Nipple Sparing Mastectomy with immediate reconstruction

TNLady

Nipple Sparing Mastectomy with immediate reconstruction

TNLady

Thank you for your response Unkle...  Yes, I have read that there is a small chance that the BC can come back in the nipples, so that is a very good point.  It just makes me cringe a little to think about losing my nipples:(

TNLady

 Ally, actually I do already have my implants. Originally, I was going to have tissue expanders, but there was enough skin for my doctor to go ahead and put in the implants.  I did not want to go with a larger breast size, so that may have helped a bit.  I may even be a little smaller, which is fine with me.  I am very active and sometimes large breasts can get in the way!:)   My GS made the incisions under the fold of my breasts, which also allowed for my PS to give me a little breast lift.  I was starting to get the middle age breast sag!  I think with the nipple sparing procedure it is more common for the surgeon to make the incisions around the areola, like you had.

Beets

TNLady-

I had my bilateral nipple sparing w/te on the 5th of Nov. After about a week and a half my rt nipple began to turn black. This was the breast that had the tumor. My GS said that because he had to aggressively remove so much from that breast, the chances of losing that nipple were very high. My PS decided it was best to remove it and because she addressed it early enough she was able to preserve the base of the original nipple. My PS has told me that I can either leave it as is after the TEs are removed or she can create a more symetrical nipple from the remaining tissue.If possible, I would recommend taking care of it asap rather than waiting for the tissue to all die.

Beets

ally1423

TNlady, beets....my right nipple looked black to me....i was very concerned...the ps looked at it and said it is healing and would be fine...he was right in a few days the black scab came off....after surgery i was told to apply bacitracin daily to the nipples......good luck....ally

TNLady

Beets, thank you for your response.  Yes, mine began to turn black the week after surgery.  Mine happens to be on the breast that I did not have cancer in. The nipple on the breast that had BC is looking okay.  I knew going in that this could be a possibility, so I had prepared myself.  I go back on Monday, which will be two weeks after surgery, so I will find out the verdict then.  Where were your incisions? 

shiny

Good luck TNLady on Tuesday! Hope you had a good Christmas.

take care

Shiny

TNLady

Ally, I hope that is the case.  I have been applying triple antibiotic ointment.  There is still no drainage, so maybe it will be okay.  I have also been putting the ointment on the spots where they took the drainage tubes out. 

Shrek4

I had that done (without alloderm - with Lattissimus Dorsi flap and silicone implants at the time of surgery under the pectoral and lattissimus dorsi muscles) on the left side (prophylactic) - the right areola and nipple had to go as there was DCIS too close to the nipple and a suspicious area on some ducts in the nipple itself. The incision was from the areola down on the "good" side and same for the BC side with an extra incision laterally (to remove the biopsy scar as there is the scare it might have had "seeded" cells from the stereotactic needle going out).

Unfortunately I had lost my areola/nipple. It blistered right after the surgery due to the underneath cauterization, then the PS didn't take care properly of it and took me off antibiotics so it got infected and had to come off.

I am not VERY upset about it - as I was told by all surgeons that the chances to have any sensation on that nipple were close to nil - the nerves being completely severed. The only thing I am a little upset is purely esthetic. But I'll have them both re-done (I have a small piece of skin from the LD donor site grafted where the areola was removed on the BC side and it survived very well)

PB22

I had the nipple sparing mastectomies two weeks ago.  One had early stage and the other was propylatic. Drains for two weeks and now out.  Everything looks good. Incisions are lollypop, under areola and down.  implants are mentor gel placed under the muscle held up with a mesh pocket created.  Feels like a burning, tight, scraping feeling, still on pain meds. Anyone farther along in the process can tell me how long they were on pain meds. 

Beets

TNLady-

I have a lateral incision from the nipple to my armpit on each side. My GS did not do what I think they call a keyhole incision. I have healed quite well despite having my drains in for 7 weeks. Just had my first saline fill up on Tues. after the drains were finally removed. What is triple antibiotic ointment? Is that anything like Neosporin?

