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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.

Posted on: Oct 20, 2015 12:47AM - edited Jul 15, 2020 12:44AM by macb04

macb04 wrote:

I want to put this out there as an option for implant reconstruction. Initially I had uni mx and delayed reconstruction with a TE put under my pectoral muscle. Hated, just hated it. Was painful and crampy for all the muscles of my chest. No strength because my pectoral muscle was cut. So bad I couldn't open a bag of chips. Was slowly inflated, while waiting to do DIEP. Changed my mind and did fat grafting 3 times with an inexperienced PS who took out my TE. Had infections twice and lost a lot of my grafted fat. Got a new , better, forward thinking PS who agreed to putting a new tissue expander OVER my pectoral muscle, with no cutting of my muscle whatsoever. In August 2015 I did implant exchange, to a 420cc Mentor Anatomic Implant. Then had breast lift of right side for symmetry in September 2015, about 4 weeks ago.. Plan nipple reconstruction this December, with areola tattooing in late spring with Vinnie Myers.

Looks pretty good, have a very realistic, custom made prosthetic nipple that I wear every day until I get the reconstruction done. Made by Feeling WholeAgain.com. Really nice guy named Paul created it for me. Used to be called Custom DSE.

Using Embrace Scar therapy system for the next 8 weeks on the vertical lift/breast lift incision. Hope it will minimize my scar. I will update how that goes.

Important point, had 5 weeks rads, had rad fibrosis. Got Hyperbaric Oxygen therapy in conjunction with fat grafting which healed my skin almost back to normal. Despite these setbacks I was still sucessful at Implant reconstruction. Realize is still early days. Plan to keep taking Pentoxifylline and vit E for a long while yet to prevent capsular contracture. Not perfect, but enough to make me feel nearly whole. Plan to go back to my gym and change in the locker room like a normal woman again, instead of hiding and changing in the toilet.

UPDATE : List of Plastic Surgeons doing OVER Pectoral Implant Reconstruction , ( Prepectoral Implant Reconstruction )

WEST COAST

Dr. Hakim Said - UW Medical Center, Seattle, WA

Dr. Jonathan Hutter -Valley Hospital, Renton, WA

Dr. Mark Tseng - Multicare, Auburn, WA

Dr Reid Mueller - OSHU, Portland, OR

Dr. Lisa Cassileth - Beverly Hills, CA

Dr. Leif Rogers - Beverly Hills, CA

Dr Kamakshi Zeidler - Campbell, CA

Dr. Michael Halls--La Jolla, CA

Dr Elizabeth Kim - Los Angeles, CA

Dr. Charlotta Lavia - Los Angeles, CA

Dr. Charles Tseng - UCLA , CA

Dr. Mark Gaon - Newport Beach, CA

Dr. Sara Yegiyants - Santa Barbara, CA

Dr. John G. Apostoledes - San Diego, CA 619-222-3339

Dr. Jyoti Arya - San Diego, CA

Dr Karen Horton--San Francisco, CA

Dr Anne Peled, MD - San Francisco, CA

Dr Arash Momeni - Stanford, CA Has done >100 prepecs/Only does Prepectoral now

MIDWEST/CENTRAL/MOUNTAIN

Dr. Julie Park - University of Chicago Medicine, Il

Dr. Sandeep Jejurikar - Downers Grove & Batavia, IL , Advocate Good Samaritan Hospital

Dr. William Dougherty - Taos, NM

Dr. Minh-Doan T. Nguyen, MD, Ph.D - Mayo Clinic, Rochester,MN

Dr Steven R Jacobson - Mayo Clinic, Rochester MN

Dr. Bruce Chau- Berkley, MI

Dr. Marissa Tenenbaum - St Louis, MO

Dr. Terry Myckatyn - St. Louis, MO

Dr William Stefani - Renaissance Plastic Surgery, Troy, Michigan

Dr. Richard Hainer - North Oakland Plastic Surgery, Rochester, MI

Dr Ryan Gobble - UC in Cincinnati, OH

Dr. Neil Kundu - Jewish Hospital, Cincinnati, OH

Dr. Timothy Schaefer - Edina, MN

Dr. Oscar Masters - Oklahoma City, OK

Dr Tiwari & Dr Kocak - Columbus Ohio. mwbreast.com

Dr Michael Bateman - Denver, CO

Dr. Hardy -Northwest Plastic Surgery Associates, Missoula MT.

