Why tissue expanders?

I_Spy

Hi guys I need help. Just met with the plastic surgeon today for consultation regarding my PBMX. First I had to meet with her Physician's Assistant, who seemed to want to answer every question I might have so that the doctor didn't have to. The problem is her answers didn't make sense, and then I felt flustered when the ps came in and I didn't re-ask the questions that had answers that made no sense. So let me ask you this: If I'm having prophylactic surgery, why do I need a tissue expander? Why can some people get direct to implant and others can't? I assume I'll have skin left over -- I'm not flat chested. I'm just really confused on this point. The PA said something stupid like it was dangerous or higher risk of infection or something, but if that were the case why do tons of women get it? Maybe it isn't right for me, but I wish I had a sensible answer. Anyone?

inks

If you want direct to implant you should look for surgeon who will give you what you want. With prophylactic surgery it makes sense to do it all in one step and avoid the second surgery. Breast reconstruction is an area of expertise and surgeons seem to have their favorite type of surgery, some like flaps, some like implants etc. The only contraindication for one step implant is BMI above 30 but I never quite understood that. Overweight people get reconstruction all the time.

I_Spy

ugh that's what I thought. I am doing the surgery at UCSD Moores Cancer Center, and I think the way my insurance works I have met my out of pocket maximum and there is no copayment if I continue with them. This ps is really the only I one I want at that facility. I literally feel sick over this and had to come home and lie down. I felt less confused before I went.

exbrnxgrl

hi ipsy,

I have one step implants. My feeling is that, since it a less popular form of recon, that docs who don't do it a lot are not comfortable with the procedure and tend to steer patients away from it. My doctor did one steps frequently, if he felt it would yield the best results for the patient. One steps are also not recommended if you want to go much bigger than your natural breasts. I have been very happy with mine and hope you can find someone with the expertise to helpyou out.

I_Spy

Thank you exbrnxgrl. I really am confused. I think the problem was the PA who gave me a stupid answer, and then I felt like it would be rude to ask the same question of the doctor right in front of the PA (I should have been rude). I am meeting with my breast surgeon again, and I may ask her. I think maybe the ps is thinking with the fact that I have a suspicious growth right underneath the nipple, and so I may not be able to do skin sparing if that is cancer. So technically speaking, it isn't wholly a prophylactic mastectomy. I don't know. I am really spinning tonight on this! I wanted to love my ps the way I love my surgeon, and the experience (really with the PA) has left me sort of reeling and not knowing if I'm doing the right thing. I wanted to leave feeling secure and I instead I feel "kind of" secure which is not enough. I may call her or ask for another appointment.

GoodConstitution

I'm so sorry you have this anxiety...but it's normal when there is so much uncertainty. I have a problem under my nipple also and my surgeon thinks a she will be able to do skin sparing but not nipple sparing if I elect to do mastectomy over a fourth lumpectomy. And she gavel two referrals to consult with plastic surgeons. One who does immediate and one who does not. She said she can make a case for either. You will feel better when you get the information you need. I haven't hesitated to call back and ask the surgeon for more information. It was given to me kindly. I wish you peace and health!

uds17

My plastic surgeon explained that it has to do with maintaining the integrity of the tissues; I don't think the fact that your BMX is prophylactic has anything to do with it. Remember that your implants will go behind your pecs, so they have to be stretched to accommodate these. Also, your skin needs to heal and if stretched too thin too quickly this can be adversely effected.

I_Spy

Thank you girls. Yes, I reflected and slept on it, and I've come to the following conclusions:

1. I'm not excited about getting double mastectomies.

1.A. Therefore, the whole subject is upsetting to me. All discussion of it is upsetting. I am used to being the tough (bitch) who can handle anything, any discussion, any situation (including deaths from cancer of both parents and handling all of their care), and have a steely eyed determination. Well, I guess I've met my match. I need some hand-holding through this one, I admit it.

1.B. The PA needs to realize that I am not facing an exciting prospect of "new boobs hooray!" and work on her tone of voice with patients facing mastectomy.

2. The Tissue Expanders are to create a pocket for the implants, gently, and create new skin (even if my old skin would have been okay) and an even, aesthetic quality. It is the standard of care for reconstruction. While there are other methods that work for some, this is the one that works for most; my ps is doing what is most likely to give me a good outcome in the safest manner.

