Visible ripples in implants

slinky

Sweetie, yes, I have the Mentor high profile 45's.  I am really, really happy with them.

Anonymous

fire-dancer- I think the FG does make a huge difference in feeling more normal.  They feel a little less "foob-like" now.  Just having the skin warm again was a huge thing for me.  

leeinfl

it funny how feeling warm, soft skin makes SUCH a difference.....that was a huge thing for me too.

sweetie2040

Hi ladies, had my consult today with a new PS. Basically she thinks I have issues with the pocket being too big and the nipple too high. She thinks I would need the pocket adjusted, alloderm added maybe some FG. She didn't think FG alone would help my issues because there is so many other problems. She said it is NOT an easy fix and nothing would be guaranteed. She also thought a lap flap was a better option. I don't want that at all! I'd rather do nothing. She knows Dr. Khouri but doesn't do his method. She didn't seem to agree that's what I needed. I left feeling more discouraged and confused than ever. It's not like anyone can give me one answer and say this will pretty much help. They are all saying it may help like 50/50and donot seem to positive about it either. One more appt on Wed with Dr who does do Dr. K's method. We'll see what she says.

Anonymous

Sorry sweetie!  This whole process is so incredibly frustrating when we can't get the same answer twice.  There seems to be such a wide range of opinions out there as to what is best.  It's really hard to sort it out and to know which direction to go with the least wear and tear on us.  I think it's so hard because they all seem to just have their own specialties and that's the one they push.  I'll be curious to see what the next doctor says.  I admire you for doing all this research.  I guess in the end when you have it all together you'll just have to follow your gut.  I hope you find the answer to all this because you deserve it.  (((hugs)))

takeadeepbreath

Hey all

I also had a follow up with PS today too as one boob seemed to have dropped a bit and has ripples. I can feel the implant when I am sitting and my shoulders are slumped. In a bra/clothes everything looks fine. My doc originally thought we might discuss FG but today explained he thinks tightening the pocket would be the best way to try and address this. When he pinched IMF fold, everything seemed to tighten, hiding ripples. He said one side softened too much (and the other side has not softened enough yet, but has no ripples at all, just is sitting a bit high). Will go back end of October and see how things look. Anyone here have just pocket work done to try and fix ripples? My other thought that I didn't ask about was why not just put in a slightly bigger implant to fill the space (I guess then it's a much bigger deal as he would have to swap 2 sides to make even?).

slinky

Takeadeepbreath, I just had alot of pocket work done to try to reduce the rippling.  I was told the doc even tried to put in a larger implant, but it looked way too big on my body.  I had new implants put in, pockets tightened and hiked up, alloderm and fatgrafting.  The ripples and divots are back.  Sigh.  Not sure what then answer is, but it is still early, so maybe they will settle nicely.  My fingers and toes are crossed!

sweetie2040

takeadeepbreath-pocket tightening is what the Dr I just saw recommended me for. I already had one revision to a larger implant with a lift and some stitching and it did nothing. Also she explained if I keep going larger it will stretch the skin again and I may end up in the same place. She suggested lifting as well like Slinky had. I think the issue has a lot to do with thin skin and nothing to hide the implant after a MX. She did recommend more alloderm, which is not without risks either. There seems no easy solution for fixing ripples at all. I think Dr. Khouri's method may be the best way to hide the implant and pad the area of you want to go that route.

Kate-thanks so much for your support. Your always there for me and I really appreciate that. I am looking foward to what PS two says since she does do Dr. K's method. Your right about how they all have their own specialities. The ones around here who so say they do fg grafting really are the ones who like to do flaps. The Dr I just saw doesn't really like TE to implant reconstructions. I am fine with it if it would work! I'll keep you posted on this next visit. Oh by the way when we talked about alloderm I thought of you and how you had the marks. The Dr. did sigh and say yes that's an issue because they have to sew it in.

