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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 19, 2015 09:47PM - edited Nov 12, 2018 05:43PM 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 Arash Momeni - Stanford, CA Has done >100 prepecs/Only does Prepectoral now

MIDWEST/CENTRAL/MOUNTAIN

Dr. Julie Park - University of Chicago Medicine, Il

Dr. William Dougherty - Santa Fe, 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 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 Philip Sonderman, Greater Milwaukee Plastic Surgeons - Milwaukee, WI

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

EAST COAST

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

Dr Amy Colwell - Boston MA

Dr. Helen Perakis - Hartford, CT

Dr. Glassman - Pomona NY

Dr. Andrew Smith - Rochester, NY

Dr. Andrew Salzberg - NYC

Dr. David Otterburn - NYC

Dr. Constance Chen - NYC

Dr. Tzvi Small - Valley Hospital , Ridgewood NJ

Dr Russell Babbitt - Fall River, MA

Dr. Joseph Woods - Piedmont Hospital, Atlanta GA

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

Dr. Stacy Stephenson - UTMC, Knoxville, 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. 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. Michelle Roughton - UNC Chapel Hill, NC.

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

Dr Kent Higdon - Vanderbilt Medical Center, Nashville, TN

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. Joanne Lenert - Washington, DC

Dr Troy Pittman - Georgetown University, Washington, DC

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

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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Sep 8, 2018 12:16PM macb04 wrote:

Hi ReadyAbout. I am so sorry to hear about your troubles. No question, you have been through the ringer. I know about that as well. I don't even have a completely symmetrical result, despite my best efforts, thanks to several doctor errors. I know the feeling, that you would like to tear our your hair. It's not that much to ask, not really, to look symmetrical, and have what looks like 2 moderaly matching breasts.

By all means, get a good prosthetic to tide you over until you get the new TE. You deserve as much normality as you can get. I am glad to hear you left that difficult dufus of a PS.


Rachelcarter, I am glad you got the OK to get your surgery, despite possible chemo issues. Just build up your nutrition, especially the Vitamin C when you go for it. Liposomal Vitamin C can be really helpful with ensuring you get adequate Vitamin C for strong healing of incisions. With regular oral Vitamin C, it can be hard to get sufficient doses. That is where the Liposomal process can be really sucessful at getting a larger dose of Vitamin C into the body before reaching bowel tolerances and diarrhea.

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Sep 8, 2018 02:54PM wanderweg wrote:

You can add Dr. Stacy Stephenson at UTMC, Knoxville, TN to the east coast list. She did my over-the muscle silicone implants. I had a nipple-sparing bilateral mastectomy, with scars in the fold. They are still new (I'm a month out from the exchange) and so not fully comfortable yet, but definitely getting better.

weakly ER+, TNBC on oncotype Dx 5/10/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR-, HER2- Surgery 6/10/2018 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 8/6/2018 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Chemotherapy 8/31/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Sep 11, 2018 10:05AM raven4mi wrote:

ReadyAbout, I'm so sorry you've been through so much. I had to live with a lopsided situation for three months when I also had a TE removed due to infection so I completely get the frustration. I agree, get a prosthetic or whatever you need to make yourself comfortable during the waiting period which, I realize, will seem extremely long. But hang in there - you can still have a successful outcome.

Dx 2008, DCIS, Right, 1cm, Stage 0, Grade 1, ER-/PR- Dx 1/2016, DCIS, Right, 2cm, Stage 0, Grade 3, ER-/PR- Surgery 4/15/2016 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery Lumpectomy: Right Radiation Therapy
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Sep 11, 2018 04:58PM ReadyAbout wrote:

Thanks so much for the encouragement everyone! I am getting my nurse practitioner neighbor to pull the drain tonight, although I watched a YouTube on it today and am willing to go for it if she's unavailable. I was supposed to set up a follow up appointment this week with my PS but I haven't since I'm leaving him, and of course no one from his office has called me to set anything up. On my discharge papers from the hospital it said, "No driving until given permission by Dr. _________" and I never received word on that, either. If there's an upside to all this, it's that I was finally motivated to find a new PS.

raven4mi: Didn't you have the onset of an infection recently? If so, how are you doing?

