We are 226,650 members in 82 forums discussing 158,896 topics.

Help with Abbreviations

Topic: Help, Implants over or under the muscle?

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

Posted on: Jan 18, 2020 11:54AM

JRNJ wrote:

I know there is a thread on switching from under to over, but I didn't see anything with input from both sides pros and cons. My PS put TEs over the muscle without discussing the options with me. Due to infection, they were removed. So I have had time to research. I had a consultation with a new BS and she said definitely under the muscle and I should consult with her PS. I also have a friend without BC that has under the muscle saline and says that is the way to go. I am planning on saline. I'm reading over the muscle has more chance of capsular contraction and if I have any tissue left from bmx, it might be harder to find a reoccurance, which really scares me if this is true. Especially since my new BS said my old one may have left some tissue. But I have thick skin and I read over the muscle looks more natural. I don't want weird muscle pains and the muscle smooshing the implant and a large space between. I don't exercise. I'm also getting radiation, so may be a factor. Plan is to put TE back in before radiation. So tired of making so many decisions! Input please!

Pleomorphic Multifocal LCIS, Extranodal Extension, Lymphovascular Invasion. TE removed due to infection Dx 8/15/2019, ILC, Right, 2cm, Grade 3, 2/5 nodes, ER+/PR+, HER2- Dx 8/15/2019, LCIS, Right, 6cm+, Grade 3, ER+/PR+, HER2- Surgery 9/23/2019 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 12/1/2019 CMF Radiation Therapy Whole-breast: Breast, Lymph nodes, Chest wall
Log in to post a reply

Page 1 of 1 (13 results)

Posts 1 - 13 (13 total)

Log in to post a reply

Jan 18, 2020 09:54PM JRNJ wrote:

bump

Pleomorphic Multifocal LCIS, Extranodal Extension, Lymphovascular Invasion. TE removed due to infection Dx 8/15/2019, ILC, Right, 2cm, Grade 3, 2/5 nodes, ER+/PR+, HER2- Dx 8/15/2019, LCIS, Right, 6cm+, Grade 3, ER+/PR+, HER2- Surgery 9/23/2019 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 12/1/2019 CMF Radiation Therapy Whole-breast: Breast, Lymph nodes, Chest wall
Log in to post a reply

Jan 21, 2020 07:05AM mnsotamom74 wrote:

I just had over the muscle delayed reconstruction. I was terrified of the ( breast cancer hiding behind the implant) my surgeon said that’s a myth. Also, he said because I’m having implants I will automatically get a yearly mri because they have to check the implants and make sure they are holding up and not leaking, etc. he said they will be looking for anything concerning at that time as well.

I’m so glad I went this route, I have had zero pain!!

Dx 10/25/2018, DCIS/IDC/IDC: Cribriform, Right, 3cm, Stage IIB, Grade 2, ER+/PR+, HER2- (IHC) Surgery 11/4/2018 Lymph node removal: Sentinel; Mastectomy: Left, Right Chemotherapy 1/6/2019 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 4/3/2019 Prophylactic ovary removal Hormonal Therapy Arimidex (anastrozole)
Log in to post a reply

Jan 21, 2020 07:55AM OCDAmy wrote:

I think pre pec (over the muscle) is getting to be standard now. My PS says he rarely does under the muscle.Why do you want saline? The new silicone implants feel much more natural and when they are over the muscle they are more comfortable.

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 Hormonal Therapy Arimidex (anastrozole) Surgery Reconstruction (left): DIEP flap Radiation Therapy Whole-breast Chemotherapy Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery Lymph node removal; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
Log in to post a reply

Jan 21, 2020 08:06AM Brilee76 wrote:

I have over the muscle, silicone implants. I was told that the implants under the muscle cause a longer healing time and when you flex your pecs your boob moves in an unnatural way.

~Bridget (BRCA2, 7/1/19-Lupron, 12/30/19-Zometa) Dx 5/16/2019, ILC, Left, 3cm, Stage IB, Grade 2, 1/3 nodes, ER+/PR+, HER2- Hormonal Therapy 7/1/2019 Hormonal Therapy 7/1/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 8/6/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Chemotherapy 9/18/2019 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 12/16/2019 Femara (letrozole) Hormonal Therapy 12/30/2019 Surgery 1/20/2020 Prophylactic ovary removal
Log in to post a reply

Jan 21, 2020 09:15AM SummerAngel wrote:

I have under the muscle silicone. I'm happy with them and they look great, but if I had the choice I would have gone with over the muscle. There was a lot of pain with under, especially because I had "very well-developed pecs" according to my PS. (I've always worked out.) Now I've given up doing push-ups because of the distortion and permanent movement towards the outside it caused when I was doing them. It's also still odd the way my breasts move up and down when using my arms for anything strenuous.

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 3/27/2015, 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 8/27/2015 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant Surgery 12/3/2015 Reconstruction (left): Fat grafting, Nipple reconstruction; Reconstruction (right): Fat grafting, Nipple reconstruction
Log in to post a reply

Jan 21, 2020 09:50AM JRNJ wrote:

thanks girls!!! I wasn’t getting any responses. My dr does over. Going for another consultation this morning with a dr that likes under. Im stuck on saline just don’t want to risk leakage. I’m looking long term results. I can suffer in the beginning if better in long run. I don’t exercise but I do a lot of house projects. I don’t think they do mris for saline. The “botched” drs on tv appear to do under. Still confused.

