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

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

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

macb04 wrote:

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

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

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

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

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

WEST COAST

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

Dr. Jonathan Hutter -Valley Hospital, Renton, WA

Dr. Mark Tseng - Multicare, Auburn, WA

Dr Reid Mueller - OSHU, Portland, OR

Dr. Lisa Cassileth - Beverly Hills, CA

Dr. Leif Rogers - Beverly Hills, CA

Dr Kamakshi Zeidler - Campbell, CA

Dr. Michael Halls--La Jolla, CA

Dr Elizabeth Kim - Los Angeles, CA

Dr. Charlotta Lavia - Los Angeles, CA

Dr. Charles Tseng - UCLA , CA

Dr. Mark Gaon - Newport Beach, CA

Dr. Sara Yegiyants - Santa Barbara, CA

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

Dr. Jyoti Arya - San Diego, CA

Dr Karen Horton--San Francisco, CA

Dr Anne Peled, MD - San Francisco, CA

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

MIDWEST/CENTRAL/MOUNTAIN

Dr. Julie Park - University of Chicago Medicine, Il

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

Dr. William Dougherty - Taos, NM

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

Dr Steven R Jacobson - Mayo Clinic, Rochester MN

Dr. Bruce Chau- Berkley, MI

Dr. Marissa Tenenbaum - St Louis, MO

Dr. Terry Myckatyn - St. Louis, MO

Dr William Stefani - Renaissance Plastic Surgery, Troy, Michigan

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

Dr Ryan Gobble - UC in Cincinnati, OH

Dr. Neil Kundu - Jewish Hospital, Cincinnati, OH

Dr. Timothy Schaefer - Edina, MN

Dr. Oscar Masters - Oklahoma City, OK

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

Dr Michael Bateman - Denver, CO

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

Dr Jeffrey Lind II - Houston, TX

Dr. Danielle LeBlanc - Ft Worth, TX

Dr. John Hijjawi - SLC Utah

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

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

EAST COAST

Dr. Helen Perakis - Hartford, CT

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

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

Dr. David Lickstein, Palm Beach FL

Dr. Joseph Woods - Piedmont Hospital, Atlanta GA

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

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

Dr Amy Colwell - Boston MA

Dr Russell Babbitt - Fall River, MA

Dr Davinder Singh - Annapolis, MD

Dr. Vincent Perrotta - Salisbury, MD

Dr Claire Duggal - Annapolis, MD

Dr. Eric Chang - Columbia, MD

Dr Justin Sacks - Johns Hopkins, Baltimore, MD

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

Dr Therese K White - South Portland, ME

Dr. Michelle Roughton - UNC Chapel Hill, NC

Dr. Tzvi Small - Valley Hospital , Ridgewood NJ

Dr. Glassman - Pomona NY

Dr. Andrew Smith - Rochester, NY

Dr. Andrew Salzberg - NYC

Dr. David Otterburn - NYC

Dr. Constance Chen - NYC

Dr. Sameer Patel - Fox Chase, Philadelphia, PA

Dr. Thomas Hahm - Charleston, SC

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

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

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

Dr. Stacy Stephenson - UTMC, Knoxville, TN

Dr Kent Higdon - Vanderbilt Medical Center, Nashville, TN

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

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

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

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

Dr Mark Venturi - McLean, VA

Dr. Nahabedian - McLean,VA

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

Dr. Joanne Lenert - Washington, DC

Dr Troy Pittman - Georgetown University, Washington, DC

EAST COAST, CANADA

Dr Mitchell Brown, Toronto Canada

Dr Jason Williams - Hallifax, Nova Scotia

AUSTRALIA


Dr Beverley Fosh - Adelaide, South Australia

Dr Amy Jeeves - Adelaide, South Australia

RESEARCH LINKS ABOUT PREPECTORAL RECONSTRUCTION

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

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

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

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

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

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

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

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

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

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

Pharmacokinetics of oral vitamin C

Abstract

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

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

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

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

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


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

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

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

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

Nicholas A Boire1, Stefan Riedel2 and Nicole M Parrish2*

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

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

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

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

www.microbiology5.org › book

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

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

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

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

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

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

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

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

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

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

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

Herbal Medicines

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

Herbal medicines that increase the risk of bleeding:

