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Topic: TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!

Forum: Breast Reconstruction — Is it right for you? Discuss timing and various procedures and techniques.

Posted on: Oct 20, 2015 05:47AM - edited Sep 6, 2019 05:49AM by macb04

macb04 wrote:

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

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

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

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

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

WEST COAST

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

Dr. Jonathan Hutter -Valley Hospital, Renton, WA

Dr. Mark Tseng - Multicare, Auburn, WA

Dr Reid Mueller - OSHU, Portland, OR

Dr. Lisa Cassileth - Beverly Hills, CA

Dr. Leif Rogers - Beverly Hills, CA

Dr Kamakshi Zeidler - Campbell, CA

Dr. Michael Halls--La Jolla, CA

Dr Elizabeth Kim - Los Angeles, CA

Dr. Charlotta Lavia - Los Angeles, CA

Dr. Charles Tseng - UCLA , CA

Dr. Mark Gaon - Newport Beach, CA

Dr. Sara Yegiyants - Santa Barbara, CA

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

Dr. Jyoti Arya - San Diego, CA

Dr Karen Horton--San Francisco, CA

Dr Anne Peled, MD - San Francisco, CA

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

MIDWEST/CENTRAL/MOUNTAIN

Dr. Julie Park - University of Chicago Medicine, Il

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

Dr. William Dougherty - Taos, NM

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

Dr Steven R Jacobson - Mayo Clinic, Rochester MN

Dr. Bruce Chau- Berkley, MI

Dr. Marissa Tenenbaum - St Louis, MO

Dr. Terry Myckatyn - St. Louis, MO

Dr William Stefani - Renaissance Plastic Surgery, Troy, Michigan

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

Dr Ryan Gobble - UC in Cincinnati, OH

Dr. Neil Kundu - Jewish Hospital, Cincinnati, OH

Dr. Timothy Schaefer - Edina, MN

Dr. Oscar Masters - Oklahoma City, OK

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

Dr Michael Bateman - Denver, CO

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

Dr Jeffrey Lind II - Houston, TX

Dr. Danielle LeBlanc - Ft Worth, 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

EAST COAST

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 Davinder Singh - Annapolis, MD

Dr. Vincent Perrotta - Salisbury, MD

Dr Claire Duggal - Annapolis, MD

Dr. Eric Chang - Columbia, MD

Dr Justin Sacks - Johns Hopkins, Baltimore, MD

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

Dr Therese K White - South Portland, ME

Dr. Michelle Roughton - UNC Chapel Hill, NC

Dr. Tzvi Small - Valley Hospital , Ridgewood NJ

Dr. Glassman - Pomona NY

Dr. Andrew Smith - Rochester, NY

Dr. Andrew Salzberg - NYC

Dr. David Otterburn - NYC

Dr. Constance Chen - NYC

Dr. Sameer Patel - Fox Chase, Philadelphia, PA

Dr. Thomas Hahm - Charleston, SC

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

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

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

Dr. Stacy Stephenson - UTMC, Knoxville, TN

Dr Kent Higdon - Vanderbilt Medical Center, Nashville, TN

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

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

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

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

Dr Mark Venturi - McLean, VA

Dr. Nahabedian - McLean,VA

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

Dr. Joanne Lenert - Washington, DC

Dr Troy Pittman - Georgetown University, Washington, DC

EAST COAST, CANADA

Dr Mitchell Brown, Toronto Canada

Dr Jason Williams - Hallifax, Nova Scotia

AUSTRALIA


Dr Beverley Fosh - Adelaide, South Australia

Dr Amy Jeeves - Adelaide, South Australia

RESEARCH LINKS ABOUT PREPECTORAL RECONSTRUCTION

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

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

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

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

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

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

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

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

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

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

Pharmacokinetics of oral vitamin C

Abstract

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

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

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

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

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


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

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

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

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

Nicholas A Boire1, Stefan Riedel2 and Nicole M Parrish2*

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

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

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

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

www.microbiology5.org › book

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

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

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

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

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

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

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

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

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

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

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

Herbal Medicines

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

Herbal medicines that increase the risk of bleeding:

  • Black Cohosh: Claims to be useful for menopausal symptoms. Contains small amounts of anti-inflammatory compounds, including salicylic acid. Theoretically could have intrinsic/additive antiplatelet activity.
  • Chamomile: Claims to reduce inflammation and fever, to be a mild sedative, relieve stomach cramps. Increases risk of bleeding because it contains phytocoumarins, which have additive effects with warfarin.
  • Feverfew: Claims to prevent migraines. Increases the risk of bleeding because it individually inhibits platelet aggregation, has additive effects with other antiplatelet drugs. Also additive effects with warfarin.
  • Fish Oil: Claims to prevent/treat atherosclerotic CV disease (800-1500mg/day). Also used to decrease triglycerides (>4g/day). Dose dependent bleeding risk increases with dose >3g/day.
  • Garlic, Ginger, Ginko, Ginseng: Increases bleeding risk by interacting with antiplatelet drugs to inhibit platelet aggregation and inhibit fibrinolysis. Also augments warfarin
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May 25, 2019 11:48PM Bird-of-light wrote:

Macb, His name is Dr. John Hijjawi, SLC Utah. He has great reviews.

