Reconstruction after RADIATION

4sewwhat

Happy Monday Ladies!!

Raelan, hope you are feeling great while you get to lounge around!!  Are the twins boys??  I find my youngest, the 9yo girl child, is much more helpful than tth three older brothers put together!! (11,14 &16)

Quiltrunner!  I found the tags!!  SimplyBasic style 4153  $5.98  Red headed lady in a black bra on a white label with a blue stripe across the top.  Comes small -2X  and NoBo (no boundaries) $4.98sku ends in 16889   It is lacy across the bottom and I don't like it as well as the other.  It does ride up more.  Beige label with red on it.

Babs, Lojo and Patricia!!!  How are you girls doing!!

I'm off to see a new PS today to get his take on my little Nemo boob!  My friend says I am just Flirting, not cheating on my PS!  Yet!!

Have a great day ladies!!

Raelan

FG Amigos-  made it through another night relatively unscathed.  Not sure if it's the Valium or anti-nauseous drugs that knock me out out, but either way, no complaints.  My body clearly needs the rest to heal.

The 300 pound elephant on my chest is starting to feel lighter and I'm hoping to start weaning myself off the Valium sometime today.  We'll see how that goes.  Interestingly I really don't feel the T.E.s to the extent I thought I would.  Of course, this may change as they get larger.

babs6287

Raelan  I never felt the TE's except after a fill-then they felt tight.  My right TE is just a part of me now until we figure out what we're definitely going to do with Mr Lefty.

So for the next few months I'm in a holding pattern-as they say "no news is good news!!!"

4sewwhat-let us know what the PS from today says!!!!

Babs

Raelan

4sewwhat- how'd your appointment go?  Interested to hear what a different PS has to say.  

I posted an updated photo on the picture forum without all the extra tape you seem to leave surgery with.    See my PS tomorrow, so hopefully he's pleased with my progress.  I'll let you know how it goes.

4sewwhat

Hiya Girls!

Raelan, hope each day you are feeling better.  Will be interesting to hear what your doc has to say.

Speaking of interesting, the PS I consulted with yesterday threw me a curve ball I never saw coming!  He pretty much did not agree with this type af fat grafting.  He said they have not "proven" fat has stem cells and said that the blood flow they establish is minimal.

What he does and is recommending for me is Hyperbaric treatments.  He also said he wouldn't take me until I was 6 flipping months out from the infection.

Hyperbaric therapy...

90 minutes a day, 5 days a week, for 4 weeks.  Then put in anTE. Then do another 4 weeks in the tube!

I didn't even know this was an option and seems WAY time consuming.  I don't know if it permanently helps or wears off after you stop.  I know it is cumulative that's why every day like rads.  I know they use it a lot with flaps that are trying to fail to speed healing, increase blood flow and try to stop necrosis.  It is not without SEs, the worst of which seems to be it can accelerate or cause cataracts. It can mess with your ears and blood sugar too.  But they said it could cause weight loss too!  That's in the plus column for me!!

I just don't even know what I am thinking now.  I need more information as I don't know a thing about hyperbaric in this type of application.  I do know they are using different oxygenation techniques to try to kill cancer cells in studies. I don't have any of those left, for the record!  

I guess I need a lot more info and I am initially thinking why can't they do both?  Maybe fat graft and then only 2 weeks in the tube before and 2 weeks after.  Plus I don't know what they do with exchange surgery?

I have a consult with Dr. Namnoum on the 15th and another doc here on the 2nd.  I have been told I could go back with a TE and nothing else has to be done by one doc.  My doc said wait 4 months and he initially told me flap was all I could do. He has been researching and has now changed to another TE, but still undecided on what to do to make it successful.  Now this new guy says 6 months after an infection and says no to flaps.

ARGHHHHHHHH.  I just want my boob back!

Have a good night Ladies!

Lynne

4sewwhat

Hey Girls!!  Whatcha all up too???

Raelan, how are you feeling???

Here's to a good week for all!!