Dr Jeffrey Lind II - Houston, TX

Dr. Danielle LeBlanc - Ft Worth, TX

Dr. John Hijjawi - SLC Utah

Dr Philip Sonderman, Greater Milwaukee Plastic Surgeons - Milwaukee, WI

Dr. David Janssen & Dr. William Doubek, Fox Valley PS - Oshkosh and Appleton, WI

EAST COAST

Dr. Helen Perakis - Hartford, CT

Dr Hilton Becker - Hilton Becker Clinic of Plastic Surgery, Boca Raton, Fl

Dr. Kenneth Lee, UF Orlando Health -Orlando, Fl

Dr. David Lickstein, Palm Beach FL

Dr. Joseph Woods - Piedmont Hospital, Atlanta GA

Dr. Mark Deutsch, Perimeter Plastic Surgeons - Atlanta, GA

Dr Jessica Erdmann-Sager - Brigham & Women's/Dana Farber, Boston MA

Dr Amy Colwell - Boston MA

Dr Russell Babbitt - Fall River, MA

Dr Davinder Singh - Annapolis, MD

Dr. Vincent Perrotta - Salisbury, MD

Dr Claire Duggal - Annapolis, MD

Dr. Eric Chang - Columbia, MD

Dr Justin Sacks - Johns Hopkins, Baltimore, MD

Dr. Nassif Soueid (pronounced "swayed") - Baltimore, MD

Dr Therese K White - South Portland, ME

Dr. Michelle Roughton - UNC Chapel Hill, NC

Dr. Tzvi Small - Valley Hospital , Ridgewood NJ

Dr. Glassman - Pomona NY

Dr. Andrew Smith - Rochester, NY

Dr. Andrew Salzberg - NYC

Dr. David Otterburn - NYC

Dr. Constance Chen - NYC

Dr. Sameer Patel - Fox Chase, Philadelphia, PA

Dr. Thomas Hahm - Charleston, SC

Dr. Kevin Delaney - Medical University of South Carolina (MUSC), SC

Dr Jason Ulm - Medical University of South Carolina (MUSC), SC .

Dr. James Craigie and Dr. Richard Kline Jr. - East Cooper Plastic Surgery, Mount Pleasant, SC

Dr. Stacy Stephenson - UTMC, Knoxville, TN

Dr Kent Higdon - Vanderbilt Medical Center, Nashville, TN

Dr. Mark Leech, Chattanooga Plastic Surgery, Chattanooga, TN

Dr. Brad Medling, in Murfreesboro (and Franklin), TN

Dr. Irfan Galaria - Ashburn, Chantilly & Haymarket, VA

Dr. Samir Rao - 3299 Woodburn Rd Ste 490 , Annandale, VA 22003

Dr Mark Venturi - McLean, VA

Dr. Nahabedian - McLean,VA

Dr David Habin-Song - Washington DC/ Maryland and Virginia :https://www.medstarhealth.org/doctor/dr-david-habi...

Dr. Joanne Lenert - Washington, DC

Dr Troy Pittman - Georgetown University, Washington, DC

EAST COAST, CANADA

Dr Mitchell Brown, Toronto Canada

Dr Jason Williams - Hallifax, Nova Scotia

AUSTRALIA


Dr Beverley Fosh - Adelaide, South Australia

Dr Amy Jeeves - Adelaide, South Australia

RESEARCH LINKS ABOUT PREPECTORAL RECONSTRUCTION

https://www.sciencedaily.com/releases/2016/03/160302182438.htm

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4494482/

http://www.nesps.org/meeting/abstracts/2016/57.cgi

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4727683/

https://www.ncbi.nlm.nih.gov/pubmed/28027223

https://www.ncbi.nlm.nih.gov/pubmed/29978367

VITAMIN C HELPS WITH HEALING FROM SURGERY/and can kill bacteria such as Pseudomonas with high dose IV Vitamin C. If you can't get Intravenous Vitamin C, Liposomal Vitamin C can be a big help if you can't afford or find IV Vitamin C.

Having extra Vitamin C, 1,000mg to 3,000mg per day for at least a week before surgery and for at least 2 weeks afterwards. That is what Dr Andrew Weil says. I tend to think it is possible to have even higher amounts of Vitamin C safely. I did that on a number of occasions, what is called "Titrating to bowel tolerance " Basically it means to take a Vitamin C tablet, (chewable type are some of the easiest) once an hour throughout the day. When your body is finally starting to have more Vitamin C than you need, then you will begin to experience loose stools. Then you stop taking Vitamin C, count up how many tablets you have had over the course of the day, and the next day take one or two less tablets of Vitamin C for that day. Repeat that for several days, but as you heal and your health improves you will get to the point of loose stools sooner and sooner (needing less and less pills every day in a gradual taper downward) It is quite safe to do it this way, if you have normal kidney and bowel function. The worst that happens is that you can get diarrhea. It is a great way to tell exactly how much Vitamin C your body needs. Sufficient Vitamin C is crucial to wound healing, helps with making strong collagen. When you hear stories of surgical wounds that dehise it is a high probability that there is a Vitamin C deficiency leading to inadequate collagen production.

Nutritional Support for Wound Healing - Alternative Medicine Review https://www.ncbi.nlm.nih.gov/pubmed/14653765

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915787/

Pharmacokinetics of oral vitamin C

Abstract

Purpose. To test whether plasma vitamin C levels, following oral doses in supplemented volunteers, are tightly controlled and subject to a maximum in the region of 220 µm L−1, as suggested by previous researchers for depleted subjects. To determine plasma levels following single, variable‐sized doses of standard and liposomal formulations of vitamin C and compare the effects of the different formulations. To determine whether plasma levels above ∼280 µm L−1, which have selectively killed cancer, bacteria or viruses (in laboratory experiments), can be achieved using oral doses of vitamin C.

