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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 05:47PM - edited Nov 12, 2018 02:43PM 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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Posts 1801 - 1830 (1,832 total)

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Oct 31, 2018 10:12AM Shoregirl wrote:

Bird, thank you, I am really hoping for a great outcome. Its been a fight to get to this stage. But others have done it before me so I know its possible. My new surgeon is Dr. Vincent Perrotta in Salisbury, MD.

Macbo4, lots of great info and sources on the Progesterone! My stepfather put me on the bioidentical cream prior to my bc dx after determining I was in mp. My uterus was removed in 2001 due to adenomyosis so I had to kind of guess when I was in mp as I retained my ovaries. He told me progesterone is good for many things but I didn't get all the detail you have provided. Of interest to me is the blood sugar and thyroid support. I also noticed you put "improving libido" on the list more than once *wink*. I am thinking I will ask my NP gyno about the oral bioidentical progesterone. I don't want to be discussing my libido with my stepdad!

Faith, Hope & Love, the greatest of these is Love 1st Cor 13:13 Dx 12/2/2016, DCIS, Right, 6cm+, Stage 0, Grade 3, 0/2 nodes, ER-/PR-, HER2- (IHC) Surgery 1/27/2017 Lymph node removal: Sentinel; Mastectomy: Left, Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 4/25/2017 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 11/29/2017 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant Surgery 12/4/2018 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Nov 2, 2018 03:45PM macb04 wrote:

Shoregirl, that made me laugh saying you didn't want to talk to your stepdad about your libido. I didn't realize that I had duplicated the libido one. Actually I want to add that Progesterone helps with Hair Loss as well. My hair started thinning at the front when I was first poisoned, pushed into menopause. The tamoxifen finished the neutering process. I hated feeling like I was going bald on top of everything else, the mutilation, ect. When I started on the Bioidentical Progesterone I saw new hair, like baby hairs start growing in. My hair is closer to my norm then it was. Thank God for Bioidentical Progesterone!


https://ndnr.com/womens-health/treating-female-pattern-hair-loss/

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Nov 3, 2018 01:21AM DebAL wrote:

rachelcarter, I didnt go all the way back to read posts but I saw your last one. I'm 3 months post exchange. I get what you are saying. Even though TEs were hard and stuck out more they felt lighter. These do take some getting used to as far as the heaviness goes. Laying on my back they feel like heavy blobs. I try to sleep without a bra but it's just not as comfortable. I also had a fair amount of pocket revision on one side. Definitely a difference. It just takes a little time. Hope you are feeling ok!

Dx 1/22/2018, IDC, Left, <1cm, Stage IA, Grade 1, 0/3 nodes, ER+/PR-, HER2- (IHC) Surgery 2/12/2018 Mastectomy: Left, Right Surgery 2/12/2018 Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 4/2/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 6/14/2018 Arimidex (anastrozole) Surgery 8/9/2018 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Nov 3, 2018 02:51AM Shoregirl wrote:

Macb04, hair loss/thinning yes! Another bane of my 50s!! I say this only being silly...I realize it is a privilege to grow old as so many don't get to. But my hairdresser actually pointed it out to me before I even realized I was a little light on top 2 yrs ago, just before my dx. Mine is probably due to low thyroid and MTHFR. Super thin along the front hairline and in front of ears. It's getting better since I stopped commercial dye and went to henna and sulfate & silicone free hair care products, but I still notice it. I don't think the topical progesterone is enough. Thanks for mentioning this!

DebAl, Rachel...I am almost 12 months out from my exchange and just now feeling like I could live with these implants. The strange peeling of my chest feeling when I get up from lying down is pretty much gone. There are still twinges in one, but I have a problem with either a creased implant or a creased pocket that will be addressed Dec 4th. I knew 1 month after exchange last year I would be going back for revision for several reasons. But you are very early in the healing in the grand scheme of things. Unless there are obvious reasons to consider revising I would recommend giving it at least 8 months to settle. I was not prepared for how long it takes to start being comfortable with implants! Feel better soon!

