May 25, 2019 06:48PM Bird-of-light wrote:
Macb, His name is Dr. John Hijjawi, SLC Utah. He has great reviews.
Posted on: Oct 20, 2015 12:47AM - edited Jun 11, 2019 11:14PM by macb04
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 )
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
Dr. Julie Park - University of Chicago Medicine, Il
Dr. Sandeep Jejurikar - Downers Grove & Batavia, IL , Advocate Good Samaritan Hospital
Dr. William Dougherty - Taos, NM
Dr. Minh-Doan T. Nguyen, MD, Ph.D - Mayo Clinic, Rochester,MN
Dr Steven R Jacobson - Mayo Clinic, Rochester MN
Dr. Bruce Chau- Berkley, MI
Dr. Marissa Tenenbaum - St Louis, MO
Dr. Terry Myckatyn - St. Louis, MO
Dr William Stefani - Renaissance Plastic Surgery, Troy, Michigan
Dr. Richard Hainer - North Oakland Plastic Surgery, Rochester, MI
Dr Ryan Gobble - UC in Cincinnati, OH
Dr. Neil Kundu - Jewish Hospital, Cincinnati, OH
Dr. Timothy Schaefer - Edina, MN
Dr. Oscar Masters - Oklahoma City, OK
Dr Tiwari & Dr Kocak - Columbus Ohio. mwbreast.com
Dr Michael Bateman - Denver, CO
Dr. Hardy -Northwest Plastic Surgery Associates, Missoula MT.
Dr Jeffrey Lind II - Houston, TXDr. Danielle LeBlanc - Ft Worth, T
Dr. John Hijjawi - SLC Utah
Dr Philip Sonderman, Greater Milwaukee Plastic Surgeons - Milwaukee, WI
Dr. David Janssen & Dr. William Doubek, Fox Valley PS - Oshkosh and Appleton, WI
Dr. Helen Perakis - Hartford, CT
Dr Hilton Becker - Hilton Becker Clinic of Plastic Surgery, Boca Raton, Fla
Dr. Joseph Woods - Piedmont Hospital, Atlanta GA
Dr. Mark Deutsch, Perimeter Plastic Surgeons - Atlanta, GA
Dr Jessica Erdmann-Sager - Brigham & Women's/Dana Farber, Boston MA
Dr Amy Colwell - Boston MA
Dr Russell Babbitt - Fall River, MA
Dr Therese K White - South Portland, MA
Dr Davinder Singh - Annapolis, MD
Dr. Vincent Perrotta - Salisbury, MD
Dr Claire Duggal - Annapolis, MD
Dr. Eric Chang - Columbia, MD
Dr Justin Sacks - Johns Hopkins, Baltimore, MD
Dr. Michelle Roughton - UNC Chapel Hill, NC
Dr. Tzvi Small - Valley Hospital , Ridgewood NJ
Dr. Glassman - Pomona NY
Dr. Andrew Smith - Rochester, NY
Dr. Andrew Salzberg - NYC
Dr. David Otterburn - NYC
Dr. Constance Chen - NYC
Dr. Thomas Hahm - Charleston, SC
Dr. Kevin Delaney - Medical University of South Carolina (MUSC), SC
Dr Jason Ulm - Medical University of South Carolina (MUSC), SC .
Dr. James Craigie and Dr. Richard Kline Jr. - East Cooper Plastic Surgery, Mount Pleasant, SC
Dr. Stacy Stephenson - UTMC, Knoxville, TN
Dr Kent Higdon - Vanderbilt Medical Center, Nashville, TN
Dr. Mark Leech, Chattanooga Plastic Surgery, Chattanooga, TN
Dr. Brad Medling, in Murfreesboro (and Franklin), TN
Dr. Irfan Galaria - Ashburn, Chantilly & Haymarket, VA
Dr. Samir Rao - 3299 Woodburn Rd Ste 490 , Annandale, VA 22003
Dr Mark Venturi - McLean, VA
Dr. Nahabedian - McLean,VA
Dr. Joanne Lenert - Washington, DC
Dr Troy Pittman - Georgetown University, Washington, DC
EAST COAST, CANADA
Dr Mitchell Brown, Toronto Canada
Dr Jason Williams - Hallifax, Nova ScotiaAUSTRALIA
Dr Beverley Fosh - Adelaide, South Australia
Dr Amy Jeeves - Adelaide, South Australia
RESEARCH LINKS ABOUT PREPECTORAL RECONSTRUCTION
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
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 ..
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.
