Exchange City

CBK

Shoregirl

That is what I have heard as well, downsizing is not an easy revision. I am weighing the decision to go down a size during nipple reconstruction and I’m not so sure I want to do it. I feel like my implants are definitely still settling in.. and hard to assess the needto go smaller at the 6 month mark when I have some revisions and nipple reconstruction scheduled. Thank you for this information ... I’m going to think this thru better.

Was your recovery more difficult than your initial exchange?

GaGrandma

Shoregirl, well that is terrifying. I had no idea that going down in size was so involved. My PS acted like it was a simple "swap out".

MinusTwo

GaGran - yes, back to my questions about what goes in the cavity created for the original larger expanders. And what happens to all the skin w/o cutting off the lymph system. Lots of questions.

robinblessed54

Yes, Minus Two and I are usually on the same page. I am very blessed that I was able to tell my PS that I wanted to stay about the same size I was and he accommodated me completely. I was able to hold and touch all the options as well. I am very pleased that I chose the Allergan 410 gummies. I was filled to 420cc and he put in 475cc. I am happy with them and I don't see a revision necessary. I am 4 years out tomorrow!! Hope you get all the answers you need.

Robin

Shoregirl

CBK, the 1st small downsize from 470 to 440 was a super easy recovery. If the ps had not neglected to add ADM to one side, I would have left well enough alone. She did a beautiful job and made the implants more secure so I didn't get that "implants peeling off my chest" feeling when getting up from a lying down position. But without the ADM, the implant which is pre-pec immediately dropped 2" lower. The 2nd downsize which was 95cc less to a 345cc was about like the TE to implant exchange recovery. I had a drain because he added ADM. Unfortunately, when he added the ADM, it bunched up beneath my collarbone so when he did the revision in his office later to correct the too tight internal sutures he had to remove the implant and the bunched up ADM, wash the cavity and replace the implant. Which just reminded me, during my 1st downsize PS2 discovered a bunch of ADM up beneath my collarbone that PS1 had put in on the other side. The bunched up ADM was causing waves of searing pain just beneath my skin.

GaGrandma, I don't mean to frighten you but you do need to know the possible complications. The ps never mentioned any of these possibilities to me prior to my surgery so when I saw ladies on here considering downsizing I felt I should share my story so they could be more aware of what can happen and discuss with their ps how to avoid or minimize the complications.

One other thing I forgot to mention re implant sizing. 100cc is equivilant to 6 tablespoons in volume. I filled baggies with different amounts of water to simulate an implant plus studied the size charts for Sientra and Allergan to come up with my desired size of 345cc. The extra skin was not an issue for me as I am having fg done to fill the void. I just wanted lighter weight implants for comfort and room to put fat in front for warmth and cushioning. If I had my way, I would have just fat and no implants!!! There is actually a place in Winter Park FL that does this. Bougainvillea Clinic.

Edited to add: CBK, If just downsizing and no additional ADM is needed, the recovery is very easy. With ADM drains are required (at least have been for me). Also to add for GaGrandma that 200cc downsize is roughly 12 Tbsp or 3/4 cup to help you visualize.

CBK

Thanks Shoregirl

I’ll be sure to ask about ADM. My implants are behind the pec so less of an issue I believe. But very relevant information for me. I don’t have that “peeling off my chest” feeling but now that my non-lat flap side implant has settled in, I have a lot of animation with that foob. Any words of wisdom there?

I think I had that on lat flap side and PS may have futzed with the motor nerve and fixed it. I have to ask when I go back in a couple weeks.

Did you have NS BMX?

Thank you again

kandyhunt

My new foobs hurt. I had to have the right side fixed on February 14th and the first foob surgery on January 8th. Should I still be feeling pain? The pain is on the left side under the foob, sort a in the bra-line. But I am not wearing a bra. Is this normal? Thanks

HikingLady

kandyhunt I think you should phone up your PS office and describe the pain. Maybe there was some stitching inside that is just going to be sore for awhile as it heals. I had some soreness near my ribcage for a few weeks, but not severe pain, and by 5-6 weeks it only hurt when I pulled my arm into in certain positions or when I stretched my chest kind of extremely.

