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Topic: Over or under pec muscle

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

Posted on: Apr 1, 2019 08:53PM

Motheroftwo36 wrote:

my PS has me for under the muscle but he talked about going over. He is good either way, he said over is more new so he just has me for under since it’s the more known surgery. He said over often looks better and less painful. He said he typically does them in older patients. Any reasons to not go over?

Dx 2/5/2019, DCIS, Right, 3cm, Stage 0, Grade 3, 1/2 nodes, ER+/PR+ Surgery 4/17/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Apr 1, 2019 09:29PM - edited Apr 1, 2019 09:30PM by Fritzmylove

My PS has only done over pec for the past 3 years. I have had very little pain. I was off narcotics 2 days after surgery, and I've had no pain after every fill. I can't say how they look after exchange since I won't have that until the fall, but so far I'm very happy with how the reconstruction process has gone. I’m 35.

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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Apr 1, 2019 10:15PM Motheroftwo36 wrote:

fritzmylove

Did you get to look at pictures and compare? I can’t find hardly any examples and I want the most natural look possible.

Dx 2/5/2019, DCIS, Right, 3cm, Stage 0, Grade 3, 1/2 nodes, ER+/PR+ Surgery 4/17/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Apr 1, 2019 10:30PM VegGal wrote:

If you want natural looking, go with over. If necessary, fat grafting can fine tune your look. You may also want to seek a second opinion from someone absolutely confident in the procedure. Measure twice, cut once!

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 6/10/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 9/8/2017 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Apr 1, 2019 10:37PM Solobroker wrote:

I have a combo and I'm not really sure all of it but I had my surgery last week January and am very happy so far. As for pain, I have a low threshold so you can't really go by me. Plus all the medical professionals involved in my care have said what an outstanding job my BS and PS did. I  am going through chemo now and won't have exchange til July or August.

The way the PS put it to me was once they are in there and see what's actually going on, they make the decision then.

For me I just turned 47 but was a smoker so that was a factor.


Hoping for the best for you ……. 

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Apr 1, 2019 10:41PM Motheroftwo36 wrote:

I get conflicting answers, some say over is more natural and some say under is! Ugh . I heard going over makes it look like balls on top of chest and I don’t want that! My surgery is in two weeks and I’m not willing to delay my surgery to get a second opinion

Dx 2/5/2019, DCIS, Right, 3cm, Stage 0, Grade 3, 1/2 nodes, ER+/PR+ Surgery 4/17/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Apr 1, 2019 11:27PM Fritzmylove wrote:

I didn’t really look at pictures or question my PS’s choice. I knew he was a great PS that is up to date on the best procedures, and I wanted to get the surgery scheduled ASAP since I had a small window of timerecommended by my MO after I finished chemo to get it done.

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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Apr 1, 2019 11:27PM LaughingGull wrote:

Are complications more common with one over the other? Somebody must have those numbers. What is the lifecycle of the results and potential long term problems?

I have under and I have zero pain. I had two mastectomies and both times came home with Tylenol, same with the exchange surgery. I don’t think there can be much difference since the pec muscle is very very thin and covers the prostheses only partially. Really cant see how having these things under the skin would make much of a difference. I am very active and a swimmer and have full mobility. I was offered only under and the reasons sounded reasonable to me and the results look okay -forfake boobs. They would be just as fake with the implants under the skin. They wouldn’t look much different.

Good luck with your decision!

ACx4, THPx4, HP (to complete 1y); Nerlynx (1y); AI (expected 10y), Surgery: BMX + ALND, Reconstruction, Oophorectomy. Radiation. Dx 10/26/2017, IDC, Right, 3cm, Stage IIB, Grade 3, 2/6 nodes, ER+/PR+, HER2+ (IHC)
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Apr 1, 2019 11:32PM Rrobin0200 wrote:

I have pre-pectoral implants. They do not look like balls on my chest. Instead, they are very natural looking... almost to the point that I love them more now than I do before the doublemastectomy!