Faith, Hope & Love, the greatest of these is Love 1st Cor 13:13 Dx 12/2/2016, DCIS, Right, 6cm+, Stage 0, Grade 3, 0/2 nodes, ER-/PR-, HER2- (IHC) Surgery 1/27/2017 Lymph node removal: Sentinel; Mastectomy: Left, Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 4/25/2017 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 11/29/2017 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant Surgery 12/4/2018 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Nov 3, 2018 05:32AM CaliKelly wrote:

I have had both under the pectoral and now, over the pectoral muscle implant. HATED the under pec implant! After I eventually had to have the lat flap surgery, the pectoral was relocated back to its original place, under the boob(or foob , I guess,fake boob) So much better esp if you work out with weights. The relocated latissimus muscle does sometimes forget it's in front now, weirdly contracting when I'm using certain machines at the gym, but I'm getting used to it! About the progesterone cream, I used bioidentical estrogen, progesterone and testosterone creams, pre breast cancer diagnosis. Never felt better! But my Doctors took me off them!😔. I'm er, pr positive. Going to have to ask about Progesterone again, I always believed it was protective against BC. About hair loss, see the hair loss solved post I wrote! Worked for me. I'll show you before and after pics!pm me

Dx 6/17/2015, IDC, Left, 6cm+, Stage IIIC, Grade 2, 8/20 nodes, ER+/PR+, HER2- (IHC) Chemotherapy 8/10/2015 TAC Surgery 1/19/2016 Lymph node removal: Left, Underarm/Axillary; Mastectomy: Left Hormonal Therapy 1/29/2016 Arimidex (anastrozole) Surgery 6/28/2016 Reconstruction (left): Silicone implant Chemotherapy 11/2/2016 Xeloda (capecitabine) Surgery 10/6/2017 Reconstruction (left): Latissimus dorsi flap Surgery Radiation Therapy Whole-breast: Breast, Lymph nodes, Chest wall
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Nov 3, 2018 09:33AM rachelcarter35 wrote:

I'm on my second month of Tamoxifen with no SEs so far but if needed down the road I'm wondering if these creams might counter the Tamoxifen's effectiveness.

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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Nov 3, 2018 12:22PM CaliKelly wrote:

I know you can't use Estrace, a vaginal estrogen cream, with tamoxifen . My Dr switched me to anastrazole so I could use it for dryness and pain. But I don't know about Progesterone.

Dx 6/17/2015, IDC, Left, 6cm+, Stage IIIC, Grade 2, 8/20 nodes, ER+/PR+, HER2- (IHC) Chemotherapy 8/10/2015 TAC Surgery 1/19/2016 Lymph node removal: Left, Underarm/Axillary; Mastectomy: Left Hormonal Therapy 1/29/2016 Arimidex (anastrozole) Surgery 6/28/2016 Reconstruction (left): Silicone implant Chemotherapy 11/2/2016 Xeloda (capecitabine) Surgery 10/6/2017 Reconstruction (left): Latissimus dorsi flap Surgery Radiation Therapy Whole-breast: Breast, Lymph nodes, Chest wall
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Nov 3, 2018 01:51PM macb04 wrote:

This diagram, prettier way to show that Real, Bioidentical Progesterone is good for us, better than I can say it., heck it used to be used for bc treatment prior to AI/tamoxifen

After Twenty Years Cancer Research Blog Exploring progress in cancer research from the patient perspective.

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A Role for Progesterone in Breast Cancer Treatment?

June 20, 2017By Lisa DeFerrariin Research ProgressTags: Cancer Clinical Trials, Hormone Receptor-Positive Breast Cancer, Tamoxifen, Targeted Therapies3 Comments

New research sheds light on the role of progesterone in hormone receptor-positive breast cancer.Back in August 2015, I wrote about an article in the journal Nature on some interesting new discoveries about the role of the hormone progesterone in hormone receptor-positive breast cancer.

