Exchange City
Comments
-
Candy: Based on my research, I would suggest that you consider exchanging the Becker Spectrums out for silicone or saline implants. I would do it while you have cadillac care. I think that your complaint of how they feel is one which seems to be the most common reason for explantation of the device, by patients who are implanted with same after mastectomy. Here is the research article which might help you in your decision to exchange out the Becker Spectrum [Mentor] single stage implants. This was a study which followed women for a period longer than the 3 year U.S. studies...one of which I have linked as well. I think it is a case where this device has some advantages with certain patient profiles, but it is not a one-size fits all solution for all mastectomy patients.
http://www.springerlink.com/content/g148784024850335/
Deborah
0 -
Hi Rebecca-
Who did your pocket re-work? Need the same as I want to go smaller cause implants hurt.
Best,
Jessica
0 -
Hi Everybody, Just reading the posts about thin skin from not wearing a bra with TEs. My PS never said anything about this, other than that I should wear a good sports bra if exercising. In fact, when I complained that I couldn't find one that fit properly, the nurse said "so don't wear one". I haven't worn a bra since my 2nd expansion, only tank tops under eveything. Were you all told to wear a bra? I love this thread- I learn so much, but keep finding new things to worry about!
0 -
HI LEE45, If I remember from your earlier posts, I think you had your surgery at MSKCC? Me too, and I was told by my BS and by my PS that I did not need to ever wear a bra again. From the time I got out of my surgical bra (which was just holding gauze pads in place), about 5 or 6 days after my BMX, I have just worn camis and tank tops. I've got quite a collection now, as I had been assuming that this was it from here on out. My exchange is 6/17. I've tried wearing bras when exercising -- I actually fit exactly into my old 36D's, but they do not feel comfortable and sports bras feel way to compressive on my TE's. Maybe its a MSKCC thing! All of the talk here about bras has got me worried, though.
0 -
I was told by my first PS that I didn't have to wear a bra with the TEs. I didn't. Nothing fit right. After my exchange to 400cc textured implants, I was told again, I didn't have to wear a bra if I didn't want to. I did hear him tell a patient in the next room who had 700cc implants that she had to wear a bra all the time. My revision with PS2 to 550cc smooth implants came with instructions to wear a bra for at least one year until all the internal healing was done. Then I can go without once in a while if I want. But he told me the 550s are heavy and need support. I do think that the need to wear a bra or not has to do with the weight of the implant, whether the implant is textured or smooth, the integrity of the skin, if Alloderm was used and how and how long it's been since the exchange. I wear a bra 24/7 since out of my surgical bra 9 months ago. There are too many variables to risk having to need yet another surgery to put things back into place.
0 -
All great questions, my postop exchange instructions state wear bra 24/7 x 3 weeks, but it does not state surgical bra. This is where I need help, how long should it be the surgical bra since this provides so much support, infact it really smashes you down as least in my case. I have my 1 week post op visit Wednesday but am curious about experiences and any advice here. Wow, I am amazed at how little I was prepared prior to this surgery. But then again, I don't believe I was told much about the TE experience either. Anna
0 -
I did not wear a bra with my TEs either. Some plastic surgeons have their patients wearing a compression bra or some type of bra after MX/TE insertion, and some do not. Mine did not. I was discharged home from the hospital with only bandaids covering my incision site.
However, I think that having some type of support might be helpful/required if you have TEs which have dropped in the pocket due to the skin stretching rapidly [and this would typically occur with TEs filled at the higher volumes - 500 ccs and above]; if the TEs are too close together due to the pocket being over-dissected at the sternum; if the TEs have migrated towards the armpits to the extent that the thin tissues of the skin are being unduly stretched. The bra would be chosen according to the particular "defect" or migration issue of the TEs.
Delilahbear's post was referable to wearing support after the exchange.
0 -
Might I add that I should have worn some type of support three months prior to the exchange. My skin stretches very easily and at some point, my TEs began to drop due to the weight of the TEs and it was around that time that I saw the step-off deformity occuring. Wearing some type of support might have prevented the defect from becoming so significant. I will never know. Two fat graft transfer procedures have corrected the defect somewhat, but it still persists.
I agree with everything Firni said above regarding implant support!!
0 -
I too had my initial surgery at MSK, and the doctor's opinion was that I did not have to wear a bra if I did not want to. But his PA and the female physical therapists at MSK were of the opinion that given the weight of the implant and the size of my frame that support was a good idea if for nothing other than good posture and avoiding muscle strain on my neck and upper back. Some of the doctors seem to say you don't need to wear a bra because your breasts are not saggy, but they don't really go to the next level of should you wear a bra. Once I have clearance to, I will go back to wearing one, I would like to see the girls remain in their present location, gravity is gravity and at the end of the day there is only so much our pecs and skin can support without an eventual downward migration.
