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Topic: Sub & Prepectoral placement, at the same time

Forum: Breast Reconstruction —

If you've had or will be having a mastectomy (or in some cases, lumpectomy), you're likely facing decisions about whether or not to have breast reconstruction, and if so, what type and when. Deciding whether or not to have a breast reconstructed is a very personal choice. Take the time you need to learn about how breast reconstruction might affect you, both emotionally and physically, before you decide to have the surgery.

Learn about different surgical options and the medical and personal issues around breast reconstruction.

Intro medically reviewed by: Brian Wojciechowski, M.D.
Last review date: November 22, 2020

Posted on: Mar 11, 2021 08:19PM

Dfigravity wrote:

Hi wife was recently diagnosed with DCIS, ER/PR +, HER2 -, BRCA2 +.

We are two weeks out from her double mastectomy but have some concerns. Basically the general surgeon and plastic surgeon worked at the same time. The general surgeon removed her tumor, and also removed three lymph nodes from her armpit and sent them off for pathology...which is pretty quick. During that time, the plastic surgeon removed breast tissue is her unaffected breast and placed the tissue expander in the Prepectoral position. Low and behold two of the three lymph nodes came back positive for cancer cells, and so they placed the tissue expander on her affected side in the SUB pectoral position.

It just seems like the plastic surgeon rushed through work on the unaffected side, instead of waiting for pathology to come back...and now she has tissue expanders with different placement.

.We were curious if anyone else has had an this, or has tissue.expander/implants placed in both the sub and pre pec positions at the same time.

Thank you in advance!

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Mar 12, 2021 05:59AM - edited Mar 12, 2021 06:01AM by DiveCat

I never had TEs and was direct to implant sub pec but I just wanted to say there are some ladies on here who have different implant placement on each side due to issues such as a failed implant on one side. Hopefully one or two of them see your post and chime in; I can't recall their user names off hand however I know there are other threads around here where they have discussed it.

However I would like to note that placing a TE sub-pec now does not mean that they cannot later place the implant in a pre-pec position if it is suitable.

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 7/9/2020 Reconstruction (left): Fat grafting; Reconstruction (right): Fat grafting Surgery 12/11/2020 Reconstruction (left): Nipple tattoo; Reconstruction (right): Nipple tattoo Surgery 3/4/2021 Reconstruction (left): Fat grafting; Reconstruction (right): Fat grafting
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Mar 12, 2021 02:08PM Moderators wrote:

Hi Dfigravity,

We are sorry to hear what you and your wife are going through. We have indeed heard this from others, but certainly an important conversation to have with the PS. Their suggestions may depend on the course of additional treatment based on the pathology report. Even a second opinion may be helpful. Here is an article on When Is Breast Reconstruction Done?

Hoping others chime in, but we're all here for you.

Warmly, The Mods

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Mar 13, 2021 09:41AM Dfigravity wrote:

Thank you very much DiveCat and Mods for the responses. It was confirmed by the GS ysterday that the PS rushed his portion so that she "wouldn't have to stay in the OR too long". We let the PS talk her in to placing the TE's pre-pec because it's "better" and we should trust him because he's the expert. Well, it turns out that when pathology came back with positive lymph nodes, he had to call in the other plastic surgeon to perform the sub-pec placement because he wasn't comfortable doing it. There is not a lot of trust right now between us and the PS team, to say the least.

It's so unfortunate, since the actually has feeling over ~90% of the breast done by the GE, and is completely numb on the other side, clear around to her back.

It is good to hear that there is the possibility to have the TE moved.

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