Dx 3/6/2017, DCIS, Left, 1cm, Stage 0, Grade 3, 0/4 nodes, ER-/PR- Surgery 3/31/2017 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Apr 2, 2019 12:03AM Beesie wrote:

For me, the big selling point for sub-pectoral is that the chest wall and skin are pressed together above the implant, and therefore any local recurrence, either against the chest wall or against the skin, will be easily felt when doing a breast self-exam.

The following article fairly assesses the pros and cons of both pre-pectoral and sub-pectoral reconstruction. To my point, it does note that pre-pectoral reconstruction is contraindicated for those with deep tumors or tumors near the chest wall.

http://gs.amegroups.com/article/download/20787/20414


“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Apr 2, 2019 07:09AM - edited Apr 2, 2019 07:28AM by CBK


Beesie- That's a great piece. I'm going in for some revisions Friday and that seals my deal.

Mother-Over the pec has the potential for more (for lack of better words) rippling on the chest wall that would necessitate fat grafting. Under the pec for some has a lot of animation. Like when I'm lifting weights in the gym.

My surgeon will do either if tissue is stable but prefers under the pec for appearance as the rippling can be very unsightly; she showed me some photos. Then when you get into fat grafting to “fix it" it can take several procedures to get desired result.

I can't speak to the comfort level between both as my implants on my side that didn't end up with contracture feels great to me. But my other side is tight .....getting that fixed Friday.

Good luck on your decision wishing you an easeful procedure whatever your decision.

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 7/21/2017 AC + T (Taxol) Surgery 1/25/2018 Prophylactic ovary removal Hormonal Therapy 2/17/2018 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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Apr 2, 2019 07:54AM Motheroftwo36 wrote:

Rrobin

Did u have nipple sparring

Dx 2/5/2019, DCIS, Right, 3cm, Stage 0, Grade 3, 1/2 nodes, ER+/PR+ Surgery 4/17/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Apr 2, 2019 08:19AM Rah2464 wrote:

Motheroftwo36 I had nipple sparing with immediate reconstruction. My PS did a kind of combo type where she put the leading edge of the implant (towards the center of your chest) under a small amount of muscle. The majority of the implant is above the muscle. So I don't get any strange movement when I flex. I am really skinny right now so I would look better if I had a little meat on my bones. I can see some ripples on mine but it isn't much and quite honestly these foobs look better than what I had before. I am usually someone who researches everything but funnily enough on this one I just went with whatever my PS said because I really trusted her judgment. Does your PS have images you can look at of their work?

Dx 5/23/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 6/27/2018 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 7/27/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Apr 2, 2019 09:14AM SummerAngel wrote:

I didn't have a choice, mine are under. I had extremely strong pecs and the surgery and expander process was very painful, probably because my pecs were so tight. (My PS was surprised and told me and my family that my pecs were stronger than his! Smile)

I am very happy with them overall and they look great, but the animation when lifting weights has caused me to modify my workouts. I no longer do push-ups, which were my favorite exercise, because I found that my implants were moving towards my armpits and staying there. I figure it's a small price to pay, but I think if I had a choice now I would go over the muscle.

Age at dx: 45. Oncotype, left-side tumor: 9. Right side had multifocal IDC and "extensive" LCIS. Isolated tumor cells in 1 right-side node. Dx 4/3/2015, IDC, Left, 2cm, Stage IIA, Grade 1, 0/3 nodes, ER+/PR+, HER2- (FISH) Dx 4/27/2015, IDC, Right, 1cm, Grade 1, 0/2 nodes, ER+/PR+, HER2- (FISH) Surgery 6/1/2015 Lymph node removal: Sentinel; Mastectomy: Left, Right Surgery 6/1/2015 Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 8/28/2015 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant Surgery 12/4/2015 Reconstruction (left): Fat grafting, Nipple reconstruction; Reconstruction (right): Fat grafting, Nipple reconstruction
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Apr 2, 2019 12:33PM KBeee wrote:

Mine are under. It perhaps restricts push ups a bit, but full disclosure...I sucked at them before as well. Other than that, I have not had problems. I am a firefighter/paramedic, and I do still have the strength I need for it. My biggest challenge is that bathing suits fit weird. It is a challenge trying them on. I do think that overall, mine look very good; better than my previous breasts, to be honest. I had a local recurrence and because my implants are under the pec, I was able to feel the recurrence when it was still small. It scares me to think how big it might have gotten if it were under the implant. Local recurrences are rare after BMX, but low risk does not equal no risk. There is no screening such as mammograms after BMX unless you feel a lump.