Raelan

Hi Ladies - Just wanted to give you all a quick update on how I'm doing.  So far, everything looks good.  Saw my PS last Wednesday and he was happy that we made it past this first phase.  I'm still getting used to the feel of the T.E.'s (do you ever really get used to them?) and had to show my husband the cool party trick you can do with them when you flex your pec muscles.  For some reason, he wasn't impressed

My non-radiated side continues to perform like a rock star.  It's soft and pliable, and there is definitely more tissue on that side for my PS to work with.  In fact, he put about 50cc's more on that side during my surgery.  His current line of thinking has him filling up the left (non-radiated side) faster, then letting it just sit on the sidelines while Mr. Righty gets low and slow fills.  So, sounds like I'll be lopsided for awhile, which will be really interesting to manage since he also doesn't want me wearing a bra at all during this time .  I'll have to get creative with how I dress for work for a couple of months.  I think nice drapy scarves will be my best friend for awhile!

Otherwise, I'm feeling good and have to keep telling myself "just because you can do it, you shouldn't!"  I'm working from home this week and noticed after sitting at my computer all day my back started to get really tight, which in turn started to cause my pec muscles to tighten up.....everything's connected isn't it.  So, will need to make sure to get up from my chair for frequent breaks.  I'm also doing some minor stretching.....but not too much yet.  Just enough to keep things loosened up a bit.     

I go in next Wednesday for my first fill so that should be interesting.  Until then, just enjoying the freedom of no longer having to mess with prosthesis.....I couldn't put those things away fast enough after being flat for 2 years.  And yes, I keep touching them just to confirm there's actually a "mound" there.  Didn't realize how much I missed them. 

Raelan

4sewwhat - Interesting counsel regarding the hyperbaric chamber.  I've definitely heard of it being used to help with wound healing, but it's a huge time commitment.

Glad to hear you're also planning to have a consult with Dr. Namnoum.  I understand he led several lectures at Atlanta's 30th annual Breast Surgery Symposium in January including one titled, "Reconstruction of the Radiated Masectomy, Fat is the Key to Success".  Whippetmom is attemtping to get more information on what he shared with his collegues as part of this lecture.

All to say, I suspect you'll get a different opinion from him regarding the benefits of fat grafting than what you received from the PS you saw on 3/24.  However, I do think most PS's are going to want you to wait for several months before they attempt reinsertion of a T.E.  It's frustrating, I know, but hey, if a few additional month's wait means the difference between a successful outcome and a less than optimal one......it will be worth the wait.

Hang in there and keep us posted on everything you're learning during this reseach phase.  

babs6287

Raelan

so glad you're doing well!  Remember, not to overdo!!!!

Babs

Sherryc

Raelan so glad you are doing well.

Lynne I have heard that the Hyperbaric is very good for healing.  I know it is time consuming but if it will help the outcome I think it would be worth it.

I was filled to 100cc at time of surgery.  The sad thing is I was so flat to begin with that I looked exactly the same coming out of surgery. LOL  My PS filled 100cc at a time once a month for each fill to settle and then once the last was done had me wait 3 months.  For me the TE's were uncomfortable but the fills actually were not that bad.  With my rads damage I actually expanded pretty well, but my skin on the rads side is super thin and I have bottomed out again.  Need to get it fixed but taking a break from surgeries.Next time my PS is doing FG and more permanent stitching for support.  Not sure when I will have it done.  He said whenever I am ready.  He is a great guy very humble and does not like to take credit for his work, gives all the credit to God.  There are 7 PS in practice and they all specialize in breast reconstruction.  Amazing that they have found 7 PS that are all very sensitive to breast cancer patients and all very humble at their job.  No god complexes there.  

4sewwhat

Hi Ladies!!

Raelan, hope you are lounging somewhere with wonderful weather, a cool, refreshing beverage and a good book all while feeling wonderful!!!!

Quiltrunner!  How are you coming along since that fat grafting a few weeks ago??

Babs! How are you doing.  Any ideas for Mr. Lefty yet???  

Sherry!!  Your group of PS sound like my guy!  In fact he is leaving for Africa tomorrow to work.  He showed me a pic of a pregnant lady with seizures.  Unfortunately they dont have much medicine to offer her there and she had a seizure while cooking and fell into the open fire.  Her whole left leg is burned horribly.  She is one of the ladies he is going over there to take care of.  I am so lucky to have found him. We have a very open dialogue and talk with each other not at each other.  I always feel like he is listening AND hearing me!!