Pleomorphic Multifocal LCIS, Extranodal Extension, Lymphovascular Invasion. TE removed due to infection Dx 8/15/2019, ILC, Right, 2cm, Grade 3, 2/5 nodes, ER+/PR+, HER2- Dx 8/15/2019, LCIS, Right, 6cm+, Grade 3, ER+/PR+, HER2- Surgery 9/23/2019 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 12/1/2019 CMF Radiation Therapy Whole-breast: Breast, Lymph nodes, Chest wall
Log in to post a reply

Jan 21, 2020 11:22AM SimoneRC wrote:

JRNJ,

Hi! Lots to think about, right! The Botched doctors on TV are cosmetic plastic surgeons doing cosmetic Breast Revision Surgeries. They are not doing Breast Reconstruction Surgeries. Two totally different ballgames. Those ladies have breast tissue. Women who have had mastectomies have no breast tissue. Apples and oranges.

Sounds good you are gathering information and getting different options. The new silicone implants are a gel material and if the rupture they do not leak as before. There are pro’s and cons for over muscle (prepectoral), under muscle, silicone and saline.

Keep us posted and keep asking questions to make the best decision for you!


ATM Gene Mutation, Deletion. IDC w/Lobular Features and Focal Mucinous Features. Pre Pectoral Reconstruction. Hysterectomy Surgery 4/6/2018 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 5/6/2018 Arimidex (anastrozole) Surgery 7/3/2018 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant Surgery 4/30/2019 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 4/30/2019 Prophylactic ovary removal Surgery 8/6/2019 Reconstruction (left): Fat grafting; Reconstruction (right): Fat grafting
Log in to post a reply

Jan 21, 2020 06:59PM - edited Jan 21, 2020 07:00PM by farmerlucy

I have under the muscle and the initial phase was excruciating for me. My sil had her breast tissue removed and 2x over the muscle implants with major capsular contracture. This last time she had under and is not having the same issue w capsular contracture.

Dx at 51 after a preventive mx that wasn't. Oncotype dx 3. 3D tattoos from Vinnie! PTSD?? You are not alone! Surgery 2/21/2012 Prophylactic mastectomy; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Dx 2/24/2012, IDC, Right, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- (FISH) Surgery 3/11/2012 Lymph node removal: Sentinel Surgery 7/22/2012 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 4/10/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 4/14/2015 Prophylactic ovary removal
Log in to post a reply

Jan 21, 2020 10:13PM JRNJ wrote:

Thank you all for the input! So I have a crazy update. Went for a consultation today with a new PS. I'm going to start a new thread because it involves DIEP and a bad mastectomy so I want to pull those people in.

Pleomorphic Multifocal LCIS, Extranodal Extension, Lymphovascular Invasion. TE removed due to infection Dx 8/15/2019, ILC, Right, 2cm, Grade 3, 2/5 nodes, ER+/PR+, HER2- Dx 8/15/2019, LCIS, Right, 6cm+, Grade 3, ER+/PR+, HER2- Surgery 9/23/2019 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 12/1/2019 CMF Radiation Therapy Whole-breast: Breast, Lymph nodes, Chest wall
Log in to post a reply

Jan 22, 2020 12:41AM MinusTwo wrote:

JRNJ - I have under the muscle and silicone and I'm very happy with them.

Please note: the newer silicone implants are cohesive gel. Think gummy bears. Saline can leak, but cohesive gel silicone can't leak. I suppose a lump could break off, but you're more likely to get a leak with saline than the new silicone.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
Log in to post a reply

Jan 22, 2020 11:39AM JRNJ wrote:

Thanks MinusTwo. Were you fully expanded before radiation? Has the radiation had an impact on the implants?

Pleomorphic Multifocal LCIS, Extranodal Extension, Lymphovascular Invasion. TE removed due to infection Dx 8/15/2019, ILC, Right, 2cm, Grade 3, 2/5 nodes, ER+/PR+, HER2- Dx 8/15/2019, LCIS, Right, 6cm+, Grade 3, ER+/PR+, HER2- Surgery 9/23/2019 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 12/1/2019 CMF Radiation Therapy Whole-breast: Breast, Lymph nodes, Chest wall
Log in to post a reply

Jan 22, 2020 03:46PM MinusTwo wrote:

JRNJ - I actually had the implants themselves in place. Radiation was part of the treatment for a BC recurrence. Surgeon was able to do ALND (lymph node dissection) w/o touching the implants or the capsule. Amazing work. Radiation did make that side higher & tighter, but otherwise did not hurt the implant in any way. Original exchange to implants in 2011 and now 4 years out from the radiation after the chemo & 2nd surgery. I just had an MRI and confirmed that everything is OK.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
Log in to post a reply

Jan 23, 2020 12:07AM JRNJ wrote:

Minustwo, thanks for the info! Going back to PS#1 tomorrow for more information on options.

Pleomorphic Multifocal LCIS, Extranodal Extension, Lymphovascular Invasion. TE removed due to infection Dx 8/15/2019, ILC, Right, 2cm, Grade 3, 2/5 nodes, ER+/PR+, HER2- Dx 8/15/2019, LCIS, Right, 6cm+, Grade 3, ER+/PR+, HER2- Surgery 9/23/2019 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 12/1/2019 CMF Radiation Therapy Whole-breast: Breast, Lymph nodes, Chest wall

Page 1 of 1 (13 results)