Dx 2/1/2018, IDC: Papillary, Left, 1cm, Stage IA, Grade 2, 0/5 nodes, ER+/PR+ Surgery 2/23/2018 Lumpectomy: Left Surgery 5/16/2018 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant, Tissue expander placement; Reconstruction (right): Silicone implant, Tissue expander placement Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Sep 11, 2018 05:24PM macb04 wrote:

ReadyAbout, You go Girl! You probably could do it youself, but avail yourself of that helpful NP neighbor, if you have any doubts.


Hey Raven, How are you? I hope you have gotten that possible infection under control. Hope you are well. Let us know or you can PM me too.


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Sep 12, 2018 03:14AM raven4mi wrote:

Hi, macb04. Called the ID who thought I needed to be evaluated by the PS first, so went to see him last Thursday. He doesn't really think it's an infection, just a collection of fluid, for whatever crazy reason. The very slight fever I had abated after only a couple of days. PS wanted me to go get an u/s and have them do a needle aspiration at that time if they found a pocket of fluid. I called last Thursday to get that schedule and have since called back again but no one has called me to schedule anything. At this point, the redness and swelling is starting to go away on its own so I'm not even sure it will be worth going in for the u/s (which they'll never call me to schedule in the first place because my hospital sucks and the right hand doesn't know what the left hand is doing.) I forgot how much peace there was now in my life not having to deal with this crap on a day to day basis without it making my BP rise! LOL!

Anyhow, that was a long-winded way of saying I'm doing better, just pissed off about the lack of "care".

Dx 2008, DCIS, Right, 1cm, Stage 0, Grade 1, ER-/PR- Dx 1/2016, DCIS, Right, 2cm, Stage 0, Grade 3, ER-/PR- Surgery 4/15/2016 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery Lumpectomy: Right Radiation Therapy
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Sep 12, 2018 04:33PM Lalala1 wrote:

Hi,

I have a revision question and wanted to ask if anyone has had to get their nipple removed after implant reconstruction to remove excess skin and lift the breast?

I had cancer on the left side and had a lumpectomy. Margins were not clear so this was followed by a bilateral mastectomy.

The left nipple was removed with a skin sparing mastectomy. On the right side I had a prophylactic nipple sparing mastectomy.

However, due to the initial lumpectomy and nipple removal on my left breast, the skin envelope was smaller than on my right.

Initially, I had teardrop implants put in under the muscle but they were too small and there was a lot of extra skin and muscle distortion.

They were replaced with larger round implants covered in adm &placed pre-pectorally over the muscle. This fixed the muscle distortion and filled the skin envelope better but the right breast skin envelope is still bigger and the implant hangs lower on that side.

My right breast needs to be lifted to match my left breast and they will do it by tightening the right pocket to sit the breast higher/closer to chest and then remove the excess skin.

However, it was suggested that I would need to have the nipple removed along with the excess skin using a diagonal incision to match the original mastectomy incision on the left.

I understand that you can't just remove the excess skin from the IMF area, where my current right side scar is, because the nipple will be pulled down too low. I just wasn't expecting to loose the good nipple or have mastectomy scars on my good breast as well.

Has anyone been in this situation? Does anyone know if I have any options to have a lift & remove excess skin and not loose the nipple?

Many Thanks :)

Dx 11/21/2014, IDC, Left, Grade 2, ER+/PR+, HER2- Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lumpectomy: Left; Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant, Tissue expander placement; Reconstruction (right): Silicone implant, Tissue expander placement
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Sep 12, 2018 10:10PM macb04 wrote:

Hi Lalala1,

I had a breast lift using a Lollipop incision. That was to lift my breast, to get a closer match to my reconstructed side. It is also known as a Vertical Incision. Then there is a Lollipop Incision whereby the incision first goes around the areola, and then extends downwards from the areola towards the inframammary fold. I had to look around to find a PS doing that kind of incision.

I think it is pretty cavalier and insensitive attitude to act as if cutting your nipple off is no biggie. If you managed to hold on to even 1 functiong ( to whatever degree) nipple, then they can work with you to save it while managing a lift.




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Sep 13, 2018 04:55AM Lalala1 wrote:

hi macb04,

Thanks for your information. The type of insicion you mention is what I thought could be done but It was suggested the nipple wouldn't make it. Although I have seen some recent research where this has been successfully done after mastectomy.