Shoregirl

CBK, the animation occurs with sub pec implants as the muscles flex they distort the implant. Aside from being a less painful recovery, the other reason my ps did the pre-pec was to avoid the distortion.

CBK

Well that should have been very obvious to me- thanks for explanation. It is a one-sided situation hmmmmmmmmm!

I feel like my revisions could go on for years.

Thanks Shoregirl!!

Wink22

Hi all, I am seven weeks post exchange (BMX with lat flap recon, tissue expanders then implants) and I have an infection:( Feeling really down about it as everything was going so well. Then a few days ago, a spreading patch of redness appeared on my left breast skin. My PS has started me on antibiotics but no improvement yet. Anyone else have any late complications like this? I am feeling scared that I will end up having to have more surgery.

Wink

Westwick

Hi- I'm having exchange sx for my bilateral TE on 3/13, very much looking forward to getting rid of the TE. Any ideas of how soon I can fly afterwards (assuming no infections etc)? Kids have spring break 2.5 weeks after my surgery, wondering if we can fly anywhere. Have found this thread really helpful in making plans for post op, excited to try the pineapple, hasn't heard that one before!

HikingLady

Westwick See what your plastic surgeon says about any restrictions after your exchange surgery. The main thing is to be sure that healing is going well, with no infection. There might be some lifting and exercise restrictions for awhile. My PS told me not to elevate my heart rate for 4 weeks, and no heavy lifting. All restrictions and care instructions are to maximize the chances of healing without any complications, such as wound not healing well, or infection.

First two weeks I was DEFINITELY extra tired. Healing is exhausting, of course, after any surgery. A lot of the stitching is inside---removing the TE's and their tabs, etc., so the exterior incision isn't the whole story---there is 'inside work' done. It's often called 'pocket work,' because the PS sometimes has to make the pockets be a good fit for the implants. In my case, he also took out some extra side-boob-skin on one side that had stretched more, but even so, this was a very comfortable recovery.

I think I would have felt comfortable getting on a plane at 2.5 weeks after exchange, if my doctor had cleared me to do that. If I'd had someone else to travel with who could lift everything and carry things for me, I could have had a trip, and could have walked around, just couldn't have done any hugely exerting activity until 4-6 weeks after surgery.

I was told to 'reduce activity level' for 4-6 weeks. Healing made me feel kind of low energy, but I was up and about, just had to sit down and rest more than usual. Also, of course no swimming. My PS said it was okay to get in a pool / ocean, etc no sooner than 5-6 weeks, to be sure that incision was totally healed.

I had very little post-surgery pain--just 2 days when I needed any painkillers. My doctor said to eat extra protein for several weeks for cell repair/healing, and drink a lot of water. I was very comfortable after just a few days, and didn't even have a lot of swelling. UNLIKE after the BMX w/ TE surgery, I was allowed to lift my hands above shoulders, etc. right away. That might be different with different PS instructions, but mine were relaxed on that stuff. It made everything SO much easier than after the BMX. Getting dressed, reaching for something in the cupboard...I was happy to have this surgery be super-much easier than the first one.

The new Foobs ARE more comfortable than the TE's. At first, I didn't think so, but now that everything's healed, I'm finding that I don't notice them much, so my brain is getting pretty used to the feel of them.

TrmTab

Westwick...I had a business trip 5 weeks posts exchange, on my own and had to manage my own bags...that was okay with PS as long as I didn't hoist my roller bag into the overhead.  At 2.5 weeks I would have been allowed to travel, but with more weight restrictions...like your family needs to hold your bags.  You need to talk to PS...mine was concerned with where I traveled a month before and three months after...I had been in Canada a month before and am currently in Spain less than three months after...these choices were okay, but other places would have been restricted.  Also no skiing or swimming...if those are Sprig Break destinations for you. TT

GAWarrior

Westwick, I had my exchange surgery on 3/1/19 and am getting on a plane for long (quiet, relaxing) weekend on Thursday. Definitely clear it with your PS before committing to a trip. My PS ok'd mine except for the luggage. No dragging it behind me and no lifting it into the overhead bins! So, DH will be the one lugging it around for me.