0 -
I'm reading about the various opinions regarding doctors and bras. My head is spinning. I've been in a bra 24/7 since BMX from Deborah's recommendation and the nurses at the PS office. Although when I complained after BMX to one nurse how every bra was painful, She tried to be nice and supportive and told me I didn't need to get stressed and I could wear a tank with a shelf bra. I tried but that didn't offer the support I needed. I was still droopy post op and needed support. It felt like I had a waterbed squsing around in my chest. The drains came out, I went to Nordstroms, got fitted and "invested" in my first non underwire bra since puberty!!! I found Waacol Awareness to be perfect. I am having a lollipop lift along with my exchange on thursday. I was told by the nurses to wear the surgical bra for 24 hours post op- to take it off and put on a cotton sports bra. The nurse said it is too much compression to wear for more than 24 hours. If the Waacol fits (its unwired and snug) I will wear that since the cotton bras I have do have seams that run under the breast and that's where I'll have some new incisions.
I may also just ask the PS about the bras function post op- what are his support goals for me- what needs to be supported and how much support- I plan to wear one again 24/7- except for showering and other more intimate moments.
0 -
Hi everyone, My final fills were in Jan. prior to rads on the affected side. Total of 600cc on each side, filled 100cc's every week without a break I told my PS that I did not want to be as big as I was 36D but he insisted because radiation may shrink the skin. He told me I would never have to ware a bra and to leave them alone, no massage or manipulation. So I had not worn a bra for a year now.Originally I had a lumpectomy which later turned into a BMX. I tried to put on one of my bras but because of the placement and shape of the TE it didn't fit;Why bother there was no moving theese hard balls. I thought it might releave some of the pain I was feeling from carrying around all the extra weight.
.The only thing he told me about the TE is that they were shapped like a sideways football. My concerns are that they were looking and feeling like I have half my TE undermy arms. I think maybe from having 22 lymph nodes removed may be why the TE migrated to the armpit.Just don't know, Just want it to turn out right I miss my girls.
After spending the weekend in bed crying and feeling like I was going to have my final out come look like this I had a devine intrevention.
While sitting in my infussion I met a woman who had BMX with TE the day after mine. She was wearing a low cut top and looked absolutley beautiful. I got the name of her PS and went to her.
At my apt. she said that he put them to far apart and too low and that I needed to start pushing them together and get a bra. Wow! So that's what I'm doing. My skin seems to be stretching pretty good but, that right side looks small and way low. I hope today to post my pics on the forum. I'm really anxious to have oppinions when you can see what I'm talking about.
The bra fitter at Norstrums had me in the right bra in 10 minutes. Don't have a man in my life to help with the manual manipulation. Darn.
Everyone here has been very informative and supportive. Hopefully I'm helping someone here as I have been helped. Thanks Sisters
0 -
Hey ladies,
It's raining here in Oregon and I"m still in my jammies, having a second cup of coffee before getting myself together and making myself somewhat useful.
Hi KristinPink -- I'd suggest that you see your PS and see what he says about CC. At 3 months, there may be some things you haven't tried that will soften up the implant.
I had CC after my initial exchange last April, but I also had radiation before the exchange and that has a lot to do with what happened in my situation. When my implant started to get firm and immovable, the BS and PS prescribed 800 IU of Vitamin E, along with Trental (a prescription drug) plus manual massage every day for 6 months. The Trental made me sick, but I took the Vitamin E and did the massage every day for a few months, until it became obvious that it was not working. The implant was slowly getting larger from the formation of scar tissue around it and it continued to get more firm and more uncomfortable. By November it was diagnosed as a Baker III CC and the PS removed/replaced the implant with a smaller one in early December. Now, nearly 6 months later, this new implant seems to be doing the same thing so I'll be seeing the PS soon for his opinion.
On a different topic, has anyone out there found a cami with a built in bra that works well? I'm having problems with sensitive skin because of all the additional moisture from hot flashes and need to wear less clothes and still look somewhat balanced. A bra is necessary, but OH SO UNCOMFORTABLE!
Have a great day!
0 -
Thank you, Bonnie, for your input. I appreciate you responding to my question! I did not have rads but did have a CC in that same breast with the TEs.
I hope you do not end up needing more surgery!
Kristen
0 -
You're welcome, Kristen. I hope neither of us has to have more surgery! --bonnie
0 -
Happy Memorial Day Ladies.
