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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 Jul 15, 2020 05:44AM 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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Oct 30, 2019 12:58AM macb04 wrote:

hapa, we could try to keep the peace and cognitively reframe your husband giving you grief about your next revision, say it is only because he is worried. It could be that AND he is just being a selfish pain in the butt if he is at all like my dh. . My husband used to give me grief with every reconstruction procedure because it meant he would be expected to take care of the house and the kids for a while. No support there for me unfortunately. I hope your dh is better for you than mine, and that you have a safe, sucessful revision.

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Oct 30, 2019 05:15AM - edited Oct 30, 2019 05:17AM by hapa

Thanks mac. He's not better than yours; possibly worse. We don't even have kids, and after my last revision we road tripped to Santa Fe literally the morning after, I had so few problems with recovery. He's just complaining out of some moral distaste for plastic surgery and concern that I'll "never be happy", which is entirely possible. Though back before my BMX, when I floated the idea of no reconstruction at all, he didn't like that either. I guess a shitty looking reconstruction was his idea of an optimal outcome? It is going to be very tense in our house for the next few days, at least.

Andra - do you know how much fat (how many ccs) your PS removed when you had fat grafting? Mine is saying he wants 100-200 ccs, which seems like a LOT to put on my 210cc implants. He's expecting 50-60% to "take".

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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Oct 30, 2019 12:35PM tibet1 wrote:

Hi Macb4, may I ask if you have scars on the reconstruction? I am kind of hiding in changing rooms because my reconstructed boobs have big scars that they cannot get ride of. ….How are yours?

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Oct 30, 2019 09:28PM Andraxo wrote:

hapa - no idea how much fat CCs were taken last time. It was 3 years ago. I do recall PS saying it was hard to get though (he tried lower abdomen and couldn't get anything, ultimately took it from my hip area which is crazy because I have boyish hips). I also oddly tend to lose a few pounds every fall so my weight is down now. I'd have more fat in the spring when I oddly gain it back (all without changing my habits) so maybe I could fat graft later. 100-200 ccs isn't much when you consider the area that is it spread out over. My recon looks great in clothing and I know nothing will really make it look good naked (i.e. natural). That's OK. It's mostly about my ability to be active, and also low maintenance. I'd be fine flat. Funny you road tripped to Santa Fe right after surgery. I'm in Santa Fe! - at least on weekends. Are you in the area? I work in AZ weekdays on the Navajo Indian Reservation and my spouse lives and works in Santa Fe, so I guess that is home. I like the commuter marriage since I have a very high need for alone time and I'm simply too busy and then drained on workdays to want to even talk to another person when I'm done.

So sorry hapa and mAcb04 that your SOs aren't as supportive as you'd like them to be. With all the other crap you have to deal with it just sucks to add that as another layer. *sigh*

- xo

Andra :) Dx at age 45. Super active in outdoor adventures in the southwest/4 corners area. Dx 7/2015, IDC, Left, <1cm, Stage IIA, 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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Oct 31, 2019 05:27AM macb04 wrote:

hapa, I do wish I could give your dh a figurative slap up side the head for being a selfish horse's ass. Sorry if that is too frank, but that kind of nonsense makes my blood boil.

Can you go stay at a friend's house for the next few days leading up to surgery? I certainly wouldn't have hung around with the lack of empathy I experienced before and after my many, many, many surgeries if I didn't have kids to consider. We need caring and compassion at home, as surely as competence in the OR. Lack of caring and the distress it causes harms us, and impedes our ability to heal. We deserve better.

Reconstruction has absolutely nothing whatsoever to do with your dh. His opinion doesn't count in the slightest, only yours counts.

___________________________________________________

Hey tibet 1, I do have scars which I put Embrace Scar therapy for existing scars or other Silicon scar strips on. I have also had some real improvement with getting Pulsed Dye laser treatment at my Dermatologist. I have left the scar strips on for months at a time, which seems to be the only way to get the scars to fade appreciably. See a Derm, with specific experience in dealing with improving scars. They can improve the situation, although this is unfortunately not covered by insurance.


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Oct 31, 2019 04:36PM hapa wrote:

Mac - thanks. I don't plan to take his opinion into consideration at this point. He spent my whole treatment year playing video games instead of helping me research or make decisions, I consider it too late for him to jump in with an opinion now. He's been complaining about things I do a lot lately. I'm not sure how this is going to play out, but I think it is just a symptom of a bigger problem -- this experience has changed my priorities, my tolerance for risk, and my philosophy on life in general and he is not on board with those changes.