Quick update as I saw said PS yesterday!

First off he pulled the damn drain!!!  I slept well last night.  I know they are necessary, but going on 3 weeks with the drain after 4 weeks of manual draining in the office was getting really old!!!

He says as soon as he gets back from Africa he will see me (5/1) and we will schedule a procedure.  I asked what that would be and he said we can't go wrong with trying the fat grafting!!!

I also told him about my consult where the hyperbaric came into play.  That doctor is actually a friend of his and they handle on call stuff for each other.  He said HB could be wonderful for the rads damage, even though mine is minimal and can be fixed without, but if I can do anything to make it even better, we should consider it.

So he committed to getting together with the other doctor and discussing my personal case to come up with a plan!  I told him I would buy the coffee!!

The questions I have about the HB are other than possible accelerated cataracts, what are the dangers?  Also is there a test that can be done to determine the actual amount of damage I have and then adjust the time in the tube accordingly, or is 8 weeks total just what they do?

The time commitment is big, but if it helps I'm all for it.  I really wonder what it could do for my poor ankle too.  It was doing awesome before chemo.  I came out of the boot 4 weeks early and even chaperoned an 8th grade trip to Disney 3 months after it shattered!  Chemo really did a number on the nerves that were still healing from the trauma though.  They have said it will be 2 years before I know if the neuropathy is permanant.  Some days I think it is getting better and some days not.  I really wonder what the HB could do for the nerve damage there???

Raelan!  I do have a consult on 4/15 with Dr. Namnoum.  I had to postpone after I got the drain put in.  I have been in touch with Deborah and she actually said go for the HB!!!  I talked with my PS about maybe doing both because the HB might actually make the fat grafting more effective.

My PS attended that conference where Namnoum gave that talk.  His office is trying to get me a transcript or something that I can post here and pass on to WhippetMom.

As far as the wait, I have been told many things.  One doc said she would place a TE at 2 months, no grafting, no nothing.  Another said 6 months to start anything.  My PS is going more on fact, by what we observe.  The infection went away quickly with minimal antiB's.  He is also judging based on what he sees and feels as far as the tissue softening up.  I am taking several vitamins and supplements to help that also.

My I have run on at the mouth!!!  Or keyboard as the case my be!  I so should be cleaning and packing for my trip.  I can't wait and my husband is so excited I'm surprised he doesn't jump up and down when he talks about it!!

You all have a great weekend!

Lynne

babs6287

Lynne

Have a great vacation!!!!!

I'm still on hold but see the PS on 4/22 for him to see how my skin is/has changed from the fat grafting!  Will report in after the visit

Babs

Sherryc

Hope everyone has a great weekend.

Carmen1954

Hi Ladies!

I am new to this thread.  I am scheduled for reconstructive surgery on Wednesday, April 9th.  My PS plans on putting in a TE on my radiated side (finished up rads 19 months ago in September of 2012) as well as a reduction, lift and some lipo. on my good breast.  My question is, has anyone had good results going this route?  Most of the research that I have done indicates that TEs and permanent implants are not recommended for radiated skin.  I have also seen some pictures of what the complications can look like.  I'm hoping this will not happen.  Can one of you kind ladies give me some much needed advice or direction to take as my surgery day is only 5 days away.

Many thanks and hope everyone has a great weekend!

Carmen

4sewwhat

HI Carmen!

The only thing I could think of would be to ask your PS to do some fat grafting into, not around, the radiated tissue and then place the implant.  If you are having some lipy already it would be a really simple thing to add to the mix!   He must (hopefully) feel pretty comfortable going this route to give the TE a try.

Good Luck and have a great weekend!

quiltrunner

Carmen1954, I am kinda in your shoes.  I am so excited to get to the day I get the tissue expander placement!  But, I agree with what Raelan says in that sometimes doing some precursory steps may take longer but well worth the wait to have a successful outcome.  We all know that TE and implants after rads have a pretty high risk of failure.  I've had an infection, skin splitting open and had to have the implants removed after one-stage recon failure during chemo but before rads.  I was so sick that I truly thought I had MERSA and was dying.  I never want to go through that again!!!  However, now that I've had rads the options for recon are fewer.  Having several fat grafts, with 2-3 months 'cooking ' time between grafts, before TE placemat helps rad tissue rejuvenate and is more pliable and softer.  The risk of failure is significantly reduced and the final outcome is better. 