Scrapmom, Waldo, Susiered I will say a prayer for your surgeries this week. Good luck and best wishes.
Rebecca
0 -
Katey - Just watched the video - very interesting as were the questions - thanks for posting!
0 -
This may be a little off topic but did anyone, who has had SNB, insist on precautions during exchange surgery to prevent lymphedema? Just wondering if you insisted on leg BP, i.v. and blood draws. My BS said I didn't have to take precautions with SNB but research seems to say otherwise. I'm going to bring it up during my pre-op appointment with my PS but just wondered what everyone else's experience was.
0 -
I'm already a day behind in reading posts....
Jizogarden- happy you are seeing positive changes now!. Mine do feel better with each day, but still concerned about the tightness and pulling at the underarm ligament--especially the right side. Whippletmom seems to think it may be the type of pec placement. I'll ask PS next week. Your comments regarding implant size and TE size being equal makes sense. I know I have to be patient and allow time to do it's thing.
Kristinka- it's great that you don't have that tight bra feeling much anymore. There is a light at the end of the tunnel!
Katey- thanks for the massage recommendation. I will ask PS next week if I can start.
Whippletmon- you mentioned your sister had complete sub-muscular and has firmness. Is she happy with that outcome? Will the implants ever get soft and squishy with a complete sub-muscular placement?
0 -
Kate33- I had bilateral SNB. My bilateral MX and my implant exchange surgery was performed at a hospital totally devoted to cancer treatment. They always did BP on my leg. At exchange surgery, the anesthesia was initally given via my port(which was removed during surgery) and the IV was inserted in my ankle. Even with SNB, it's important to always avoid the arms. You never want to put yourself at an increased risk for lymphadema. Never, never, never.....
0 -
Kate33:
I had left SNB and had some cording issues afterwards, which took a few months of PT to resolve. Since then I have them take precations all the time, all blood work, BP etc always on the right. This was followed during my two subsequent surgeries and hospital stays. The cording was so painful, I'd rather have a nurse roll her eyes than risk having full blown LD. If I had no problems following the SNB, I'd probably not go through the recautions because it really is painful having everything run through the same arm when you have a hep lock replaced a bunch of times, they start to run out of spots.
0 -
DelrayBeach and Bigapple09- Thanks for the input. I had SNB on both sides during my BMX according to my BS. Yet no precautions were taken during my second surgery when they placed the TE. No one even discussed this issue with me. My PS kind of rolls her eyes when I bring up things I've learned on here but maybe if doctors would keep us more informed we wouldn't need to do our own research! Thanks again! I will definitely bring this up at my next appointment.
0 -
I think I'll dub this the Great Bra Debate of 2010
, but unfortunately I don't think anyone's ever going to be declared a winner until some PS's do a full-scale clinical study of bra vs no bra on a lot of women of different sizes etc and that's just not likely to happen. C'est la vie. For me, despite my PS telling me I could now go braless last week, I've been wearing one most of every day/night and unfortunately at this point I think it's actually a problem - it appears my implant has moved up a quarter to half an inch. I'm taking the bra off and hoping it settles back down. Gravity - do your work!To the discussion about implant placement, that's something I got interested in early on and finally concluded there are simply a lot of ways to reconstruct a breast and what is done is very PS-dependent. Right at the start the 2 PSs I consulted, who work in the same clinic dept, described quite different methods they'd use for my recon. Both were 2-step: TE at time of MX, xchg to implant later. But the first said he'd partially release the outer lower pec attachments from the rib and add alloderm to the edge of the pec and reconnect it to the rib, and place the implant under the pec and the alloderm. He didn't explain what he'd have done with the TE; I assumed it would have been the same. The 2nd PS said he wouldn't use any alloderm nor would he release the edge of the muscle from the ribs, rather he'd use the TE only to create the space needed for the implant. I didn't know enough at the time to ask about fully or partly submuscular placement. For mostly other reasons, I went with the 2nd PS.
So here's the interesting part, which I only learned about 80% through the process. The PS placed my TE fully submuscular - under the pec and the serratus and whatever other muscles are in the lower part of the breast so that the muscle could support the healing of the overlying skin just after MX. In my exchange, in order to move the implant down about an inch, he changed the lower part of the pocket, separating the muscle from skin and putting the implant only partly submuscular (under the pec on top, but between the serratus etc & skin on bottom). No alloderm. That lower skin has some extra healing and stretching to do since it wasn't stretched by the TE. So far it looks healthy (2 wks out).
