Nipple Sparing Mastectomy with immediate reconstruction

TinaT

I just found something interesting on a PS website.  It addresses cleavage determinants for augmentation patients, but it seems it would apply to reconstruction as well.  Helps to explain why chest/ribcage/sternum configuration dictates the amount of cleavage we might end up with after surgery. 

http://www.advanced-art.com/Breast-Aug-Cleavage.htm

(I am posting this on a few of my threads so forgive the repeat...)

Anonymous

Tina- Thanks for the great link.  Wish my first PS had read it.  The PS I just consulted with in Beverly Hills, Dr. Lawrence Koplin, explained it the same way to me.  He said when PS's try to force the issue, and try to move the implants closer together, is when you can end up with the nipples facing outwards or "wall-eyed".   

TinaT

Kate33 - Glad you found a great new PS, if only to consult with.  Is he the one from whom you posted a few emails a month or so ago? 

I didn't have cleavage before BMX and the word never even came up in all my many PS visits along the way.  It wasn't a focus of mine as I kept stressing I wanted to "look like me".  I do now remember PS discussing my prominent bony sternum, wide ribcage, and (of course) natural nipple placement would dictate reconstruction.  It would be nice to have some cleavage, but that website really demonstrates why it just wouldn't look right on me.  Of course it makes sense, but the graphics really help!    

Just_V

So I am 16 days out from my second NSS (the first MX was in June and the skin and nipple were compromised)- must say that the second breast with NSS looks great - the BS made an incision just above the nipple about 2 inches long b/c the PS wants to do a breast lift in my phase 2... the other side, the one done in June with the compromised skin and nipple - the one that the PS removed the nipple and skin graphed back on... I must say although I look a bit Bride of Frankenstein in that breast, the nipple is healing and I am excited.... The incision in the belly from the double DIEP is also healing... I go back to work on Monday already, and except for getting fatigued easily and having a huge gauze party each morning to cover the various incisions, I am ready!

SAOIsenberg

Tina - that is a great link! I had no cleavage pre-op and still have none, like you - and those are great pics. Women keep emailing me and saying "but do you have cleavage?" and frankly, it hadn't occurred to me at all to even want it - I was so fixated too (still am) on looking like myself pre-op - which, thankfully, I do. I'd look very artificial w/cleavage.

V - sounds like things have gone really well for you - that's awesome! Hope going back to work is great and that you continue to heal up nicely. 

Sarah 

thatsvanity

Hi everyone,

I had a Bmx nsm alloderm implants 600 cc high profile implants on may 26, 2011 one of my nipples took awhile to heal about 4 months longer than the other nipple. It looked black and purple after surgery but it finally healed up. My ps watched it very carefully---weekly then on an appointment day of checking my nipple, the ps could see my implant. He immediately removed the implant sterilized the implant, increased the size of the breast pocket---snippety snip, then he reinserted the implant all in about 45 minutes. The moment he took the implant out and put the implant back in my chest, I iimmediately felt better and I healed fast. I agree with KEW, my breasts look like my breasts but way higher up on my chest. It has been 6 months since my surgery, and every day they feel different---not in a bad way but just like they are finding their comfort zone.

thatsvanity

Hi again,

I have a few question for the other ladies on this thread.

1. Do your implants feel achey if you don't wear a bra?

2. Have the shape of your implants changed 1 year out or 2 years out after your surgery?

3. Has improving upper body strength changed the feel and shape of your implants?

4. Does losing or gaining weight change the shape of implants?

Thanks,

Amy

thatsvanity

Also what is everyone's opinion on a BRACA positive woman who has a sister who is BRACA positive and their mom died young of met BC, she wants the one step Bmx nsm with implants but insurance doesn't cover the procedure?

Hindsfeet

Kate, thanks. I have Blue Cross, Blue Shield, Enhanced. The idea of half and half is interesting. What if one PS does the implant and another the fat grafting? Insurence pay for two surgeons.

I hate that some say it's necessary to wear a bra 24/7. After work, I come home, take off my bra and wear something comfortable. I hate the idea of the feeling of wearing a bra 24/7. Scary. I wonder if having smaller breast won't hurt as much. I am comfortable with a B size.

I also hate the idea of nipples hurting. Do the tatoo nipples hurt? or the recontructed or natural nns hurt? The idea of a hot shower hurting doesn't seem fun.

I've asked for a nsm ... not sure if they will let me do both. Dreading the day, and another part of me just wants it over.

good quest thatsvanity

Hindsfeet

One more question...

For nspm...where does your plastic surgeon cut. Someone I just spoke said it was under neith her breast crease...the scar can't be seen.

Someone else said it was around the nipple.

The plastic surgeon drew a picture for me and said it was under the breast creast with a line going up toward the nipple. I already have a scar at the 8 "O Clock position on that breast. Too many scars that way. Do the scars fade? How long?