Design. This was a single blind study, measuring plasma levels in two subjects, in samples taken half‐hourly or hourly for 6 hours, following ingestion of vitamin C. Data were compared with published results and with data from 10 years of laboratory plasma determinations.

Materials and methods. Standard 1 gram tablets of vitamin C; liposomal vitamin C. Plasma levels were analysed using the method of Butts and Mulvihill.

Results. Preliminary investigations of the effects of liposomal and standard formulation ascorbate showed that blood plasma levels in excess of the previously assumed maximum of 220 µm L−1 are possible. Large oral doses of liposomal ascorbate resulted in plasma levels above 400 µm L−1.

Conclusions. Since a single oral dose can produce plasma levels in excess of 400 µm L−1, pharmacokinetic theory suggests that repeated doses could sustain levels well above the formerly assumed maximum. These results have implications for the use of ascorbate, as a nutrient and as a drug. For example, a short in vitro treatment of human Burkitt's lymphoma cells with ascorbate, at 400 µm L−1, has been shown to result in ∼50% cancer cell death. Using frequent oral doses, an equivalent plasma level could be sustained indefinitely. Thus, oral vitamin C has potential for use as a non‐toxic, sustainable, therapeutic agent. Further research into the experimental and therapeutic aspects of high, frequent, oral doses of ascorbic acid either alone or (for cancer therapy) in combination with synergistic substances, such as alpha‐lipoic acid, copper or vitamin K3, is needed urgently.


ALSO, WANT TO BRING UP ESSENTIAL OILS SUCH AS OREGANO/THYME and GOLDENSEAL have Synergistic Effects against bacteria, alone or in combination with antibiotics. I posted this info somewhere else, but copied it to here again.

Essential Oils and Their Components as Modulators of Antibiotic Activity against Gram-Negative Bacteria ..

http://www.mdpi.com/2305-6320/3/3/19

Essential Oils and Future Antibiotics: New Weapons against Emerging ' Superbugs ' ?

Nicholas A Boire1, Stefan Riedel2 and Nicole M Parrish2*

1The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA

2 Department of Pathology, Division of Microbiology, The Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA

https://www.researchgate.net/publication/253567306_Essential_Oils_and_Future_Antibiotics_New_Weapons_against_Emerging'Superbugs'

PDF]Antimicrobial and synergistic effects of some essential oils to fight ... - The Battle Against Microbial Pathogens: Basic Science, Technological Advances and Educational Programs

www.microbiology5.org › book

by H Padalia - ‎2015 - ‎Cited by 2 - ‎Related articlesEssential oils can be individually effective or they may be combined with antibiotics or plant extracts. Traditional healers often use combinations of plants to treat or cure diseases and found that synergy was most

According to a report published in The Review on Antimicrobial Resistance, the government of the United Kingdom estimates that by the year 2050, more than 10 million deaths and 100 trillion dollars in global health care costs will have resulted from drug-resistant microbes.

https://www.ncbi.nlm.nih.gov/pubmed/27872555

https://www.ncbi.nlm.nih.gov/pubmed/28224112

https://www.ncbi.nlm.nih.gov/pubmed/27895802

https://www.ncbi.nlm.nih.gov/pubmed/26256994

https://www.ncbi.nlm.nih.gov/pubmed/25185110

https://www.ncbi.nlm.nih.gov/pubmed/16085104

https://www.ncbi.nlm.nih.gov/pubmed/12643856

The only contraindications I know of regarding herbs/supplements after surgery is the increased risk of bleeding that can occur in the early PostOp period, usually the first 3 to 7 days. Blood clots are a very small risk in the PostOp period (for nonorthopedic procedures), but one that is not much affected by use of herbs/supplements, except a few that interfere with the effectiveness of Warfarin/Coumadin anticlotting medications, like CoQ10, Goldenseal, or St John's Wort. .

Certain herbs are known to increase the risk of blood thinning,

Herbal Medicines

  • Garlic: inhibits platelet aggregation (organosulfur), discontinue for seven days
  • Ginkgo: inhibits platelet activating factor (terpenoids, flavonoids), discontinue for thirty six hours
  • Ginseng: inhibits platelet aggregation and lowers blood glucose(ginsensosides [mimic steroids]). Check PT/PTT/glucose, d/c for 24 hours (preferably seven days)
  • Saw Palmetto: associated with excessive intraoperative bleeding(mechanism unknown, likely multiple), in the absence of pharmacokinetic data, no recommendations re: preoperative continuation can be made

Herbal medicines that increase the risk of bleeding:

  • Black Cohosh: Claims to be useful for menopausal symptoms. Contains small amounts of anti-inflammatory compounds, including salicylic acid. Theoretically could have intrinsic/additive antiplatelet activity.
  • Chamomile: Claims to reduce inflammation and fever, to be a mild sedative, relieve stomach cramps. Increases risk of bleeding because it contains phytocoumarins, which have additive effects with warfarin.
  • Feverfew: Claims to prevent migraines. Increases the risk of bleeding because it individually inhibits platelet aggregation, has additive effects with other antiplatelet drugs. Also additive effects with warfarin.
  • Fish Oil: Claims to prevent/treat atherosclerotic CV disease (800-1500mg/day). Also used to decrease triglycerides (>4g/day). Dose dependent bleeding risk increases with dose >3g/day.
  • Garlic, Ginger, Ginko, Ginseng: Increases bleeding risk by interacting with antiplatelet drugs to inhibit platelet aggregation and inhibit fibrinolysis. Also augments warfarin
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Oct 20, 2015 11:20AM sunshinegal wrote:

Wow, this is very interesting! I have been under the impression that a silicone/saline implant must go under the pec muscle - my surgeon said that's what holds the implant in place (along with an alloderm tissue matrix at the bottom). What is holding your implant in place?

