Still Uncomfortable with Implants

mom3band1g

Eve -- I was gonig to suggest you look into the fat grafting too.  I wish i had known about it before I had my mast.  I don't know a lot about it but it sounds amazing.  have you looked at Timtam's site?

k

Anonymous

Eve- I don't think you are vain or a coward for wanting to have breasts after MX.  All our lives we've been told that having breasts is important- a part of our feminity.  Yet, if we get BC we're suddenly supposed to not care?  It just doesn't work for a lot of us so we understand your need for reconstruction.  For me, it goes a long way towards feeling whole again.  I do understand your fears about implants and you're smart to be researching things.  I really wish I had.  The hardest part for me is just as you described- that feeling of wearing a bra 24/7 and not being able to take it off.  Like others have said, I would really recommend fat grafting and it really doesn't take much fat.  I just had my first round and I am 5'4" and was around 118 lbs at the time of my surgery.  Yet, the PS was able to swap out my implants for much smaller ones and then do FG over the top keeping me about the same size.  (I hope to eventually get rid of the implants all together.)  Let us know if you're trying to find a PS who does fat grafting in your area.

As far as your RSD you're probably right to be concerned.  I do think having the implants has caused my fibro to flare a lot more and my PS said that can happen to anyone who has an auto-immune disease.  (Not sure if RSD is considered auto-immune but you could have smiliar issues.)  There is a thread on here for those of us dealing with AI and BC if you're interested.  The title is "anyone out there with auto-immune/chronic pain before dx?"  

http://community.breastcancer.org/forum/108/topic/754362?page=16#idx_478 

Hindsfeet

Thanks Kate for understanding. Sometimes I feel bad for feeling bad for being so reluctant to getting a mx. Yes, let me know of any PS who does fat grafting in Portland, Oregon. Appreciate it.

Anonymous

Eve- I don't think you should feel bad for recognizing what a loss a MX can be. So many women, myself included, go into this thinking it's not a big deal. But it is. It's a physical and emotional loss and you're smart to recognize that.



I'm not home right now but will check my list when I get back and see if I have any fat graft surgeons in Portland on it. BTW, I love Portland! My DH and I try to get there at least once a year.

Anonymous

Eve- The only doctors that were on my list were both in WA.  Dr. Chris Nichols (pearlplasticsurgery.com) and Dr. Peter Neligan (uwmedicine.washington.edu).  I found a few in OR that seem to do fat grafting to augment.  You could contact them because sometimes they don't always have an updated website if they are doing whole breast fat grafting.  They are Dr. Timothy Connall (drconnall.com) in Tualatin, OR or Dr. Elisa Burgess (burgessplasticsurgery.com) in Lake Oswego, OR.  You should definitely research them first to make sure they're board certified, to check patient reviews and to see if there have been any complaints registered against them.  Good luck!

hallsnj5

Hello all! I have been lurking here for a month now. I find myself in the same situation as many of you. I had a biMX with lat. flap reconstruction 2 years ago and on August 29 had cellulitis and had both implants removed. I was a D cup before breast cancer and felt at the time that if I had to lose my breasts, at least I wanted to look the same as before. I lugged around two 550cc silicone implants on my chest and was never comfortable with them. I couldn't believe how good I felt when they were removed. I wish I knew more about fat grafting 2 years ago! I would highly suggest anybody going through a mastectomy to look into this. Because of the lat. flap my cleavage looked great, but I live with the tightness an pulling across my back every day. I am taking my time researching reconstruction this time around and hope to find a Dr. in the NJ area who does fat grafting. I hope this option becomes more readily available for all women facing the decision of reconstruction.