Ginger48

tina- thanks for the link; it was very informative. I asked my PS why my nipples are pointing outward a little bit and she said the same thing. If you try to push the implants towards the center then it causes the nipples to point out a little. She was trying to compromise between some cleavage and centering the nipples. I don't really mind the way mine are; I am so happy to look like myself. My sisters were checking out my chest for the first time since surgery yesterday and they could not believe how small the scars are and how much it just looks like me.

That'svanity- I think it is a personal decision for a BRCA+ woman to make. I am BRCA2+ and I am glad that I am doing everything I can to avoid further BC. However, I have good insurance. I think my NSBMX cost over $60,000 and I could never have done it without insurance.

evebarry- my scars are around the nipple and out toward my underarm area at about 3 o'clock.. Not big at all.

Ella1998

evebarry - I had  nipple sparing BMX with one stage reconstruction silicon gel implants on November 10, my scars are under breast 10cm long . looks great hard to see the scars.

That'svanity- I am BRACA1 + and was diagnose with DCIS on left breast and I made decision to do BMX to avoid further BC

SAOIsenberg

evebarry - you should ask your PS if s/he can go in through the scar you already have on one side - might have to elongate it a little, but I had an old lumpectomy scar on Lefty and they went in thru that for my NSM - so no new scar on that side. For right, my PS cut in the fold under the breast - it does extend a little bit up the side toward my armpit, but it's barely noticeable - I'm 9 weeks out of surgery and I have gotten dressed in the gym locker room already and felt fine - w/my own skin & nipples, you'd have to really be checking me out to figure out that anything's gone wrong. My re-excised scar actually looks better than ever - the PS did a very neat job of stitching it up and it's fading fast.

Ginger and I have the same PS, and yet our incisions are different - so I wonder if some of the decision on incision placement is guided by breast size/shape and/or cancer size/location? Someone here must know that.

Re bras - I am a B, was always a B, and I do not feel the need to wear a bra 24/7 at all! I am more comfortable during the day w/one on, just like I used to be, but I do take mine off when I get into pj's/loungewear and I find it far more comfortable to sleep w/o a bra . . . so I think it's a personal thing dependent on many factors.

Sarah 

Ella1998

Hi everyone! I am two weeks after NSBMX I had no cleavage , my PS said that he want to  move implants closer together. I was B cup before surgery. Now I have 350 CC silicon gel implants. I think I will be little smaller. I have shoulders and arms pain. Is this is normal? Also my implants feel uncomfortable, maybe from swelling.

TinaT

Just_V - Yahoo!!!!!  I'm so happy that you're finally taking some big steps forward.  Yay!!!!!!!!!!

thatsvanity

Thank you

thatsvanity

Hi Everyone thanks for your input!

Evebarry--- my surgical incision for NSM looks like the shape of a lollipop.

@----- if u can picture the a as the nipple and the circle or the incision right next to the brown areaof he nipple as it has healed it is very light, the scar then is under the breast not visible to me unless I pull my boob up to look at it.

Sorry that all sounds goofy but I'm not a doctor, lol

Amy

ThisTooShallPass

Hi girls,



I would like to join your group if possible. Did anyone have Alloderm as well? My surgery was on Thurs Nov 24 and recovery is somewhat slow and I feel very uncomfortable.





Ella1998 - I just had NSBMX with Alloderm 3 days ago and I was C cup before, got filled with 445cc and when I look down my chest it looks like I have no breasts at all, barely an A cup. I am disappointed and will be talking to my ps about this on Friday on my post op. Did you speak to your ps yet?

Ginger48

Sarah- When I read your post I was wondering the same thing about how the PS decides to do the incision. I just figured she would have done ours the same way. Interesting question. She said I could wear any bra I want to; but I forgot to ask her about going braless;.

Ella1998

ThisTooShallPass - I talk to my PS he said need to be healed to see final result and if i will still not happy after everything healed he can to larger size. Before surgery he said he try to do little bigger not much or will be the same size . He is not recommended TE. How do you feeling? My nipple looks great. I don't feel them.  Let me know when you talk to your PS.

amsk

Hi all.  

I had NSS BMX on November 21st.  My incisions were under the breast fold on both sides -- no incisions around nipples.  I must say I am pretty pleased with the result so far - even though I have TEs and only 175 ccs of saline right now (about an A cup).  My breasts look like two deflated balloons!  I think I am scheduled for my first fill a week from Thursday.   Should be an interesting process

Sherryc

I will be having NSSM in March.  My Doctor is going to use existing scars.  On my left I have a scar around my nipple already so will use that scar and continue to the outer side of my breast.  On my right side I have a scar on the outer side of my breast so he will go around the nipple and then use this scar.  I kinda like the idea of having as little new scars as possible.

tigerw0man

I had a scar on the left breast from an excisional biopsy in May that was about 3 inches long from my armpit towards my nipple. I talked to several PSs before I had NSMs in August and they all agreed that it would be best to cut in the same place, but extend it a bit more. Then mimic that incision on the right breast. The rationale that they gave for using the same incision is that if they were to make an incision below the breast in the fold, I would have two parallel scars, which means blood flow would be highly restricted between the two scars which could lead to necrosis.