Dx 10/7/2010, DCIS, 6cm+, Stage 0, Grade 2, 0/4 nodes, ER+/PR+
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Oct 20, 2015 03:27PM - edited Oct 20, 2015 03:31PM by macb04

Scar tissue?? My PS put stitching in to make a proper Inframammary fold(IMF) underneath my breast. I had numerous fatgrafting episodes with a different, less skilled PS, so I had about 3 or 4cm of my fat under my skin which cushions and hides the implant completely. And I mean 100% coverage of the implant. ZERO rippling. When I exercise none of the implant can be seen. I have tested this out in a mirror before I would dare go in my tight, workout tank top. So now I can work out in comfort and feel like I fit in again. It is not a perfect looking breast, .my IMF is a little off in the middle, but not so much that other people, ie my husband, a friend, noticed. I am also happy to report a cleavage that looks normal and beautifu,l This probably wouldn't have worked so well without my fat grafted fat being there or Acellular Dermal Matrix of some kind, although I corresponded with a woman who put the implant on top of her pectoral without either fat grafting or Acellular dermal matrix stuff either. She said that she then had to switch PS and had mx on her other side and had the implant put under her pectoral. So she had one each way and says she prefers it over her pectoral. Look up an article about doing reconstruction, something like PRE PECTORAL IMPLANTS FOR IRRADIATED PATIENTS, something like that. Look it up in our friend google.

Could be that the residual skin tightness and scarring I am told I have from radation fibrosis are acting like a natural sling to holding the implant. That is what my PS said is happening, and he was looking under my skin during the surgery so he should know. He had never done it that way before and I begged him to do it over my pectoral. I said I understood that it might not work, but that I was desperate to try it that way. After he put in my TE, he kept asking if I was having problems when I came in every week for the fills. Never had a problem, got filled all the way up to 600cc's. Now I have a 420cc Mentor Anatomic Implant on my L breast. Got my right breast lifted, and now have fairly good symmetry. At least enough symmetry that I can pass as someone who wasn't chopped up by the bc industry. Of course I can always feel my implant, but when I am active and busy, not very much at all

So that is my story in a nutshell. Fixed the radiation fibrosis by fat grafting, pentoxifylline, vit E, and Hyperbaric Oxygen Therapy. Still planning to do maintenance stuff like pentoxifylline for a long while because capsular contracture is a very real potential problem that is more of a risk with rad damage.

Ask away if you have more questions. I am happy to let women know about this option that might work well for many, without the pectoral damage of traditional, old fashioned techniques.

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Nov 15, 2015 11:50PM MrsGreenJeans wrote:

Hi macb04, I am very interested in how things are still going with your implant. I am scheduled for NSPBMX in December, and my PS wants to put the TEs over the pec using alloderm. At first I was pretty excited about it, since he said the recovery time is much shorter than the traditional under the pec method. He has done this procedure before.

After looking it up online I haven't yet been able to find anyone endorsing this method for MX patients, only for augmentation. This is because of the lack of tissue between the implant and the skin. He did say that he could do fat grafting to fill in, but I don't know if that means the entire area between skin and implant.

I am very concerned about the implant showing, and about rippling. Are you still happy with yours? What was your recovery time? Any other advice or input you can share?

Family History, Negative for Genetic Mutations Dx 6/19/2015, LCIS, Right Surgery 12/2/2015 Prophylactic mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Dx 12/10/2015, DCIS, Left, <1cm, Stage 0, Grade 2, 0/2 nodes, ER+/PR+ Surgery 4/12/2016 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Nov 16, 2015 01:30AM macb04 wrote:

Hello, I am 2 and a half months out from having the implant exchange. My PS put a Mentor 420cc form stable implant over my pectoral and then I had a lift of my other breast in September. I am going for nipple reconstruction on Dec 3rd. I had fat grafting using BRAVA 5 times, had 2 bad infections where I lostmost of my grafted fat. About 4cm of fat was there when myPS put in my TE, which had thinned to 1cm plus when I had my implant exchange. I had the fat grafting first, then the implant. Now they are doing it with Acellular Dermal Matrix stuff as a kind of sling. If I didn't have fat grafting I would try that, my PS wasn't sure if he wouldneed Acellular Dermal Matrix stuff, but he said after thesurgery that it wasn't necessary because I seemed to have enough coverage of my implant with my fat. Did you see the study about this? Look up the following on Google. Sorry I can't post links from my tablet. PRE PECTORAL IMPLANT PLACEMENT AND COMPLETE COVERAGE WITH PORCINE ACELLULAR DERMAL MATRIX, A NEW TECHNIQUE FOR DIRECT TO IMPLANT BREAST RECONSTRUCTION FOLLOWING NIPPLE SPARING MASECTOMY.