Like HikingLady said, I have been exhausted after this surgery, so don't sign up for anything strenuous (lay on a beach, but don't ride the jet ski, lol). Also, as she said, I can shower now that I am past Week 1, but was told no pool, ocean, hot tubs, etc for 6 weeks. Be aware that there can be late infections (as Wink22 mentioned), so watch your temperature (I ran a low grade fever a few times during Week 1) and have an escape plan (in other words, know where the nearest hospital is, be sure you can get hold of your PS, have a pharmacy located, etc).

kandyhunt

Wink22--- I got an infection in my right side thanks to bad care in a hospital stay for another infection. It was bad and it would not clear up so after about a week and a half I was scheduled for surgery. It was an easy surgery but it required me to accept a certain amount of risk. The first thought the PS had was to just pull out the foob and leave it and have me get better and than come back later and start all over again with the TE's and fills. I looked at him like I was going to cry and said, "and door number 2, is what?" He said that they could go in a "take out the foob clean me up by washing my insides with the same stuff they use on his hands before surgery, 2 times and than the third wash would be with an iodine type solution and put in a new foob. and that he would do a Voo doo prayer, make the sign of the cross and throw in some pixie dust and If I consented to a month of antibiotics", he would do it. I am one month out on Thursday from having the foob replaced. I am feeling really good. There is some pain but a whole lot better than having to start from scratch and having 3 more surgeries.

I sucks to have an infection. Take your antibiotics and hopefully you will avoid the extra surgey.

wdwxox

Hi, this is my first time posting tho I’ve been reading posts since my bilateral mastectomy in July. I had implants put in 12/18 and the right radiated side opened up 4 weeks later. Had it replaced 1/15/19 and I still have a tiny hole oozing. It is 8 weeks. Has anyone had oozing this long & had it heal after 8 weeks? I’ve been pretty upbeat about it all but am getting really discouraged now.

HikingLady

wdwxox Good for you to be your own good self-advocate. What you're experiencing is not usual. If you don't have an infection, maybe it's just going to heal super slowly. If there's any suspicion of an infection (red, sore, inflamed, hot to the touch, sudden change, running a fever, etc), PS needs to look and assess in person. Do not pass Go--be seen immediately. Also be seen if you're concerned.

I did not have this problem after my implant surgery. However, I DID have this happen to me last May after the BMX + TE surgery. My previously-radiated (15 years before) side took 8 weeks to completely close. My PS prescribed a much longer course of antibiotics since that side was open longer. The longer an incision is open, the longer you're at risk for an infection.

Wound care sometimes needs extra help. I would ask for a referral to a Wound Care Clinic. Also, I would ask about Hyperbaric Oxygen Chamber Therapy. Look up whether it's offered at any hospital in your city; it's becoming quite commonly available.

Hyperbaric Oxygen Therapy

My friend had super good results doing this for a worrisomely long healing time after a foot surgery. She got into a device (like a tunnel) and lay there for 90 minutes, and they showed her a movie of her choice. DAILY, for 6 weeks, so this is a huge commitment, but healing often is at least 20% faster with this therapy. It's studied and credible, not quackery.

As I'm sure you know, tissue that's been through radiation has (invisible) scarring, and a compromised blood supply to the skin and the pectoral muscle, which is what you have left after a MX. My PS said "20% higher rate of complications after radiation than for people who haven't had radiation." "Complications" means either slow healing, or failure to heal ever, or infection. Good for you to ask about this, and it's time to have a plan with your PS. Ask your PS if s/he's seen this before, and how much experience he/she has with this, and 'what are our options at this point to improve healing?' It's time to find out if it's a problem with a new solution, or if you're just on a slow healing track. One thing to keep track of is whether you're seeing closure of the wound-- perhaps .5 cm per week, etc.? Keep track of the changes over a week or several days. Data on this will help you self-advocate as necessary.

