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Topic: Direct to implant experience

Forum: Surgery - Before, During, and After — Surgical options and helpful tips for recovery and side effects.

Posted on: Aug 8, 2020 03:10PM

Smichaels11 wrote:

I am currently mulling over lumpectomy or BMX. My tumor is small and near my armpit, so I am a candidate for nipple sparing. I really don't want to put implants under the muscle and would rather have it all done at once if BMX is the route I choose. I'm interested in hearing from those who had nipple sparing direct to implant reconstruction. Anything you wish you had known? Were you able to have radiation? How was the recovery? If a thread already exists about this, please let me know. I tried to search but didn't find what I was looking for.

Diagnosed at 30 years old. Mom to a 5 year old son. Dx 6/11/2020, IDC, Left, 2cm, Stage IB, Grade 3, ER+/PR+, HER2+ Targeted Therapy 7/1/2020 Herceptin (trastuzumab) Chemotherapy 7/1/2020 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 7/1/2020 Perjeta (pertuzumab)
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Aug 8, 2020 05:58PM - edited Aug 8, 2020 06:55PM by Pi-Xi

Hello Smichaels11.

So sorry you find yourself here. I was lucky to have a "one and done". Going in, the doctor was fairly sure I only had DCIS and I declined SNB. (At the time I was more afraid of lymphedema.) Gambled and lost as pathology showed IDC. I did not have radiation or chemo, but I did jump at tamoxifen after the news it was invasive. The plastic surgeon wasn't happy when it was invasive as radiation and chemo would take its toll on the reconstruction.

I was lucky to have a very smooth recovery! My implants are under the muscle (which freaked me out), over the muscle wasn’t really being done then. Having little body fat, I think they wouldn’t have looked too good anyway, but cutting up healthy muscle seemed barbaric. I can still bang out pushups from my toes and that’s all I cared about. 😊

So far I'm doing okay. It took me about three years to make peace with my "new" body, but I've gotten to the point where I am grateful for what I have!

There is a very old thread on this. I read the whole thing. I'll see if I can dig it up for you.

Pi-Xi

Oncotype 12 Dx 4/7/2016, DCIS, Left, 2cm, Stage 0, Grade 1, ER+/PR+ Surgery 7/11/2016 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Dx 8/3/2016, DCIS/IDC/IDC: Papillary, Left, 1cm, Grade 2, ER+/PR+, HER2- Hormonal Therapy 9/1/2016 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Aug 8, 2020 06:00PM - edited Aug 8, 2020 07:01PM by Pi-Xi

Here is the link.

https://community.breastcancer.org/forum/44/topics/736507?page=1

And here is a newer thread.

https://community.breastcancer.org/forum/44/topics/835911?page=1

Oncotype 12 Dx 4/7/2016, DCIS, Left, 2cm, Stage 0, Grade 1, ER+/PR+ Surgery 7/11/2016 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Dx 8/3/2016, DCIS/IDC/IDC: Papillary, Left, 1cm, Grade 2, ER+/PR+, HER2- Hormonal Therapy 9/1/2016 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Aug 8, 2020 10:17PM bcincolorado wrote:

I had skin sparing and it is really not "one and done" as they say. I had skin and able to do nipple sparing as well.

They put in an expander first. So you are not totally flat right away. After you get your drains pulled from your mastectomy (I went home with drains in) Then you go in every week to 10 days for a "fill up" where they inject into the expander (does not hurt too bad at that point until they are the right size. Then they let them sit for a few weeks to stretch your skin some more.

Then they did the exchange surgery which was super easy to recover from comparatively.

Best wishes to you and hope you recover well.

Dx 8/2009, IDC, Left, 5cm, Stage IIA, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 1/7/2010 Lumpectomy: Left; Lymph node removal: Left Hormonal Therapy 1/15/2010 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Hormonal Therapy 1/30/2016 Femara (letrozole)
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Aug 9, 2020 10:51AM exbrnxgrl wrote:

I think the op is asking about one step implants which do require a skin/nipple sparing mx, rather than a skin sparing mx itself.

I had my one steps implants put in at the time of my bmx 9 years ago. My ps was experienced in this procedure. My goal was to look as much like my original self as possible. I had no problem with healing and recovery. My implants are under the muscle as they did not offer over the muscle back then


Bilateral mx 9/7/11 with one step ns reconstruction. As of 11/21/11, 2cm met to upper left femur Dx 7/8/2011, IDC, Left, 4cm, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Surgery 9/7/2011 Lymph node removal: Left; Mastectomy: Left, Right; Reconstruction (left); Reconstruction (right) Dx 11/2011, IDC, Left, 4cm, Stage IV, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Hormonal Therapy 11/21/2011 Arimidex (anastrozole) Radiation Therapy 11/21/2011 Bone Hormonal Therapy 6/19/2014 Femara (letrozole) Hormonal Therapy Aromasin (exemestane)
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Aug 9, 2020 11:20AM Smichaels11 wrote:

Exbrnxgrl, thank you for sharing your experience. I didn't realize that direct to implant under the muscle was an option. You'd think more people would opt for that? Did you have any trouble with radiation? I was told that if they determine I will need radiation that we'll have to go with plan B (although I wouldn't know until I'm awake which sucks).