The research suggested that adding progesterone to standard treatment with tamoxifen or an aromatase inhibitor could increase the effectiveness of treatment for this subtype of breast cancer, while possibly also lowering toxicity.

Cancer Research UK reports that these findings are now going to be investigated in three clinical trials that are set to begin.

In addition to possibly increasing the effectiveness of existing anti-estrogen therapies, and maybe also lowering toxicity, another benefit of this potential treatment approach is that it involves existing drugs that are already well understood and widely used–and whose cost is low.

It's encouraging to see these studies going forward. I'll be following developments in these trials with interest. In the meantime, I'm attaching below my earlier post, which includes some background on the role of the progesterone receptor and what the researchers found.

Hormone Receptor Positive Breast Cancer: A Look At New Research Findings

About two out of three women diagnosed with breast cancer have the sub-type that is referred to as hormone receptor-positive breast cancer. This means that when tumor cells (from a biopsy or surgery) are examined under a microscope they're found to have receptors for the hormone estrogen (they are "ER-positive") and/or the hormone progesterone (they are "PR-positive).

The prognosis generally tends to be somewhat better for this type of breast cancer, and there are several targeted hormonal therapies available. These treatment options, which include tamoxifen and aromatase inhibitors, focus on the sensitivity of this type of breast cancer to the hormone estrogen. These drugs work in slightly different ways, but the goal is to "starve" tumor cells of the estrogen they need to survive and grow.

For hormone-positive metastatic breast cancer as well, there are a number of hormonal therapies available. These include tamoxifen and aromatase inhibitors and several newer drugs. All of these treatments work by interfering with the ability of estrogen to fuel the growth of breast cancer cells.

But there are no therapies widely used today that target progesterone or its receptor in either early stage or metastatic breast cancer. Why do we even measure this characteristic at all if it doesn't have any role in determining treatment?

Role of the Progesterone Receptor

Delving into this question a little, I found that the role of the progesterone receptor in hormone-positive breast cancer has been somewhat controversial. The information about PR status has mostly been used to help determine prognosis. That is, a higher level of PR positivity (a numerical level is assigned) has been associated with a somewhat better outcome. And a lower PR level or lack of PR receptors ("PR-negative" breast cancer) is generally not as good a prognosis.

Beyond this role in determining prognosis though, there is disagreement. Some believe that PR status has no role in determining treatment, and that there really is no need to continue measuring it. However, others are of the view that PR status is useful as a biomarker to help identify patients whose ER-positive breast cancer is most likely to respond to specific types of anti-estrogen treatments and to help in choosing the most beneficial treatments for these patients.

Progesterone Receptor Study

In this new study, researchers set out to learn more about how the progesterone receptor actually works. Conducting experiments in cell lines (human breast cancer cells grown in the lab), the researchers found that there is "cross-talk" between the progesterone receptors and the estrogen receptors on breast cancer cells. In other words, they found that the receptors are communicating with each other.

And what was really interesting was that the more of this communication that was going on the better–this was because signals from the progesterone receptor served to tone down the pro-cancer activity of the estrogen receptor.

In another set of experiments, the researchers implanted hormone-positive human breast cancer tumors into mice. They found that exposing the mice to estrogen caused the tumors to grow, while exposing the mice to both estrogen and progesterone actually caused the tumors to shrink. They also found that treatment that included the hormone progesterone, in addition to anti-estrogen therapy (tamoxifen), was more effective than just tamoxifen in reducing the size of the tumors.

What These Findings Could Mean For Patients

These findings will of course need to be confirmed in additional studies including clinical trials. And the possible side effects of combining the hormonal treatments would have to be evaluated.

Hopefully, that follow-up will happen.

The lead researcher on the study, quoted in Medical News Today said the findings provide "a strong case for a clinical trial to investigate the potential benefit of adding progesterone to drugs that target the estrogen receptor, which could improve treatment for the majority of hormone-driven breast cancers."

An interesting aspect of this approach is that it would use an existing drug that is currently available as a generic.