I really wasn't expecting to be told this and I was kind of in shock when I got home. I had really wanted to keep my nipples originally but the cancer was too close on the left side so I had to loose that one. As the right side didn't have cancer it seems extreme to now have to loose a perfectly good nipple.

I’ll get a second opinion about this before doing anything. I find it's these curveballs that keep getting thrown at you when you least expect it, that are the hardest to deal with on this 'journey'. I hadn't appreciated how many steps and revisions were involved in this process. Time marches on & you are still half-done. You just want it to be completed already!

Thanks again for your message & thanks for starting this thread, it really is so helpful.

Dx 11/21/2014, IDC, Left, Grade 2, ER+/PR+, HER2- Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lumpectomy: Left; Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant, Tissue expander placement; Reconstruction (right): Silicone implant, Tissue expander placement
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Sep 13, 2018 07:10AM ReadyAbout wrote:

macb: Thanks for sharing info on this type of incision. I interviewed two PS last week and one implied that I would definitely lose both nipples during exchange sugery while the other said that as long as I was ok with them not being perfectly placed, he didn't see any reason I should lose them. My NP neighbor said it's usually a question of the tissue getting adequate blood flow. She also gave me a great piece of encouragement: that while the reconstruction/recovery from BC takes a long time (in my case, a year), that when you compare it to the 80 years you are expected to live, it's just one sliver. That shored me up.

Dx 2/1/2018, IDC: Papillary, Left, 1cm, Stage IA, Grade 2, 0/5 nodes, ER+/PR+ Surgery 2/23/2018 Lumpectomy: Left Surgery 5/16/2018 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant, Tissue expander placement; Reconstruction (right): Silicone implant, Tissue expander placement Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Sep 13, 2018 01:10PM macb04 wrote:

ALWAYS QUESTION what they tell you. Everyone has their own biases that influence the answers they give you. Even me, I suppose. It is especially true of PS's, that they will steer you towards techniques they are most familiar and comfortable with. What they recommend may not be what you want, so ask around.

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Sep 13, 2018 06:21PM joy2 wrote:

Hello Lalala1! I have similar situation like yours. I did prophylactic nipple/skin sparing bilateral mastectomy on April 2018 and followed by other 2 surgeries due to skin necroses. I was told that my nipples it may not survive, due to a large breast that i had and the blood flow was difficult to travel around. After 3 surgeries and infections and 3 month antibiotics, my nipples survived, so i have another surgery end of October to remove the excess skin , lifting, and place my nipples in a center position.(Right now they facing down). I am guessing that my would be a lollipop incision because i already have the vertical incision line from the previous surgery when my doctor was removing skin necrosis. He told me that he would do a lot of fat grafting too, to make look better and more natural. I have under muscle round implants. I am hopping that everything would go fine. I think if you really want to keep your nipple give it a try, it might make it and you would be happy. I asked 3 doctors before my surgery and 2 of them told me not even try because my nipples would't make it, because my of my breast size and drop.

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Sep 14, 2018 05:30AM Lalala1 wrote:

Hi Joy2,

Thank you so much for your message.

It is great that your nipples survived after all you had to go through with skin necrosis and infections. Was the skin necrosis after the nipple sparing mastectomy in the nipple area?

Were your original insicions for the mastectomy in the imf or were theythe vertical insicions that were used for the necrosis surgery?

Luckily my nipple survived the nipple sparing mastectomy ok. However they are not sure if it will survive the lift.

My implants are placed over the muscle wrapped in an adm pocket which will be lifted too so I am not sure if this makes a difference.

The higher side does not have any rippling but the side that needs lifting does. So I am hoping that once it’s lifted and the skin reduced that the rippling go will too. But as you say, fat grafting can be good for that.

Thanks again, your story gives me hope that my nipple may be ok with a lift. I’ll get a second opinion & see what my options are.

Good luck with your upcoming surgery. I hope it goes really well for you & you have a great outcome.