KEW

You can see in my signature line what I've had done.  It has been over a year since BLM and my exchange was in May.  I'm on the picture forum if you want to see.  My PS was very careful and so he only added 125cc at BLM we waited two weeks and then added 50cc a week, with a few breaks in there.  After I was expanded to 750cc we waited at least 2months before exchange surgery.  I could have used a lift, from nursing two kids, but we've opted not to do that because we really don't want to move the nipples.  Do I have Playboy breasts? No, but I have two beautiful breasts that look like my own did, except they are perkier.  My incision is from the outside of my aureole towards my arm pit, and much of it has faded.  For me, it made a huge difference after mx, to see myself, I looked like me, but deflated, and it was OK.  I feel comfortable with my breasts, change in the gym, etc.  I feel lucky, my nipples always remained pinkish, they respond to cold and stimulation, although I have no feeling.  Since we didn't do a lift, I have some step-off at the upper pole which we will attempt to soften with fat grafting in May or June.  I think it is important to move slowly, let things settle, see how it looks. Happy to answer any questions.

Yes, I do have Alloderm slings on both sides. 

Best--KEW 

TNLady

PB22-We are about the same amount of time along.  I am still taking pain meds, only 1/2 a pill only when needed.  Today has been the longest time I have been able to go, which so far, has been ten hours.  I also have the burning, tight feeling in my chest.  I feel like I am carrying bricks around on my chest.  I have the same brand implants too.  Mine are finally starting to soften up.  I have nice cleavage, but they look mushed in near the bottom of the fold of my breast.  My PS said it would take about six weeks for them to drop.  The hardest part has been trying to find something comfortable to wear over them.  The swelling is down enough for me to put on a sports bra, I had bought before surgery, that zippers in the front, but it still seems to cut into me.  The sports bra helps hold everything in better and makes it more comfortable moving around.  Has your pain been bad?

TNLady

Beet,

 Yes, it is the generic version of Neosporin. LOL  I don't know how you made it 7 weeks with drains, they drove me crazy!  I have read where some women have had them out too soon and had to go back and have their breast drained, so it is better not to rush it.  I did not have the key-whole incision either.  My incisions were near the curve of my breasts. 

PB22

TNLady, thanks for sharing your experience.  I am so unco mfortable was wondering if I was doing something I shouldn't be in the recovery which isn't much.  Pain is pretty bad with shooting sharp pains which the PS said would happen as nerve endings repair.  I am trying to transition to tylenol to keep a clear head.  PS said to use cocoa butter which was purchased at whole foods and needs to be placed in a microwave for softening.  My gel size is 375, seems small compared to most I'm reading. Was a C before.  I am hoping to be that again but not complaining considering the circumstances.  One thing I am noticing is that since most of my breast tissue was removed, I am feeling the cold when I drink cold water. Takes awhile to warm up again.  I guess its lack of the fat insulation.  I live in Fl so its not the weather.

ally1423

hello ladies....pb22. i had b/l mx one step procedure with alloderm, silicone allergan implants, my incision is at the bottom of the areola, it is almost healed. i have to tell you that my only problem is PAIN, my surgery was nov. 20. i went back to work dec. 10. my pain is mostly the pec. muscle. i am still taking percocet 10mg every 4h and i'm taking soma 3x day, that's a muscle relaxer. i have a very low tolerance for pain. every time i try to cut back, it doesn't work out.i'm no martyr, i just want to feel good, some of us just experience more pain, if i have to take meds for several months, then i will, the ps said the muscle has to work in, i guess it's a slow process. cosmetically i look very similar to the way i did before, just higher and a little fuller.....i was a little droopy before, it's amazing but i have no scars from this procedure, previously i had a lumpectomy on the right and excisonal biopsy on the left, and i have faded scars from those procedures. also i had alot of pain in the right nipple, but it wasn't constant, it was totally black and i thought for sure i would loose it, i applied the bacitracin directly on the nipple and areola, then applied a sterile 4x4, i used a sterile qtip to apply bacitracin (u can buy them at surg supply store) i did this once a day after a shower  and washing the area with soap and water. TNlady and beets i think your nipples will be ok, mine are looking better each day, and one week ago it was completely black, i believe this happens because it is healing from the inside out. i'm not wearing a bra yet, it's just comfortable without one, the foobs don't move around yet, so i don't need a bra, i've just been wearing dark colored shirts. most of my old bras are paded, push-ups...can't wear those any more, i also have that cold water thing that pb22 has ....it's so weird.....i think we pretty much all want the same thing....we want our boobs to look nice and be a good size after going through reconstruction, i think it's ok that we feel that way, pb22 i think it's ok that you want to be a size c, since that's what you're comfortable with.....wishing you guys the best...keep in touch, also i wanted to mention that my ps now wants me to massage the boobs/pec muscle area with lotion to break the muscle in, i have been doing this......i guess the healing is a slow process, and it will just take time........take care....ally

PB22

Ladies and Ally, thanks for all your helpful input.  I had not known to expect this much pain for so long.  I was prescribed percocet from the GS and hydrocodone from the PS.  With the percocet I can function more around the house, I was afraid of depending on it, but the tylenol was useless and the hydrocodone took the edge off but made me foggy.  I was wondering how people can drive and go back to work.  Its a relief to know that others have this cold sensation when drinking cold bev. like wearing two icepacks.   Concentrating on trying not to walk hunched over.  Tomorrow will be three weeks post op.