Nutritional Support: To support your healing, be sure you're drinking 2-3 qts of water every day, and also try to eat a lot of food with antioxidants (blueberries, etc.) and 80-100 g of protein daily. Cell repair requires all of these things, and it's also important to rest and have a low activity level. I wasn't allowed to raise my heart rate or do anything vigorous until my incision was healed after exchange surgery.

wdwxox

Thank you HikingLady! If this doesn’t heal, our plan b is a Latissimus flap. My PS is trying to avoid that if we can, prob partly because of me being 66. I don’t feel like 66 but my bod is. I’m supposed to go back to work on Friday but I may have to delay it. Tonight my breast is looking red. I will try to get in to see my PS in the morning. Thank you for your help & encouragement

Girl279

hey sisters! So glad I found this thread! I have Mentor TE (medium profile). Previously was a 34A/ 32B super droopy boob girl. I’m at the end of my fills and waiting for surgery to be scheduled. Currently weighing in at 143, 5’3 (trying to get back to my happy weight of 132). My goal was a full C cup. Right now I am sitting at 350ccs and curious if I need to go up to 400. My surgeon told me told me today that he would probably go with a slightly wider implant than what my expanders are...to me that means that I won’t have as much projection with the implants and i do with the expanders. Ian that correct? Going with the super gummy implants. Any thoughts? Should I fill up you 400?

Thanks!!!!

HikingLady

Girl279 Answering your cup size question from my experience.

My PS said that the TE bra cup size would be approximately the same as my future/implant bra size. My final size ended up a wee bit smaller than the TE size, but he was fairly accurate with that prediction. When I had TE's in, I was between a B and C cup. Once the exchange surgery was completed, the foobs were a perfect fit in B cups. So, if you like where you are in what cup size fits on you right now, stay put. If you want them a little bit bigger, have another fill.

My PS had a certain number of weeks required between 'last fill' and implant swap surgery---I think it had to be 4 weeks, no less than that. I would trust the PS on width of implants, and if you don't like how that sounds projection-wise, then another fill sounds like a good idea. The width is a set thing, based on your rib cage, and implants that are too wide or too narrow on your rib cage would look weird, so that's why they come in so many (dozens!) of sizes/widths / projections, and I'm sure your PS has carefully measured your torso and is planning accordingly.

My PS said that he always goes into swap surgery with a couple of different implant options/sizes, and he sees which is the best fit in all ways, according to the pocket size and shape, and anatomy of torso. He customizes based on exactly which one will look best. Part of the art-not-science part of his job, he said.

crossh

I am 5’3” 130 lbs and was originally a C cup before BMX last November. First implants after TE exchange were 400cc Mentor High Profile silicone. These left me a B cup. 7 weeks later had the exchange for 500cc. Much better, a C cup at last. The exchange was a piece of cake for me, 45 minute surgery, Tylenol for one day. I’m really happy with the size, very proportional to my size. It’s still early and they’re just starting to loosen up (5 weeks out)I have pre-pectoral (above the muscle), which is why both my implant surgeries have been without any serious pain. Highly recommended.

applejuice

I am 5'3" 144 lb now (regularly around 130 lb and trying to go back down now ) and my size before the BMX was C\D. I am currently at 400cc and the PS normally uses Allergan Inspira Smooth implants. TEs are under pectorals. He said he is thinking will fill one more time, another 50cc and that's going to be last time. Shall I ask for 500cc as final TE size before the replacement? I would like to be the size I was before the BMX, but apparently he thinks need to be smaller.

I also feel like the expanders are not symmetrical right now, one is higher profile and the nipple on that side is lower comparing to the other side. I asked today if the final shape, after replacement, will look more symmetrical and the PS said, because of the scar under one breast is more tight and did not soften, the final picture will look better than now, but he didn't say more symmetrical, and i think he did not sound very encouraging (
Shall I look for another PS? Did anybody go with another PS before the final exchange from TE to implants?