Finally, when talking about progesterone, there's an important distinction to be aware of. The Nature article points out that there's compelling evidence that including progesterone as part of hormone replacement therapy (HRT) increases the risk of breast cancer. However, the authors say the increased risk is mostly attributed to the synthetic form of progesterone that's used in HRT. That increased risk, they said, is not significant when natural progesterone is used.

Photo Credit: designer491 via Shutterstock

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3 responses
  1. thesmallc says:June 20, 2017 at 10:43 amThank you for this information. I have always had a curiosity about how progesterone contributes to BC. I had very high level of progesterone (87%) and estrogen (99%) on my pathology report. But now they are saying progesterone may actually be helpful? This is all interesting and I look forward to knowing what researchers find out.
    • Lisa DeFerrari says:June 23, 2017 at 9:31 amHi, Rebeca. I'm very interested too in seeing what they find out. I always wondered what the purpose was in measuring the level of the progesterone receptor because it didn't seem like a whole lot was done with that information. Perhaps some new insights will come out of this that will be valuable for patients. Thanks as always for reading and for your comments!
  2. Eileen says:June 29, 2017 at 3:10 amAlmost seems counter intuitive. Fascinating though. Who knew?

Welcome! I'm a cancer research advocate who was diagnosed with breast cancer in 1993 at the age of 35. I'm a graduate of the National Breast Cancer Coalition's Project LEAD program, which trains advocates in the fundamentals of breast cancer science. I've also served on numerous panels reviewing cancer research proposals for government funding. Please join us as we follow the progress that's being made in cancer research, care and prevention.
- Lisa DeFerrari

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Nov 5, 2018 09:23AM - edited Nov 5, 2018 09:38AM by Meeshelle

This Post was deleted by Meeshelle.
Meesh
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Nov 5, 2018 09:32AM Meeshelle wrote:

hi there question for people? I had bilateral mastectomy August 2017 with immediate reconstruction and tissue expanders UNDER THE PECTORAL MUSCLES.. it was AWFUL, I literally could not take a deep breath or even talk without excruciating pain. So I looked forward to having the swap with the implants on November of 2017. I continue to have excruciating pain and So I found a specialist and had the implant put on top of my pec muscle on January 10th 2018. It's 10 months later and I'm still having terrible pec muscle spasm pain and the tightness on my chest. It's affecting my everyday life even more because now I'm having terrible middle back pain from all of this. What I'm wondering is anyone out there had the BOTOX to QUIET the nerves for the PEC muscles? I've been doing physical therapy and myofascial release and acupuncture for over a year now and nothing seems to help. I am desperate for help and at the end of my rope. There's no way I could live like this for another year let alone even a few more months. I would love to go flat but the emotional struggle with that is really scary to me. PLEASE HELP ANYONE!!!

Meesh
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Nov 5, 2018 09:37AM Meeshelle wrote:

hi there question for people? I had bilateral mastectomy August 2017 with immediate reconstruction and tissue expanders UNDER THE PECTORAL MUSCLES.. it was AWFUL, I literally could not take a deep breath or even talk without excruciating pain. So I looked forward to having the swap with the implants on November of 2017. I continue to have excruciating pain and So I found a specialist and had the implant put on top of my pec muscle on January 10th 2018. It's 10 months later and I'm still having terrible pec muscle spasm pain and the tightness on my chest. It's affecting my everyday life even more because now I'm having terrible middle back pain from all of this. What I'm wondering is anyone out there had the BOTOX to QUIET the nerves for the PEC muscles? I've been doing physical therapy and myofascial release and acupuncture for over a year now and nothing seems to help. I am desperate for help and at the end of my rope. There's no way I could live like this for another year let alone even a few more months. I would love to go flat but the emotional struggle with that is really scary to me. PLEASE HELP ANYONE!!!

Meesh
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Nov 5, 2018 04:52PM macb04 wrote:

Hi Meeshelle, I sent you a PM with some info on things you may already know about for pain.

I hope something is helpful for you soon.


Macb04

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Nov 6, 2018 01:27AM - edited Nov 6, 2018 01:28AM by Bird-of-light

Not Very Brave, how large are your implants?