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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Oct 31, 2019 06:18PM macb04 wrote:

I feel much the same about my own dh, that since he didn't have my back, wasn't supportive when I most desperately needed it, he has forfeited the right to be a priority in my personal decision making.

Well I hope you find support from other areas or people in your life. We are all here for you as well.

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Nov 1, 2019 04:03AM hapa wrote:

Oh yeah, you guys are the best!

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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Nov 15, 2019 05:28PM Sunshine39 wrote:

Hi Ladies, I’m new to posting but have been reading. I have a question regarding revision from sub to pre pec implant - I currently have the tissue expanders under the pec. I’m done with the fills. Is it possible to place the implant pre pec during the exchange even though the pockets are under? The chest area is very tight and when I flex there’s animation. I just wish I was more informed of the options before going into surgery. I want to make it right this time and avoid having to have the revision after the implants are in


thank you very much!

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Nov 15, 2019 09:56PM Magari wrote:

Hi, sunshine -

Great question! I would think that if you're a candidate for pre-pec reconstruction you could opt for it now and have the expanders removed and the pre-pectoral implants placed at the same time.

But not all surgeons do pre-pec implants, or yours may have had reasons for choosing sub-pectoral reconstruction in your case.

Ask your surgeon, and if s/he says no, ask why not. If you don't like the answer, get a second opinion. And let us know the outcome!

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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Nov 16, 2019 02:59AM Sunshine39 wrote:

Hi Margari, thank you for your response. I was bleeding a lot from surgery so I had the BM first and a week later had the expanders put in. The surgeon was worried about necrosis so he placed the expanders under the muscle. I really don’t want to have to go through more surgeries after the exchange surgery so I wanted to see if anyone here had a similar situation. I have an appointment with the PS in a few weeks and will see if he’s willing to do this and will report back so it will be informative for others going through this difficult time.


thank you again.

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Nov 16, 2019 04:31AM macb04 wrote:

Hi Sunshine39, welcome. I know what you mean about wanting to minimize more surgeries. I wonder if there would be enough loose skin over your pectoral to fit in an Prepectoral Implant of the size you might want. That is the real determining factor. I see you said your chest was tight. I worry you might need a Prepectoral TE before you can have Prepectoral Reconstruction done. I hope not, but want to say this is a possibility and feel it's best to discuss it here for you and others. I had a subpectoral TE initially, and then a Prepectoral TE before my Prepectoral Implant Reconstruction myself, as the subpectoral didn't make Prepectoral possible.

By all means get a couple of opinions. So you are making the best informed choice for yourself. Let us know what they all say, and what you decide to do.

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Nov 17, 2019 07:52PM Sunshine39 wrote:

Hi macb04, thank you for your response and this wonderful thread you created! My chest is tight but I think it’s the upper pole where the muscle is being stretched above the TE as my nurse said I can get at least 2 more fills (120cc) if I really wanted. I was a 34b prior to BM and don’t really want anything bigger. Just want to feel as natural and comfortable as possible..That being said, I think my skin would be ok for some Morestretching pre pec? I will definitely ask the question when I see the surgeon. I don’t mind having the TE until I find the best solution so I appreciate everyone / anyone’s input here. Happy Sunday!

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Nov 17, 2019 08:57PM OCDAmy wrote:

I had sub pec TE and exchanged for pre pec implant. They just have to repair the pec muscle. It’s all done in one surgery.

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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Nov 18, 2019 02:34AM Sunshine39 wrote:

Hi Amy, thank you so much for responding to me! May I ask how you feel about the exchange surgery overall? I.e. recovery specifically related to the pec and what made you so sure that a pre pec exchange would be a better choice considering you didn’t have the sub pec implant yet at the time of your decision. I had raised my discomfort and concerns to the surgeon a week after my surgery and Mentioned again last time I saw him. Both times he said that I would feel better after the exchange surgery. We all know that is true though I just don’t know how much better and I hate to have to revisit and make a correction later. May I ask how you came to making that decision?

Thanks again!

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Nov 19, 2019 05:43PM Andraxo wrote:

Hi All!