I am obsessing over this, as the main reason i went with BMX was to be able to have both breasts look the same and to not see a major difference between them. Not sure what to do at this moment

HikingLady

applejuice For your own peace of mind, maybe it's worth having a consult with another PS. That way, you'll have another opinion on board about the question of symmetry. Perhaps to get exactly what you want, you might choose more extensive reconstruction options, like Flap/DIEP, etc. and not all PS do all types of reconstruction.

As for how high on chest, that might have to do with where your pec muscles are. The Alloderm pockets for my implants are attached to the tops of my pec muscles.

My PS warned me that my two foobs wouldn't be identical. I had radiation in 2003, and that right side is tighter, and pec and also the skin didn't want to stretch as much. Final shape with implants is slightly different looking on the two sides. But, in a bra and clothes, the difference isn't noticeable.

robinblessed54

Girl279, I was a B cup before BMX. I was filled to 420cc and my PS put in 475cc Allergan gummy bear implants. It gave me about a large B/small C which was what I wanted. I am very happy with my results. No revisions, no infections, no problems. Follow your PS instructions to the "T". Don't do more than you should because you will feel like you can do anything, but don't. Just because you can doesn't mean you should. I am 4 years post EX. I have 3D nipple tattoos that are amazing! Take care and PM me if you want anymore support. Minus Two on this thread has the same implants and she has had them for about 10 year. She is also very happy. Your PS has to be very skilled with the gummy bears. They must fit tight and remain contained in a bra for a long time. They are very comfortable.

Blessings,Robin

MinusTwo

Hey Robin - HI. Robin is correct in everything she says. My TE's were placed in February 2011. Then exchange to Allergan 410 anatomical cohesive gel implants (the original gummies) in September 2011. I was a D or DD before the mastectomy, and I was SOOOOO grateful to be able to go smaller to a C. I'm very happy with my implants, the cleavage, the lack of side flaps, etc. You really do need a very experienced PS to do anatomical implants since the tolerances must be precise. And after the surgery? JUST BECAUSE YOU CAN DOESN'T MEAN YOU SHOULD.

Wink22

Thank you, kandyhunt! I am glad that you are doing well post infection and replacement. Your post made me laugh...sign of the Cross and pixie dust! I finished my course of antibiotics and things are looking quite good. Fingers crossed. Thanks for your reply :

kandyhunt

Wink22- I'm still on my antibiotics. One more week. But I am feeling really good. The the proof comes in two weeks when I have been off the antibiotic for a week. The pixie dust was added because we are in the Orlando area. So everything gets pixie dust. My PS says he is an atheist but was raised Catholic. We have some very interesting discussions. He came to my hospital room the day after the BMX and spent about a half an hour just chatting as he was ahead of schedule. He also loved my ducks. the last few surgeries I brought little rubber ducks and handed them out to all the people that helped me as I was getting ready for surgery. They are crazy looking from holding surf boards, sand pails, some look alike animals(sort of) they are too funny.

allebasi

I got my exchange on Monday, March 25, 2019. Originally it was supposed to be April 2014! Had this expander in me for about 5 and a half years. But I got pregnant while off my mirena. So couldn't have surgery. Breastfed for 3 years on the breast I still had. So finally got the exchange on left side and a small implant and lift on the right side. I'm on lots of medicine for pain but still have quite a bit of soreness. It's mostly in my upper chest right above my "foob" and "boob" almost to my collar bone. Hard to go back yesterday morning to get bandages removed and am now in one of those lovely surgical bras. Go back in 2 weeks.

HikingLady

allebasi Thanks for this update. Glad you're finally finished with having the TE---I felt the implants to be more comfortable, starting maybe 2-3 weeks post exchange, than the TE's. My discomfort was very short-lived after my exchange surgery (this January), and I wish that for you. I felt better and more comfortable very soon. Wonderful that you still had one breast over these years, and could breast feed your baby; thanks for sharing that. You've been through a lot. Take care and don't overdo it--there's plenty of healing, even though most of us found the exchange to be easier than the mastectomy. Get your rest! Wishing you good healing and smooth sailing.