Lisa 

Anonymous

hallsnj5- You may want to check out Dr. Christina Ahn in New York City.  I've been hearing some great things about her.  Her website is nycbreastreconstruction.com.  She does fat grafting for total MX and implant deformity.  There is a link on her website to email questions.  Good luck with your research!

beacher4209

Hi Kate33, Hope you are feeling better and hope your husband is doing ok. I was going through this thread and came across a post you made on September 14th . I wanted to know if you still had the puling from your armpit scar tissue,and the tight pec muscles? I hope you do not have truncal LE. Has this all happened after fat grafting or did you have it before also?  I recently had a consultation with Dr. Trott and have one coming yp with Dr. Koplin Oct 27th. I was hoping the fat grafting and smaller implant would relieve me of the same issues you were dealing with in Sept.? Take Care,Karin

Anonymous

Hey Karin- I do still have the pulling.  I had started PT with US but Dr. Khouri told me what they were doing could actually break down the fat grafting so I stopped.  He recommended a breast MRI which I have scheduled for 11/3.  (He wanted me to wait until I was 6 months out from the FG for some reason.)  These are all new issues since the FG but I really think it may be because Dr. K insisted on putting new incisions in my armpits when he swapped out my implants instead of using my original incisions (under the fold of my breast).  I had questioned him about the risk of LE but he said it wasn't a concern.  Now I know that's not true.  

I was considering scheduling a consult with Dr. Koplin but found out he's not in network for me.     I did find out that Dr. Trott is, though, so may schedule one with her.  I really just want to get rid of these implants all together.  I do think just swapping to a smaller implant with the FG can bring a lot of relief, though.  The fat seems so much less heavy than those implants did.  And the results are so much more natural looking.  I think you would be very happy with everything.  I've heard lots of good things about Dr. Trott, too.  Good luck with your appointment with Dr. Koplin.  Hope one of them can help! 

dancetrancer

Kate,

Do you know if it was just the US that Dr. K felt was contraindicated for the fat grafting?  I know the LE manual lymph drainage is very gentle, and it is hard for me to believe that would do anything to the fat, especially when you are this far out.  Perhaps you could go ahead with the PT as long as they didn't do US (running it by Dr. K, of course).  I'm just thinking it may offer you some relief from the swelling and tightness, even without the US.

Lorraine  

orangemat

Do I have to post in order to make a thread appear in my favorite topics? This is a very interesting conversation, thanks!

dancetrancer

Orangemat, at the top of the thread on the right you'll see a link that says add to favorite topics.  Click that to add it (I think there is also an option to add it when you post - a little box you can click).  If you want email notification of new posts, you need to go to your favorite topics, find the topic, and click "add email notification".  There might be an easier way, but this is how I've been doing it. 

orangemat

Thanks! I had been trying to click the box next to the reply box, but it wasn't taking. Totally missed the link at the top of the page.

Anonymous

Lorraine- The PT also involved lots of manual manipulation as they tried to break up the scar tissue and Dr. K said this could break down the FG, too.  I didn't want to continue with the physical therapist since she didn't know she was risking my FG by her technique.  It kind of made me lose confidence in her.  I can still do the LE therapy (which was being done by a different therapist in the same place) but just decided to wait until the MRI so I know exactly what is going on.  I have been taking all the LE precautions in the meantime, though.

dancetrancer

Gotcha Kate.  Since fat grafting is such a new procedure, it's not something I ever had training on when I was in PT school, so it is likely the PT never had training on working with a patient with it either - and especially if she wasn't a specialist in treating post-MX patients. One of two things should have happened: (1) the MD who ordered it should have listed manual tx and US as a contraindication, or (2) the PT should have asked Dr. K if there were any special precautions since he/she was unfamiliar with the procedure.   It's always better to call the doc and be safe.  

mlp730

Kate,

Just curious, why is your dr ordering an MRI? I am also scheduled for one through my GP on the 24th. He wants to rule out that there isn't anything else going on with the continued pain I am having since deconstructing. I am now 11 weeks out from having my implants removed and continue to have the "iron bra" on. A very tight heavy feeling - almost like the TE phase!! I see my PS tomorrow but it will be the same response as it has been for 2 yrs - "everything looks good!" I also am scheduled for a consult with a dr. in the Pain Clinic on the 27th - hoping for some anwers soon!

Are you now dealing with LE as well?