3. I need to calm down. I think a massage is in order.

4. Thank God for this website to let me talk it out with my sisters!

farmerlucy

I wondered why I could not do one-step as well since mine was initially a PBM and I was staying the same size. In retrospect I needed the gradual stretching of the muscle and my PS was able to tweak a few things at the exchange. I hated the expanders, but as my PS surgeon suggested I resolved to endure it for the five months it took to complete. Getting the cancer monkey off your back is the main thing. I reminded myself often that I was so fortunate that medical science allowed me a choice about reconstruction, one my mother and grandmother didn't have. Good luck with your surgery!

I_Spy

thank you farmer Lucy, very true.

Sheidaii

Dear ispy,

Have you made your final decision to go for a double mastectomy and immediate reconstruction ? I am pretty much in your situation, but have not made my decision yet. I was wondering what will happen if we have a local recurrence later in the future (after double mastectomy and reconstruction) ? I mean, how they will treat the tumor? Can we still keep the implant or they have to remove it?

Because, the only reason I am thinking radiation+hormonal therapy is bad, is that, if we have a local recurrence, we have to go for mastectomy and at that point, they probably can't do a successful reconstruction using implants, and need to use our own body flash, which is a much more complicated surgery. So, in case of recurrence double mastectomy work better or radiation ?

I_Spy

Hi Sheidaii,

My understanding is that while it is possible to have a local recurrence after a mastectomy, the chances are very low. It has been difficult to make this decision because nothing is a guarantee in this breast cancer game. You have to just weigh all of the options and make the best choice for you. Yes, I've decided to do this (but sometimes, like yesterday, I get overwhelmed and think "what am doing?). For me, I have a strong family history (mother and her sister both died of bc) and I have dense breasts that are hard to see cancer on a mammogram. So it is harder for me to closely watch for a recurrence in my breast; it might not be seen until it has spread to another part of the body. My mantra is this: "Breast cancer in the breast doesn't kill you." It is breast cancer that has spread that kills you. So I am doing everything I can to prevent that, and this is how I have chosen to do it. However, it doesn't mean that it is the right choice for you.

I_Spy

Sheidaii one other thing -- I've already had a lumpectomy for DCIS. This would be my second lumpectomy. If I had to do it over again I would still get a lumpectomy for the first DCIS diagnosis. It was a small bit of cancer, and that could have been it and I would be done with it. However, not my situation -- now I have more that has to come out, and am being more aggressive this time.

DiveCat

Does your PS do/have experience with direct to implant? Not all PS's do, and so won't do it (nor do you want them to!). Some who do both have preferences for one over the other, but the good ones will recommend the one that is best for YOU. My PS does both, but considered me a good candidate for direct to implant for my PBMX (he even told me if it was his wife in my shoes, he would recommend the same), and that is what I did. It really has nothing to do with whether your surgery is prophylactic or not, but rather their experience and comfort, how much tissue you have, the integrity of your skin, what your size goals are, and so on.

I had natural 30E breasts. I had nipple sparing and had 446g and 371g of breast tissue removed. My PS did Alloderm slings (this is what allows them to make room behind muscle/form pocket without expanders) and put in 435cc smooth round implants. I switched almost a year later to 450g anatomicals, but this was to try and address some rippling I had due to thin skin which would have been there no matter what as that was the result of my body type and my BS's work removing tissue. I still have about 30E/F breasts though they look different and feel different than they did. I personally am VERY happy I did direct to implant, I had a very smooth and relatively easy recovery, and am very glad I did not have to go through expansion and so on, but everyone is different. It is best to ask your PS HOWEVER I would first find out if they even do that surgery, as they are not likely to say you are a good candidate for direct to implant if they don't do it!

If you want to explore direct to implant, go get a second opinion with someone who does it.

I_Spy

Thank you divecat. I really don't have a huge choice of ps. I am at an NCI cancer institute in San Diego, and I want to stay at this cancer institute. My surgeon, whom I adore, uses two of the plastic surgeon's at the institute; I want her working with someone she likes. This is the only woman ps of the two, and I just want a woman. She is a professor of plastic surgery at the University of California, so she teaches all of the methods. Clearly this is the method that she is the most comfortable with, for whatever reason. When I posted this yesterday, I was reeling from the appointment (and the bad bedside manner of the PA). However, as I mentioned a few posts above, a good night's sleep has restored my equilibrium and I'm okay with the expanders.

tangerinequeen222

I'm getting expanders too for my PBMX. The PS I'm using does a lot of both, but recommended the expanders for me due to my breasts (let's just say they hang rather (*very*) low from nursing). It has nothing to do with size as I already have a D. She said the expanders would yield a better outcome for me but that everyone is different. I'm having this done in two days, by the say, and I'm scared out of my mind. Positive thoughts please!