Surgery was Nov 6th. Plan A was to remove my nipples and exchange my pre-pec textured anatomics for smooth rounds - as long as they didn't look worse (in terms of edges etc) than the current ones or if any concerns about blood supply on radiated side etc. Plan B was go flat even though he wasn't sure I could really be flat because of the extra alloderm on radiated side (it would be visible edges all around). Well, the smooth rounds looked worse and surgeon said all the OR staff groaned when he tested one out. He took a picture and came out to talk with my spouse explaining to him that I would not be happy. My spouse agreed. I saw the picture later and yes, worse (edges even more prominent and warped/rippled). Even if I had enough fat for one round of grafting it wouldn't come close to helping that. Surgeon spent hours meticulously teasing out some of the extra alloderm so I wouldn't have edges. He did a great job, but I'm a bit sad to be flat. It will be an adjustment - feels like mastectomy all over again and I find my self emotional about on and off. My spouse is adjusting as well but just like everything else he says we will get through this together. I do like it more when I'm naked - would much rather look at scars than look at those implant edges of fake breasts - but bummed because my implants looked really awesome in clothes with or without a bra (aside from nipple issues). They were only 250cc and the smooth rounds were even smaller at 220 cc since the pocket was smaller after removing nipples, but it just wasn't meant to be. Flat is where I will remain unless in the future someone develops better implants or other technology for pre-pec breasts where there can't be fat grafting to blend the edges and ripples.

Thanks for all your support on this thread! I hope you all get the results you want!

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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Nov 19, 2019 06:13PM macb04 wrote:

Sunshine39, sounds like you are doing a good job gathering as much info as possible, that will make whatever way you go easier to live with. I hope you get a result you are happy with. Like OCD Amy said, people do switch from subpectoral to Prepectoral fairly often since it has become an option thanks to ADM stuff like Alloderm and Strattice. I will say that my Pectoral recovered almost completely back to normal after the subpectoral TE was removed. He didn't stitch it back into place, just put it back into the right spot and it seems to have healed well all on its own. I have 98% of function and strength I had before first being chopped up.

Andra, that is so hard. I know appearances are important, but comfort is equally, if not more so. I know you will find a way to be pleased with how you look without the implants, just will take some time, as you said. I will let you know if something amazing come to fruition, like 3d implants made to order using our own cells. I am ever hopeful about that one being part of the future of reconstruction.

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Nov 19, 2019 08:40PM - edited Nov 19, 2019 08:54PM by Andraxo

Thanks Macb04! My surgeon said many years ago he was working with a Chinese scientist on a type of hydrogel that would fill the space to create a breast mound. It sounded similar to wound care many years ago when patients have deep wounds and you needed to fill the space while the body granulated tissue (which is now assisted by wound vacs). He said it worked great in mice and was a substance that had zero toxicity. He said there wasn't much interest though in developing it more because of how much the implant industry has grown and dominates. It reminded me of lobby groups owning our democracy. Dang! As someone who used to perform a lot of wound care in PT, it sounded great!

I'm doing well functionally flat, as I did with pre-pecs. 3 days post-op I hiked 9 miles at 10k elevation with a drain. 8 days post-op I ran 8 miles. I started weight lifting again too and made sure to get in extra push-ups. Without breasts I need better pecs! :)

- xo

Andra :) Dx at age 45. Super active in outdoor adventures in the southwest/4 corners area. Dx 7/2015, IDC, Left, <1cm, Stage IIA, 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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Nov 20, 2019 03:30AM macb04 wrote:

Andra, very interesting to hear about Hydrogel Breast Implants. Theses studies are about the ones called Monobloc Hydrogel Implants. It sounds pretty good, anI will definitely start reading up on it.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276769/

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Nov 20, 2019 03:52AM - edited Nov 20, 2019 03:59AM by macb04

Here is one about a really cool idea where these French Researchers made a lattice from a Bioabsorbable material, and then grow a patients own Fat Cells on it, which is absorbed over 6 months to creatr a more natural, and safe "breast.

https://3dprintingindustry.com/news/3d-printed-breast-implant-lattice-revolutionize-cancer-reconstructive-surgery-109165/

Here is an Israeli company also creating an better breast implant, of your own Fat tissues in a 3D collagen scaffold.

https://www.3dprintingmedia.network/collplant-bioprinted-tissue-breast-implants/

_____________________________________________________________________________________________

Not ready for Prime Time yet, but will keep you all informed.