Anonymous

dancetrancer- I think part of the communication problems are I had my surgery with Dr. Khouri in Miami, consulted with a local PS here in Phoenix who doesn't do FG and she is the one who sent me for PT and then was seen by a physical therapist who has never worked with a patient who has had fat grafting before.  And Dr. Khouri didn't know I had started PT since it didn't occur to me to let him know since I didn't think there was any harm in doing it.  I did call back to the PT facility to let them know about special precautions for those who have had FG.  

mlp- Dr. Khouri recommended the MRI because I am getting a sensation of my left implant rotating or that something is pulling on it with certain arm movements.  So I went to my GP (who has also had BC) and she ordered it for me.  I also went in for an LE evaluation.  The therapist said I do have some swelling which could be early truncal LE or just residual swelling from my revision.  Just to be safe I've been taking LE precautions and am waiting to see what the MRI reveals before doing therapy.  Sorry you're still not feeling relief from the deconstruction.  That is so discouraging!  I hope your PS has some answers but, if not, good luck at the pain clinic. 

dancetrancer

Kate - I figured that was what happened.  Might be a good thing to share on the FG board, especially for those who travel and need follow-up care at home with other docs.  

Anonymous

Dance- I did post something on my thread on there.  Maybe we should start a new one, though, about aftercare.  Dr. K's office should really be going over all these precautions, though.  I feel like I was pretty much on my own after my surgery.  Thank God for Lee and Alexandra or I would have been totally unprepared going in, too.

dancetrancer

Oh yeah, I forgot about that!  I totally agree with you.  I did get very quick replies to my questions, but  I just think something written should be given out, since we don't always know what questions to ask.  It's easy to break precautions when you don't know what they are, LOL!  

Hindsfeet

Kate...Thank you, thank you and thank you for the names of doctors who do fat grafting in this area. Actually Tualatin, and Lake Oswego aren't that far. I will call tomorrow morning. Now I am concerned that those doctors may not work with the hospital where the surgeon who may be doing my mx. Is the fat grafting immediately after surgery or do they put saline in the breast and you go in later to do the fat grafting. I tried logging on to the Brava website in Florida but couldn't get in. Tomorrow, I'll see the surgeon...new one, so I'll see how it goes. I really want the whole breast to be fat grafting.

Anonymous

evebarry- You'll have to check with those doctors to see what kind of fat grafting they do.  Some just augment other kinds of recon or to fill divots from lumpectomies.  Not all of them will do the whole breast recon but it's worth checking.  Usually those that do will do your first round of fat grafting during the same surgery as your MX.  The nice part about that is you wake up with a small breast mound.  I don't see why they couldn't do it later, though.  I know they do the fat grafting on women who have delayed recon.  Good luck with your appointment tomorrow.  I know how hard this time is as you try to figure all this out.  Once you have a plan in place it gets so much better.  

mahometmom62

Anyone with nipple irritataion. What next really. Went with out a bra for 1 day and nipple red and stining. This is my good boob with implant.

Hindsfeet

Kate, I spoke with the office of Dr. Connel. He's supposely the best fat grafting surgeon in the N.W. The person I spoke with is going to talk to the doctor about my case. I did ask if he could do at the time of the bc surgery. She wasn't for sure if he was certified to work in the hospital where I will be having my mx. If not, I said I would find a surgeon near the hospital that they work with. I really want this fat grafting. I feel so fortunate to have learned about it before going to the surgeon and talking with just any plastic surgeon.

bigbrowneyes

Has anyone had problems with infected saline implant? I am due to have exchange surgery as I hate the feeling of the saline implant-and this is now the second anerobe type infection I have had.

hallsnj5

Jill- I had what I believe to be a silicone implant infection, though the pathology did not come back with an infection identified. My PS does not mess around with infections at all. Before even seeing me, he told me that he would probably have to remove it that day. By the time I was checked out in the ER it was spreading to the other side. I had both implants removed that afternoon. I can't believe how much better I felt without them! I saw a new BS today and really want the fat grafting. Fingers crossed for a good biopsy result and I will move forward!