Macb, do you know how the pectoral muscle is repaired? Also, why didn't go with DIEP?

Dx 4/13/2016, IDC, Left, <1cm, Grade 2, 0/3 nodes, ER+/PR+, HER2+ (IHC) Surgery 6/7/2016 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Targeted Therapy 7/13/2016 Herceptin (trastuzumab) Chemotherapy 7/14/2016 Taxol (paclitaxel)
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Nov 6, 2018 03:19AM - edited Nov 6, 2018 05:35AM by Bcbc

Meeshelle, did you listen to this podcast from this website?

https://www.breastcancer.org/community/podcasts/postmastectomy-pain-20181005

This physician has had very positive results with botox, but sounds like he usually tries an injection of a combination of a steroid and long acting local anaesthetic first.

But before that, he starts his patients on an oral medication used specifically for nerve pain, such as gabapentin or lyrica. Have you tried either? I'm MUCH more comfortable while taking gabapentin.

So sorry you are suffering. Hopefully someone on this site has had experience with botox. Have you checked out the thread on Post Mastectomy Pain Syndrome?Here's that link... https://community.breastcancer.org/forum/136/topics/747016?page=57#idx_1687

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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Nov 6, 2018 09:55AM NotVeryBrave wrote:

Bird - My implants are 355cc and 395cc. They are Mentor MemoryShape, medium height and moderate profile.

TCHP x 6 with pCR. One year of Herceptin. DTI pre-pec surgery. Quit Tamoxifen after 3 months. Dx 11/21/2016, DCIS/IDC, Left, 2cm, Stage IIA, Grade 2, 0/3 nodes, ER+/PR+, HER2+ (IHC) Targeted Therapy 12/18/2016 Perjeta (pertuzumab) Targeted Therapy 12/19/2016 Herceptin (trastuzumab) Chemotherapy 12/19/2016 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 5/9/2017 Lymph node removal: Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 9/9/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Nov 6, 2018 12:14PM - edited Nov 6, 2018 12:16PM by macb04

bird-of-Light, my Pectoral muscle was just arranged in the proper location after the TE was removed. Wasn't sutured in place, weird PS, not sure why he didn't suture. He said he didn't.Despite that, my Pectoral Muscle recovered about 95 plus percent of what it was before the whole mess. I

I was initially going for DIEP and changed my mind because I didn't want such an extensive surgery and long recovery. I especially didn't want such enormous scars.

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Nov 8, 2018 09:12AM - edited Nov 9, 2018 08:24PM by macb04

There is interesting research being done on Progesterone as a treatment for breast c.


https://www.eurekalert.org/pub_releases/2014-07/pf...

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Nov 11, 2018 05:45AM macb04 wrote:

Hey all of you Ladies,, please spread the word about the safety and efficacy of Bioidentical Progesterone, a grassroots campaign for much needed improvement in QOL

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Nov 11, 2018 08:21PM macb04 wrote:

The list is now up to over 60 Plastic Surgeon's who do Prepectoral Implant Reconstruction in the US.

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Nov 12, 2018 07:41AM macb04 wrote:

I just added Arash Momeni MD to the list. He's at Stanford and has done >100 prepecs.

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Nov 12, 2018 11:25AM - edited Nov 12, 2018 11:25AM by HoldingOnToHope

Please add Dr. Timothy Schaefer to the Midwest list. He is based out of Edina, MN. Thank hou

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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Nov 15, 2018 11:11AM Andraxo wrote:

Macb04 - where do you get your bioidentical progesterone and is there a specific brand/manufacturer you'd found is best (at least for you)? I haven't seen a lot of info about dosage and I think my oncologist will just dismiss my wanting to try it.