I was doing research today on something else related to implants, and came across this article on the mesh. It weighs some pros and cons of it and some unanswered questions. (I do have a mesh sling with mine). https://www.philly.com/health/breast-implant-reconstruction-surgical-mesh-cancer-mastectomy-fda-study-20190401.html There are a lof of articles posted in the last few days about various implants because of FDA hearings. They may help in your discussion with PS.

Karen. Dx 8/5/2013, IDC, Right, 1cm, Grade 2, 0/1 nodes, ER+/PR+, HER2- (IHC) Surgery 8/25/2013 Mastectomy: Left, Right Chemotherapy 9/19/2013 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 12/11/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 1/22/2014 Reconstruction (left); Reconstruction (right) Surgery 1/28/2015 Lumpectomy: Right Dx 2/2/2015, IDC, Right, 1cm, Grade 2, 0/0 nodes, ER+/PR-, HER2- (FISH) Surgery 2/24/2015 Lumpectomy: Right; Lymph node removal: Right, Sentinel, Underarm/Axillary; Prophylactic ovary removal Dx 2/25/2015, IDC, Right, 1cm, Grade 3, 0/13 nodes, ER+/PR-, HER2- (IHC) Chemotherapy 3/30/2015 AC + T (Taxol) Radiation Therapy 8/24/2015 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy Femara (letrozole)
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Apr 7, 2019 04:08PM gracem1 wrote:

OMG Motheroftwo... My surgery is on Wednesday and I although I asked for over the pec from the beginning and I am finally having the switch... I'm totally nervous. I heard the same thing about the balls on top of the chest but clients of mine and women from the forums all seem to have a more natural result with over... from what I can see... it's a little nerve wracking. All I know is that I can't stand the animation and how my strong pecs push my implants out to the armpits. it's really uncomfortable, especially as I use my pecs ALL DAY as a massage therapist, yoga instructor and surfer. FREE MY PECS IS MY MANTRA

My surgeon isn't keen on fat grafting for me and I really don't want to endure another procedure (up to 14 surgeries with this one). The fellow i spoke to that is working with my surgeon said that i am too big for pver the pec. Can some of you share your implant size with over thepec and did you have any issues with wound healing??

Kbee.. omg ..i just read the article on the mesh! jesus wept. I declined the teardrop shaped implant due to the link to BIA LCL lymphoma and now this. ufff. I have the alloderm sling and have had no reactions 1 1/2 years later and will now will be having the implant wrapped in some dermal matrix ... this has added another big QUESTION mark and worry now. :O



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Apr 7, 2019 10:01PM Motheroftwo36 wrote:

I opted to keep mine under muscle. Only because over is new and not much long term is known. Since I’m 33 I have lots more years with the foobs. I do hate the idea of the flexing issue. If I hate it too much I can always switch it to over. I don’t blame u at all with going over based off your lifestyle. I do have small breasts though so I don’t know about larger implants just over. My doctor said over would sag more down the road. So there is no perfect choice so we just have to pick one and be at peace with it. Good luck

Dx 2/5/2019, DCIS, Right, 3cm, Stage 0, Grade 3, 1/2 nodes, ER+/PR+ Surgery 4/17/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Apr 8, 2019 11:23AM VegGal wrote:

Mine are 615 cc over pec with thin, saggy, menopausal skin. I do wear a bra 24/7 but they look fabulous 19 mos in. I also went from under to over. Much better. 

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 6/10/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 9/8/2017 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Apr 9, 2019 01:11PM Dhbbfh1999 wrote:

hi ya'll, first I want to say that I just barely skimmed the article that was posted above because of where it was from philly.com!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! The Inquirer post or whatever! NOT REAL NEWS IMHO

I am a surgical nurse and it was not in a medical journal and I work in the operating room and have for the last 21 years. I get all of my info from factual medical journal and RESEARCH articles not just what you can find on the internet. Do not let that stuff scare you. We have to do a research class in Nursing School for a Bachelors of Science in Nursing four yr degree and there are very strong stipulations for research and that article had none of them, no abstract, nothing because it was just an "article" and could site no research! Put no faith in such articles.

