way they felt and when I heard about the possibility of relieving these feelings by going pre pec, I was very excited to have this operation. I just got my drains removed yesterday by a nurse and won't see my doctor for another two weeks. I was not really given any expectations by my doctor to expect muscle soreness, tightness and restriction after surgery, I was only told not to lift more than 5 lbs for 4-6 weeks. I know it's early but I am feeling very concerned that my pecs are not going to be normal (without tightness, pre mastectomy normal). My range of motion is limited and the pecs seem to spas and tighten and then are in pain for a while if I try to stretch my arm motion beyond its current range. My questions: How long did it take for your muscles to heal and feel normal? Did you have range of motion limitation after surgery and if so, has it been resolved and how? PT? you mentioned that you will need to have tightness "relieved"? what do you mean by that, How is that done? BTW, my PS is very renowned and highly experienced in all types of reconstruction. Maybe I am jumping the gun and just need to give it time but I was told that this operation was going to be a gamechanger and not much told about the recovery. Thank you for any input.
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hi, very quick reply.... on my way to work.
The tightness is due to the pocket on the right being too tight. So tight that it has caused a fold in the implant. I have read on bc.org that I'm not the only one this has happened to.
Surgery scheduled for tuesday 5th... next week! He is also doing fat grafting. Nervous making since i haven't had any before.
Be careful.your reattached muscles are fragile. My muscles are back to normal but hurt for quite awhile.
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Donna, my pecs still hurt several weeks after surgery. It's not surprising that you are still having muscle symptoms. Creating a new pocket for the pre pec implant, plus tacking the muscles back down where they belong means the pecs are going to take more time to heal.
I'm 2+ months out now and I have no muscle pain. Full strength. Full range of motion. I'm very glad I had the revision to pre pec.
Part of my pre op pain was related to the muscle spasms, but a good deal of it was neuropathy.(Post Mastectomy Pain Syndrome)
I didn't expect this surgery to affect that and It didn't, but I'm now on a good dose of lyrica so I'm nearly pain free. 👍
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Thanks for the replies. It's helps to know my experience is normal! Good luck with the fat grafting Yaniza!
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Hello ladies! I have a sub pec implant to and on March 7th i am having a revision surgery and going from sub pec to pre pec. I have done several surgeries and my result are not good. I have the deformity and by the time it shows more even when i don't do anything. I hope the pre pec is going to look better because i am not planning doing other surgeries. I don't have any pain with my sub pec implants but i hate the way how it looks.
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Hi all, I am thinking about having this done. I am curious about sizing. For those of you who went from sub-pec to pre-pec, were your new implants the same size?
I guess I want to know if the same sized implants pre-pec would look larger or smaller than if they were sub-pec. Also, I know that I currently have some alloderm in my current sub-pec reconstruction. Would the PS remove it and use new alloderm when doing the revision?
thanks
jojo
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Joy2, I think the primary reasons most women revise to pre pec is to eliminate the animation deformity and the muscle spasms that occur with sub pec placement. I went from sub pec tissue expanders to pre pec implants. I'm very happy with the results.
JoJo, I had 540cc TEs , went to 455cc implants. It's hard to compare since these look so much more naturaL, but I think they look about the same size. Best of luck to both of you!
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In my case the 325 high profile smooth mentor implants seemed slightly larger in the pre pec position. The ps said this would happen but it isn't a "big" problem. They are also lower, which seems more natural. There are ripples for sure. The implants being wrapped in alloderm at the time of the revision surgery must have helped some. I do think that the fat grafting I just had along with the pocket revision on the tight, right side will need more of something in the future unless I op for bras night and day for the rest of my lfe. Right now it's too early to say for sure.
This morning I am trying to remember that at least my muscles are functioning properly. And that the animation deformity was spectacularly ugly when I flexed, before revision.
I may feel and look very different when things settle down from these last procedures... 5 days ago.
Cheers, Yaniza
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I will be having my revision surgery in 10 days. I am mostly having it because I have capsular contracture on my left side, and I can feel it starting on my right. My biggest worry right now is that it will happen again with the new implants. My ps says the chances are the lowest they have ever been with the pre-pectoral placement, and the next generation of implants, but I am still a little worried.
I am looking forward to having my pecs back where they belong, and I hope it will feel better.
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I am curious if any of you who have changed from sub to pre pec have previously had radiation?
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