PS73

Hi ladies.  Hope everyone is having a good holiday.

I am having BMX with Nipple Sparing and alloderm on Jan 8th.  This information is helpful.  Kew, I am having the same type of incision (from outside areola to armpit).  The type of nipple sparing they are doing for me is not cutting around the areola but scraping out the cells behind it.  This is fairly new, Sloan and another hospital were involved in a very large trial on Nipple Sparing with favorable results.  I feel confident about my BS and my PS. 

Unfortunately Im allergic to muscle relaxers.  Will the pain be manageable w/o muscle relaxers? 

ally1423

ps73...there are all different types of pain meds....you might be lucky and not need any, many women have reported very little pain, unfortunately that was not my case, you should get a prescription for pain meds before surgery and have it filled...this way, if you need them you will have them there for you....good luck...and as you can see we're all doing ok....ally

TNLady

PB-I too am having the sharp pains now and then.   It is very cold where I live and when I get chilled I get weird sensations in my chest, I think it is from my pecs tightening up.  I am also very itchy all over, not sure why. I'm hoping that is not from my implants.  Maybe it's some kind of side effect from surgery.  I have only been put under one other time, it that was years ago.  My PS put 650 implants in, which he told me I would be around the size I was before or a little smaller.  I was also between a C and D cup, depending what brand bra I bought.  I am not having the cold sensation you are having while drinking, maybe that is something that will go away with time.  Is the coco butter to help with the scars?  I still have my stitches in and the tape over them.  It is so nice to have someone to compare things with, Thank you!

TNLady

PS-thank you for joining.  I did not take muscle relaxers after my surgery.  I know some doctors prescribe them, but my dr did not.  My doctor prescribed Lorcet 10/650 tab and after the first few days  I only needed a 1/2 pill every six hours.  I am almost at the two week mark and I don't have to take them as often.  Of course, everyones pain tolerance is different.  What seemed to bother me the most was the tightness in my chest, maybe muscle relaxers might help that, but it was not unbearable.  I wish you the best of luck with your surgery and please keep us posted!  If you have any other questions of what you might need before or after sugery feel free to ask, we are all here to help.

ally1423

hi ladies....good news...survived today just taking advil.....i think i had a set back on monday, i lifted a bag of laundry and i think it inflammed my pec muscle ....i felt it right away...it's finally starting to subside....just want to caution you guys so that u can learn from my stupid mistake....don't do any heavy lifting....ally

TNLady

Ally,  thank you for the encouraging words.  Sorry about your set back, but it sounds like you are doing better now.  I guess it is just going to be a slow process for all of us.  Before surgery I was working out almost everyday, with weights, walking, elliptical, etc.  I'm starting to get a little stir crazy!  It is very hard for me to not be up and moving around more.  Are you able to doing any stretches or exercises yet?

ally1423

hi TN i'm an exercise person too. i went back to work pretty soon, so just my every day life...i'm constantly moving around.....so far i've walked on the treadmill one time....i just feel tired, and basically when i'm not working i just rest.....like you said, it's a slow process....i wish i could fast forward to a few months from now and skip this recovery period......i definetely don't think we should be doing any weights at this point, i think walking is fine, i just don't have the energy...too tired after work....take care

KEW

PS73---I had the same type of NS mx.  I think you will be pleased with the incisions, they fade and are located in a place where bras don't press up against them.

Pain.  I didn't use muscle relaxers, I came home with Q-pumps which constantly wash the chest wall with bivocaine for about 5 days after surgery.  They are inserted by the PS during surgery and removed after they are empty.  I also had Diluaded 2mg. and took as needed, didn't take much. I wasn't in much pain, except from where one of my drains excited my body, that area hurt the most.  I had things that felt crummy--couldn't get out of bed easily, couldn't flush the toilet--got good and learned how to use my foot.  My PS really restricted me, nothing overhead for 10 weeks, no lifting over 5 pounds for 10 weeks.