Dx 4/13/2016, IDC, Left, <1cm, Grade 2, 0/3 nodes, ER+/PR+, HER2+ (IHC) Surgery 6/8/2016 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 7/14/2016 Taxol (paclitaxel) Targeted Therapy 7/14/2016 Herceptin (trastuzumab)
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May 26, 2019 04:43AM macb04 wrote:

Hello Bird-of-light, thanks for your PS's name. I just added him to the list.

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May 26, 2019 06:09AM Bird-of-light wrote:

👍

Dx 4/13/2016, IDC, Left, <1cm, Grade 2, 0/3 nodes, ER+/PR+, HER2+ (IHC) Surgery 6/8/2016 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 7/14/2016 Taxol (paclitaxel) Targeted Therapy 7/14/2016 Herceptin (trastuzumab)
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May 27, 2019 03:17PM 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?

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 1/26/2017 Lymph node removal: Sentinel; Mastectomy: Left, Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 4/24/2017 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 11/28/2017 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant Surgery 12/3/2018 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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May 27, 2019 11:23PM Bird-of-light wrote:

Shoregirl,

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

Dx 4/13/2016, IDC, Left, <1cm, Grade 2, 0/3 nodes, ER+/PR+, HER2+ (IHC) Surgery 6/8/2016 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 7/14/2016 Taxol (paclitaxel) Targeted Therapy 7/14/2016 Herceptin (trastuzumab)
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May 28, 2019 04:15PM macb04 wrote:

I really hope this is it Shoegirl, that you get fabulous results. You certainly deserve it after all the screw ups.

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May 28, 2019 04:49PM 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!

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 1/26/2017 Lymph node removal: Sentinel; Mastectomy: Left, Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 4/24/2017 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 11/28/2017 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant Surgery 12/3/2018 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Jun 5, 2019 05:40AM CENOK2017 wrote:

Hi Jesse,

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

Dx 1/2/2018, IDC, Right, 6cm+, Stage IIB, Grade 2, 0/3 nodes, ER+/PR+, HER2+ Hormonal Therapy Targeted Therapy Herceptin (trastuzumab) Radiation Therapy Chemotherapy Carboplatin (Paraplatin), Taxotere (docetaxel)
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Jun 5, 2019 06:38AM macb04 wrote:

Hi CENOK2017, no never heard of that. If it were a big issue it would have already come up as Fat Grafting is common for the past decade or longer.

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Jun 5, 2019 01:25PM 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.

Dx 11/2016, IDC, Left, 4cm, Stage IIB, Grade 3, 1/14 nodes, ER+/PR+, HER2- Surgery 12/13/2016 Lymph node removal: Left, Sentinel, Underarm/Axillary; Mastectomy: Left, Right; Prophylactic mastectomy: Right Chemotherapy 2/2/2017 AC + T (Taxol) Surgery 7/10/2017 Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Radiation Therapy 7/31/2017 Whole-breast: Breast, Chest wall Surgery 8/27/2017 Hormonal Therapy 11/8/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 3/2/2018 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Jun 5, 2019 03:01PM macb04 wrote:

Everything else has they do to you has risks of causing bc, so I suppose it is possible, but have never heard about it, and God knows, enough women mention stuff like that that I am not going to worry about it.

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Jun 11, 2019 11:39PM Crescent5 wrote:

Dr Therese K White, South Portland, Maine

Did my revision from subpec to prepec. Great to work with!

Dx: ALH, LCIS 10/10, PLCIS 11/10 ~ PBM 1/13/12 ILC 4mm & 7mm found post MX Stage 1 Grade 2 ER/PR+ HER2- 0/9 nodes Oncotype Score = 6, Tamoxifen 4/12 ~I want this sh*t to leave me alone Dx 1/13/2012, ILC, <1cm, Stage IB, Grade 2, 0/9 nodes, ER+/PR+, HER2-
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Jun 12, 2019 04:17AM macb04 wrote:

Hi Cresent5, I just added your PS to the list. Thanks for giving me her name.