ThisTooShallPass

Ella, I am feeling ok but have random muscle spasms. I have a feeling of awareness that something is inside my chest and wonder if I will ever get used to it. Also same shoulder and chest pains. I can't see my nipples as they are completely covered with gauze and I am not allowed to remove it until ps removes them this Fri. What type of incision do you have? How is your pain level now that you are two weeks out? Do you feel better or is the recovery slow?



Amsk - hi! Our surgeries were close, mine was Nov 24. How is your pain ? My incisions are "lollipop" because I had to have breast lift along with bmx.

amsk

ThisTooShallPass:

Hi there.  I can't believe you had your operation on Thanksgiving!  Yes, we were very close - I was on Monday and you were on Thursday.  Guess you didn't have much of a T-day celebration! Neither did I - other than I was very grateful to be cancer free!!

I have TEs with 175 ccs of saline - and they are uncomfortable and tight feeling.  So I can only imagine what 445 cc implants must feel like!  That will take some getting used to I would think.  What size bra size were you before the surgery?  I thought seriously of having the one step recon -- it was a real toss up for me.  Decided to go with the TEs because my PS seemed more comfortable with that approach.

I will be interested to follow your progress.  I understand that many with the one step end up needing revision surgery - so you might want to anticipate that.  (Then again - you don't have to have the exchange surgery.)  Two different ways to skin the cat I guess.  

Are you going to post your pictures on the picture forum?  I probably will do so once I find out how to "size" the photos and once I get a little further along with the process.  

Nice to be on this thread with other NSS'ers.  

Anyone else have incisions along the breast folds only?  So far my nipples look pretty good - will see my PS this Thursday.  Hope to get my drains out.  Also hope to get my path report the day before that from my BS.

Happy Holidays all (guess it is that time of year now, officially!!) 

ThisTooShallPass

Amsk - I am interested in your progress too ;-) it o nice to have someone who is so close to compare the recovery times and other issues. I am 5'5" and 160lb and was full 36C before the surgery. My ps promised to try to keep me the same size but looking at it now i doubt that is the case. I will definately post my pictures on the picture forum but i am all bandaged up and can;t see anything and was told not to touch anything until my first post-op this coming Friday when the ps will remove the dressings. My implants do seem very far apart. I also had to have breast lift which I didn't want because ironically, I loved my breasts saggy which seems to be odd when I mentioned this to my ps. Even thought I had one step, the more I read the more it seems like many end up having second surgery. You know, my size compared to yours now seems big but I keep on reading the other thread where girls have 800cc and over and I can't imagine having so much in althogh the size must be nice. I am feeling better today (4 days post-op) and seems like the more I am in bed, the better it is. I went grocery shopping with my husband 2 days post op and it was rough and people stared at me because I really looked bad, but I had a "cabin fever" and was stir-crazy and had to get out. How are you doing?

Ella, how is it going with you?

Tigerwoman and sherryc - It's great to hear your doctors will be using the same scars. I think the estetic result will be very good.

Hi to everyone else.

Ella1998

Hi ThisTooShallPass ,  I am feeling OK , just take Advil couple times a day. I don't have spasm just  uncomfortable feeling and I have swelling under left arm where the lymph nodes were removed and breasts. I can feel how they swelling.  I feel better after drains were removed. My PS said the week or two after drains removed I have to take it easy and do not move my arms a lot , that this is very important. He said that i can not use computer also. Today I was feel that I can do some cooking , but my husband do not let me do anything. The bad that I can't hold my 14 month baby. I could see my nipple after surgery, I did not have any dressing.

Amsk- My incision is under the breast 10cm long. I could not see the incision. This is unbelievable how they did .

Hindsfeet

Thanks. I have pre-op appointments with my plastic surgeon and breast surgeon next week. I'll ask. I'm also indecisive about if to do a uni-or blmx. I'm 50/50 to what feels right. It would be nice to have one normal breast so not to forget what it's like

Sherryc

evebarry I was also not sure about what to do uni or bmx but after talking to several long term uni they all told me if they had a do over they would do bmx so that the breast would stay the same as they aged.  All the women I spoke to had it done when they were in there early 40's and now are late 50's and they say their natural breast if of course aging like it should and the implant is higher and perkier because it does not age the same. My BS was really pushing me for uni but after talking to those who have lived it I have decided on the BMX.  I had rads so I am having to wait until March.

Just_V

eveberry - I had the same question - i had a UMX on 6/8 with TE insertion - the TE failed in July.  So I opted for a proph UMX on the non cancer side (my BRCA testing indicated a mutation but not one of the known mutations for BC) because (1) I did not want to worry about BC in the other breast, (2) wanted the symmetry that Sherry talks about.  I must say that I am actually glad that the TE failed and gave me a chance to think through the options.  I went DIEP (actually free TRAM) and am so happy - both toobs (tummy boobs) are full and natural looking and great.