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Nov 20, 2019 04:11AM macb04 wrote:

Human clinical trials for technology aiming to improve the quality of life after breast reconstruction to begin later this year

14 November 2019

11:36

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Evonik, a specialist in biomaterials for implantable medical devices has signed an agreement for the use of a Resomer bioresorbable polymer for innovative breast implant technology with BellaSeno, a developer of 3D printed absorbable scaffolds. Expand

Clinical trial.jpg

BellaSeno will use Resomer in its Senella breast scaffold products with a proprietary additive manufacturing process. They are designed to be implanted after breast reconstruction, augmentation or revision surgery. The Resomer polymer features mechanical properties and a degradation profile that allows the scaffold to safely absorb at a rate that matches the formation of the patient's own tissue. These scaffolds will be available in different sizes and shapes to match the patients' needs.

The process avoids the use of silicone implants which are often associated with clinical risks such as capsular contracture and device complications such as rupture and deflation.

The first-in-human clinical trials of the Senella scaffolds with Resomer are scheduled to begin in Germany this quarter. Evonik will supply its Resomer polymer for clinical and commercial use under the agreement.

Jean-Luc Herbeaux, SVP and general manager of the health care business line of Evonik commented: "Evonik is pleased to be partnering with BellaSeno in the clinical development and commercialisation of their innovative, 3D printed breast implant technology.

"Senella breast implant scaffolds can potentially enhance the quality of life of millions of patients worldwide who undertake surgical procedures each year. This agreement underlines the ability of Evonik to leverage the safety and versatility of Resomer polymers, together with our advanced application technology services, to support customers in the commercialisation of innovative medical devices."

Simon Champ, co-founder and chief executive officer of BellaSeno said: "BellaSeno is very excited to be working together with Evonik in this collaboration.

"The level of support provided by Evonik has been excellent."

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Nov 20, 2019 03:34PM Andraxo wrote:

It is only a matter of time before we have better technology in this area! I fully expect the advances to come from Europe or Israel given their history of leading when it comes to breast cancer related research. I imagine the question will be if some of us will want to bother with surgery again by the time it is truly available.

- xo

Andra :) Dx at age 45. Super active in outdoor adventures in the southwest/4 corners area. Dx 7/2015, IDC, Left, <1cm, Stage IIA, 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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Nov 20, 2019 07:16PM OCDAmy wrote:

Sunshine, sorry for the delay in response. My story is a little complicated. I had planned at first to have BMX and implants. My PS at the time didn't even mention pre pec so my TEs were placed under the pec muscle. After chemo and rads I decided that I might want to get DIEP and my PS did not do that procedure and referred me to a college who does. I was going to have DIEP on both breasts but one of my arteries wasn't great and they were afraid they would have to do a TRAM flap and I didn't want that so I settled with DIEP on cancer/rads side and implant on the other breast. This new PS said he mostly just does pre pec now and that was what he suggested. It feels WAY MORE comfortable than the sub pec TE. I had noticed a little more rippling and the implant dropped some and was not even with DIEP breast so I had another surgery to raise it and had fat grafting and I am very pleased with the resutls.

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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Nov 20, 2019 09:16PM Sunshine39 wrote:

Hi Macb04, thank you for the encouragement. I will ask the surgeon If he can do pre pec exchange first and go from there. My gut feeling tells me he will say no but let’s see.


Hi Amy, no worries and thank you for the response! Yes, I am concerned with the rippling but I think I take comfort over that rather. I’m glad to hear you are doing well and very happy with the results!

I will post again after I meet with my surgeon. Hope everyone get to enjoy the holiday season despite what we are going / went through! X

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Dec 29, 2019 04:48PM hapa wrote:

Ok, so I had my revision with fat grafting yesterday. It seems it was a waste of anethesia, the surgeon was only able to get 30ccs out of me. I'll post in a few weeks once the swelling is down and I know what they look like. So far it seems like he smoothed out the area between the implant and my armpits, which was by far the worst looking part of my recon. You could even tell in clothes that I had fake boobs because of the divot there. Crossing my fingers that all of this fat takes because I don't think I have enough to do a second round.