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Jun 13, 2019 01:31AM Crescent5 wrote:

Thank you fo starting this thread Macb04!

Dx: ALH, LCIS 10/10, PLCIS 11/10 ~ PBM 1/13/12 ILC 4mm & 7mm found post MX Stage 1 Grade 2 ER/PR+ HER2- 0/9 nodes Oncotype Score = 6, Tamoxifen 4/12 ~I want this sh*t to leave me alone Dx 1/13/2012, ILC, <1cm, Stage IB, Grade 2, 0/9 nodes, ER+/PR+, HER2-
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Jun 13, 2019 04:43AM macb04 wrote:

Glad to share, important to pass this info on. You are so welcome Cresent5.

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Jun 17, 2019 12:44AM Crescent5 wrote:

hi Mac04. Dr Therese White is in Maine (ME) not Massachusetts (MA). Sorry for any confusion! Thanks again

Dx: ALH, LCIS 10/10, PLCIS 11/10 ~ PBM 1/13/12 ILC 4mm & 7mm found post MX Stage 1 Grade 2 ER/PR+ HER2- 0/9 nodes Oncotype Score = 6, Tamoxifen 4/12 ~I want this sh*t to leave me alone Dx 1/13/2012, ILC, <1cm, Stage IB, Grade 2, 0/9 nodes, ER+/PR+, HER2-
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Jun 20, 2019 07:45PM DiveCat wrote:

Hi all,

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!).

Hereditary High Risk, Uninformed BRCA Negative Surgery 4/24/2014 Prophylactic mastectomy: Left, Right; Reconstruction (left); Reconstruction (right) Surgery 3/12/2015 Reconstruction (left); Reconstruction (right)
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Jun 20, 2019 10:27PM 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.

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Jun 20, 2019 10:59PM 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!

Hereditary High Risk, Uninformed BRCA Negative Surgery 4/24/2014 Prophylactic mastectomy: Left, Right; Reconstruction (left); Reconstruction (right) Surgery 3/12/2015 Reconstruction (left); Reconstruction (right)
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Jun 21, 2019 01:35AM avmom wrote:

Hi DiveCat,

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.

Avmo

Surgery 12/23/2014 Lumpectomy: Right Dx 1/7/2015, IDC, Right, 4cm, Stage IIA, Grade 3, 0/11 nodes, ER-/PR-, HER2- Dx 1/7/2015, DCIS, Right, 6cm+, Stage 0, Grade 2, 0/11 nodes, ER-/PR-, HER2- Surgery 1/13/2015 Lymph node removal: Right, Underarm/Axillary; Mastectomy: Right Surgery 10/20/2015 Prophylactic mastectomy: Left Dx 10/27/2015, LCIS/DCIS, Left, 6cm+, Stage 0, Grade 2, ER+/PR+ Surgery 5/25/2016 Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery Lymph node removal: Right, Underarm/Axillary; Mastectomy: Right Chemotherapy AC + T (Taxol)
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Jun 22, 2019 03:13AM 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.

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Jul 3, 2019 05:13PM happyperidot wrote:

A new name for the list:

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

Kelley, dx at 55; Oncotype 18 Dx 5/10/2019, IDC, Left, <1cm, Grade 2, 0/5 nodes, ER+/PR+, HER2- (FISH) Surgery 7/8/2019 Lymph node removal: Sentinel, Underarm/Axillary; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Jul 9, 2019 10:26PM macb04 wrote:

Hello happyperidot, just update the list with your PS's contact. Thanks for giving me the name.

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Jul 16, 2019 05:53AM macb04 wrote:

This is great! Over 75 PS's on the List, who do are doing Prepectoral Implant Reconstruction in the United States.

I am sure there are more out there. Keep the names coming, especially for Canada and Australia.

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Jul 23, 2019 05:22AM macb04 wrote:

bump

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Jul 23, 2019 01:10PM Lexica wrote:

I just had prepectoral reconstruction at a MTF (military treatment facility near DC) on July 15. I am hesitant to share the PS's name because his care is technically 'closed' to anyone who is not under TRICARE insurance, but PM if you would like his name.

I had a skin sparing mastectomy in 2017, so he just used the spare skin and created a pocket for the implant. No mesh or anything. I'm still a bit skeptical, but they seem to have turned out well! Unfortunately, my mastectomy scars are wide - horizontal across the middle of my breast, so the shape is a little wonky. Wondering if anyone has dealt with this and if it's possible to get around this issue of shape with the previous scars?