I have a friend dealing with the exchange 'rejection' now.  Her PS did quite a bit of fat grafting at the time of the exchange, but that doesn't allow enough time for the stem cells to 'cook' and repair the rad damage.  She's since been back into surgery and it's looking like she may lose the implants.  She now wishes she had done pre-fat grafts even though it would have taken a few months longer.  

I had my 1st graft 12/5/13 and the second graft about a month ago.  The procedure is so easy!!!  I went for a 3 mile run the day after the 2nd graft.  The PS said I could possibly have the TE surgery next month, but I'm considering asking my PS to postpone the surgery and get 1 more graft under my belt and allow some more fat/ stem cell 'cooking' time.  I'm running a 1/2 marathon in July and rather than risk a less than optimal outcome and rushing through I might wait until after the race. I'm so anxious and excited to get started that waiting 2 more months just seems like a lifetime.  BUT waiting 2 more months isn't very long in the big scheme of things in this whole journey.  

Remember, postponing is not canceling!  Here's some info to use in making your decision. 

http://www.plasticsurgery.org/news/press-release-archives/2012-press-release-archives/technique-provides-new-option-for-breast-reconstruction-after-radiation-therapy.html. GOOD LUCK TO YOU!  

quiltrunner

http://www.plasticsurgery.org/news/press-release-archives/2012-press-release-archives/technique-provides-new-option-for-breast-reconstruction-after-radiation-therapy.html

quiltrunner

I can't get the link to attach but the website for the American Society For Plastic Surgery has the information on fat grafting and radiation.  Also your PS should know if this is something that would benefit your situation

Zillsnot4me

I had the whole nine yards last year. BMX, chemo and rads that I finished before Christmas. I thought I would be happy flat but had a meltdown before I went on a date with DH over my lack of curves. I know I should wait until next year to do anything. 

My question is how long do the fat grafts last. I would be perfectly happy with small "mounds" as I was barely an A cup before.  Do think that is a possibility or must one get implants? 

I should talk to a PS but am already fighting with ins about sleeves and foobs. 

Just asking an opinion. A lot can happen in 6 months. Thanks. 

Raelan

So, had my first fill yesterday, but only on the radiated side.  During surgery PS put in 200cc's on the left side and 150 cc's on the right.  Yesterday he got me evened up.  The right radiated side is much tighter than the left side, even with the 2 sessions of fat grafting prior to TE placement.  However, we're still very early in the process.  This is a marathon, not a sprint.  PS indicated we'll do 3 more fills of 50cc's each, 2 weeks apart.  This will get me to 350cc's in my low profile TEs with an end goal of 500cc implants.  Just hoping the radiated side starts to soften up a bit as we get further down the road.  I just don't have a good sense for what's normal in terms of tightness since my left side had more excess tissue and wasn't radiated so it's currently performing like a rock star....pliable, soft, and pain-free.

Just posted updated photos on the picture forum.

Zills -  Fat grafting will last indefinitely unless you lose a bunch of weight.  However not all fat takes with each graft, so multiple fat grafting sessions are generally required.  Some women have had a higher success rate using Brava, but the device is a huge time commitment. If you truly only want an A cup and have enough fat for a couple of grafting sessions, it would certainly be worth having a discussion with your PS about using this type of approach.

4sewwhat

On my way today to meet Dr. Namnoum!  I will report back in later with info!

Raelan

4sewwhat - How'd your appointment go.  I'm dying to hear about it!

geewhiz

Lynne - you are thinking about hyperbaric? That is AWESOME! I had signed up for it a few years ago and just failed to follow through. I wonder if it would help me so far out? I know Namnoum is a big proponent of it! Can't wait to hear about your appointment!

4sewwhat

Hello Girls,

Sorry I have been MIA.  Super busy with kid stuff for the end of school and I had my gallbladder removed on the 25th, took a friend to the body shop for a new hip, Sis-in-law getting divorced and having melt downs, you name it!!

I hope you all are doing well!!  Raelan, how are those TEs??  Quiltrunner, what's your doc's take on the second grafting and getting a TE in there???