The bad thing IMO is that we pick a PS and are already in TEs before we know how to ask exactly what they're doing, when it's too late to do much about it if we have issues with it. The good thing is that a lot of the methods seem to work similarly well so it probably doesn't matter that much for most of us. I suspect it matters more for rads or otherwise damaged tissues.
A good Memorial Day to everyone, with thanks to all who've served and fallen for our country! CS
0 -
BonnieK - Sports bra at JCPenny is cotton and zips up the front. Very comfortable. I read about it on a thread. I can't say enough good about them. Also, they are only $15 a piece. I sleep in them also.
0 -
What is a lollipop Lift?
Is it done by the Lollipop Guild? JK
Really do want to know what a lollipop lift is since I will probably need another lift. I am supporting as much as I can with underwire bras and underwire bra covered by the Chic Shaper at night to prevent any side sloppiness.
0 -
Kate33 I had SNB on both sides and had 7 surgeries after that within the year. Not only did they always use my arms for BP, IVs and blood draws but they almost always have to try several times to get an IV in or a blood draw. One time it was 5 sticks before they got the blood draw. For my Davinci Robotic Hysty/Ooph they wanted 2 working IVs...so 1 in each arm...but the nurses upstairs after several sticks put in the wrong size so 2 more had to be put in in the surgical waiting room and they left the 3rd in as a back up.
The only time I have had a BP check on my wrist was at the oncologist's office and the nurse put the cuff on backwards...when I remarked that oh no I have been putting my cuff on incorrectly at home...it turned out that I was doing it right and the oncologist's nurse was doing it wrong. But people here have already heard the worse stories on that oncologist !!!:(
After all these sticks and surgeries....can someone tell me if I might as well let them continue since I have no signs of lymphadema yet.....OR is it still important to change to ankle???
Thank you!
0 -
Oh....Luna....you are too funny!!! I have been snickering for the past fifteen minutes
0 -
Luna, lollipop guild...funny! Lollipop lift involves a vertical incision from imf to outer edge of areola, then around the areola.
Edited: Okay, I'm dense Luna, haha!
I have 26 missing nodes on right side and a bit of LE, left side has 3 missing nodes, after MX blood pressure was taken on leg several times but was off the charts, I'm usually very low, went to the BS he took it in my left arm and it was the usual 90/60. He said I didn't have to worry about arm, at exchange surgery. The anesthesiologists would only do iv in foot (was relieved about that). When I sit and raise my right arm up on the edge of a chair, I can feel the lymphatic fluid slowly moving down, when I do that with my left arm, I feel nothing different, therefore I know I don't have a problem yet, but will be a bit careful. Meaning bacitracin on any cuts, careful lifting heavy objects, if arm ever gets sore to hold it up resting on pillow or chair arm for 20 minutes. I'm not worrying at this point about blood pressure or draws on left arm, if there's a hint of the heaviness feeling I'll stop.
CS7777, that was really interesting! I know I was told all that, but you explained it so well! Thanks!
0 -
whippetmom: Thank you for the links to the articles on the one stage TE/expander -- very helpful. Your knowledge & willingness to share it is a blessing.
0 -
CANDY: Oh my gosh....I posted again right after my post to you with the resource links - and it never showed up! I just now looked! The link I included did not work....so I pasted the entire study for you. Here it is again...
Summary
Despite being more expensive than conventional tissue expanders, Becker expanders offer the advantage of single stage breast reconstruction. However, the large series in published literature which report good outcomes of Becker expanders in breast reconstruction have a mean follow up period of less than three years. This does not allow for definitive conclusions as to whether the Becker expander truly meets its design goal of a lasting single stage breast reconstruction.
This study is a retrospective case note review of all patients who underwent breast reconstruction using a Becker expander at our unit from 1993 to 1998, with a mean follow up of 12.5 years. Sixty-eight Becker-only breast reconstructions were carried out following oncological and risk-reducing mastectomies, and for congenital hypoplasias.
There was a high premature overall explantation rate with 68% of expanders removed by 5 years due to complications which included poor aesthetics, capsular contracture and infection. The mean time to explantation for these patients was only 23 months, and time to 50% overall expander removal (‘half life') was just 30 months. On subgroup analysis, patients in the congenital hypoplasias group had a significantly better rate of expander retention with 67% remaining in situ at 10 years. In comparison, patients in the oncological and risk-reducing mastectomy groups had implant retention rates of 2% and 7% respectively.
The Becker expander does not appear to meet its design purpose of lasting single stage breast reconstruction in post-mastectomy cases. In contrast, it appears to have significantly better longevity when used for congenital hypoplasias.
0 -
Luna: The Lollipop Guild! Too funny.
0