Is pretty comfortable, was getting slightly tight, not so you could see it, but just how it felt, so I worried about capsular contracture and prophylactically started on the generic of Accolate, which is called Zafirlucast. I take 4 ten mg tabs twice per day.Feels better again, for brief spurts of time I forget my implant is there. I guess this is as good as it gets. Last year was pretty miserable, so where I am now is a great improvement. Just cross my fingers for my nipple reconstruction, my biggest challenge is getting through the surgery without an infection. I will be getting Intravenous Vitamin C with my surgery and again the day after the procedure to fight infection, along with an antibiotic. When I just did the antibiotics it wasn't enough because I am developing antibiotic resistant infections. Not MRSA, but just other nasty staph infections.

I have cleavage and I still have no rippling. No weird rippling or bulging even with activity.

So that is where I am at the moment. PM me if you want to talk more. Good luck and let me know what you decide to do in the end.

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Nov 16, 2015 11:12PM Meadow wrote:

Mac, I saw your story on another thread, and I am so excited this worked for you. I had rads after direct-to-implants recon, and I have shrinkage and encapsulation that I want fixed one day. I would love to have my implants on top of the pectorals. Very Interesting and thanks for posting.

Dx 8/15/2013, IBC, ER-/PR-, HER2- Chemotherapy 8/25/2013 AC + T (Taxol) Radiation Therapy 2/10/2014 Breast, Lymph nodes Surgery 1/14/2017 Reconstruction (left)
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Nov 16, 2015 11:35PM macb04 wrote:

Hi Meadow, sorry to hear you have encapsulation and shrinkage. Have you read about Zafirlucast, the generic of Accolate. Studies about using that for capsular contracture. I am on it, 40mg of it twice per day. Feel a little tight, and worry about capsular contracture because of rads damage too. Also in Pentoxifylline and Vitamin E for that as well as HBOT. My skin was just like boot leather because of the rad fibrosis. Now it feels and looks nearly normal. Would any of that help you? I will PM you to look atthis posting.

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Nov 17, 2015 09:51AM Catrina wrote:

I am very excited to see this thread. I had mastectomy with expander then implants under the muscle over 2 years ago after radiation. I have had pain issues ever since, and more recently very painful muscle spasms. My PS has suggested redoing the reconstruction over the muscle using a new type of implant, he said this would make me feel much better. I am scheduled for that surgery but still wavering on the decision to go through with it since I haven't been able to find any information on this method. Knowing that others have had this done gives me a bit more courage to go through with the surgery. Thank you for posting your experience with this

Original diagnosis: DCIS, high grade, 6+ cm, after final pathology: DCIS /IDC 1 cm, multifocal micro invasion, 2 positive lymph nodes - stage 2A Dx 1/23/2012, IDC, <1cm, Stage IIA, Grade 3, 2/13 nodes, ER-/PR-, HER2+ Targeted Therapy 4/17/2012 Herceptin (trastuzumab) Chemotherapy 4/17/2012 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 9/9/2012 Breast, Lymph nodes Dx 4/18/2017, IDC, Right, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Nov 17, 2015 01:30PM Meadow wrote:

Yes thanks Mac and Catrina, good luck everything and please keep us posted

Dx 8/15/2013, IBC, ER-/PR-, HER2- Chemotherapy 8/25/2013 AC + T (Taxol) Radiation Therapy 2/10/2014 Breast, Lymph nodes Surgery 1/14/2017 Reconstruction (left)
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Nov 17, 2015 11:49PM MrsGreenJeans wrote:

Thanks for the update, macb. I will check out the study you shared. Thanks also on the zafirlucast info, I will keep that in mind if I wind up with contracture issues.

Best of luck with your upcoming procedure, I will pray for no complications or infection.

Catrina, good luck to you whatever decision you make.

Family History, Negative for Genetic Mutations Dx 6/19/2015, LCIS, Right Surgery 12/2/2015 Prophylactic mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Dx 12/10/2015, DCIS, Left, <1cm, Stage 0, Grade 2, 0/2 nodes, ER+/PR+ Surgery 4/12/2016 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Nov 17, 2015 11:55PM macb04 wrote:

http://www.healio.com/aesthetics/breast-surgery/news/online/%7B1ab19913-5049-4abd-9ea7-35726f5cf121%7D/place-implants-prepectoral-with-vertical-incision-in-immediate-breast-reconstruction

http://www.ncbi.nlm.nih.gov/pubmed/25455288

Finally figured out how to post links using my tablet.

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Nov 17, 2015 11:56PM MrsGreenJeans wrote:

Wow, just read that study, and I feel so much better about it now. Looks like they have had good results with this procedure. Thanks so much, macb04.

Family History, Negative for Genetic Mutations Dx 6/19/2015, LCIS, Right Surgery 12/2/2015 Prophylactic mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Dx 12/10/2015, DCIS, Left, <1cm, Stage 0, Grade 2, 0/2 nodes, ER+/PR+ Surgery 4/12/2016 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Nov 18, 2015 01:13AM macb04 wrote:

Good Luck MrsGreenJeans with your upcoming surgery. Let us know how it goes.