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 that increase the risk of bleeding:
Posts 2011 - 2031 (2,031 total)
May 25, 2019 06:48PM Bird-of-light wrote:
Macb, His name is Dr. John Hijjawi, SLC Utah. He has great reviews.
May 26, 2019 01:09AM Bird-of-light wrote:
May 27, 2019 10:17AM Shoregirl wrote:
Bird-of-light that is great news!! I am glad you have a good rapport with your new surgeon. I tell you, these implants have been a struggle. I personally am not a candidate for diep, but I mentioned to my (previous) surgeon I wished I could have been. He told me to be glad I didn't have one. The reason being if in the future I ever needed a cardiac bypass the internal mammary artery in the chest is no longer available. I didn't pay a whole lot of attention to the comment as I am not a candidate anyway but in a Google search I came up with This Johns Hopkins article FYI if you want to discuss with your ps. I honestly think my previous surgeon was not "all in" with breast reconstruction procedures, more of a cosmetic surgeon. I am so glad I left him.
I am status quo, my f/u appt is July 9. The botched left side remains flat at the lower/outer quadrant so it will def require surgery. I will need more fg too. For now just enjoying the summer!! Do you have a date or are you still thinking about the options?
May 27, 2019 06:23PM Bird-of-light wrote:
Thank you so much for the link! I will definitely talk to him about it. He isn’t available until Sept or Oct, so I actually think I will wait until Nov or Dec because I teach and classes are out the first week of Dec. Enjoy your summer! I’ll keep you posted. Keep us all posted too
May 28, 2019 11:49AM Shoregirl wrote:
You're welcome Bird-of-light, enjoy your summer!! Thank you macb04! I will truly be amazed if he can make the left side look fabulous. They are more level now though as the left side dropped some so that's encouraging. I will keep ya posted!
Jun 5, 2019 12:40AM CENOK2017 wrote:
My PS wants to do over the muscle TE and implant which I am happy about. However, I’ve noticed the term fat grafting. Is that the same as liposuctioning my tummy and inserting it into my chest? I read an article that scared me that said some docs feel fat transfer can stimulate cell growth and could cause dormant cancer cells to grow. Were you told this at all? Always something
Jun 5, 2019 08:25AM TWills wrote:
Ceno, I’ve read about that too, it’s been discussed here as well but it’s been a while and I’m not sure which thread. It’s like everything else, if you read the fine print it most likely doesn’t apply to most situations. I’ve had 3 rounds of fat grafting at a cancer center and was told it was not an issue but who knows.
Jun 11, 2019 06:39PM Crescent5 wrote:
Dr Therese K White, South Portland, Maine
Did my revision from subpec to prepec. Great to work with!
Jun 12, 2019 08:31PM Crescent5 wrote:
Thank you fo starting this thread Macb04!
Jun 16, 2019 07:44PM Crescent5 wrote:
hi Mac04. Dr Therese White is in Maine (ME) not Massachusetts (MA). Sorry for any confusion! Thanks again
Jun 20, 2019 02:45PM DiveCat wrote:
Not sure if this is advice or just general spilling of my thoughts as I weigh options.
I currently have sub-pectoral implants...my initial surgery in 2014 was direct to implant, nipple sparing, smooth rounds, with Alloderm. My revision in 2015 was to Allergan 410s, in order to address rippling on my right side (very thin skin)
I am in talks with surgeons about replacing the 410s. I am also looking at moving to pre-pectoral. I am in Canada, so need to see if I can find a surgeon locally or within a reasonable driving distance who does it.
My results are not bad, if both were like my left side I would be thrilled, but I am quite active (daily workouts, other physical activities) and have always had more animation deformity and "twitches" on the right side which makes that side look a bit off. I have also never been convinced on that side my implant settled in quite right, a lot of fullness higher up and a much tighter and shallower profile at bottom (remember, these are anatomicals!). It not only feels "tight" but always has looked "tighter" - like it was being squeezed "up" instead of down. And yes, I can flex my breasts but not something i would miss, ha.
I definitely am not comfortable being 'uncovered" because of that side. They look good under clothes though, and honestly, if it were not for wanting to take out the 410s I just could not be motivated to have more surgery. But I was diagnosed hypothyroid a couple years ago and have none of the usual risk factors for it, and in light of suspicions BIA-ALCL is consequence of an inflammatory reaction of some sort...eh. And, there have been some other things I have noticed in last few months that have me worried enough ("full sensation" in armpit that feels like swelling, tightness across base of one breast, increased spasms in the right side, etc).