  • Black Cohosh: Claims to be useful for menopausal symptoms. Contains small amounts of anti-inflammatory compounds, including salicylic acid. Theoretically could have intrinsic/additive antiplatelet activity.
  • Chamomile: Claims to reduce inflammation and fever, to be a mild sedative, relieve stomach cramps. Increases risk of bleeding because it contains phytocoumarins, which have additive effects with warfarin.
  • Feverfew: Claims to prevent migraines. Increases the risk of bleeding because it individually inhibits platelet aggregation, has additive effects with other antiplatelet drugs. Also additive effects with warfarin.
  • Fish Oil: Claims to prevent/treat atherosclerotic CV disease (800-1500mg/day). Also used to decrease triglycerides (>4g/day). Dose dependent bleeding risk increases with dose >3g/day.
  • Garlic, Ginger, Ginko, Ginseng: Increases bleeding risk by interacting with antiplatelet drugs to inhibit platelet aggregation and inhibit fibrinolysis. Also augments warfarin
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Aug 5, 2019 04:25PM - edited Aug 5, 2019 05:20PM by Magari

I tried Embrace at my surgeon's suggestion after my initial BMX with DTI reconstruction.

Unfortunately, I think because I was doing chemo, my skin was extremely fragile and removing the strips ended up tearing the skin. I switched to paper tape and the scars looked pretty good within about 6 months, despite the chemo.

I just had revision surgery to switch from shaped textured implants (which were causing air pockets due to the texture against the Alloderm) to smooth round, with some fat grafting. Pretty sure I will stay with paper tape again.

My wonderful oncoplastic surgeon is Anne Peled, MD - San Francisco, CA

Diagnosed at 54; Bilateral mastectomy with DTI reconstruction 10/16/17; Revision surgery to switch implants 7/19/19; Cold capped during chemo - TCHP 11/26/17 Dx 9/1/2017, DCIS/IDC, Both breasts, <1cm, Stage IB, Grade 3, 1/3 nodes, ER+/PR+, HER2+ Hormonal Therapy 6/3/2018 Arimidex (anastrozole) Hormonal Therapy 8/16/2019 Aromasin (exemestane) Hormonal Therapy 9/16/2019 Femara (letrozole) Hormonal Therapy 1/14/2020 Arimidex (anastrozole)
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Aug 5, 2019 04:45PM macb04 wrote:

Hi Magari, I could see how delicate skin could be harmed by the Embrace. You have to know the health of your skin, you are the best judge.

If skin is fragile, have more Vitamin C. There is no upward limit of toxicity if you have normal kidney and bowel function. After surgery, I had 6 to 9 grams of Vitamin C per day, and didn't even get diarrhea, because my body needed it to make strong healthy new collagen.

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Aug 6, 2019 06:58PM Andraxo wrote:

UGH! NY Times article a couple days ago about FDA recalling the textured implants. Apparently they have already been banned in Europe since last year. Mine went in April 2017. The FDA recommendation is to leave them alone if no symptoms, but surgeons are not allowed to use them anymore in the US. Just wanted to share in case some of you have these implants.

#$%^! I have been having symptoms (a little swelling and fluid collection around R implant which is not my cancer side). Need to get checked.

- xo

Breast implant maker Allergan Inc. issued a worldwide recall Wednesday for certain textured models after regulators alerted the company to a heightened cancer risk with the devices.

https://www.nytimes.com/aponline/2019/07/24/us/politics/ap-us-breast-implants-safety-recall.html


Andra :) Dx at age 45. Super active in outdoor adventures in the southwest/4 corners area. Dx 7/2015, IDC, Left, <1cm, Stage IIA, Grade 2, 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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Aug 6, 2019 07:19PM Fritzmylove wrote:

I’m sure this has been answered, but there’s so many pages to sort through. What is the exchange recovery like? I just got my surgery date scheduled, and while it’s outpatient, I’d like to know what to expect and how long to plan for childcare.