I went with over the muscle and I have never been happier. Like some have mentioned previously, I feel that after my reconstruction I look better than before. My risk went down to 1-3% I think with my mastectomy and I did nipple sparing bilateral. Based on my age and health, I am 49 active, healthy, non-smoker, no diabetes or other conditions, my PS recommended the over.

https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm241086/htm My implants are shaped textured. I took the risk as the numbers are below 500 across THE WORLD and the number that have actually died are less than TEN! The cure if you get BIA-ALCL is remove the implants. Simple enough and alright by me. I am young so I wanted the more natural looking implants that the alloderm would "grow" into and my tissue into that.

Also to note, if you read in above article it shows the percentages of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is usually found near the breast implant, contained within the fibrous scar capsule, and not in the breast tissue itself.

I had a mastectomy so a) I don't have 97% of my breast tissue b) I have the alloderm completely OVER the entire implant and c) studies have shown the body doesn't form the capsular contracture around the alloderm because it is NOT a foreign body like the implant is. The Alloderm used to cover my implant is what is routinely used in breast reconstruction. Technically it is called ADM for acellular dermal matrix. It is a biologic mesh-like material derived from animals or donated (cadaveric) human skin. Alloderm is a human product and is the most widely used ADM. It is used in many different types of reconstructive surgery not just breast reconstruction. Before being packaged for use, it undergoes a multi-step process that removes all the cells that can lead to tissue rejection: even though it comes from another person, your body does not reject Alloderm because the immune cells are removed. Alloderm essentially acts as a scaffold and over time your own cells grow into it.

This was a HUGE selling factor for me as I see patients returning back to surgery for removal of capsular contractures around implants that make them rigid and hard and implants are not aesthetically pleasing any longer and the patient wants them fixed. These were mostly augmentation cases where the patient had implants for reasons other than cancer. Knowing that I won't get capsular contractions is a huge plus. I do need to go back and look at the research and see what number of patients that got diagnosed with BIA-ALCL were post breast cancer surgery patients and what number were from augmentation surgeries.

My big concern with under the muscles was also the PAIN. I am a BIG BABY and I hate pain and I have had a lot of surgeries from injuries in the military.

https://opmed.doximity.com/articles/pre-pectoral-breast-reconstruction-a-hot-topic-at-asps <---some of you might find interesting

Very personal decision and ultimately your own. I wish you luck in deciding but go with the decision that YOU are most comfortable with. :)

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Apr 10, 2019 11:27AM spratt5 wrote:

Dhbbfh1999 - Thank you so much for sharing the reputable articles and your personal/professional experience. I received breast reconstruction opinions from 3 different PS and they all said they preferred the over the muscle for all the same reasons you mentioned and what was written in the articles. All three PS said they could do under the muscle if I wanted and were honest to tell me that under the muscle was an easier procedure for them to perform. I'm more fearful of capsular contractor than anything else relative to the implant. So I've decided to go over the muscle with the alloderm. Hopefully my BS can do nipple sparing. Did you choose to have a bilateral mastectomy or did you have to have it done do to the cancer?


Dx 3/5/2019, DCIS/IDC, Left, 2cm, Stage IIB, Grade 1, 1/1 nodes, ER+/PR+, HER2- (IHC) Surgery 5/13/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Apr 10, 2019 02:39PM Motheroftwo36 wrote:

spratt5

i am so torn! I want to go over but my PS convinced me to agree to under. I dont see any benefit of going under but he said the long term would be better?? anyone have any insight on longterm? I like to do obstacle course races like rope climbing and wall climbing and feel like my boobs that are under may be uncomfortable. Also i was told with going over that the ripples and imperfections could show more?? HELP!! Im running out of time.

Dx 2/5/2019, DCIS, Right, 3cm, Stage 0, Grade 3, 1/2 nodes, ER+/PR+ Surgery 4/17/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Apr 10, 2019 04:34PM VegGal wrote:

Find another surgeon for an opinion. Believe me...going into a surgery YOU are not completely on board with is not worth the mental energy. It seems like a huge deal right now (and it is) but even a year from now you will see it all in a different light and realize that yes, it is worth the effort to be sure going into a surgery. 

