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Topic: direct implant after failed implant?

Forum: Breast Reconstruction —

Talk with others facing decisions about whether or not to have breast reconstruction, and if so, what type and when.

Posted on: Mar 2, 2021 04:38PM

BunnyADS wrote:

I'm hoping if someone out there has been in my situation they could share their experiences.

I had a double mastecomy and immediate reconstruction. Pre-pec with silicone implants. Surgery and recovery were a breeze, I had no pain, full range of motion, and the foobs looked better than the originals (still the same small size, but robust ;) ...

Then four weeks later an infection developed in the radiated breast and that implant was removed. My plastic surgeon explained that we needed to wait 3 months to be sure all of the infection was gone and then I would get a Lat Dorsi flap with a tissue expander, and switch out to an implant later on. She said the same pre pec procedure was no longer an option because radiated skin is too prone to infection to try it again. She said that my breast needs the flap to bring in a new supply of blood and healthy skin. She also said she has in the past tried to put a pre pec implant back in after infection and has gotten burned and she will no longer attempt it.

Then Covid hit and my surgery was delayed. What was supposed to be a 3 month wait is now 13 months and counting. During this time I have tried to help my own cause. I regularly see an oncology physical therapist who specializes in breast and lymphedema. She has given me daily stretches and self massage instructions and she uses a suction cup technique to keep the flat breast and scar mobile. I also have had success with silicone sheets to keep the scar from getting stiff. The breast looks a lot better and the skin is looser than it was a year ago.

When I eventually get called in for surgery I am secretly hoping my plastic surgeon will say wow that flat breast actually looks and feels good enough to try pre pec again instead of the Lat Dorsi flap. Although she was clear to me that direct to implant was off the table, can you blame me for hoping?

So my question is, has anyone of you had an implant removed because of infection and gotten it back without having to undergo a flap procedure?

Thanks!


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Mar 5, 2021 06:48AM Moderators wrote:

BunnyADS, Welcome to our community! We are sorry for all you are going through with reconstruction, it must be so be frustrating.

We're sorry you haven't had any responses and we can't really help you with your question, but our post will "bump" your thread into active topics so that hopefully someone will see it and weigh in with their experiences and advice.

Wishing you well and hope to hear from you again soon,

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To send a Private Message to the Mods: community.breastcancer.org/mem...
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Mar 7, 2021 10:28PM OnTarget wrote:

Hi, I'm not in the exact same position. I had an infection, but no rads.

I got a new TE in November, and I'm slowly filling before getting the new implant.

My neighbor had rads and an infection in her direct implant. After a year of battling the infection, she got a DIEP surgery and is happy.

This doesn't answer your question, but it's all I've got!

Diagnosed at 42, Oncotype score 16, ITC in one node- considered node negative. Lost right implant to infection March 2020. Waiting to start reconstruction all over again. Dx 4/8/2019, ILC, Left, 3cm, Stage IB, Grade 2, 0/3 nodes, ER+/PR+, HER2- Dx 4/23/2019, ILC, Right, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- Surgery 5/15/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 6/14/2019 Zoladex (goserelin) Chemotherapy 8/6/2019 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 11/6/2019 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 2/15/2020 Reconstruction (left): Fat grafting; Reconstruction (right): Fat grafting, Silicone implant Surgery 3/30/2020 Reconstruction (right) Surgery 11/6/2020 Reconstruction (right): Tissue expander placement Surgery 6/1/2021 Reconstruction (right): Tissue expander placement
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Mar 8, 2021 09:18AM BunnyADS wrote:

Thanks so much for your reply, it's great to hear from someone.

I just want to add, that I am so grateful to be alive and hopefully will be for many years to come. So no matter what drama happens with my re-reconstruction, it is insignificant compared to the fact that I'm still here for my kids.

If anyone else out there wants to share their post infection procedure I'd love to hear it. Especially if you got a direct to implant pre pec post infection.

Thank you all!


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Mar 8, 2021 10:00AM SpecialK wrote:

bunny - I did not lose an expander, and later an implant, to infection, but rather had skin issues very similar to what can happen with radiated skin. My skin tore under a necrotic area with the expander, which ruptured through the skin and had to be addressed in an emergency surgery. I stayed flat on that side for the seven months during chemotherpay, then was able to have surgery to place another expander, slowly fill, then exchange to a silicone sub-pec implant. Two years later that same area tore during a surgery to repair my allograft material, which was perforating. I have thin skin, had a very thorough bi-lat mastectomy, and had thin pectoral muscles. I had surgery at a time when pre-pec was not yet being done, but I would not have been a candidate due to the thin aspect of my skin. I wanted to post to suggest that you consider fat grafting to your flat side ahead of attempting additional recon. Grafting fat helps improve skin integrity and provides the potential for increased vascular activity and success. Lat flap was suggested to me by my first PS after a number of surgeries as a last resort, but I didn't feel it was a viable option because I have had extensive skin cancers on that area, with more that have cropped up and needed wide excision or Mohs surgery. I did three small grafts to my flat side, over a period of time, and it made all the difference. I changed to another PS and she was able to carefully accomplish my recon. It was a bit of a saga but worked out in the end. Wishing you the best. Here are links to the fat grafting info:

https://www.breastcancer.org/treatment/surgery/reconstruction/corrective/radiation-effects

https://community.breastcancer.org/forum/70/topics/744891?page=1

BMX w/ TE 11/1/10, ALND 12/6/10. 16 additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 2013-2018. Dx 9/27/2010, DCIS, Stage 0, Grade 3 Dx 9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+ (IHC)
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Mar 8, 2021 10:10AM BunnyADS wrote:

This is great info. THANK YOU so much for it. I will definitely mention fat grafting when I see my PS!