What can you all tell me about lipo??  compression garments?????  Arnica and other supplements????

So here is my update.  Sorry it is lengthy!

 It has been 2 1/2 months (2/15) since we pulled my implant after it got infected. (ice storm, closed roads, that was me!) We also had to install a drain at one month (3/14) out because the incision would not heal. Well I kept that damn drain almost 3 weeks and the level was about 20-25cc a day. So with both Dr. Woods and myself getting ready to go out of town we pulled it. Well within 24 hours I had a small boob again. It is not all that squishy, but it is about a small B if I were to guess. It has remained that way since. Doesn't get bigger or smaller, it just is. I don't mind though because I don't really wear a fake, I just go as is.

Well anyhow, I think last I wrote I had seen Dr. Robert Miller and he told me fat grafting was basically worthless and they couldn't even prove it has stem cells and he didn't want to stab my muscle 40-50 times to implant fat. He would stick me in the Hyperbaric instead. He also said he would not touch me until I was 6 months infection free.

Next I went to see Dr. Namnoum. He is out of network for almost everyone, but he only charges $100 consult fee. He spent a good amount of time with me. They took lots of pictures then he met me again in an office, with my clothes back on, and he went through photos of other patients with me. He offered all the flaps. I told him that didn't really interest me unless it was a last resort. I told him with my node removal Lat flap worried me, he said it would be fine, he does them all the time, but we had other options. He also said the fluid isn't an issue as long as it is sterile and if we drain it, it is just going to fill back up.

When we got to discussing the fat grafting he was just all about the BRAVA. This surprised me because Geewhiz said he was exactly opposite with her, saying that the fat was the key and not the BRAVA. So long story short, this is what he was suggesting.

BRAVA for about 3 hours a day for 2 weeks. Then do a small fat grafting, around 100-150cc.

Wait 3-6 months

BRAVA VERY AGGRESSIVELY (his words and he showed me some pics where this poor woman was so distended and purple/red, yikes!) They are saying this means 8+hours at night for 3 weeks, then 24 hours nonstop and they will remove in OR. At this point he would be injecting 350-400cc.

Wait 3-6 months

At this point we would then decide if we continue only with fat or do a TE. He also mentioned AGAIN a flap at this point.

He also talked about modifying my recon on the left. Now mind you it is a 700cc implant that has gotten quite comfortable just hanging around. It has made itself a little too at home and needs a lift of some fat. With the right being with drains and stitches, etc I have not worn a bra much either.

Anyhow, he was talking about pulling it and doing the BRAVA or doing BRAVA with implant in place and adding fat. To be honest I didn't delve into options for that side much because it is not top priority for me.

I also asked him how he would rate my rads damage. He says of course it's a 10, it's radiation, it's always a 10. Dr. Woods says it's about a 4 and he has been intimate with the inner side of the area! My LE therapist says my damage is not bad at all and my RO says by feeling that there is very little damage evident. RO also said he really doesn't think hyperbaric would give me any advantage.

So, I left there with my head spinning faster than it had been to start with. His assistant said I had very good insurance so my out of pocket would not be bad and they cap it anyhow. She said she would check and let me know.  I also can't put my finger on why but the BRAVA just bothers me for some reason. I am probably being crazy!

I also told them about BCO and asked for info on his lectures, etc... They passed it on to their PR department and they were supposed to do something with it, but I haven't seen anything yet.

So, fast forward again. I saw Dr. Woods last week for a check up. He was not initially thrilled with the mound I have, but is happy with the incision healing. When he put in the drain he did some revision and re-stitched. We started discussing options. He brought up the flaps. What is it about the flaps! I again politely declined! Now he tells me he doesn't think we can do a TE again and he has never done one in a radiated site, post rads. I am cutting him a little slack for flipping on me again because he just got back from Africa where he has been working on burn victims, so he was just back in the office trying to catch up on everyone again.  Also he is a by the book guy and he acknowledged that I have him all the studies but said that the AFT to TE to Implant wasn't in any textbooks and is a new thing.