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Mar 9, 2016 07:24PM TJinVA wrote:

Hi Ms GreenJeans. I just read your post about implants over pectoral muscle. That is what my PS is recommending and I too can't find much info even now in 2016. I see your post is from Nov 2015. What did you decide to have done? IF over pectoral, are you satisfied? Any rippling? any concerns? Did you have breast CA? Or mastectomies bc of BRCA or family history? thanks for any feedback.

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Mar 9, 2016 11:55PM macb04 wrote:

Hi TJinVA, Ms Green Jeans, had my 495cc , high profile Anatomic MENTOR implant put over my pectoral muscle on Tuesday, 3/1, to replace the moderate profile, 420cc implant in the same since August.It was too small, and looked wrong compared to my real right breast. Now it is a more realistic looking implant. I have cleavage, really normal looking, as well as NO MUSCLE ARTIFACT, none at all. No chest muscle tightness, like I have seen for so many poor woman who have had so much pain/perpetual discomfort that some of them take the implant out and go flat. It , of course is not a perfect match for my real right breast, nor is it perfectly comfortable, but sometimes I forget it is there, and I have hopes that that feeling of forgetting the implant is there will get better with time.

My PS is Dr Bryan McIntosh in Bellevue, WA. He put in a silk mesh to help hold the implants lower pole/reinforce my inframammary fold. Other research has used acellular dermal matrix stuff like Stratice or Alloderm.

Look at the following research http://www.ncbi.nlm.nih.gov/pubmed/25455288

http://www.ncbi.nlm.nih.gov/pubmed/26180713

http://bcsurgerystories.com/?cat=51

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Mar 13, 2016 04:00PM mshel wrote:

I am having Nipple Sparring Mastectomy with expanders put over the muscle on April 5th.  I haven't found much online about this procedure.  My PS said its fairly new and will use a alloderm sling to protect the implant. 

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Mar 15, 2016 12:06PM JessieJake wrote:

Hello,

I'm happy to find this discussion thread, although I have to admit some of the language and things mentioned are brand new to me. I had TEs placed above the muscle on 3/1 and I was hoping to find others to share their experience. At this date I am so glad I made this choice. I have some pain from me TE on the left side when I try to lay flat. I'm simply not sure what to do about it, but will hope either it gets better over time or I'll discuss it at my first fill on 3/22.

My PS was 50/50 on which option would be best for me. I apparently have a very tiny, little coverage chest/rib cage. Initially she explained under the muscle would help cover the implant which may otherwise be quite visible due to lack of coverage, but she showed me a video of a woman who had very obvious muscle contractions that would squeeze her implants when she would use them. In part because of that and my fear of the pain I'd experience with muscle stretching, I chose over the muscle and she will do fat grafting around the top to add padding and cover the implant. She used alloderm, I know, during the initial surgery to place the TEs. I'm hoping to go a little bigger than what I was (what I was didn't fill a bra anyway) which will still be quite modest. As I never had real cleavage or anything prior, my hope is that I'll be easily satisfied with the result. I'm hoping that the next months may find some more comfort as my body adjusts to these foreign things and perhaps the fills will lift them off some pressure points, too.

Can anyone share how their fills for over the muscle went? Did you take any pain medication before hand or after? Is there anything else you can share? Your stories are reassuring!

Thanks!

Mom of teens, preventative mastectomy
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Mar 16, 2016 01:29AM macb04 wrote:

Hi JessieJake, glad you found us. I had very little pain with fills, due to some degree from numbness residual to the uni mx. It was just a weird stretching feeling. I always expected pain, but never had any with the TE over my pectoral. If you read my posts, you will see that initially I had a TE put under my pectoral muscle. Fills with that were painful, everything hurt for a while after each fill. I have to say I had very little pain with over the pectoral, having had it both ways, I definitely prefer it this way.

Hot packs to the area were helpful when I did have some pain. Also gentle massage.

Good luck. Hopefully you won't have it bother you much at all. I'll be rooting for easy fills for you.

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Mar 16, 2016 04:50AM JessieJake wrote:

Thanks macb04! Your explanation of the fill doesn't sound too bad! Tonight (this morning) my left TE woke me once again with pain under my left arm. Ugh. Coupled with some pretty intense wind rattling our house I'm up wishing desperately for a massage. Sleeping in one position makes my body almost vibrate with the need for movement.

Thanks!

Mom of teens, preventative mastectomy
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Mar 16, 2016 07:26AM katykids wrote:

jessiejake, I want to say how wonderful it is that your PS showed you a video! when I even mentioned the idea and offered journal articles regarding over the pectoral muscles my PS wouldn't hear of it. Needles to say, I have a new PS now. My foobs are in but any revisions will be done with my new PS. Who really takes the time to listen to me. I hope the pain lessens soon!

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Mar 16, 2016 09:25AM JessieJake wrote:

katykids, what a road to travel! I didn't even research or look into PS options. Where I go they just set up 2 appointments for me - 1 for a BS and one for a PS. I kind of felt I put a little blind faith in that. I can only hope that things turn out! It's great that u took control and found another. Did u end up doing over the muscle with the new PS?