Diagnosed at 34. Dx 7/2017, IDC, Left, Stage IIIC, Grade 2, ER+/PR+, HER2- (IHC) Surgery 12/14/2017 Lymph node removal: Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right Dx 12/27/2017, DCIS/IDC, Left, 6cm+, Stage IIIA, Grade 3, 5/11 nodes, ER+/PR+, HER2- (IHC) Radiation Therapy 1/15/2018 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy Aromasin (exemestane) Chemotherapy AC + T (Taxol)
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Jul 23, 2019 03:04PM hapa wrote:

Lexica - I had to massage my right scar after my revision surgery to get it to release and go back to a normal shaped boob. I would put two fingers next to each other facing opposite directions on the scar line and then rub them back and forth in opposite directions to stretch and break up the tissue. I also did that around the edges and basically anywhere rubbing the tissue hurt, until it didn't hurt anymore, to break up scar tissue. It seems to have helped. Also, maybe take some vitamin E and you can also try bio oil or silicone strips to soften the tissue.

As for your surgeon, listing him is no different from any other surgeon, who any of us can realistically only see if they are in our networks. So I would give up his name, because tons of people are on Tricare.

Dx 12/14/2017, IDC, Right, 3cm, Stage IIIA, Grade 3, ER+/PR+, HER2- (FISH) Hormonal Therapy 1/2/2018 Zoladex (goserelin) Hormonal Therapy 1/2/2018 Arimidex (anastrozole) Targeted Therapy 2/14/2018 Ibrance (palbociclib) Dx 3/20/2018, IDC, Right, 3cm, Stage IIIA, 3/18 nodes, ER+/PR+, HER2+ (FISH) Targeted Therapy 3/28/2018 Perjeta (pertuzumab) Targeted Therapy 3/28/2018 Herceptin (trastuzumab) Chemotherapy 3/28/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 8/22/2018 Lymph node removal: Right, Underarm/Axillary; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Radiation Therapy 10/22/2018 Whole-breast: Lymph nodes, Chest wall Hormonal Therapy 12/21/2018 Arimidex (anastrozole), Zoladex (goserelin) Targeted Therapy Nerlynx
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Jul 31, 2019 11:00PM - edited Jul 31, 2019 11:01PM by macb04

😯😯😯😯😯 SCARS !!!

Minimize them where possible....

Here's some helpful info on Embrace Scar Therapy. Things your doctor may not mention. Wish I knew at the start.

I found the best thing was using Embrace Scar Therapy over the new, just healed incision from my R breast lift. I kid you not, it has helped the incision heal so well there is almost zero scar visible, or able even to be felt. The PS 6 months later was absolutely astonished how wonderfully it healed.

When I first used it, it was only prescription, but now it is available OTC in places like Walgreens and Amazon. It is kind of like a Steristrip built-in to a very thin silicon gel sheet. Takes all tension off the healing scar so that it can remodel into it's optimum thin, flat shape without any hyperpigmentation.


Hope this helps. I wish I had known about this for some of the earlier scars which I am trying to improve after the fact.

https://www.embracescartherapy.com/shop-now/embrace?gclid=CjwKCAjw1f_pBRAEEiwApp0JKNgMLvwg5roFFrdRaKeHCq9j872dxKTMh56IFlvjHILhsoDnWcg-zxoCL0sQAvD_BwE


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Aug 5, 2019 01:41AM macb04 wrote:

Has anyone else tried Embrace, or anything else that did a good, or great job in minimizing scars?

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Aug 5, 2019 06:56PM hapa wrote:

mac - I have not used embrace but I am intrigued. I'm using scar away on my port scar. Nothing will stick to my right mx scar because I have to slather moisturizer on it all the time since I had radiation on that side.

You mentioned a lift on one breast, what did that entail? Was it a lift after mx or did you only have a umx and this was on the "good" side?

Dx 12/14/2017, IDC, Right, 3cm, Stage IIIA, Grade 3, ER+/PR+, HER2- (FISH) Hormonal Therapy 1/2/2018 Zoladex (goserelin) Hormonal Therapy 1/2/2018 Arimidex (anastrozole) Targeted Therapy 2/14/2018 Ibrance (palbociclib) Dx 3/20/2018, IDC, Right, 3cm, Stage IIIA, 3/18 nodes, ER+/PR+, HER2+ (FISH) Targeted Therapy 3/28/2018 Perjeta (pertuzumab) Targeted Therapy 3/28/2018 Herceptin (trastuzumab) Chemotherapy 3/28/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 8/22/2018 Lymph node removal: Right, Underarm/Axillary; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Radiation Therapy 10/22/2018 Whole-breast: Lymph nodes, Chest wall Hormonal Therapy 12/21/2018 Arimidex (anastrozole), Zoladex (goserelin) Targeted Therapy Nerlynx

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