Dx 11/21/2014, IDC, Left, Grade 2, ER+/PR+, HER2- Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lumpectomy: Left; Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant, Tissue expander placement; Reconstruction (right): Silicone implant, Tissue expander placement
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Sep 14, 2018 08:06AM rachelcarter35 wrote:

Hello all

Had implant exchange yesterday. It was so nice to entirely trust my new PS. I had zero concerns about him yesterday. My revision hurts like a Dickens this morning but I know what incisions feel like so although it's uncomfortable I'm not afraid this time. I know the healing will be quicker than the mastectomies and hubby knows the routine. I have three drains and he emptied them for me this morning. I've got to get the pillow arranging a little better so I can sleep better tonight. Sigh back to back sleeping. PS says my drains could be out in less than a week though. Yay the big reveal in just few days. I know to not judge the initial view but I'm giddy anyway just to be getting near the end.

Dx 2/21/2018, DCIS/IDC, Both breasts, 2cm, Stage IIA, Grade 3, 0/5 nodes, ER+/PR+, HER2- (FISH) Surgery 4/24/2018 Mastectomy: Left, Right; Reconstruction (left): Nipple reconstruction, Nipple tattoo, Silicone implant, Tissue expander placement; Reconstruction (right): Nipple reconstruction, Nipple tattoo, Silicone implant, Tissue expander placement Chemotherapy 6/15/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Chemotherapy Targeted Therapy Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Sep 14, 2018 09:15PM macb04 wrote:

Lalala1, just want to bring up the use of Hyperbaric Oxygen Therapy (HBOT), prophylactically in conjunction with Reconstruction Surgery. I had several HBOT sessions approved, and paid for, except for our deductible, by insurance. I had the sessions start the day after the surgery, to help minimize circulation complications due to radiation damage. It was through a local Wound Care Center at Northwest Hospital in Seattle. Time consuming, and kind of boring, but really crucial when circulation, and wound healing are issues. Lots of Diabetic patients and others with nonhealing wounds or recent surgeries were getting HBOT along with me. Miraculous benefit, should be given to more patients going through Reconstruction.


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Sep 15, 2018 06:24PM ReadyAbout wrote:

Lalala1: I'll confirm macb's suggestion of hyperbaric. After my bmx surgery, my left side had lots of bruising with purple patches. The PS said that the tissue might become necrotic and if so, he would have to go in and remove that dead tissue surgically. I learned about hyperbaric therapy on this forum and asked my PS to write a prescription for sessions. He had never sent a patient to hyperbaric but he let me do it. I did10 sessions and the tissue healed SO well that my PS was both surprised and delighted. The sessions lasted 2 hours and were boring (you're lying in a glass tube for 2 hours and I hate sitting still) but a small price to pay for avoiding another surgery. And props to BCBS for paying for the sessions.

Dx 2/1/2018, IDC: Papillary, Left, 1cm, Stage IA, Grade 2, 0/5 nodes, ER+/PR+ Surgery 2/23/2018 Lumpectomy: Left Surgery 5/16/2018 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant, Tissue expander placement; Reconstruction (right): Silicone implant, Tissue expander placement Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Sep 19, 2018 04:43PM Bcbc wrote:

Anyone have sub pectoral expander to pre pec exchange in California that would highly recommend their surgeon? I went off my gabapentin (Rx for nerve painthat was so effective for post op pain) 2 weeks post final expansion, but had to go back on because I'm still having pain. Considering pre pec consultation before my exchange. My current PS only does sub pec. Thank you. Becky

Dx 3/30/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/5 nodes, ER+/PR+ Surgery 4/18/2018 Lumpectomy; Lymph node removal Hormonal Therapy 4/24/2018 Femara (letrozole) Surgery 6/1/2018 Mastectomy: Left, Right; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Sep 19, 2018 05:33PM rachelcarter35 wrote:

Dr. Kind. San Francisco

Dx 2/21/2018, DCIS/IDC, Both breasts, 2cm, Stage IIA, Grade 3, 0/5 nodes, ER+/PR+, HER2- (FISH) Surgery 4/24/2018 Mastectomy: Left, Right; Reconstruction (left): Nipple reconstruction, Nipple tattoo, Silicone implant, Tissue expander placement; Reconstruction (right): Nipple reconstruction, Nipple tattoo, Silicone implant, Tissue expander placement Chemotherapy 6/15/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Chemotherapy Targeted Therapy Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Sep 19, 2018 08:46PM Dm39 wrote:

love this. Thanks for all the info. I also had over pectoral implants. Was much easier for te fills too. I do have rippling and and beginning to develop capsular contracture. I have been taking vitamin e. I will try vitamin c to see if that helps. Glad you are doing well and happy with your results.