CHEK2+ Dx 9/19/2018, IDC, Right, 6cm+, Stage IIIA, Grade 2, ER+/PR+, HER2- Chemotherapy 10/1/2018 TAC Surgery 2/20/2019 Lymph node removal: Right, Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 3/4/2019 Femara (letrozole), Zoladex (goserelin) Radiation Therapy 4/22/2019 Whole-breast: Lymph nodes, Chest wall
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Aug 7, 2019 01:11AM macb04 wrote:

Andraxo, I am so sorry to hear you are having problems, and then the recall on top of that as a worry for you and all of us. I get pretty angry about every last bit of the whole bc industry crap. I don't even know what to say. I also have a textured implant. I'm good, but I know it will be messing with the heads of so many women in our situation.


Hey Fritzmylove, good to hear you are getting your exchange done. For many of us, the exchange was not as bad as the initial mx. It was that way for me. I would say light activity for the first week, then gradually doing a bit more, but still no lifting over 5 to 10 lbs for the first 2 wks for most PS's.

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Aug 7, 2019 01:07PM Rosanne7 wrote:

Andraxo, Learned this week that I also have one of the recalled T/E's. Plastic surgeon would not have mentioned this -- but I asked specifically. Now I understand why I'm being pressured to do "exchange surgery" ASAP.

Won't be able to schedule surgery for five months; I'm just now planning my "new normal" life for September !!

Feeling weary of being treated like a product on a conveyor belt. I don't blame doctors & health care practitioners -- but it's sad to be treated in a cold & impersonal manner as one endeavors to go through BC treatment.

Can't tell whether rude "attitude" is due to ageism....or the new healthcare business model ??

Roseanne7

Dx 5/2007, DCIS, Left, Stage 0, ER+/PR+, HER2- Dx 9/2007, LCIS, Left Surgery 3/1/2008 Lumpectomy Dx 8/2011, DCIS/IDC, Left, 2cm, Stage IIA, 0/1 nodes, ER+/PR+, HER2- Dx 11/1/2018, IDC, Right, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR- Surgery 2/15/2019 Lymph node removal: Sentinel; Mastectomy: Right; Reconstruction (right): Tissue expander placement Hormonal Therapy 4/30/2019 Arimidex (anastrozole) Surgery Lumpectomy: Left Surgery Lumpectomy; Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Saline implant, Tissue expander placement; Reconstruction (right): Tissue expander placement Radiation Therapy Breast, Lymph nodes
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Aug 10, 2019 01:42AM macb04 wrote:

Roseanne, I feel sad to hear of shoddy care, of vulnerable people, by people who ought to know better. I think bad care in healthcare is the norm for many encounters. Doesn't matter how many surveys they have us complete.

We deserve to be treated with competence and considerstion.

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Aug 13, 2019 09:52AM Rosanne7 wrote:

Thanks macb04,

Yes, it's tough to know how to approach these situations! Several of my current Dr.'s are working Moms (plastic surgeon, med onc, PCP, etc.) For years, I've cut them a lot of slack... knowing they are "overtaxed" & wearing many hats.

However, NYC healthcare has reached a point where most doctors (except onc surgeon) don't know my medical history & waste appointment time writing frivolous "problem lists" to upcode medical billing. None of these so-called problems have anything to do w/ cancer treatment & prevention, not to mention help dealing w/ side effects of cancer tx. No awareness or compassion :(

As you've stated: Cancer patients deserve competent & considerate care !!

Roseanne7

Dx 5/2007, DCIS, Left, Stage 0, ER+/PR+, HER2- Dx 9/2007, LCIS, Left Surgery 3/1/2008 Lumpectomy Dx 8/2011, DCIS/IDC, Left, 2cm, Stage IIA, 0/1 nodes, ER+/PR+, HER2- Dx 11/1/2018, IDC, Right, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR- Surgery 2/15/2019 Lymph node removal: Sentinel; Mastectomy: Right; Reconstruction (right): Tissue expander placement Hormonal Therapy 4/30/2019 Arimidex (anastrozole) Surgery Lumpectomy: Left Surgery Lumpectomy; Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Saline implant, Tissue expander placement; Reconstruction (right): Tissue expander placement Radiation Therapy Breast, Lymph nodes
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Aug 17, 2019 08:09PM - edited Sep 13, 2019 03:47PM by

I’m having double mastectomy on Monday . Please add my plastic surgeon to the list for DC, Virginia and Maryland are- https://www.medstarhealth.org/doctor/dr-david-habin-song-md-mba/

Dx 6/17/2019, IDC, Right, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR-, HER2- (FISH) Surgery 8/19/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Aug 18, 2019 11:30AM macb04 wrote:

Hey Askmissa, sorry to hear you are joining us, but thanks for the name of your PS. I added him to the list.