So, I need to talk more to my surgeons obviously, but I am considering this option. My main concerns though is how my pectorals will "heal" after being stretched out for the last 5+ years, as well as rippling, which I am already worried about when moving away from my 410s because of past experience. I am fine doing more ADM, I had no issues with it before, but I am a little worried about fat grafting. I was not a good candidate before and while I may have a little extra now (been diligent about not saying no to chocolate!) it is still not a lot and I worry a lot about recovery. I have very good pain tolerance, and am even fine with doing drains again (likely will be required anyway as they are going to have to do a capsulectomy whey they remove the 410s) but very low tolerance for not being active and taking things "slow"!
I think a small reduction on the right side would solve some of the rippling issues I had before (I do have looser skin on that side and some "excess tissue", that breast was always larger than the left pre-surgery). I know that may mean additional scarring but I scar pretty well and am okay with a few more scars versus the misshapen look/excess skin I have now on the right side. I actually don't even care about keeping the nipple on that side. I can't feel my nipples anyway - if losing that nipple might otherwise mean other advantages I'd be prepared to say goodbye to it (so different from a few years ago when I wanted so badly to save them and was worried they were going necrotic during recovery!).
Jun 20, 2019 05:27PM macb04 wrote:
Hi DiveCat, welcome. Definitely a complex story, but similar to ones I have heard before. I had a TE subpectoral and hated it for a year, and then wound up taking it out while doing Fat Grafting. I did several Fat Grafting procedures which didn't help enough because my PS screwed up, and because of radiation fibrosis damage. The surgeon took out the TE, didn't even stitch my Pectoral down, just put it back in the right location. Long story short, switched to new PS and did Prepectoral TE, then Prepectoral Implant exchange. Now looking at my story, you can see I did things in multiple surgeries. The new PS also screwed up by putting in the Anatomical Silicone Implant too small in size. He also cut away too much skin, so he couldn't put the correct size in to match my other natural breast. So unfortunately I am somewhat lopsided. Hate that, can't stand looking at myself nude. In clothes, with certain bras, I look ok.
Now to your question. My Pectoral wasn't stretched out as long as yours, only about a year, to your 5 years. I do want to let you know that I have completely normal strength and function of that pectoral muscle. I have zero animation deformity. Other women on this thread and other threads, have also recovered normal pectoral strength and function when switching from subpectoral to Prepectoral Implant Reconstruction. Compared to the inital mx, recovery from Prepectoral Implant Reconstruction surgery was considerably easier for me and most women I have heard from. I think I was back up to driving in about 10 days, and lifting groceries, and other moderate weight items in 2 to 3 wks. My recollection is a little hazy on the exact details but that is close.
Hope this helps, and perhaps someone else will chime in with their experiences.
Jun 20, 2019 05:59PM DiveCat wrote:
Thank you so much for your response macb04, I am really relieved that you have normal strength and function.
I have been fortunate in both my surgical recoveries were quite smooth sailing, but it was a few years ago now so who knows how predictive that is! I do know I was back to driving after my revision following the weekend (surgery on Thursday, back to work on the Monday). After the original I went back to work at a month (but was working from home earlier than that, as I was going stir crazy). Both times was back to long daily walks within a handful of days - couldn't work out, but rationalized I could walk!
I will discuss with the surgeons here. If neither of them are familiar with pre-pectoral reconstruction I will probably get a referral back to my original surgeon in Calgary or another one up there as well. I would just rather do it closer to home this time if I can.
Reading your experience again reminds me that it is always so difficult to settle on a surgeon, even the great ones will have unhappy results, but it is definitely worse when they don't even try to get good ones. I'd rather a cautious surgeon with less experience in some ways than an apathetic one with extensive experience!
Jun 20, 2019 08:35PM avmom wrote:
I’m in Alberta, too, and while I have sub pec TEs right now, my surgeon in Red Deer indicated to me that I could do revision to pre pec if I wanted to. I asked my Oncologist about going to pre pec this month, and we are going to talk about it again in the fall. My concern is mostly about recurrence on the chest wall, because with sub pec implants you chest wall is on the “outside”, while pre pec implants put the chest wall under the implant. I’m pretty high risk, so we are going to consider whether MRI will do for surveillance. Where would be close to home for you for surgery? Feel free to PM me if you would like.
Jun 21, 2019 10:13PM macb04 wrote:
Hey avmom. Welcome. Could you give me the name of the PS near you in Alberta, that can do Prepectoral Implant Reconstruction for me to add to the list?
Canadian PS's are rather sparse on the list, and I am sure there are more that do Prepectoral Implant Reconstruction than are listed.