Dm39
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Sep 19, 2018 09:33PM - edited Sep 19, 2018 09:36PM by macb04

Dm39, that sucks Capsular Contracture starting. There was a research study on Low Level Laser Therapy for Capsular Contracture. It's alot safer/easier to try Low Level Laser for Capsular Contracture first before considering more invasive procedures.

I am surprised Insurance companies aren't all over this as a way to save money. If it doesn't work, there is always another surgical procedure as a last resort. I have had way, way too many surgeries, and would do most anything to skip more of that mess.

I think they used a Ryancorp Laser, from Australia, that has been also FDA approved to treat Radiation Fibrosis. You can even rent their laser, although it's a bit expensive.



Laser therapy for capsular contracture?

    Apr 7, 2015

    A new study suggests that low-level laser therapy may be the solution to capsular contracture, a troublesome problem associated with breast augmentation and reconstruction procedures. According to the authors, fibrous capsular contracture is a common complication of those procedures, one that typically results in significant patient dissatisfaction. Surgical and non-surgical measures both are used to treat the problem, mostly with mixed results, though surgery is considered the best method for treating the more severe grades of capsular contracture. For this study, two osteopathic physicians and a plastic surgeon, all from the Philadelphia area, conducted a study involving 33 patients with grades III and IV capsular contractures. For six weeks, patients underwent one weekly 10-minute laser treatment with a 904 nm laser over a 2-cm2 grid pattern at one minute per area. Patients were asked to complete a post-treatment survey to determine their level of improvement and satisfaction. The research team found that surgical intervention was avoided in 93.9% of patients with grade III and IV capsular contraction. Of the patients who avoided surgery, the laser improved breast stiffness by an average of 43.6% and improved comfort by an average of 48.2%. The researchers conclude that low-level laser therapy is a promising alternative treatment for grades III and IV capsular contracture. "This study is the first to look at using low-level laser treatment for capsular contracture," study author William L. Scarlett, D.O., of the Philadelphia College of Osteopathic Medicine, tells Cosmetic Surgery Times. "The technology is promising for non-surgical treatment of capsular contracture. A larger study needs to be done looking at the protocol, frequency of treatment and long-term follow-up." The other authors are Jason D. Johnson, D.O., also of the Philadelphia College of Osteopathic Medicine, and Paul M. Glat, M.D., of the Drexel University College of Medicine. The study appears in the March issue of the American Journal of Cosmetic Surgery.

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    Sep 20, 2018 03:53PM raven4mi wrote:

    Whelp, went in for my u/s yesterday and they found absolutely nothing of interest. So there is absolutely no way to know what may have caused the redness, pain, and swelling that started the Friday of Labor Day week-end, but it doesn't appear to have been an infection, thank God. Breast reconstruction debacles - the gift that keeps on giving!

    Redness is better, pain completely gone, and swelling getting better after starting to use thepump system that they gave me for lymphedema again. Guess I'll start using that more often on a prophylactic basis.

    Dx 2008, DCIS, Right, 1cm, Stage 0, Grade 1, ER-/PR- Dx 1/2016, DCIS, Right, 2cm, Stage 0, Grade 3, ER-/PR- Surgery 4/15/2016 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery Lumpectomy: Right Radiation Therapy
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    Sep 21, 2018 10:07AM OCAtty wrote:

    I went direct to implant but am happy with my prepectoral results. Dr. Mark Gaon in Newport Beach

    Dx 12/4/2017, DCIS, Right, <1cm, Stage 0, Grade 2, 0/3 nodes, ER+/PR+, HER2- Surgery 1/22/2018 Mastectomy; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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    Sep 22, 2018 12:11PM - edited Sep 22, 2018 12:46PM by HoldingOnToHope

    Hello Everyone,

    I just read through 58 pages on this thread and learned so much! So, thank you for posting and helping others. I have my BMX this coming Wed in Minneapolis, and I will be getting pre-pectoral TEs at the same time. The TEs will be filled at my 2-week post-op appt. I will then start radiation (right side only) on both my breast area and armpit (one positive node).