Come back and let us know if you think your doctor did a good job. I am trying to restrict the list to doctors where women say they have had a good experience.

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Sep 1, 2019 12:25AM macb04 wrote:

bump

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Sep 1, 2019 01:19AM macb04 wrote:

bump

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Sep 4, 2019 12:42AM MinuteAtATime wrote:

Hi All:

I had subpectoral implants during my double mastectomy back in 2017--didn't know about prepectoral back then. I have ripples and animation (the latter is what drives me crazy). I have Kaiser insurance and have had consultations with two separate PSs within Kaiser who do pre pec. One of them (Dr. Hornik)--PS whom my friend went to--advised that he could swap out my subpectoral for prepec in one surgery and be done with it. My friend liked him, but I had a red flag raised b/c he still was using textured implants (among other options) as of last year and downplaying their risks. I told him I would not use textured implants.

The second PS option (Dr. Jacobs) I have is much more patient centered, a great listeners, is a much longer drive from my house (about 2 hours with traffic), but the main disadvantage with him is that he wants to start me over with TEs, fill them up slowly, and then do a 2nd surgery to exchange them for permanent implants. He says that b/c of fat grafting needed, etc, that he hasn't found a way to do reconstruction without 2 surgeries, so he thinks best to start with TEs. The thought of two surgeries, and going through the whole TE expansion and wait for exchange makes me sick to my stomach. On the other hand, he was a great listener and was very focused on what my concerns were, whereas Dr. Hornik seemed almost flippant.

Thoughts? Have any of you had sub-pecs replaced with pre-pecs? If so, did you go straight to implant with the replacement, or did you go back to TEs first?

Thanks in advance for your feedback.

Dx 3/20/2017, IDC, Left, 1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2- Surgery 5/1/2017 Lumpectomy: Right Surgery 5/1/2017 Mastectomy: Left; Reconstruction (left): Tissue expander placement Dx 5/4/2017, DCIS, Right, <1cm, Stage 0, ER+/PR+ Surgery 5/22/2017 Lymph node removal: Sentinel; Mastectomy: Right; Reconstruction (right): Tissue expander placement Hormonal Therapy 6/14/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 11/3/2017 Reconstruction (left): Saline implant; Reconstruction (right): Saline implant
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Sep 4, 2019 07:49AM VegGal wrote:

Go with option 1. He can no longer use textured implants. Period. Number 2 doesn’t seem to know how to utilize the already stretched skin in a different plane, which seems absurd.

Another option is to keep visiting surgeons until you find a fit that’s *just* right.

Good luck.

Dx 1/12/2016, DCIS, Left, <1cm, Stage 0, Grade 2, 0/3 nodes, ER+/PR-, HER2- Surgery 3/11/2016 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 6/9/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 9/7/2017 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Sep 4, 2019 01:38PM hapa wrote:

IME, surgeon 2 is right that you're probably going to need fat grafting anyway, which will be a second procedure. If you have rippling it will probably be even worse when you go pre-pec.

But VegGal is right about surgeon 1. If you really don't want TEs, which I understand because I hear they are quite uncomfortable, go with surgeon 1. Or talk to surgeon 2 about doing direct to implants with your revision. At least make him explain why that's necessary when the skin is already stretched.

Dx 3/20/2018, IDC, Right, 3cm, Stage IIIA, 3/18 nodes, ER+/PR+, HER2+ (FISH) Targeted Therapy 3/28/2018 Herceptin (trastuzumab) Targeted Therapy 3/28/2018 Perjeta (pertuzumab) 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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Sep 4, 2019 07:33PM SimoneRC wrote:

Please keep in mind that not everyone is a good candidate for direct to implant. Many factors such as vascularity and skin thickness can make Alloderm with expanders the way to go. I went prepectoral right away in two stages. Tissue expanders and Alloderm, then exchange and fat grafting. For me, the exchange surgery/fat grafting was Super easy. I am thin with no upper body fat, super active, and have no rippling to mention. Good luck on your journey! I hope you make a decision you feel comfortable with and have great results!


