Revisions after Prophylactic Mastectomy

FireFly83

After testing positive for BRCA2 in August I started doing my research and decided to do PBMX nipple/skin sparing. I had surgery about 5 weeks ago. I knew my risks and my PS told me I was young (31) and healthy and this was probably my best choice. My aunt told me to do it because I shouldn't have to go through chemo and radiation like her. I'm not a big chested girl that's why I had breast augmentation several years ago. I figured getting PBMX will reduce my stress and worry of getting breast cancer and I get a new set of implants Now I'm upset that my PS went smaller than we first agreed and I know things can change and I understand why he did what he did. But I feel that I can be upset and he understands. He told me that next year I can change to bigger ones. Still upset because that's more co-pays. But now every time I flex or move certain ways I notice ripples and certain spots can feel the implants oh and can see dents. And I went with silicone teardrop implants to decrease risk of wrinkling and ripples. He said to correct this we will have to do fat grafting. Has anyone done this? I'm 5'8 and 130 lbs I don't have much fat. The only thing I have is a pooch from 3 kids lol. Does it take a lot of fat to fix the imperfections? I also heard that time can correct some of the dents by scar tissue and collagen is that true? Anyone else heard of this? Thanks for any help and reading.

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alizbeth

I had my exchange surgery to implants about 2 months ago.  My PS did fat grafting at the time of the exchange.  I am 5'2" and 103 lbs so I didn't have much fat either, but he managed to find enough.  The fat grafting is nice because it can smooth out the areas and make it look more natural.  Some of that fat did get lost or reabsorbed so it doesn't look as robust now as it did 2 months ago, but still an improvement over not having had fat grafting.

steelersluver

I'm interested to hear about your experience with fat grafting while being thin. I am about 5'7" and around 120, so I also don't have a lot of extra fat. I now have implants, but got a lot of scar tissue and constriction from rads. I had a BMX, but am pretty lopsided after rads. The PS wants to do a lat flap revision, but I'm not enthused. She wasn't convinced I had enough fat to fat graft, though she did say that was the best option under ideal circumstances.

FireFly83

Thanks for sharing your experience alizbeth. I saw my Dr today and now I'm totally confused. So now he says there's not enough fat and he wants to just wait and see. He is pleased with the appearance. Really? I put on a swim suit just to see if you can notice the rippling and guess what you can see it and the dents. So now I'm at a loss. I guess I will wait to see what the future holds and what changes. He even changed him mind on increasing the size. And I've heard two different things increasing size could decrease rippling but also heard decreasing the size decreases he rippling. I'm just really confused and didn't get much answers today.

BayouBabe

Firefly - have you considered getting a second opinion from another PS? I changed PS midway through. It was the best thing I could have done.

DiveCat

You are still VERY early out. Most PS's won't consider revisions until at least 6 months out, some until a year. There are a few reasons for this, including your body needing healing time AND because it can take that long for everything to settle and to know final outcome. My own PS would not even consider fat grafting until a year out because that way he can know exactly what he has to fix. Time indeed can change appearance - and that goes for improving it as much as worsening it.

There is always a risk of rippling with implant reconstruction. How much rippling you have or do not have depends a lot on your own skin thickness and laxity. And yes, increasing size of implants CAN decrease rippling especially if the issue is a skin pocket that is too large for the implant, but it is not foolproof. The idea is that the snugger the implant is held in the pocket, the less chance it has for movement/rippling. Some rippling may just be unavoidable, especially in certain positions. Fat grafting can minimize the appearance. Implant distortion (meaning a strange apperance when flexing) is also the nature of having the implants under the muscle and not a lot of tissue coverage over top. One thing to clarify is whether your rippling is traction rippling? Anatomical implants have a higher risk of traction rippling over smooth implants (which have rippling of course, but that is rippling of the implant itself). Traction rippling occurs where your tissues adhere to the textured surface of the implant and may pull in odd ways on the skin surface. You WANT adhesion with textured implants to prevent rotation, but sometimes it can result in this traction rippling. My understanding is the only way to resolve traction rippling is really to switch to smooth implants.

Reconstruction just won't ever be like an augmentation. That does not mean you cannot have a good result, but it just won't be like augmentation.

Anyway, I had PBMX with immediate implant reconstruction in April 2014. I have smooth round implants. I have some rippling. If that rippling was all like it is on my left side (minor) it would not bother me, but I do have more signficiant rippling on my right side, as well as a prominent dent that is there even standing straight. When I lean over my right side reminds me of water in a plastic shopping bag! Since I wear a swimsuit a lot for my hobby and the business I run with my husband, it is not something I can hide easily (I look great in clothes!) I am going in for a revision in February or March, to switch to 410s, or anatomical silicones like you currently have. Fat grafting was also an option for me, and is still an option in the future, but I would prefer to avoid it if possible. I don't have a lot of extra fat either but many PSs are good at finding what they need. My understanding is you do not necessarily need a LOT of fat, but that you may need repeat procedures as you can lose a good portion of the fact injected.

FireFly83

DiveCat thanks for your response. I know it won't be perfect and this way my choice. But I think the thing that bugs me the most is my PS suggested something at my last visit and now he took it all back. He just needs to stop suggesting stuff until he knows for sure lol. I guess I just need to be patient and thankful. May I ask why you want to avoid fat grafting?

BayouBabe I have thought about another opinion. I really like my PS staff and him. I just don't like how all of a sudden he changes his mind on our plan.

I have to stay positive. I did reduce my risk of developing breast cancer. I need to focus on that. And it is still early to see final results. I do like the silicone teardrops. They look more natural. It's just strange how they feel colder than my body temp. Has anyone experienced internal itching, like an itch you can't scratch? And I have these feelings, almost like when you are breastfeeding and you have that let down feeling. Anyone else experience that? It's very strange, I can't feel anything when I touch them but I feel that. My PS said no one had ever told him that.

BayouBabe

Just a quick note on the fat grafting. I have had it twice. It has made my implants warmer, as they are now surrounded by a bit of fat. I also retained almost all that I had grafted, though I know this is not the case for everyone

DiveCat

My reasons for not wanting to do fat grafting are multi-fold:

1. I don't think it would resolve MY particular issues which are in part simply due to the nature of the silicone and how the implant sits;

2. I don't want to start something that might require multiple attempts (and surgeries and recoveries and time off work and my hobbies) and trips (my PS is out of town);

3. I'd probably stress out over any fat necrosis;

4. From what my PS (and others) have described on limitations during recovery post fat grafting, it's something I would rather avoid if possibledue to my lifestyle and so on especially if it turned into repetitive procedures;

5. I don't really have any interest in touching other body sites, not even if that is liposuction.

I should say that it is not off limits in the future if needed, and many women are very happy with the results of their fat grafting, it just is not something that gives me warm fuzzies personally!

FireFly83

DiveCat thanks for sharing your reasons. I'm not to klen on having another surgery. My PS told me that changing the implants to larger would be a few days out of work and much faster recovery time. I guess with this surgery everyone thought it would be easy breezy and be back to myself in a few weeks. We knew there were risks and possible complications and didn't really think it would happen. I totally get your point about the fat necrosis, that will definitely be added to my cons. Especially since I had to deal with certain areas of tissue necrosis with my PBMX. I'm just wasn't use to being the person that needed the help. I'm used to being the one that helps everyone and being down for weeks was not fun. M just ready for everything to be 80-90%