    I was diagnosed with IDC Stage 2 ER and PR negative and HER2 positive at the end of April. I finished chemo a month ago and am continuing w/ Herceptin for the first full year. I am wondering if anyone went through radiation w/ TEs. My PS said this is the only way he would consider implants. Otherwise, if I completed radiation without TEs, the chances of successful pre-pectoral implants would be lower. Has anyone been through this and then had positive result w/ pre-pectoral implants after radiation w/ TEs? My anticipated implant surgery is June 2019, approximately 6 months after radiation. Thanks for your feedback.

    Be still and know that I am God. ~Psalm 46:10 Dx 4/23/2018, IDC, Right, Stage IIB, Grade 3, ER-/PR-, HER2+ Chemotherapy 5/2/2018 AC + T (Taxotere) Targeted Therapy 5/2/2018 Perjeta (pertuzumab) Targeted Therapy 5/2/2018 Herceptin (trastuzumab) Surgery 9/26/2018 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left
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    Sep 22, 2018 02:13PM Lanne2389 wrote:

    HoldingOnToHope

    I had 26 sessions of radiation with pre-pec TEs starting 8 weeks after BMX. It went well. My radiated side did contract a bit and sat higher than my non radiated side. I was required to wait at least 6 months after radiation before planned exchange (I switched to DIEP tho). I waited until after radiation to do fills and had no problems - I added about 150cc with very little discomfort caused by the fills.

    I can't tell from what you wrote how soon after BMX you will start radiation - but if it is less than a month a two you might want to give you skin more time to heal. Otherwise, it sounds like your timetable is about right. Load up on vitamin C to promote healing!

    Also I can highly recommend the cream at this link suggested by my radiologist. It worked great for me. I gooped it on right after each rad appt before going home, at night, and during the day if needed. Dr also suggested covering the cream with aquafor at night. Dr thought this cream penetrated the deepest (get Cream not gel).

    https://www.target.com/p/boiron-calendula-first-aid-cream-2-5-oz/-/A-16836633

    Good wishes to you on your upcoming surgery. Sorry you have had to join this club but we welcome you with open arms.

    Lanne Dx 11/20/2016, IDC, Right, 3cm, Stage IIB, Grade 1, 3/17 nodes, ER+/PR+, HER2- (FISH) Chemotherapy 1/3/2017 AC + T (Taxol) Surgery 6/14/2017 Lymph node removal: Right, Sentinel, Underarm/Axillary; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Radiation Therapy 8/8/2017 Whole-breast: Lymph nodes, Chest wall Hormonal Therapy 9/15/2017 Femara (letrozole) Surgery 7/17/2018 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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    Oct 1, 2018 10:26PM macb04 wrote:

    Welcome HoldingontoHope and Lanne2389. Glad you have stopped by. This is a good thread to ask questions on Prepectoral Implant Reconstruction.

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    Oct 1, 2018 11:25PM HoldingOnToHope wrote:

    Thank you, Lanne2389 and macb04. SURGERY UPDATE: My bilateral mastectomy was last Wed. After my BS completed the mastectomy, my PS placed the TEs over the pectoral muscle and slightly filled them so that I woke up with two small bumps. The anesthesiologist had indicated that nausea after surgery is common w/ patients who get mastectomies. Sure enough, I felt extremely nauseated and needed meds to combat it. I was thankful to have zero pain that entire day.

    Early the next day (Thurs), I felt pain on my right side. My BS and PS came into my hospital room an hour later at around 6:00 a.m. for their regular rounds and agreed I had a hematoma and needed to go back into surgery ASAP. After the surgery, my PS indicated he was able to find the source of the bleed (close to the area where my sentinel lymph nodes had been removed). This unplanned, urgent surgery necessitated an extra night in the hospital.

    The pathology results indicated no cancer cells in the original area where the tumor was and no cancer in the 3 sentinel lymph nodes that were biopsied. My left breast (prophylactic mastectomy) indicated abnormal cells that my breast surgeon indicated potentially could have developed into breast cancer. For this reason, I am thankful that I had a bilateral mastectomy.