Slinky-how far are you out from your surgery? Are your ripples ad bad as before or are you just seeing a little? Do you know how they placed the alloderm? Was it an alloderm bra? That is what they are recommending for me, but it is very difficult to do because they have to lay one big sheet across. Do you have any marks from stitches? I think alloderm is the best shot without FG and I think Dr. K.'s FG is the best shot of all.

slinky

Sweetie, I am three weeks out.  I have an alloderm sling and alloderm over the top inner part of the implants.  The FG that was put on the shelf of the implants seem to have stuck around - no step off.  The ripples are not as bad as my first exchange and in a bra there are no ripples.  So all in all, I did get good results from this revision.  My PS warned that rippling might always be an issue since I am thin with thin skin.  He wants to see how everything settles over the next year and not rush into another fat grafting session.  He does do the FG technique like Dr. K, so maybe next year if they get really ripply, we can look at other options.  For now, they look really amazing in clothing and a really good bra! I can even go braless, since they are high and tight and not in danger of falling - my PS said to do whatever feels the best.  I still have shooting pains all around the bad side due to all the pocket work done, so I am in soft wireless bras for now.

sweetie2040

Slinky-I'm am glad to hear your results are much improved. It sounds like he did a lot of work to get it right. It sounds basiclly what my PS suggested. I wouldn't mind going a little bigger either although she didn't seem to think I should. I'm afraid if she lifts too much they may look smaller because the volume would all be "pushed up". Do you know how he did the lift or pocketwork to get them to stay up there? I worry too about pain from the area being tight after surgery. However since you only three weeks out and had a lot of pocket work that is sure to subside with time. With the second revision I had I had some tightness where he stitched and it did evenutally go away. It sounds like your PS did everything he could to make it right for you so I'm keeping my fingers crossed with you that it did the trick. It sounds good so far and you do look really good from the pics I saw.

slinky

Sweetie, the size is the exact same as my old implants.  My PS did mention possibly going up in size to fill the pockets, but I am at a good size now.  They do get smaller, because most of what is seen in the beginning is swelling.  Are you on the pic forum? PM me with your name.

Edited to add: I don't know how he did the pocket work, but I am guessing he tacked it down internally.  The IMF area was really worked on - that is why I can't wear underwires right now - my choice.  The implants seem to defy gravity on their own right now - there is shooting pains and tightness only on the bad side.  The other side has no pain at all!

Anonymous

Sweetie - sorry you're having a tough time finding the answers. I agree with Kate about how each PS can be different in what their opinion/specialty is to remedy the situation. I think it's great that you are keeping at it. Good luck with your next appt, hope you get sone good input!



Takeadeepbreath - I didn't have pocketwork at my FG, only at exchange. I find it interesting how there can be so many combinations to getting it "right" from various PS. Sounds like you have a tentative plan ;-) Good luck in October!



Slinky - I sending good thoughts your way, I hope everything 'stays' where it's supposed to and your pain subsides soon! :-)

Anonymous

Just an update - I'm a 9 days out from FG & feeling good. My bruising is SO much better and the skin is still tender to the touch around my middle, but doable. The biggest pain is sleeping in Spanx....I can't stand that, I have woken up the past few nights and squirmed my way out of it. I know I should be wearing it "full time" but by 3 am I'm done! Hopefully a few hours won't mess with my healing, right? Here's to hoping...

I'm assuming my swelling "up top" ;-) has gone down a bit and I'm still happy with the results.

I am sure things can change, but so far so good!

Anonymous

fire-dancer- Glad you are feeling better!  I was amazed how quickly my bruising resolved since I'm not normally a quick healer.  I'm guessing lipo bruises are just on the skin's surface maybe?  I know the Spanx is miserable but I think it keeps the lipo areas smooth as they're healing otherwise you can end up with lumps.  (Not a pretty sight, lol!)  So glad you are on the other side and so happy with your results!

slinky

Sweetie, I am three weeks out and the ripples seem to be lessening.  As everyone says, give it time.  I looked at them today, and I only see a flat spot on one implant,  All the ripples that I thought I saw are gone.  What a difference a week made!