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 6/10/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 9/8/2017 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Apr 10, 2019 04:47PM - edited Apr 10, 2019 06:23PM by exercise_guru

Find a PS that is experienced in doing over the pec muscle. In under the pec muscle they release your pec major from your ribs and sew it to aloderm to form a pocket. Your pec major will never work the same again. I have many many problems with my upper chest strength because under pec was all that was available at the time. Also do not go with textured implants because the FDA is thinking of banning them. Better to not have to deal with that down the road. I am currently looking at having my textured implants removed and I am not sure how that is going to affect my pectoral muscle.

having the implant under my pec muscle has affected my ability to do planks, my range of motion over my head, swimming upper body strength and shoulder mobility.


I know that you don't want to delay surgery to get another opinion and find someone more experienced but it is a a very permanent procedure.

The reason that over the implant isn't always great is purely because the skin is so so thin from removing all the breast tissue. They fold alloderm ( or sometimes a mesh) to make a pouch and then place the implant over the pec but under the alloderm. They have to fold the alloderm from a flat sheet to make it into a perfect shape to go over the implant. The skin adheres to the mesh or alloderm to form a pocket and can dimple because the skin is so thin.

With under the pec the top part is flatter because it is being pressed down with the pec muscle. There is a much smoother appearance. It compromises shoulder action because the pec muscle is no longer in the anatomically correct position and has strain from the implants.

Neither procedure is a walk in the park and in most cases it doesn't look like a california boob job. There is uncertainty going in either way. Also there is controversy over the implant itself because of the body reacting with the surface of the textured implant in some cases causing inflamation and in what they are claiming now a rare form of cancer.

Age 42 05/15/2015 PALB2 mutation, DBL Breast Cancer Type 1A Grade 3 ER+PR+(right 1.3cm,.5cm) HERr+(left1.6 cm), 06/26/2015 BMX with TE 8/27/15 Chemotherapy TCH 12/30/2015 TAH/BSO/Reconstruction 1/29/16 Arimidex 3/1/16 Femara 5/6/16 Tamoxifen
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Apr 10, 2019 05:16PM - edited Apr 10, 2019 05:20PM by CBK

exercise guru -

Are you sure all under the pec reconstruction is done this way? You mean they detach pec muscle and attach to ACD sling that is a strip under the lower pole of implants?

What problems have you encountered with upper chest strength? I never had this described to me this way. Wow.

I've seen a lot of poorly done over the pec surgeries but that is purely from an aesthetic standpoint.


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 7/21/2017 AC + T (Taxol) Surgery 1/25/2018 Prophylactic ovary removal Hormonal Therapy 2/17/2018 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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Apr 10, 2019 05:59PM Motheroftwo36 wrote:

CBK

how have you seen a lot of poor over pec surgeries? are you in medical field? can you explain what poor means?

Dx 2/5/2019, DCIS, Right, 3cm, Stage 0, Grade 3, 1/2 nodes, ER+/PR+ Surgery 4/17/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Apr 10, 2019 06:39PM CBK wrote:

Mother

I’m just a lay person. I have some friends that have had over the pec reconstruction that does not look good. And they are not happy with results but that I attribute to their choice in surgeon and I didn’t mean to make a broad sweeping generalization about over the pec reconstruction! That was NOT my intention !! I honestly don’t advocate one way or the other for the record!!

Make sure your surgeon is a true breast reconstruction surgeon. Not an experienced plastic surgeon that just decided to dabble in recon recently. Breast reconstruction is an art and a process! It isn’t always a simple one or two surgeries to get your desired result.

In general over the pec will have less animation but MAY have more rippling in the upper poles and chest that will require multiple fat grafting surgeries to get desired appearance. My PS showed me this on her photos of people that came to her to fix their pre-pec surgeries.

Under the pec MAY have significant animation and tightness ... but these can be minimized as well. I understand some people have terrible tightness with under pec reconstruction, this has not been the case for me. But I’m sure with the vast majority of complaints here this is sure to be a serious consideration.