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Mar 8, 2021 10:19AM SpecialK wrote:

bunny - you're welcome, glad it is helpful! Hang in there - I know this is disappointing, but hopefully a temporary situation. Just wanted to add that the grafts I had were easy - it is a small amount of harvested fat, so super short surgery, minor discomfort at the harvest site. Totally worth it for me, and maybe for you too!

BMX w/ TE 11/1/10, ALND 12/6/10. 16 additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 2013-2018. Dx 9/27/2010, DCIS, Stage 0, Grade 3 Dx 9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+ (IHC)
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Jun 22, 2021 08:44AM BunnyADS wrote:

SpecialK, I just wanted to take a minute to send a massive thank you to you.

I finally saw my PS again (surgeries where I live are hugely backed up because of COVID). I asked her would she consider trying pre-pec again, with fat grafting, per the information you sent me… AND SHE SAID YES!!! The LD flap is now off the table. Even if I end up back at square one, at least she is willing to try pre pec again which is all I wanted. She says she had been successful improving radiated breasts with fat grafting in the past during her fellowship. Not sure why she didn't mention this before!!? But thanks to your suggestion I was able to bring it up. To know that there is a chance I can avoid the flap means the world to me!

And she will do 2-3 rounds of grafting - from my flabby little tummy - so needless to say I'm happy about that too LOL ;)….

I still have a long way to go: 2-3 grafting procedures > expander > final implant, and there is of course the risk of another infection at every step along the way. But thanks to you I am getting a second chance with the pre pec. You took the time to write a reply to me and you have potentially changed my life!

I can't thank you enough!!!!!

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Jun 22, 2021 09:53AM SpecialK wrote:

Oh yay! I am sending hopeful energy that this works for you! If anyone wonders why I still post on this site 11 years after being diagnosed your message is the reason. If I can pass on a nugget of info based on my experience that someone finds helpful, that is my silver lining!

Repeat fat grafting may be a bit of a pain because any hospital procedure is more complicated now due to COVID, but it could be the game changer! I just had surgery on 6/8 to replace my ruptured right implant so had to have a COVID test just prior to surgery even though I am fully vaccinated. We replaced the right and also did a swap of the left as well because my implants were textured. Since I was under anesthesia my PS agreed that we should remove the left due to the recall, but she was also able to remove a lot of scarred skin from the front of the breast where I had all these previous issues. That never could have happened successfully without the previous fat grafting I had done, I am absolutely convinced. Despite an allergic reaction to the surgical tape I have not looked this symmetrical and well shaped since my first surgery. I never thought things could look as good as they look right now - I am super happy! In the past I had multiple skin excisions in that same area and keeping those incisions closed was extremely challenging and not always successful. I would also encourage you to consume 100g of protein a day while healing from surgery, and ask your PS about possibly taking extended antibiotics and some extra zinc, bromelaine, and arnica supplements to aid with healing. I found that wearing a compression garment on the fat harvest sites helped manage the discomfort. My first PS required it, current PS leaves it up to the patient for relatively minor fat harvest. Topical arnica gel or cream you can get over the counter helps dissipate any bruising also.

BMX w/ TE 11/1/10, ALND 12/6/10. 16 additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 2013-2018. Dx 9/27/2010, DCIS, Stage 0, Grade 3 Dx 9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+ (IHC)
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Jun 22, 2021 07:11PM BunnyADS wrote:

yes my PS has told me to buy a compression garment! And I appreciate all your other advice. So sorry to hear that you’re still having surgeries but it’s great that your having success! All my best for continued good health

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Jun 22, 2021 08:01PM - edited Jun 22, 2021 08:01PM by SpecialK

If you use a high waisted panty type garment or body suit with low front that puts no compression over the breast area, make sure you find one with a snap crotch! Trust me when I say you don't want to pull your garment down every time you have to use the bathroom, lol! Something like this:

https://www.target.com/p/assets-by-spanx-women-s-remarkable-results-open-bust-brief-bodysuit/-/A-81397547

It has been five years since my last surgery and the need for this one caught me by surprise. We have no idea why the right one ruptured. It was found on a routine MRI, but never a dull moment. The aesthetic is so much improved it has been worth it! So, yay!

BMX w/ TE 11/1/10, ALND 12/6/10. 16 additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 2013-2018. Dx 9/27/2010, DCIS, Stage 0, Grade 3 Dx 9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+ (IHC)
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Jun 22, 2021 08:11PM BunnyADS wrote:

I was thinking of something much smaller. Would something like this work? https://www.spanx.com/shapewear/waist-cinchers/waist-cincher

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Jun 22, 2021 09:38PM SpecialK wrote:

Yes! And solves the problem mentioned above, lol! The only caveat I can provide is that it is important that it doesn't bunch if you are laying or sitting which may be more problematic if it has less structure than a panty or body suit style. I am kind of short-waisted so that has been an issue for me in the past, but hopefully won't be for you. I had a similar one except that it velcroed rather than pulled on, I woke up from the first fat graft surgery in it at the hospital but it was too "tall" for me because it was a one size fits all thing. It created some discomfort so I switched to the bodysuit type.

BMX w/ TE 11/1/10, ALND 12/6/10. 16 additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 2013-2018. Dx 9/27/2010, DCIS, Stage 0, Grade 3 Dx 9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+ (IHC)

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