I_Spy

tangerine queen good luck! You can do it! Come back when you're up to it and let us know how it went.

happynewyorker

i have breast expanders and I'm having my reconstructive surgery on Friday may 15th. I will miss my football that feels like a basketball. My expander. I had my mastectomy surgery on 2/19/15 and on Thursday 5/14/15 it will be 3 months since my surgery. I also have one drainage attached. Having a expander the experience for me it's like having a suit of armour. I couldn't sleep on the bed and stayed on the couch. When you get filled each week I suggest you don't get a double dose, it hurts. Over time for me the expander hurt on the weekend. As time goes by you don't feel the medal plate as much. But I found for myself that because it's hot in new York I stuff gauze inside the space of the expander and skin. To easy the sweat from the football and my skin. I have taken many pictures of my football and steel syringe that contains the saline to show friends and family. My experience to share. I can't wait for my surgery as my drainage has caused a infection inside my football and the pain is unbearable.

happynewyorker

i have breast expanders and I'm having my reconstructive surgery on Friday may 15th. I will miss my football that feels like a basketball. My expander. I had my mastectomy surgery on 2/19/15 and on Thursday 5/14/15 it will be 3 months since my surgery. I also have one drainage attached. Having a expander the experience for me it's like having a suit of armour. I couldn't sleep on the bed and stayed on the couch. When you get filled each week I suggest you don't get a double dose, it hurts. Over time for me the expander hurt on the weekend. As time goes by you don't feel the medal plate as much. But I found for myself that because it's hot in new York I stuff gauze inside the space of the expander and skin. To easy the sweat from the football and my skin. I have taken many pictures of my football and steel syringe that contains the saline to show friends and family. My experience to share. I can't wait for my surgery as my drainage has caused a infection inside my football and the pain is unbearable.

I_Spy

Wow that sounds terrible. I'm a little confused by your metaphors -- your "football that feels like a basketball" has an infection in it causing pain? do you mean your expander has an infection? have they given you antibiotics for that? And what part of the expander is a metal plate??

happynewyorker

the football is the breast expanders. The weight of it feels like a basketball. The expander is a plastic bag with a metal plate in the front. I goggle it and found a picture of it, to see what it looks like. What your plastic surgeon does is uses what looks like a stud finder (you know to find the studs in the walls at home). The device the doctor uses is smaller same concept with a small needle inside. What they do is move it along on your chest where the expander is and when the needle is straight they found the port for the needle. you'll feel pressure. Then they use a butterfly needle to release the saline from the syringe. It's cool to watch for me once or twice. Other that I just relax and her do her job. You'll lie on the chair back when the process is being done.

I'm intrigued in learning new things. Like a big kid. I'm 51 years of age. I'm fascinated in the process. You go flat to having a mini football in a couple of weeks.

I once said to my doctor that I'm having smaller breast since the expander looks small. She said I could be a DD. They stretch the skin so they have extra just in case. I read that part about the extra skin.

The infection I have is because I still have my drain which normally comes out after a month of surgery. My drain loves me so much it doesn't want to leave me. It's a joke. I stopped taking the antibiotics. The infection will go away once the drain goes out.

When you see your plastic surgeon ask what instruments are used. Don't be afraid of the size of the syringe. I was amazed. Took pictures just to show family and friends on Facebook. I like to share.

I didn't since I was clueless. But I'm my own experience. Just to give others an insight of my experience.or how it maybe for others.

Lee

happynewyorker

TANGERINE Queen 222 - the best advice I can give you. Is gets lots of pillows. You'll be sleeping on the couch for a while. If you'll have the drainage get some pillows for under your arms. I found for myself medium size bean bags pillows, worked. Take it easy.if you bend over bend using your knees to bend. You will feel like you have a metal inside your chest. It will go away over time when its expanded. breast expanders are temporarily. After I the skin are expanded you'll going to have a nice pair of breasts.

For me making jokes helped me. Think positive this will help with your recovery.

Keep a journal of your journey this will help you.

My surgery is on Friday the 15th of may. My expander is removed and I get a lift on one breast and the expander removed on the other.

Try attending breast cancer group meeting. This will help you and the process you're dealing with now. It has helped me.