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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Dec 30, 2019 04:27AM macb04 wrote:

Dang, hapa. Hope the fat takes too. Best of luck with recovery from surgery.

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Jan 2, 2020 08:02PM - edited Jan 2, 2020 08:03PM by DiveCat

This Post was deleted by DiveCat.
Hereditary High Risk, Uninformed BRCA Negative Surgery 4/23/2014 Prophylactic mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 3/11/2015 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 11/13/2019 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 5/27/2020 Reconstruction (left): Fat grafting; Reconstruction (right): Fat grafting
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Jan 8, 2020 03:48AM willa216 wrote:

Hi everyone: 

I have some questions about capsular contracture and pre-pec revisions. 

I've tried twice with pre-pec implants (single mx). Each time I have developed grade IV capsular contracture within a few months of surgery.  I am going to have to do something different.  My current implant is very deformed and painful. 

My original PS says that diep would be the best option.  I've thought about this for a year and cannot get in a comfortable place with it for a variety of reasons and risks particular to my case.  

I've sought additional opinions.  Usually I hear that I sub pec would be required to get any luck avoiding subsequent contracture.  I don't want to do that. My latest consult  who has a stellar reputation does diep but says he can also do a pre-pec using alloderm or some other mesh.  The Alloderm  worries me as it is another foreign substance for my body to disagree with. This PS says he has no trouble with Alloderm. My original PS says Alloderm causes all sorts of issues and she won't touch it.  Bleh.

So I have 2 questions really:  

Has anybody had a successful pre-pec revision to fix capsular contracture? 

Do you have Alloderm and has it caused any issues? 

Thanks so much. Grateful to be able to come here when my husband and friends do not want to think about or discuss all of this. 

Sending love and good vibes to all.





IDC; 2cm; 0/4 nodes; ER+ PR+ HER2+; UMX and reconstruction July 2016; Taxol , Carboplatin, Perjeta, Herceptin 12x/weekly August 2016; Herceptin through Aug 2017
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Jan 8, 2020 04:31AM VegGal wrote:

I have Alloderm and pre-pecs. No issues.

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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Jan 8, 2020 05:58AM - edited Jan 8, 2020 06:24AM by macb04

I had Alloderm initially with a Subpectoral TE. Had that removed and then got Seri Silk mesh when I switched to Prepectoral TE, the Silicone implant.

That is very tricky for you if you have tried Prepectoral twice, with CC developing each time. I was at increased risk of CC due to Rads Fibrosis, so I was on Pentoxfylline ( a prescription medication) and Vitamin E OTC twice per day for about 2 years.

I have often wondered if Pentoxfylline and Vitamin E can help prevent CC in women without Rad Fibrosis. Weirdly there seems to be no studies on that.

I have often read several hypotheses over how CC develops. One is the potential low level bacterial infection from biofilm adhereing to the implant shell and causing an inflammatory process. Or, of course, that an implant is a foreign body that our body encapsulates to wall off a potential danger from the rest of the body. Could be a bit of both. No firm understanding has yet to come to light.

It has been shown in studies that Pentoxfylline and Vitamin E do seem to decrease risks of CC for Rads Fibrosis, so maybe there is some problem related to blood flow which the Pentoxfylline fixes. Pentoxfylline is used on label for an issue called Intermittent Claudication, whereby it causes red blood cells to be more easily distorted so they can fit into abnormally narrowed blood vessels and improve tissue oxygenation.

I also got IV Vitamin C (50 grams) at my Naturopath the day after each surgery to put in the TE, otherwise then I got infections. Perhaps if the low level bacterial thing is true,, then the IV Vitamin C would have killed any bacterial at the high dose I took. High dose IV Vitamin C produces Hydrogen Peroxide in the tissues which kills most bacteria.

So my thought is if you wanted to take another Prepectoral Implant chance, then you would have to do stuff like Pentoxfylline and Vitamin E, and or IV Vitamin C in conjunction to see if it could work out. I had severe Radiation Fibrosis, really awful, and had an extremely high risk of CC, so I feel these extra steps were crucial to my sucess.

Also wondering if you read the articles on treatment of CC with Low Level Laser Therapy.

https://www.thepmfajournal.com/education/how-i-do-it/post/how-i-do-it-postoperative-care-following-aesthetic-breast-surgery-treatment-of-capsular-contracture-with-celluma-low-level-light-therapy

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