All who are just past mx or about to have one, I would encourage you not to do any exercise until PS releases you to do so, then ask for a referral to a Physical Therapist.  I went to  a PT weekly between mx and exchange and I think it helped greatly, but go to one who is trained or very familiar with breast reconstruction.  As much as we don't want to admit it getting dx and treatment is emotionally and physically challenging.  You will be back to working out soon, but it takes most people awhile to really get to where they were before.  I told myself a year after surgery, and my exchange was in May, so by May 2010, I hope to be as close to the old me and accepting of the new me as possible.  The only thing I cannot do is anything that build pecs, no more flies, some presses, and some things on the Pilates reformer.  I was even back on the rowing maching until I injured my shoulder a couple of months ago.

KEW 

PB22

Good morning girls,  ally, cant believe you are working so soon. TN  The sharp shooting pains I was told was the nerve endings repairing.  My PS gave me the Loricet which is hydrocodone but do better for pain control on the Percocet( oxycodone) no wonder.  It makes me extemely itchy.  I have a back scratcher.  During post op PACU recovery had the itchy reaction to the antinausea meds given.  It must all still be in our systems.  I, too, worked out every day and its hard to think that I can't lift a finger.  Thanks for the warning ally about doing too much.  My husband reminded me that from working out previously we have tight pec muscles which are now suddenly stretched to accommodate the implants.  KEW...thanks for the encouragement.  My PS told me if I wasnt pleased after things have settled to consider fat transplantation in the area where the chest wall was scaped.  Couldn't bear to think about any more procedures.  TN...PS suggested the cocoa butter for the scars.  I am allergic to adhesives so don't have any tape covering mine. The sutures are inside, and dissolve and I had sterile gauge covering until they were closed. I am pleased with the way the scars are healing, and the nipple is pink. Don't see any scars under the areola. I am exactly 3 weeks today post op.  Hoping that I will be able to drive when school starts back after New Years.  I go nuts looking at the dust collecting!  Did you ever think we would be so preoccupied with boobs.

TNLady

Ally,  I went to my PS today, he said not to worry about the nipple.  He said to keep using the ointment and using the sterile pads and it should heal in time.  He said he would be worried if the whole area was black, but it is just the nipple.  He explained it is where the GS was aggressive getting the tissue around the nipple area.  So, I feel better.  He gave me the okay  to start walking again, but no weights.  I went for a walk this evening and it felt good.  Of course I had to take a pain pill before, due to the fact that my doctor is over an hour away, one way, and I was a little sore from the two hour ride round trip.  We live in the boondocks and have very curvy, bumpy roads.  I plan on starting back to work in two weeks and am hoping the walking will build my stamina up.  How long did you take off before you went back to work?

ally1423

hi pb22....i know, it's very weird not being able to do any housework. i just do the basics, nothing heavy, i don't do anything at work that is too physical, i think you're husband is right, i'm used to doing weights several times a week, only 5lbs, but consistently for several years....and my pec muscle is just not happy about this....i also can relate to not wanting any other procedures, i even cancelled my dentist apt......i don't wnt any dr's inflicting pain for a long time....lol....hopefully in several months we'll be back to ourselves.......ally

TNLady

KEW, thank you for the helpful information.  You had mentioned the picture forum, how do you get to that?  I have been looking for it, but have not been able to find it.  I have looked at many before and after pictures myself and I think it is very helpful for woman to be able to take a look at pics to help them be more prepared for what they will see after surgery.  I was still a little shocked when I first saw mine, but not as much if I had never looked at other peoples before and after pics.  So thank you for being brave and posting photos to share with others.

Kimber

Hey ladies - I am having skin sparing PBM with immed recon sometime in Jan.  I am very very active and my biggest concern is recovery and not being able to work out.  I am so concerned about losing all of my hard work...I know that is stupid, in light of the situation.  Do you lose all your muscle mass and did you lose weight?  I have been consistently active since I was 10...I am now 45.  I had to take time off for a few things, but not like this. Any advice appreciated!

Kimber 

TNLady

PB22, thank you for the laugh! I know what you mean about being preoccupied about the boobs! LOL  I feel that is all I ever talk about with everyone-my husband, my kids, my friends, etc.  I will be glad to have this past me.  I guess I have much to feel blessed about and should not complain, but sometimes we need to vent.  I am thankful to have people to talk to that are going through the same process.  You said you were three weeks in, I am at two, do you still have stitches in then?  I was curious how long they would stay in?  Mine are also supposed to be dissolving and I have the tape on them.  They told me I can change the tape every three days or so.  I will have to try the cocoa butter when I take the tape off.  Does your doctor think that is better than the creams made for helping scars?