Firedancer, I hear you about the spanx.  I wore my compression binder and bra at night, but when I woke up, both were on the floor.  Even with just the few hours they were off, I don't think it made a difference.

christine47

Bought my Spanx today.  I was kind of between sizes so I went small, hoping this is not a mistake.  Did your PS send you home with a garment?  Can or should you wear a bra right after the fat grafting?  I am also having CV flaps, so I am not sure what I will be able to wear.  Good thing the weather is getting cooler so clothing will be less of am issue.  Off now to my anesthesia consult for surgery.  I so appriciate all the bits of info I learn from this site.

slinky

Christine, I woke up from surgery with the compression binder and a surgical bra.  I almost bought some spanx two weeks after surgery because the compression binder was alittle bulky under clothing, but I wore stretchy pants.  I think Spanx are supposed to be tight - I am guessing.  Maybe someone else can jump in about Spanx.

Anonymous

christine- You definitely want the Spanx really tight.  The compression garment they sent me home in was incredibly tight.  Once I got that baby off it was not coming back on.  As far as a bra they had me wrapped but I had my implants exchanged.  I was able to change into a really firm sports bra 4 days after surgery at my post op appointment.

leeinfl

Didn't use Spanx.  I used compression shorts & capris (I love the Fila brand ones).  They are nice and tight but still comfortable.  I actually still wear them to work out in.  I also had some Flexees but my Fila gear was hands down the best.  If you head over to fatgraftpatients.com, there is a whole section on compression garments. 

Anonymous

I wore spanx after 4 days. I did have to go purchase a larger size than the one I had previously at home. I think it was about day 6 when I fit back into my regular smaller sized spanx. I wear the tube kind that you shimmy up. Mine is Flexees, but I pretty much think as long as it's tight where you need it, then you're good!

Funny, I had worn spanx under dresses, like for a wedding reception, and couldn't wait to get home and get out of that thing...never did it occur to me that someday I'd be wearing it 24/7 for days and days!!!!

NormaJean65

If I may jump in here after finding this thread yesterday, I can tell you after reading all the posts I am definitely reconsidering recon.  I had a UMX last year, but was going to proceed with removing my opposite breast.  I have a considerable amount of calcifications which are prefect places for small piece of cancer to hide during a mammo until it gets LARGE along with the fact that I am very high risk.  Oncotype Score 100 (I know, I know.....and no I am not reading it wrong) plus I had a Grade 3 remove last July.  I suppose at my age I could go w/o foobs but I struggle with self esteem/image issues............even at this ripe old age of 64y/o. 

Y'all have me rethinking all that is involved and then possibly end up with more surgeries to "correct" what I personally feel is a foob job lacking.  Just MHO. 

Best of luck to all you ladies.

sweetie2040

Slinky and Firedancer-I'm with you and hoping those nasty ripples never return! I'm following both of you because I may be next with some FG.

I went to PS #2 on Wed for a consult on what to do. Once again told overall FG would not help because the rippling is secondary to the fact I have excess skin that is overstreched. She said I would need a lollipop lift and have skin removed to push up the breasts. She said they are in the wrong place to low. She could try some other sizes of implants and FG would be done as a second procedure. I really liked this Dr but the thing that threw me off was having additional scars from the lift. I had emailed Dr. Khouri in the past and he even said I had excess skin that he would tighten up.

Slinky-I may have asked you this, but I keep forgetting this (darn medication) How did you Dr do your lift? Was it in the IMF and did have any skin removed or have any new scars?

slinky

Sweetie, my body is a scar zone! The cancer breast is all scarred up, but I don't really mind.  The scars fade with time and they give my body character.  My doc went through the IMF incision and really sutured internally - probably tacted everything down too.  No extra skin to get rid of.  I guess you really have to weigh out the risks versus the gain.  For me, nothing ventured, nothing gained, but everyone is different.

For me, the FG added the extra touch to make me not so self-concious in lower cut shirts. I don't even obsess over my foobs anymore.  I am on the road to my new "normal". 

sweetie2040

Slinky-thanks for letting me know. I am going to see my PS on Monday and ask him if he can do it in the IMF.  He already tried that on the second surgery though and it didn't hold so I don't know if there's a more aggressive way to do it like your Dr did so they hold. Thanks for sharing about your scars. I always say a scar means life, it means you went through something and your still here. I'm glad your happy with everything and feeling more "normal". It's encouraging to know others have had similar issues that ulitmately did get resolved. I wish I could just take you with me to my consult!