    At home resting and recovering. Although I have had virtually no pain, my right armpit area (where the lymph nodes were removed and the hematoma occurred) is very bruised and tender. I have a post-op appt a week from tomorrow, and I will get my TEs filled a bit more. My PS said he plans to slightly underfill my TEs so that the implant will be “snug.” Here and happy to answer any questions you may have about pre-pectoral TEs before radiation. Learned so much from everyone on this board and I continue to lea every day from walking this unexpected path.

    Be still and know that I am God. ~Psalm 46:10 Dx 4/23/2018, IDC, Right, Stage IIB, Grade 3, ER-/PR-, HER2+ Chemotherapy 5/2/2018 AC + T (Taxotere) Targeted Therapy 5/2/2018 Perjeta (pertuzumab) Targeted Therapy 5/2/2018 Herceptin (trastuzumab) Surgery 9/26/2018 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left
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    Oct 2, 2018 07:40AM borogirl wrote:

    Holdingontohope - did you have nipple sparing, and if so where were your incisions? I’m doing prophylactic bilateral next month, prepectoral, and am a little concerned about BS plan to do lateral incision that goes around top half of Areola.


    Surgery 3/12/2018 Lumpectomy: Left Surgery 11/11/2018 Lumpectomy: Left; Mastectomy: Left, Right; Prophylactic mastectomy: Left, Right; Reconstruction (left): Silicone implant, Tissue expander placement; Reconstruction (right): Silicone implant, Tissue expander placement
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    Oct 2, 2018 07:51AM HoldingOnToHope wrote:

    Borogirl, Because my original tumor was so close to my nipple, I did not do nipple sparing. I could have opted for nipple sparing on my prophylactic side but decided against it in hopes that my final outcome will have more symmetry w/ nipple size, placement, etc.

    My incisions are lateral extensions (horizontal from the outside towards the nipple, so just a little more than halfway across each breast). I am amazed at the fact that I feel almost no pain at all, just some tenderness on the right where the sentinel nodes were taken and some itching where I am healing. I wish you the best with your upcoming procedure!

    Be still and know that I am God. ~Psalm 46:10 Dx 4/23/2018, IDC, Right, Stage IIB, Grade 3, ER-/PR-, HER2+ Chemotherapy 5/2/2018 AC + T (Taxotere) Targeted Therapy 5/2/2018 Perjeta (pertuzumab) Targeted Therapy 5/2/2018 Herceptin (trastuzumab) Surgery 9/26/2018 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left
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    Oct 2, 2018 08:06AM borogirl wrote:

    Great to hear you are doing so well HoldingontoHope. Since I don’t have to have any lymph nodes touched, I hope pain won’t be as bad. I’ll be following your progress.

    Surgery 3/12/2018 Lumpectomy: Left Surgery 11/11/2018 Lumpectomy: Left; Mastectomy: Left, Right; Prophylactic mastectomy: Left, Right; Reconstruction (left): Silicone implant, Tissue expander placement; Reconstruction (right): Silicone implant, Tissue expander placement
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    Oct 2, 2018 12:32PM Lanne2389 wrote:

    borogirl, I've wondered why there are so many different scar patterns with mastectomies. Some are right across the front or some variation, and some like mine are under the breast and out under the arm. Will a PS be part of your team? Obviously tumor placement, type of cancer, and reconstruction plans play a roll, but it's worth a convo with the Dr. If it helps, it seems that breast scars heal very well and (relatively) fast for many ppl. I used Scar-away silicon strips on a short portion of my scar that was raised and redder than the rest (the back-stitch section at the end) and could see improvement the first week. Load up on Vit C to promote healing!

    Lanne Dx 11/20/2016, IDC, Right, 3cm, Stage IIB, Grade 1, 3/17 nodes, ER+/PR+, HER2- (FISH) Chemotherapy 1/3/2017 AC + T (Taxol) Surgery 6/14/2017 Lymph node removal: Right, Sentinel, Underarm/Axillary; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Radiation Therapy 8/8/2017 Whole-breast: Lymph nodes, Chest wall Hormonal Therapy 9/15/2017 Femara (letrozole) Surgery 7/17/2018 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap

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