It took 2 meetings for me to decide I do really like my PS. She met with me the day before surgery (between other surgeries!) and let me hem and haw on which choice to make and didn't hurry me at all. That's when I saw the video and also she said she had done above the muscle on several similar shaped women and really like the results. It was then I decided above and she updated all the surgery prep. So, on one hand I like all that, but I was the one that iniatated the additional conversation. I guess it's important in this process to not just take it as it comes, but to do some proactive questions or research. Although, it can be overwhelming! What's that funny saying? You don't know what you don't know Loopy

Mom of teens, preventative mastectomy
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Mar 16, 2016 03:42PM macb04 wrote:

Hey JessieJake, glad you have a PS who is a modern thinker, when you led her to it. I had to beg my PS, who was my 3rd PS, by the way, to put the implant OVER my pectoral muscle. He had never heard of doing it that way. Then he researched it and found it WAS being done, just not here in Seattle area.

Well ladies, we are finally getting care that is smart and cutting edge.

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Mar 16, 2016 04:49PM MmeJ wrote:

macb04, if I may ask:

You had the typical under-the-pec implant, which you've since had removed and now have an over-the-pec, with which you seem pretty satisfied.

Maybe I miss the obvious: What about your pec muscle? Did they re-stitch it and it's now mostly back in its original (pre-surgical) place? Or are they, once stretched, just loose but under the implant so you don't notice? And can one regain muscle strength?

I, too, had rads. As with the more traditional implant setup, I'm sure most women who didn't have rads have a better cosmetic outcome than those of us who did.

While I'm not overly thrilled with my recon, I wasn't about to undertake any of the flap surgeries. I am glad to have something there and would not have gone without it. However, I am also not crazy about feeling I need to be sure no one's looking if I reach for something off a high shelf at the store because of the muscle flex/ripples.

DX 07/2010, L ILC Stage IIIc, Grade 1, 15/15 nodes. R IDC, 1cm, Stage I, Grade 1, 0/2 nodes. Both ER+PR+ HER2-.
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Mar 16, 2016 09:23PM mshel wrote:

Following... I get over the muscle TEs on April 5th. 

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Mar 17, 2016 12:00PM JessieJake wrote:

MmeJ, my DH asked so many questions at my follow up appointment with the PS that you'd think he was having it done himself or wanted to help out with the actual surgery! He asked the specific question you asked about what happens to the muscle if you switch from under to over or simply decide to have implants removed. I have, of course, lost some of the detail she explained, but she did say the muscle goes back pretty much on its own. It will regain strength. She talked about muscle having "good memory". I recall leaving there thinking that if it ever comes to that I could always switch options without too much consequence (relatively speaking, I realize this all surgery stuff which is not minor). I'm sure she said more, but just can't recall.

Mom of teens, preventative mastectomy
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Mar 17, 2016 12:59PM MmeJ wrote:

JessieJake, first - I'm sorry you have to be here, and hooray for your DH. Second, thank you for sharing your info and for replying to me. How encouraging! I'm glad to know this over-the-pec thing is now being discussed in some circles within the recon world, and especially for you and your PS. It takes a long time for things to change, and there are big regional differences here in the U.S.

I am several years out now ... as a matter of fact, I just noticed that tomorrow is the fifth anniversary of my biggest surgery. I see my plastic surgeon once a year for a physical exam (no imaging is done). Last year I asked him about fat grafting, and he was pretty skeptical because the failure/less-than-successful rate is fairly high. This year I'm going to discuss the over-the-pec matter with him in general and for post-rads people in particular, since our muscles have been under the broiler (therefore, maybe not as elastic). I will report back here.

DX 07/2010, L ILC Stage IIIc, Grade 1, 15/15 nodes. R IDC, 1cm, Stage I, Grade 1, 0/2 nodes. Both ER+PR+ HER2-.
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Mar 17, 2016 03:31PM JessieJake wrote:

MmeJ, I see we are from the same area. It's possible my place is an option for you if you are at all interested. I'm having fat transfer (is that the same as grafting?) done with I get my implants. Again, hoping for all good outcomes but I'm still on this path. Good luck with your next PS meeting. Hopefully you'll hear some good options from him!

Mom of teens, preventative mastectomy
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Mar 17, 2016 09:05PM macb04 wrote:

MmeJ, I was initially going to do a Diep, then heard about fat grafting with BRAVA and had that done with a different PS at the Polyclinic in Seattle. He decided that the TE was interfering with the fat grafting so he took it out. Then I got a huge,nasty infection and lost most of my fat. Then had adhesions. He didn't stitch down my pectoral muscle, but somehow it returned to normal over time, all on its own. That PS from the Polyclinic, was not good enough at fat grafting for a woman like me who had bad radiation damage. I couldn't afford to go down to the inventor of the Brava Fat grafting method in Florida, so I let him try fat grafting 2 more times. Then he wouldn't do any more, said it wasn't working. Then I had fat grafting twice more with another PS. Had another bad infection. Did Fat grafting 5 times and only got to a A cup because of the bad infections and inexperienced PS with fat grafting method. Skill is crucial for Fat grafting sucess after rads damage, something I could not afford to get for myself. So I was flat and miserable and decided to go see another PS I had been told was a great surgeon and a really nice guy. He listened to me, really listened, and as I said I begged him to put the implant OVER my pectoral. I had to do a TE again. That was in April of 2015. Then in August of 2015 I had an exchange to a 420cc Mentor Anatomic Silicone implant. Unfortunately it was too small. I tried to make my peace with it, had my other breast lifted. Finally, couldn't stand seeing how lopsided it looked, like breasts for two different women on my chest, So....., once last time I went under the knife and had a larger 495cc high profile Anatomic MENTOR implant put over my pectoral muscle on March 1st 2016. It is good enough now, not perfect by any means. But at least it looks closer to balanced now than it hasfor a long three plus years.