- xo

Andra :) Dx at age 45. Super active in outdoor adventures in the southwest/4 corners area. Dx 7/2015, IDC, Left, <1cm, Stage IIA, 3/5 nodes, ER+/PR+, HER2- Surgery 9/4/2015 Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 10/5/2015 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 2/29/2016
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Nov 15, 2018 08:16PM macb04 wrote:

I take specially Compounded Prescription Progesterone that is prescribed by my Oncology trained Naturopath. I take two 25mg capsules at Bedtime. I thought about using Bioidentical Progesterone in a Topical form, but I also wanted steady dosing and the improved sleep benefits you get with the Oral Progesterone instead of the topical Progesterone cream. I read up on it and talked to my Naturopath, who agreed with my idea.

Topical Progesterone needs to be rotated to different sites each time it is used, and there can be differing rates of absorption depending on where you place the cream. For example, women put the Progesterone cream on their shins, or inner forearms, areas without a lot of fat. I use the Progesterone to prevent overgrowth of my Uterine lining, which can occur with use of vaginal estrogen, which I use for treatment of vaginal atrophy.

Another Progesterone is Micronized Progesterone called Prometrium. Alot of other sites wrongly describe the Artificial Progestins side effect when they are describing side effects of Prometrium. This Canadian site is very informative and accurate.

https://www.cemcor.ca/ask/bewildered-bio-identical-hormones

Bewildered by Bio-Identical Hormones QUESTION

Are bio-identical hormones safe for treatment in menopause? I have no symptoms but did have a blood clot in my calf years ago when I was first pregnant. I was told then to never take estrogen. Could I safely take bio-identical hormones? I'm asking because I recently saw Suzanne Somers on the Oprah show discussing hormone replacement with bio-identicalhormones. She says they are making her feel great. CBC's "The National" last week said that drug company hormone therapy, too, is now considered safe.

ANSWER

Thank you for your question about bio-identical hormone therapy. Each "side" wants us to believe that hormones are safe and to ignore the questions we should all ask: What do I want to treat? Has this medicine been shown to be an effective treatment for this problem? Is this hormone safe for me?

I agree that it is confusing when a form of estrogen that is called "bio-identical" or "natural" is reported to be safe, but the kind of estrogen in Premarin® pills has been proven to cause heart disease, blood clots and strokes. I also saw Suzanne Somers eating her meter-long row of supplements and applying a dab here and a dab there, of what she calls "bioidentical hormone replacement therapy."

I believe that bio-identical hormones are the ideal kind of hormones to use for any necessary treatment because we know how they are metabolized in our bodies and therefore can predict their actions. When something is different from what our bodies make, it may have unexpected effects. For example, medroxyprogesterone (a cousin of progesterone) when used with estrogen treatment, causes an increase in breast cancer risk (1). However, the bio-identical, natural progesterone (Prometrium®) with estrogen prevents a 29% estrogen-related breast cancer increase (2).

What most of us don't realize is that many official drugs—made by pharmaceutical companies and licensed by the FDA or Canada's Health Protection Branch—are bio-identical. For estrogen (officially called 17-beta estradiol), the list of drugs that are bio-identical include Estrace®, Estragel®, Estradot®, Estraderm®, and Climera®. For progesterone, there is Prometrium® and, in some places, a vaginal gel.

There is another reason for the debate over bio-identical hormones—they are regulated differently in different countries. In the USA, bio-identicalhormones can be obtained without a prescription as a "dietary supplement". In Canada they are considered drugs and must be prescribed by a health care provider. That being said, in both the USA and Canada, most compounding pharmacists are trained and certified by an organization that ensures quality control—purity of the basic hormone preparation, careful measurement of the dose, and excellent reliability of the finished medicine.

This is the other important issue that was ignored in the Suzanne Somers episode—any hormones, bio-identical or not, should be used with care. They are not like skin lotion or aspirin. Bio-identical hormones are powerful substances with effects throughout our bodies. We use hormones for a reason. Would you take an antacid if you didn't have heart burn? A pain pill if you have no discomfort? A sleeping pill if you're sleeping well? I don't think so. Menopause is not an illness. It is normal. Low estrogen and progesterone levels are also normal for menopausalwomen. Menopause causes no problems for the majority of menopausalwomen.