ATM Gene Mutation, Deletion. IDC w/Lobular Features and Focal Mucinous Features. Pre Pectoral Reconstruction. Hysterectomy
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Sep 4, 2019 09:53PM MinuteAtATime wrote:

VegGal--Thanks--your comment makes sense! I think the textured implants (even though I would have insisted on not using them even before the recall) was more a kind of an indicator that he didn't seem very patient-centered and it made me worried that he may not make the decisions that would be best for his patients given the research; that it is more about how it looks than the health of his patients. But I also agree that it seems absurd that the 2nd guy can't swap implants and needs to go back to TEs. It doesn't make logical sense to me. As for searching further, there is only one more PS I can use with my Kaiser insurance and he is really too far away.

Hapa--all he said was that he couldn't figure out a way to make it look good with just one surgery. I pushed him on it, but he insisted on the TEs. I don't want to go back to them not only b/c of the discomfort (and I understand they are not as uncomfortable over the pec), but b/c it means going back to square one with being flat and then all the slowness of the fills and then waiting for the exchange and then having the exchange surgery before I look halfway normal again. That was awful. Once was OK--i could handle it. But I can't imagine doing it all over again.

SimoneRC--It wouldn't be direct to implant. I already have implants (have had since Nov 2017), but they are under the pec. So it doesn't make sense to me why they need to go back to square one and start over with TEs again.



Dx 3/20/2017, IDC, Left, 1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2- Surgery 5/1/2017 Lumpectomy: Right Surgery 5/1/2017 Mastectomy: Left; Reconstruction (left): Tissue expander placement Dx 5/4/2017, DCIS, Right, <1cm, Stage 0, ER+/PR+ Surgery 5/22/2017 Lymph node removal: Sentinel; Mastectomy: Right; Reconstruction (right): Tissue expander placement Hormonal Therapy 6/14/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 11/3/2017 Reconstruction (left): Saline implant; Reconstruction (right): Saline implant
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Sep 4, 2019 10:17PM SimoneRC wrote:

Hi MinuteAtATime,

I think they need to lift that skin to create the new prepectoral pocket that holds the implant. Your current pocket is under the muscle, right? That skin is not just floating around unattached. So I think when they create the new prepectoral pocket you are faced with the same issues for making sure you do not wind up with necrosis.

My fills were super quick. Many women wake up with the expanders already partially filled. My time from expander to exchange was three months and I woke up flat from my mastectomy. I had super thin skin FWIW.

ATM Gene Mutation, Deletion. IDC w/Lobular Features and Focal Mucinous Features. Pre Pectoral Reconstruction. Hysterectomy
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Sep 5, 2019 03:14PM Randi64 wrote:

Hi ladies! I am set for surgery 9/20 to replace Allergen 410 textured implants. I decided today after speaking with my PS to try pre-pectoral after having under the muscle since 2011. To say I am nervous about the outcome is an understatement. I have had considerable animation deformity for years as well as neck, scapula pain since my mastectomy. If this new surgery can relieve this, I'd be thrilled. I know there an increased risk of infection, but fingers crossed this wont be an issue!

I want to add him to the list as he has been doing these for a number of years. Dr. Sameer Patel at Fox Chase in Philadelphia.

Dx 11/5/2010, IDC, 3cm, Stage IIB, Grade 2, 1/4 nodes, ER+/PR+, HER2-
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Sep 5, 2019 05:12PM - edited Sep 5, 2019 05:15PM by Crescent5

hi Randi64!

I made the switch from subpec to prepec and truly I couldn't be happier. I had grotesque animation deformity and one implant was being clenched so tightly by my pecs so it never dropped. I had shooting pains going down my upper, inner arms that my onc thought was a lymph node issue! Nope. It was subpec implants messing with my pecs

Three + months out from surgery, I keep looking at my breasts because they look real again. They jiggle. They're squishy. They even sag a little. She put in 520s from 400s (both sets rounds, not textured) They're beautiful.