My strength did come back to about 95% of normal. As I mentioned I can do rowing /kayaking/ swimming without any problems. I am starting a rowing course at Green Lake near where I live in Seattle on April 23rd.

I healed from the rad damage, which was awful. Tight tight skin/muscles of my chest and shoulder. Just like wood or boot leather. Almost feels normal after Hyperbaric Oxygen Therapy. ........Alot. Not easy, time consuming. Not cheap either, have 4500 out of pocket expenses for insurance. Miraculous improvement really. I was so badly burnt that I was told I likely would not be able to reconstruct sucessfully. Found HBOT myself, got it approved by my insurance myself. Figured out that Pentoxifylline and Vitamin E have been used in studies to help Radiation fibrosis heal by improving blood flow. And of course fat grafting heals Radiation fibrosis damage as well.

That is my long story, in a nut shell.17 surgeries in the past 3 .5 years. 15 of them for reconstruction because I wouldn't give up on my goal of looking halfway normal.

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Mar 19, 2016 08:54AM katykids wrote:

jessiejake, my new PS wants me to ride these implants out at least a year. I am now working on a list of pros and cons. I have two frozen shoulders...so my view of them may be jaded. ;) I am glad things worked out so well for you. I interviewed a couple of different doctors and all of my friends had lots of opinions. I, ultimately, stayed with my first doctors, my mom's doctors. But now I have moved on. I have a lot of rippling. And what may be an implant edge on the bottom right.

New PS did talk about placing over the pecs for certain women. And that could be considered, in the future, if these do wind up coming out. So glad to read success stories with this technique!

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Mar 21, 2016 04:09PM MmeJ wrote:

macb04, thank you for the very thorough response. Holy moly, I am so sorry to know how much time, money, effort, physical and emotional capital you've spent on this and I have the utmost admiration for your tenacity. I hope this last surgery is truly The Last for you. And I'm glad to hear that your strength has come back.

My guess, with my own PS, is that he's reluctant to do the fat grafting because of his own lack of experience with it. But it'll be a year since my last visit, and maybe that's changed. Last year I asked him about putting in a larger implant; he said he could go up one size but anything bigger and I'd need to go the TE route again. That sure wasn't appealing, so I thought maybe I could "fill out" with fat grafting instead.

Unlike you, I was fortunate enough to avoid the complication of infections with the TE. However, I had rads and I don't think I was expanded enough between the surgery and the start of rads so the implant I have is too small. I had not one, but two reductions on the lumpectomy breast and it's still much larger than the implant side - I will say the silhouettes are a good match but the sizes are off; like you said, looks like two different women. I burned badly with rads but somehow was able to keep the skin intact. And both sides still hurt, almost five years later.

I didn't know that the fat grafting helps with fibrosis; thank you for that tip, too.

katykids, two frozen shoulders might not be something you want to stick with for an entire year. Ouch!

JessieJake, yes, fat transfer = fat grafting. You're walking a new recon path that wasn't around in 2010-11. I'm going to send you a PM.

DX 07/2010, L ILC Stage IIIc, Grade 1, 15/15 nodes. R IDC, 1cm, Stage I, Grade 1, 0/2 nodes. Both ER+PR+ HER2-.
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Mar 22, 2016 10:05AM kmahalick wrote:

In response to whether the pectoral muscle is stitched back down, my initial TE's were placed in 2013 and in the course of 2 1/2 years and numerous attempts to place an implant the muscle was disturbed a number of times. In January of this year I had the implant placed over the pec and the muscle was stitched down, I was told to not raise the arm over a foot from the hip and not engage in push-up or stretches for 6 weeks. I have begun regular workouts and activity and I am working to ease into certain yoga stretches which pull the repaired areas. Laying on my stomach or side for the first 6 weeks was not possible and is still uncomfortable for the reconstructed side.

I think it is great that a PS showed a video of the animation deformity which can occur with the placement of an under muscle implant.

Surgery 12/13/2012 Mastectomy: Right; Reconstruction (right): Tissue expander placement Surgery 2/28/2013 Reconstruction (right) Surgery 8/14/2013 Reconstruction (right): Nipple reconstruction Surgery 2/20/2014 Reconstruction (right): Nipple reconstruction Surgery 8/22/2014 Reconstruction (right) Surgery 8/27/2014 Reconstruction (right) Surgery 10/16/2014 Reconstruction (right): Nipple reconstruction Surgery 1/19/2016 Reconstruction (right)

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