MaryAgatha

Ipsy, I will be having BMX with implants, no TEs. I was upset and confused when my PS told me that he is not going to do TEs. I thought TE was the standard of care and without a TE a breast could get stretched too quickly and cause complications. When I questioned him, he said there are three reasons why I don't need TEs. (1) I'm a B cup asking to go B+ (if not asking for a huge "upgrade", TE is not needed) (2) I breastfed four children so my skin is stretched enough already, and (3) he is very experienced with same day implants, which ("not to brag") some doctors just don't have the expertise or experience to perform. My PS is very experienced and comes highly recommended by a friend who had hers done by the same PS. I am still anxious and wish my PS would do TEs but reading some of the posts here that explain why TEs are not always needed were very reassuring. Thank you.

I_Spy

Hi Mary Agatha,

It is so hard to be sure of anything in this thing, isn't it? I wish I had a crystal ball for all of it. My situation is similar to yours, but my ps wants to do TEs (and she is at an NCI designated Cancer Center). I think it has to do with what each ps has seen as the best outcome for the most patients. If I could get direct to implant I think I would, because it means you are over and done with it so much faster. It is reassuring that your friend got a good outcome -- I assume she had BMX and direct to implant with him? I mean, was it the same surgery that you are going to have that she got the great outcome from?

exbrnxgrl

maryagatha,

If you are having a skin sparing mastectomy and a ps who is experienced in one steps and says that you're a good candidate, then no need to fret. There is no "standard of care" as there are several options when it comes to recon. I was a B cup before surgery and pretty much look the same after my one step, almost 4 years ago. I will say that my ps did bring te's into the operating room and said he would use them if he thought the one steps did not look good, cosmetically or there was a medical reason not to use them If you are not comfortable with your ps, seek a second opinion. Personally, I am very pleased with the results I have and one less surgery!

MaryAgatha

ipsy, my friend who recommended this PS initially got her reconstruction (direct to implants) by another PS who really messed up. Her implants were too large and very uncomfortable for months. Eventually, one of them "failed" and got infected. She went to a different PS to fix all the issues and ended up with smaller more natural looking implants that made her very happy. The new PS is the one she recommended to me. My friend and I have the same built with similar sized breasts. I'm hoping to have the same outcome that she has now, while avoiding all the pains and bumps she experienced for months to get to where she is now.

MaryAgatha

Thank you, exbmsxgrl. I'm very encouraged by your experience. I do like my PS and I really just want this whole thing to be over with as quickly as possible, so I'm going to stick with the plan without complaining. Just hoping for the best!!! Aren't we all?!

I_Spy

MaryAgatha you sound like you're all set -- let's hope for smooth sailing!

tangerinequeen222

Hi, I'm not sure if you remember me, but I was getting a PBM with sentinel node biopsies on both sides - and I was scared out of my mind (not just about the surgery itself, but about waking up, and the risk of lymphedema from the sentinel node biopsies). I'm 11 days out from my surgery and I'm happy to report that all is good (so far so good, knocking on wood here). It wasn't as bad as I had anticipated. Everyone kept telling me about the pain afterwards, but thankfully I found it very manageable with the pain meds. My only problem with the pain meds is that they make me sooooooo sleepy. I'm usually asleep within the hour after taking one. I still have drains (three of them now; I started with 4). I'm hoping to get another out tomorrow. As far as reconstruction, I got expanders because I wasn't a good candidate for direct due to my floppy-nursing breasts. The expanders don't bother me so far. And, to be honest, my breasts look much like they did before, minus any volume. There wasn't any bruising after surgery. I'm just waiting to heal fully before I get my first fill. Anyway, I just wanted to say thanks so much to everyone who cheered me on and answered my questions. Am I still scared? Yes, absolutely, this is just one stop on my BRCA+ road, but it feels good to have this done. Oh, and by the way, some of you may remember that I tried to avoid the SNB's by getting an MRI before the surgery. The MRI showed 2 things on one breast; the other breast was too spotty and unreadable, which is why I had to go ahead and get the SNB done on both sides. The biopsy of my breasts at surgery found six things - all benign, thank god!

I_Spy

tangerine queen so glad you're doing well! That's hope for all of us. Did you have nipple or skin sparing? I don't think I'm having either, I'll know for sure at my final meeting with breast surgeon on Thursday.

tangerinequeen222

I had nipple sparing, which means they also spared my skin as well.