The way my PS explained to me my implants are kind of half under and half above; but I will double confirm that with her tmr!

If you are feeling on the fence take some more time to explore ! You will find the right option for you.

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 7/21/2017 AC + T (Taxol) Surgery 1/25/2018 Prophylactic ovary removal Hormonal Therapy 2/17/2018 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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Apr 10, 2019 06:50PM VegGal wrote:

I had so many ripples with the subpectoral implants. They were so ugly. Now I can't make the pre-pectoral ripple at all, no matter how I try. I will add that I had fat grafting. 

Definitely find a surgeon who is really good at it. I was lucky to have stumbled upon my surgeon (#4). 

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 6/10/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 9/8/2017 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Apr 10, 2019 06:56PM spratt5 wrote:

@Motheroftwo36 You will have a quicker recovery, you will be able to do all the rope climbing,obstacle coarse, cross fit type of workouts without your pec muscles hindering you. How much experience has your PS had with under muscle vs over the muscle reconstruction? If you feel or see rippling of the implant because it's over the muscle then they will do fat injections in an office visit to correct it. You are a young mom who is active and wants to continue to be active. I'm not saying that you won't be able to do those activities if your implants are under the muscle. My point is that it will take a lot longer to be able to do those activities due to the muscle and you may not be able to do them without some discomfort. I am a mom of 2 kids 10 & 12, I'm tad older than you but I am a big HIIT/crossfit workout junkie and I'm listening and reading all the info that is out there. What made me decide was that three PS (all with a combined experience of 55 years) said the same thing about the benefit they have seen by going over the muscle. Go with your intuition.

Dx 3/5/2019, DCIS/IDC, Left, 2cm, Stage IIB, Grade 1, 1/1 nodes, ER+/PR+, HER2- (IHC) Surgery 5/13/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Apr 10, 2019 08:35PM Motheroftwo36 wrote:

CBK

So why did u choose under?

Spratt5

Did u have nipple sparring? I’m not eligible for nipple sparring so curious what those that have had over muscle with no nipple and how that looks.

I’m not willing to switch surgeons because I’m not willing to push back my surgery date which is next week. I’d rather have this cancer out and no breasts. Because of that, I’m inclined to keep it sub pectoral since my PS has more experience. BUT he did say he’s had good results with going over cosmetically.


Dx 2/5/2019, DCIS, Right, 3cm, Stage 0, Grade 3, 1/2 nodes, ER+/PR+ Surgery 4/17/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Apr 11, 2019 12:17AM rachelcarter35 wrote:

I think surgeons will direct you to the surgery they feel most comfortable doing. I had pre pectoral implants and made the decision based on my concerns about chronic pain. Yes pre pectoral implants are new and some doctors are still not on board. Also we don't know how they will hold up compared to sub pectoral because like I said its a relatively new procedure. I certainly don't feel I look better than before but my results are satisfactory. All these friggen decisions!

Dx 2/21/2018, DCIS/IDC, Both breasts, 2cm, Stage IIA, Grade 3, 0/5 nodes, ER+/PR+, HER2- (FISH) Surgery 4/24/2018 Mastectomy: Left, Right; Reconstruction (left): Nipple reconstruction, Nipple tattoo, Silicone implant, Tissue expander placement; Reconstruction (right): Nipple reconstruction, Nipple tattoo, Silicone implant, Tissue expander placement Chemotherapy 6/14/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Chemotherapy Targeted Therapy Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Apr 11, 2019 07:43AM spratt5 wrote:

https://opmed.doximity.com/articles/pre-pectoral-breast-reconstruction-a-hot-topic-at-asps Here is an article about pre-pectoral implants for reconstruction. PS first started doing it this way in the 70's but the lack of technology they had back then caused complications so PS abandoned that technique.

https://journals.lww.com/prsgo/Fulltext/2018/06000/The_Evolution_from_Subcutaneous_to_Prepectoral.18.aspx - This article describes the evolution of BR with implants.

Dx 3/5/2019, DCIS/IDC, Left, 2cm, Stage IIB, Grade 1, 1/1 nodes, ER+/PR+, HER2- (IHC) Surgery 5/13/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement

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