I have some rippling as I have very thin skin but it's not worth it for me to go back under for fat grafting. They're very pretty as they are and I couldn't care less about minor rippling. I felt like Frankenstein before (no offense to anyone with subpec... some look beautiful, mine did not) and now I feel like a natural woman. Love them that much ! Good luck luck to you!! Ps there's a thread here for this type of revision surgery. I'll bump it for you

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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Sep 6, 2019 12:48AM - edited Sep 6, 2019 12:51AM by macb04

MinuteAtATime, that is understandable, not wanting to go through being flat again. I absolutely hated that, being lopsided and always worrying about matching my R side with a prosthetic. But like SimoneRC said, TE's are often partially filled during surgery, so you wouldn't be completely flat most likely. And every week fills would get you closer and closer to the right size.

That being said, I don't know if all women switching from Subpectoral to Prepectoral Implant Reconstruction have had TE's. Perhaps someone will chime in.

Hi Randi64. Welcome and the Best of Luck in converting from subpectoral to Prepectoral. I really hope your pain issues improve greatly. Why do you say there is an increased risk of infection?

I will add Dr Patel to the list.

Hi Cresent5, so happy to hear you have had such a lovely result changing over from subpectoral to Prepectoral Implant Reconstruction. I am sure your story will bring hope of good outcomes to many women.

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Sep 6, 2019 08:21AM - edited Sep 6, 2019 08:22AM by OCDAmy

I had sub pec TE and switched to a different PS and he suggested pre pec. So he removed sub pec TE, repaired the muscle and put in pre pec. I'm not sure I understand why you would need TE if you already have an implant.

Dx 2/2017, IDC, Left, 4cm, Stage IIB, Grade 2, 2/13 nodes, ER+/PR+, HER2- Surgery 11/15/2018 Reconstruction (left): Fat grafting; Reconstruction (right): Fat grafting, Silicone implant Surgery Lymph node removal; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy Arimidex (anastrozole) Surgery Reconstruction (left): DIEP flap Radiation Therapy Whole-breast
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Sep 6, 2019 01:46PM - edited Sep 6, 2019 01:47PM by Randi64

Thank you ladies! macb04 PS said higher risk for infection because of the Alloderm I believe? Crescent5 Thank you for directing me to the other thread! Your experience has really helped the confidence in my new decision to go prepectoral! I look forward to hopefully feeling and looking better!

Dx 11/5/2010, IDC, 3cm, Stage IIB, Grade 2, 1/4 nodes, ER+/PR+, HER2-
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Sep 6, 2019 10:01PM - edited Sep 7, 2019 06:45PM by Magari

Minute - My oncoplastic surgeon does prepectoral implants just about exclusively, and direct to implant whenever possible. She is switching my coworker's subpectoral implants to prepectoral, with some nerve grafting at the same time. My coworker wants smaller implants than her originals, and I'm virtually certain there will be no TEs involved.

I had shaped, textured highly cohesive gel implants (Sientra) when I had my nipple-sparing double mastectomy with direct to implant, prepectoral reconstruction a couple of years ago. I had significant rippling on one side, and an air bubble that seemed to be growing which was causing discomfort. So my surgeon switched me to smooth round implants (also Sientra, highly cohesive gel) and did a small amount of fat grafting at the same time, about a month ago. This was done as a single outpatient, 2 hour surgery, and I am very happy with my results.

Diagnosed at 54; Bilateral mastectomy with DTI reconstruction 10/16/17; Revision surgery to switch implants 7/19/19; Cold capped during chemo - TCHP 11/26/17 Dx 9/1/2017, DCIS/IDC, Both breasts, <1cm, Stage IB, Grade 3, 1/3 nodes, ER+/PR+, HER2+ Hormonal Therapy 6/3/2018 Arimidex (anastrozole) Hormonal Therapy 8/16/2019 Aromasin (exemestane) Hormonal Therapy 9/16/2019 Femara (letrozole) Hormonal Therapy 1/14/2020 Arimidex (anastrozole)
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Sep 16, 2019 02:41AM macb04 wrote:

bump

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Sep 18, 2019 07:19AM CBK wrote:

Has anyone had pre/pec done a few years ago and still no rippling? I’m trying to find any long-term reliable research on outcome.

I know the immediate results can be quite compelling as my friend just went through the procedure here at hospital I was reconstructed at with a different surgeon, but she’s only a month out and healing.