Anonymous

This is a post I put on from another thread but thought it was applicable here, too, so am copying and pasting it-

I am trying to compile a datebase of PS's who are offering fat grafting.  I have been emailing them and trying to find out exactly what type of fat grafting they do and how they are using it.  I just emailed Dr. Lawrence Koplin in Beverly Hills and he personally emailed me back.  He was extremely kind and caring.  Here is his contact information-Dr. Lawrence Koplin465 N. Roxbury Dr,. Suite 800, Beverly Hills, CA 90210310-277-3223   Website- drkoplin.com    Email- lkoplin@drkoplin.comI'm going to copy and paste portions of our email correspondence, too-Dear Dr. Koplin-Would you please tell me if you are currently offering fat grafting fortotal breast reconstruction or as a way to augment breast reconstruction?And, if you are, do you use the BRAVA system in your technique? I am a regular poster on breastcancer.org and am trying to establish adatabase of surgeons offering this procedure to assist breast cancerpatients interested in pursuing this option for reconstruction.If you are not currently offering this technique, but know of anothersurgeon who is, I would appreciate that information as well.  Thank you for your time. Hello, Kate!First of all, please accept my thanks for having contacted me.  There are so many places patients look for information, and it is a fabulous idea to be compiling this type of database to help them find the quality surgeons they deserve.Without getting too technical (although I can if you don't get too bored-feel free to ask), I have refined my thoughts about breast reconstruction toseveral distinct categories.For patients who have had true mastectomies, and have had fairly largebreasts, total breast reconstruction with fat grafting is a multi-stageprocedure that requires a large amount of fat to donate, BRAVA to stretchthe skin, and quite a long journey.For a patient who has lost a small and well-shaped breast and has the fat to donate, then BRAVA and 2-3+ procedures really are a viable alternative to be considered.More to my passion and focus are women who have partial breast defects from aggressive lumpectomies followed by radiation therapy, and aren't "fixable" with implants even if they wanted them.  For this large group of patients, I am extremely passionate about offering fat grafting/transfer as the absolutely best alternative for them!The final thing I do often and very well is to "finesse" and "rescue" breastreconstructions that have not gone well- using fat grafting to fill defects,round out areas of deficiency, and hide implants that are visible underextremely thin skin.  I am extremely comfortable in this world of frustratedand confused patients- I have been actively researching and performing fatgrafting since 1985 and have successfully treated thousands of patients inall areas of fat transfer.I hope this helps.  Please feel free to write back and ask any additionalquestions I might be able to answer for you.With warm regards and thank you again for contacting me, Lawrence M. Koplin, M.D., F.A.C.S. Dear Dr. Koplin-I appreciate so much your reply and all the information you shared.  Irecently had fat grafting done by Dr. Roger Khouri in Miami, Floridaand it made a huge difference in my overall reconstruction results.(It worked wonders for hiding the implants under my thin skin just asyou described.)  After posting my story I have been inundated byemails from other women trying to find a surgeon in their own area whodoes this procedure as well, particularly on the west coast.  I am sopleased that I finally have a name to pass on to them.I post on several threads on breastcancer.org regarding fat grafting,issues with implants such as rippling and overall dissatisfaction withreconstruction results.  I was wondering if you would mind if I sharedwhat you have written to me in this email and your contactinformation?  There are many women posting regarding Dr. Khouri butvery little information about other surgeons who also offer fatgrafting.  I will wait to hear from you before doing so.Since you offered I do have a few questions for you.  I hope I'm nottaking advantage of your kindness.  I am really just trying to educatemyself as much as possible since so many women are turning to me forhelp.Many women, myself included, are experiencing discomfort due to thestretching and tightness of the pectoral muscles following the use ofthe tissue expanders and now implants.  If a women is able to use theBRAVA system, go through several rounds of fat grafting and have theimplants removed all together is there anything that can be done torestore the pectoral muscles to their original condition?  This seemsto be a question on everyone's mind.  During my surgery with Dr.Khouri he swapped out my implants for much smaller ones and, at first,the relief was amazing.  Over the past four months, though, the pecsseem to have tightened up again and the pain has returned.  This isanother issue I see being discussed time and time again on my forumand I have never seen it addressed by any surgeon.Also, regarding fat grafting to improve defects post followinglumpectomy and/or mastectomy do you accept insurance and is it yourexperience that this is typically covered?  There seems to be a hugedisparity among surgeons/insurance companies regarding the coverage ofthis.  It is very frustrating for some women to know there issomething out there that would improve things only to find out it isbeyond her reach.Thank you again for your time.  You have no idea how refreshing it isto find a physician who goes out of his way to make this informationmore accessible to women.  Your email alone shows your caring nature and I will pass this along to anyone seeking out a surgeon in your area.Sincerely,Kate Smith Good evening, Kate! Sounds like we are all on similar tracks, and that you have had great experiences with Dr. Khouri.  He is, of course, a champion of all things fat grafting and we all all indebted to his skill and teaching.  Although he doesn't know me, his "Mentor" Dr. Thomas Biggs, knows me extremely well.  He was my professor of plastic surgery in Houston, and can give any references you might wish.You are of course most welcome to publish any and all of my email comments, and my contact information as well.  I don't think there are many surgeons on the West Coast doing these types of procedures, and I would be most honored to be included in your posts.  Also, feel free to ask additional questions at any time, or even call at your convenience- all my info is on my website, which will undergo a fabulous upgrade in the next couple months.Finally, as for pectoral muscle issues.  This is perplexing to me, as I really have NO complaints such as these in my patients.  I place implants exclusively under the muscle.  I use textured gel implants as my first choice, as these seem to have the lowest rates of capsular contracture (firmness, tightness, etc.).  The only time I hear of these chronic issues of tightening and pain is when capsular contractures recur (return).  This could be your case as well.....?  Again, in patients who have had expanders, then implants.... everything should return to normal anatomy and function (without pain or tightness) unless contracture is present.  Many studies have shown that patients with soft implants have totally normal pectoralis function, strength, range of motion and comfort.I know Dr. Khouri, and other visionaries like him, often charge very reasonable fees for their fat grafting reconstructions.  I feel similarly, especially in breast cancer patients.  Yes, insurance should well cover fat grafting to lumpectomy defects.... but they don't always.  They should, as the law currently requires insurance companies to restore breast cancer patients to their "normal" state.  We always check insurance first and try very hard to preauthorize coverage.  Still, it is one of the joys and pleasures of being a physician to treat the patient rather than the bank account; we never turn anyone down for a breast reconstruction for financial reasons.I hope this helps.  Keep up the good work!With best wishes,Lawrence Koplin, M.D. 