However, some menopausal women do need treatment with what I call "Ovarian Hormone Therapy" (OHT, progesterone with transdermalestradiol). OHT is needed and scientifically justified in menopausal women for these two reasons:

  1. Early menopause that occurred before age 40. It is appropriate to continue bio-identical hormones until age 52 (the average age of menopause), then taper and stop estrogen. You can safely continue progesterone if hot flushes persist.
  2. Osteoporosis in a woman who is newly menopausal who also has intense night sweats chronically disturbing sleep. Here the OHT can be safely continued for five years before a bone loss-stopping medicine, such as a bisphosphonate, is added. Then the estrogencan be tapered and stopped. Again, progesterone should be continued until off the estrogen and may be safely continued if needed for hot flushes

Severe hot flushes/night sweats only need progesterone or medroxyprogesterone (which is as effective as estrogen) (3).

Now to answer your question: it sounds like you do not need any hormone therapy. If you did, suddenly, start having hot flushes, you can use progesterone cream (20 mg twice a day) that has been shown to improve them (4) and won't increase clotting. I believe that a woman with a past blood clot should never take a pill form of estrogen, whether bio-identicalor not, because that will increase her already increased risk for a second blood clot. You should use caution also, and have a very strong reason for taking estrogen as a patch, gel or vaginal form, although these are less likely than pill estrogen to cause blood clots (5).

Back to Oprah and Suzanne—given that menopause is a normal part of every woman's life cycle, and not a disease—I strongly question the use of any hormone therapy, bio-identical or not, in healthy menopausal women. The notion of menopausal hormone "replacement" is just plain wrong.

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Nov 16, 2018 06:57AM Andraxo wrote:

Thanks for all that info Macb04! :)

- xo

Andra :) Dx at age 45. Super active in outdoor adventures in the southwest/4 corners area. Dx 7/2015, IDC, Left, <1cm, Stage IIA, 3/5 nodes, ER+/PR+, HER2- Surgery 9/4/2015 Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 10/5/2015 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 2/29/2016
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Nov 16, 2018 08:00AM rachelcarter35 wrote:

FYI: Tattoos DO make you feel better. I had no idea how much better everything looks and feels. If I'd know I might have pushed for it sooner. My PS office did such a good job!

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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Nov 16, 2018 09:35AM macb04 wrote:

Glad I could help, Andraxo. Let me know if you have any other questions.

I agree Rachecarter35, 3D Nipple/areola tattooing make a huge difference. I had mine done by Vinnie Myers.

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Nov 17, 2018 08:53AM Lanne2389 wrote:

macb04 - would you be comfortable sharing the cost of vinnie's tattoos and how long the wait for an appt was?

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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Nov 17, 2018 03:39PM macb04 wrote:

Well, I forget exactly, but it was something like 1,000 per breast. The wait was around 6 months. I travelled down to San Diego area to meet up with him. He rented a posh suite in a Resort which is where I had to go. I paid out of pocket, because my insurance wouldn't pay as it wasn't done in a clinic or hospital. Just one more of the endless sea of expenses that depleted my retirement savings, for no safety in the end.

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Nov 17, 2018 04:18PM rachelcarter35 wrote:

Insurance is supposed to pay for tattoos. That seems crazy expensive.

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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Nov 17, 2018 05:21PM macb04 wrote:

My husbands backwards insurance would only pay for tattoo if done in a hospital or a clinic. I wanted the tattoo by Vinnie, and he only does hospital tattos back East, in Maryland or somewhere. Actually I think most of his tattooing is done in his tattoo studio. I think it was less money at his regular place, more money when he travels with a crew to do tattoos.

I regretted having reconstruction done in Seattle, my husband was an unsupportive turd about me going away for better surgical options out of state. So when it came time for the tattoo, I decided to get the best tatto I could possibly find. I researched tattoos and spoke with people. He has amazing results, took him 15 minutes as he is just so skilled. He tattoed my real right areola/nipple to get a match when he created the 3d nipple and areola complex for my Left reconstructed breast.

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