Even her surgeon who is very qualified surgeon says rippling remains an issue. But my friend was having terrible pain with sub-pecs and this was more the primary issue for her.

Dx 3/26/2017, IDC, Left, 2cm, Stage IIA, Grade 3, ER+/PR+, HER2- Surgery 5/11/2017 Mastectomy: Left, Right; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 7/22/2017 AC + T (Taxol) Surgery 1/25/2018 Prophylactic ovary removal Hormonal Therapy 2/18/2018 Arimidex (anastrozole) Surgery 4/9/2018 Reconstruction (right): Latissimus dorsi flap, Silicone implant Surgery 9/28/2018 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 4/3/2019 Reconstruction (left): Nipple reconstruction, Silicone implant; Reconstruction (right): Nipple reconstruction, Silicone implant
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Sep 18, 2019 10:05PM - edited Sep 18, 2019 10:06PM by macb04

Well, I had the second , larger Silicone implant placed in March 2016, and still no rippling. The PS, mcintyre, put in a 420 for some nutty reason in January 2016. It was way, way, way too small. I knew it was too small the second I woke up. He cut away too much skin, so when I did reconstruction surgery number 15 in March he was only able to fit in a 495cc implant. Still too small. Need a 550cc or 575cc size implant, but the PS screwed up, and left me lopsided unless I want to do ANOTHER breast reduction on my R real side AGAIN. ( Had the R lifted due to insurance issues sooner than I should have)

Anyhow, No ripples 3 years out. I know that is not a huge amount of time gone by. A women I met through the boards had Prepectoral Implant Reconstruction done in England about 10 years ago and was still happy with it, which is what convinced me it was the way to go.

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Sep 22, 2019 02:54PM CBK wrote:

I’m sure much of outcome besides surgeon’s expertise is what the surgeon is left with skin-wise to work with. And quality of the skin.

I’m going to talk to my surgeon again about pre-pec thoughts and see where she is at on the spectrum. I need to go for nipple and areola revise tmr. I’ll have an hour to bend her ear uninterrupted.

Dx 3/26/2017, IDC, Left, 2cm, Stage IIA, Grade 3, ER+/PR+, HER2- Surgery 5/11/2017 Mastectomy: Left, Right; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 7/22/2017 AC + T (Taxol) Surgery 1/25/2018 Prophylactic ovary removal Hormonal Therapy 2/18/2018 Arimidex (anastrozole) Surgery 4/9/2018 Reconstruction (right): Latissimus dorsi flap, Silicone implant Surgery 9/28/2018 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 4/3/2019 Reconstruction (left): Nipple reconstruction, Silicone implant; Reconstruction (right): Nipple reconstruction, Silicone implant
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Sep 22, 2019 03:57PM VegGal wrote:

Mine will be two years old on Thursday. No ripples.

Dx 1/12/2016, DCIS, Left, <1cm, Stage 0, Grade 2, 0/3 nodes, ER+/PR-, HER2- Surgery 3/11/2016 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 6/9/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 9/7/2017 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Sep 24, 2019 12:04AM MinuteAtATime wrote:

Ladies, thank you for sharing your info and all of your encouragement. I decided not to settle for the doc who required two surgeries and starting with TEs. I decided that this surgery is important enough for me to try my 3rd option for a PS, which is quite a drive (a few hours). I read his bio and he sounds great. I meet with him next week. Fingers crossed the third one is the charm.

As for ripples, I have them already with my subpec implants, which are saline. But I don't mind the rippling as much as the animation. that's why I want to switch to prepec.

Do any of you have saline implants prepec? I would like to stick with saline--i feel a little safer with them. I worry the silicone ones will leak without me knowing.

Happy first day of fall.

Dx 3/20/2017, IDC, Left, 1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2- Surgery 5/1/2017 Lumpectomy: Right Surgery 5/1/2017 Mastectomy: Left; Reconstruction (left): Tissue expander placement Dx 5/4/2017, DCIS, Right, <1cm, Stage 0, ER+/PR+ Surgery 5/22/2017 Lymph node removal: Sentinel; Mastectomy: Right; Reconstruction (right): Tissue expander placement Hormonal Therapy 6/14/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 11/3/2017 Reconstruction (left): Saline implant; Reconstruction (right): Saline implant

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