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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 Really nice guy named Paul created it for me. Used to be called Custom DSE.

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

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

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


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

Dr. Jonathan Hutter -Valley Hospital, Renton, WA

Dr. Mark Tseng - Multicare, Auburn, WA

Dr Reid Mueller - OSHU, Portland, OR

Dr. Lisa Cassileth - Beverly Hills, CA

Dr. Leif Rogers - Beverly Hills, CA

Dr Kamakshi Zeidler - Campbell, CA

Dr. Michael Halls--La Jolla, CA

Dr Elizabeth Kim - Los Angeles, CA

Dr. Charlotta Lavia - Los Angeles, CA

Dr. Charles Tseng - UCLA , CA

Dr. Mark Gaon - Newport Beach, CA

Dr. Sara Yegiyants - Santa Barbara, CA

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

Dr. Jyoti Arya - San Diego, CA

Dr Karen Horton--San Francisco, CA

Dr Anne Peled, MD - San Francisco, CA

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


Dr. Julie Park - University of Chicago Medicine, Il

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

Dr. William Dougherty - Taos, NM

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

Dr Steven R Jacobson - Mayo Clinic, Rochester MN

Dr. Bruce Chau- Berkley, MI

Dr. Marissa Tenenbaum - St Louis, MO

Dr. Terry Myckatyn - St. Louis, MO

Dr William Stefani - Renaissance Plastic Surgery, Troy, Michigan

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

Dr Ryan Gobble - UC in Cincinnati, OH

Dr. Neil Kundu - Jewish Hospital, Cincinnati, OH

Dr. Timothy Schaefer - Edina, MN

Dr. Oscar Masters - Oklahoma City, OK

Dr Tiwari & Dr Kocak - Columbus Ohio.

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


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 :

Dr. Joanne Lenert - Washington, DC

Dr Troy Pittman - Georgetown University, Washington, DC


Dr Mitchell Brown, Toronto Canada

Dr Jason Williams - Hallifax, Nova Scotia


Dr Beverley Fosh - Adelaide, South Australia

Dr Amy Jeeves - Adelaide, South Australia


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

Pharmacokinetics of oral vitamin C


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 ..

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'Superbugs'

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

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

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

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

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

Herbal Medicines

  • 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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Jan 28, 2020 08:29PM macb04 wrote:

LiveLoveLaugh, they say the cancer industry is a huge cause of bankruptcy. One year I had 13,000 dollars out of pocket, between 3 surgeries and all the other medical bills.

I itemized it, and I wasn't even able to get money back, because you can't claim it off taxes unless the amount spent is a ruinous high percentage of gross income. Even the government is in on the swindle that impoverishes and bankrupts cancer industry victims.

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Jan 29, 2020 07:23AM DiveCat wrote:


I have sub pec but was direct to implant so have Alloderm slings (placed 2014) and it caused no issues. I DID get that temporary “red breast syndrome” under one breast for a little while but that is not uncommon and is just a visual thing. It went away fairly quickly.

My sister had pre-pec with Alloderm in December. While she has to go back for fat grafting due to significant rippling and perhaps get larger implants (her PS was concerned at time of revision about skin so went smaller), the Alloderm caused her no issues thus far. I know her doctor did talk to her about how some patients do have an issue with it but it was rare in his experience.

But with two bouts of capsular contracture, you are at definitely at higher risk of more with more implants (especially pre-pec as I understand it but that is from my own research before my surgery years ago, not sure if that is still the case so don’t rely on me there!) and I am not sure how the Alloderm may work for you with that either. The issue is it is still another item foreign to your body, so if your body has a history of reacting to that it may be an issue.

I am sorry you don’t have many people in your life who are willing to talk about this with. I am so grateful for my husband and my sister to talk about this kind of thing with. I hope you find this community helpful. Hug

Hereditary High Risk, Uninformed BRCA Negative Surgery 4/24/2014 Prophylactic mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 3/12/2015 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 11/14/2019 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 5/28/2020 Reconstruction (left): Fat grafting; Reconstruction (right): Fat grafting
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Jul 10, 2020 02:25PM orchidgal wrote:

Just want to echo what SimoneRC wrote. I currently have nine year old subpectoral implants that have capsular contracture on one side and have been driving me crazy since day one. I just got back from a consultation with a PS who does prepectoral exchange/reconstruction using TEs and Alloderm. He explained that since the skin is so thin it's best to create a pocket using alloderm so it forms and holds rather than taking a chance that the prepectoral implants migrate after surgery. This greatly lessens the chance of that happening. I hated the TEs too but am willing to go for it if it means freedom of movement, etc., and having my pecs back on my chest wall as nature intended. The fat grafting if desired would happen after exchange surgery.

Dx 4/20/2010, DCIS, 5cm, Stage 0, Grade 2, ER+/PR+, HER2-
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Jul 10, 2020 04:58PM macb04 wrote:

I might say that rehabilitation of fragile skin with the improved micro circulation that occurs after fat grafting might not be a bad idea.

I had all of my fat grafting done prior to changing TE/Implants.

My PS did say my skin looked better than others he had seen, with similar history, but not fat grafted.

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Jul 24, 2020 12:27PM macb04 wrote:


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Jul 28, 2020 07:28PM LaVue wrote:

Is the issue with rippling cosmetic or is it painful?

Dx 2/3/2020, DCIS, Left, 3cm, Stage 0, Grade 2, 0/5 nodes Surgery 6/10/2020 Lymph node removal: Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Dx 6/22/2020, LCIS, Right, 0/4 nodes
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Jul 28, 2020 07:46PM VegGal wrote:

Cosmetic...yet emotionally painful.

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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Jul 29, 2020 05:02PM macb04 wrote:

Totally understand VegGal. For many of us getting a decent cosmetic result is as elusive as finding the Holy Grail.

It is something we are entitled to, getting a result we can be comfortable with. I wonder how many of us just give up because we are worn out with endless suffering and painful procedures, and just settle for what we’re left with. I know I have just finally given up and just feel stuck with how it looks.

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