So, we agreed on lipo and fat grafting without BRAVA. He said we can't go wrong and we will see how it takes and where we go from here. I am scheduled for 5/21 and he is going to lipo from my thighs because I just had gallbladder removed and they were poking around in my belly. Plus I figure I will start at the bottom and just keep working my way up!!! I told his office girls I was just going to let him keep moving fat until I had nothing left to lipo and then ask for a breast reduction!! Their response....."PLEASE Don't!!"

He said he will harvest about 800cc and transplant about 400-600 depending how it goes while he is doing it. He decided the fluid pocket is actually a good thing because it is acting as a natural expander for now.

He is planning to inject in 6 spots. If you imagine a clock he will use 12, 2, 4, 6, 8, and 10 for positioning. He plans to go parallel to the pec muscle and insert the needle then deposit the fat as he is withdrawing the needle. At each entry point he will do this several times in a fan shape, so like 5 lines stemming out from each entry point. He explained how it overlaps this way without putting fat cells directly next to each other. The fat deposits will be within the muscle and some between the muscle and skin layer. They say even in radiated tissue something like 57% takes on average. I hope so!

I hope that made some sense!! He drew me a picture.

After this he just wants me to sit tight for 4 months or so, but he does flip flop on me! I am hopeful that in 3 months we can go in with some more fat and a TE. Time will tell, but for now this is progress!

I have not dismissed Dr. Namnoum. I just don't know what to do so right now starting with this fat transfer seems the simplest way to go and see what happens. I will post pics on the pic forum both before and after.

babs6287

Next fat grafting is now scheduled for Thursday 5/22.  Just hope I don't get another infection!

Babs

4sewwhat

Good Luck Babs!!  I go on Wednesday 5/21!!  I can't wait to get this show on the road.

Do you have any TEs or implants now?

Did you have staph infection??  I saw where if you take garlic and oregano supplements they are natural fighters of staph.  That is supposed to help clear up an infection and also prevent staph infections.  It may be bunk, but I figure it can't hurt anymore than a good Italian dinner!!! 

Also they say if you rub Tea Tree oil on the infection site it helps clear it from the outside.

Like I said, it may be crazy but these days I will take what I can get!!

Have a great weekend girls!!

babs6287

4sewwhat

I still have my TE in on the right and had my left TE removed due to infection- which we now think was cellulitis. (After all the tests that were taken, nothing showed on ANY blood work or in any cultures.)  I'm hoping that this fat grafting (on the left)does the trick and that maybe???? I'll have a very small implant done on the left in about 3-4 months-at which time I'll do the right exchange with a mastopexy.  

The only thing I'm doing now is Hibeclens washes on the left to help prevent me from another bout of cellulitis.  The garlic sounds great and so delicious!!!!  I remember my grandmother telling me that as a kid they wore garlic around their necks to ward off evil and illness-maybe it's time to bring that back for BC women!!!

Babs

4sewwhat

Hey Girls!!

Got my fat grafting yesterday and my doctor is really excited and said it went great.  In the pre-op area he actually said he read everything I gave him, which was quite a stack!  He said it was fascinating and "Cutting Edge" stuff!!

He was very pleased when he saw me in post op and my husband said doc seemed really happy about how things went when he talked to him!

Now I just gotta sit and percolate!  Thighs have a little bruising, but not bad.  Where the bruising is is not where I expected.  I wanted to lose the inner thigh up high but it is the outer area and low/back inner.  Oh well there is always next time!  

He grafted in 5 places around the boob and sent 4-6 (i think) "fingers out from each spot.  It is a little tight and sore to the touch, nothing terrible to speak of though.  Thighs are fine if I am sitting or laying.  When I stand up and gravity and change of position takes over they smart/burn for a few seconds.  All in all nothing to complain about!  Especially since it hasn't even been 24 hours!

Let me know how you all are doing!  I am going to try to get pics posted to the forum.  May have to wait for my tech support to get home from work!

Take care!  It's almost the weekend!

babs6287

just finished fat grafting number 2. Dr said all went really well- just out of fat!!!    Now we wait and see. Hopefully in 3-4 months the TE exchange on the right and small implant on left. Just hoping I don't get cellulitis again !!!   Taking anti biotics to prevent that but you never know!!!  On my way home from hospital now. 

good weekend to all

Babs

quiltrunner

HAPPY HAPPY JOY JOY for you both.