Diagnosed at 30 years old. Mom to a 5 year old son. Dx 6/11/2020, IDC, Left, 2cm, Stage IB, Grade 3, ER+/PR+, HER2+ Targeted Therapy 7/1/2020 Herceptin (trastuzumab) Chemotherapy 7/1/2020 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 7/1/2020 Perjeta (pertuzumab)
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Aug 9, 2020 01:06PM exbrnxgrl wrote:

Smichaels,

Over the muscle implants, for any type of implant reconstruction, are relatively new. Both Pi-xi and I had our recon before over the muscle was done so my experience is only with under the muscle implants. I should also mention that I have Alloderm “slings” which function as an internal support and help prevent bottoming out. I did not have rads to the breast area so that was not a consideration.

Bilateral mx 9/7/11 with one step ns reconstruction. As of 11/21/11, 2cm met to upper left femur Dx 7/8/2011, IDC, Left, 4cm, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Surgery 9/7/2011 Lymph node removal: Left; Mastectomy: Left, Right; Reconstruction (left); Reconstruction (right) Dx 11/2011, IDC, Left, 4cm, Stage IV, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Hormonal Therapy 11/21/2011 Arimidex (anastrozole) Radiation Therapy 11/21/2011 Bone Hormonal Therapy 6/19/2014 Femara (letrozole) Hormonal Therapy Aromasin (exemestane)
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Aug 10, 2020 06:17AM Rah2464 wrote:

Smichaels I had nipple sparing direct to implant in a one step procedure, over the muscle. I had some level of difficulty with skin sensitivity in recovering I think because I am very thin, and my PS made me a little larger than I was - so my skin was stretched as well as abused from the surgery. (because if I'm going thru this I might as well upgrade as I was what my PS called an A+ ha) The cosmetic result is very nice and I am fully recovered now. I would say the worst period in my recovery was around week 4-5 That was when I seemed to have the most nerve regeneration/healing. However everyone is different in their experiences. I was able to go on vacation to Mexico week 6 so there is that. I just wasn't fully operational. The surgery was about 3 1/2 - 4 hours and there were two surgeons working on me the breast surgeon then the plastic surgeon. I am going back in to do some fat grafting because with over the muscle you can see the edges of the implants in certain areas without the fat grafting. I am glad I didn't have the extra impact of fat grafting given how involved the first surgery was, that might be something to speak with your surgeons about.

I did not have any chemo or radiation. I would recommend if you go this route to be careful if going larger size and also to start physical therapy as soon as possible after surgery.

Dx 5/23/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 6/26/2018 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 7/26/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Aug 10, 2020 10:16PM - edited Aug 10, 2020 10:16PM by Redkitty815

I had a BMX direct-to-implant and node dissection at the end of May. I will be having radiation and my PS said that the over the muscle implant was the best approach to be able to do this as a one-step surgery before radiation.

I wanted a reduction so nipple sparing was not possible (they would have ended up in weird spots once there was a change in size). Recovery was not bad-I had 2 sets of drains. One came out 5 days after surgery and the other about a week after that. That was really the worst of it so far. PS gave me lifting and motion restrictions for 6 weeks, but I have full range of motion now with the help of a physical therapist. There was some pain in the first week or two and some adjustment to these things that are now attached to my chest, which may be smaller than the original equipment, but still heavy. In the 10 weeks since surgery, they have felt increasingly like they are mine and not as much like foreign objects.

My RO did warn me that radiation can impact their size and appearance so I do think I am in for some adjustments down the line.

Dx 11/26/2019, IDC, Left, 3cm, Stage IIB, Grade 3, 1/12 nodes, ER+/PR+, HER2+ (FISH) Chemotherapy 12/19/2019 AC + T (Taxol) Targeted Therapy 7/12/2020 Herceptin (trastuzumab) Chemotherapy 7/12/2020 Navelbine (vinorelbine) Surgery Lymph node removal; Mastectomy; Reconstruction (left); Reconstruction (right)
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Aug 19, 2020 01:59PM AZNative2020 wrote:

I was fortunate enough to have direct to implant DMX with nipple/skin sparing surgery. My surgery was 12/11, so I am eight months out. My scars are half moons on the tops of my aerolas. My PS's goal was to make me look as close to myself as she could. That was the goal going into surgery, but there were no guarantees prior since they had to see what they had to work with in surgery. I did undergo 30 rounds of radiation (no chemo onco score was low enough). I chose a DMX to avoid radiation, but I did have one positive node. My left radiated side is firmer, larger and a bit higher than the right. And I have lumps and bumps on the outer edges and a few underneath- they suspect it's fat, but I just had a follow up CT and MRI this week to confirm all is good. I think that doctors glaze over the lack of feeling in your breasts after surgery since everyone is so focused on removing the tumors. I have only slight feeling in my nipples and where they removed the lymph nodes is still numb and a few spots on my left breast- it's a strange feeling for sure. There are tons of posts on radiation and join the group in your month for support from other women going through at the same time. I looked at previous months too. I finished rads in March and my skin did fairly well. Only one spot in the middle of my neck and my clavicle were a bit red. Be sure to look in mirror as you turn your head and adjust your head so your clavicle stays as flat as possible. I took pictures everyday as well. And my PS prescribed singulair during radiaiton and beyond- it's supposed to help the implant. Best of luck and health to you.


Dx 11/2019, ILC, Left, 4cm, Stage IIB, Grade 2, 1/6 nodes, ER+/PR-, HER2- (FISH) Surgery 12/10/2019 Lymph node removal: Left; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Radiation Therapy 2/12/2020 Whole-breast: Chest wall

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