Lisa 

Hindsfeet

Kate...I'm not sure the breast surgeon I saw today knows much about fat-grafting. Also the doctor I spoke with who is suppose to be the best in the N.W. has never done a whole breast fat grafting. He has done lumpectomies and breast enhancements. I would be his first. The other major concern is I'm not sure if my insurence will just accept any plastic surgeon.

I'm so torn. The PS the surgeon recommended is suppose to be one of the best around, but he doesn't do fat grafting. I wonder if I could talk him into doing one for me.

kriserts

My surgeon recommended agaisnt fat grafting. She said there was a lot of chance of necrosis, and that when it happens, they can't tell whether it's a recurrence or not.

Anonymous

evebarry- Not sure I would be willing to be someone's first patient- especially if they haven't specifically trained in this procedure.  Is it possible for you to travel out of state with your insurance?  I know it can seem overwhelming to consider doing surgery away from home but this is something you are going to have to live with for a very long time.  There's a member on here, IrishLuck, who flew from southern California to Miami to have her NSM and immediate fat grafting.  I can tell you I saw her photos just a few weeks later and she looked amazing.  Worst case you can always go the implant route and then someday have the implants replaced with the fat grafting down the road as it becomes more available or delay reconstruction all together.  I know these probably don't seem like as appealing an opton as fat grafting but, unfortunately, we are on the cusp of all this.  We know it's out there but not that many surgeons are doing it.

kriserts- I wouldn't necessarily take the advice of a surgeon who isn't trained in and does not perform fat grafting.  And she seems to be quoting outdated research, actually.  The fat grafting in the past did have a tendency to calcify causing hard lumps to form.  Surgeons who are trained in this have become much better at preventing this from happening.  The ones that are very skilled at it will inject the fat drop by drop which decreases the chance of calcification tremendously.  Even if calcification occurs it is very easy to tell in scans what is calcified fat and what is BC.  With any kind of recon there is risk but it seems as though there are a lot more complications with flaps and implants that has been seen by using a woman's own fat.   

Here is some info on the BRAVA site-

In 1987, tlie American Society of Plastic and Reconstructive Surgeons institute a ban on fat grafting to the breast because of poor graft survival, fat necrosis and limited breast imaging.Today, radiologists can clearly differentiate neoplastic properties from fat necrosis.Micro fat grafting has been markedly improved with refinements made in harvesting teclmiques. preparation of the graft site and specialized instrumentation.In addition Brava , an external breast tissue expander, was found to increase the vascularity of the breast and to temporarily expand the extracellular and extra glandular preferred recipient site.

Anonymous

If anyone wants to read up on fat grafting here is a great article-

http://www.lipotransferencia.com/files/papers/011.pdf 

Here's an excerpt-

Limitations and Complications 

The complications associated with fat grafting to 

the breast in the fashion described here seem to be 

similar to or less severe than those experienced with 

other breast procedures. With the use of minuscule 

incisions and the blunt nature of the technique, the 

possibility of damaging the underlying structures 

such as nerves, ducts, and blood vessels is signifi- 

cantly reduced. Fat tissue that is not perfused can die 

and result in necrotic cysts and even calcifications, 

but this can occur in any surgical breast procedure. 

An added benefit of this procedure is body con- 

touring with the removal of fat. 

 

For 19 years, plastic surgeons have rejected fat 

grafting to the breast because of speculation that 

transplanted fat might die and cause lumps or 

calcifications that would interfere with breast can- 

cer detection. There is no evidence that fat graft- 

ing should cause greater concern than any other 

breast procedure. Fat necrosis and calcifications 

occur in patients with every type of breast surgery: 

breast biopsy, implant procedures, radia- 

tion therapy, breast reduction, breast 

reconstruction, and liposuction of the 

breast.  The incidence of calcifications after all 

types of breast operations varies but has been re- 

ported to be as high as 50 percent of patients after 

2 years.  Fortunately, radiologists are adept at dis- 

tinguishing the calcifications of malignant causes 

from the benign calcifications resulting from fat 

necrosis.