  

leeinfl

Wow Kate!  He sounds wonderful!  Dr Biggs & Dr. Khouri are actually hosting a huge workshop/conference at the end of October.  Hopefully this will again turn out many more surgeons willing to offer this.  It's great to hear that Dr. Biggs knows him well  - I'd say that is a great endorsement!

You're doing such a HUGE service to so many women - thank you so much!  

Loved his comment about the financial aspect of all of this.  He seems to be a compassionate soul as well.

christine47

Kate,

You are a true champion in asking the questions we all want to know.  How wonderful that you are getting these questions answered, and compiling a data base. I am have fat grafting tomorrow, to help with several small divots (clevage area), improve slope on one side and fill large deficit axillary area on node removal side.  My PS seems confident in what he has offered.  I have 600 cc smooth round high profile implants and so far no discomfort like I experienced with the TEs in the pec area. Will let you all know how things go tomorrow, My PS is not one you are discussing, sure hope is capable.

Anonymous

Lee- He does seem very compassionate and caring!

christine- Hope you will share the name of your PS so I can add it to the list!  Good luck with your fat grafting tomorrow!   

Anonymous

Wow Kate! I have to agree with Lee & Christine, what a great service you are doing for women!  Thank you for your research.  I feel like I went into my FG procedure with knowledge I certainly wouldn't of had prior, if it wasn't for the women and discussions I found here.  Your email correspondance was interesting and yes, Dr Koplin sounds like a pretty amazing person!  Thanks for sharing!!!

Anonymous

Megan- Thank you!



Christine- Hope your fat grafting went well!



After a few more emails from Dr Koplin I am considering flying out to have a consult with him regarding my next round of fat grafting. I am hoping to be able to get rid of the implants all together.