Anyone had good results with direct to implant reconstruction?

9lives70

If so I would love to hear your thoughts!

this procedure sounds almost too good to be true and the surgeons I've consulted with so far advise against it but maybe that's because they're just not experienced with it here in Seattle. They seem to do it often in California.

I've been advised the complication rate is much higher especially for women with large breasts like myself ( I am a D cup, with implants )

If you have gone through this procedure I would love to hear your thoughts good and bad and also would love to know who your doctor was!

Thank you!

Marina

exbrnxgrl

Hi Marina,

I assume that you're referring to one step implants (no TE's). I had mine done a little over 5 years ago and had an easy time with great results. I would agree that an experienced ps is the key, and a ps who is completely honest and realistic is important. By this I mean that my ps brought TE's in to the operating room and said he would use them if he felt that going straight to the permanent implant did not yield a good aesthetic result. My ps only did reconstructive surgery and had a lot of experience with one step implants. I was a large b/small c prior to surgery and had, as the ps put it, "youthful breasts". My goal was to look exactly the same post surgery and that was accomplished.

My understanding, in addition to an experienced ps, is it works best for c cups or smaller. Please let me know if you have any questions and have a happy New Year.

PS: I think, on these boards and perhaps in the real world, that I am an exception with respect to the success of my one step implants.

9lives70

thanks so much for your reply and detailed information I'm glad to hear it went so well for you :-) I do think my case would be a bit more of a challenge being that I'm D+ cup size and older (48) with a bit of sagginess at this point... so not sure it's a realistic option for me. I would love to know who your surgeon was and how you ultimately chose him or her if you'd be willing to tell me that? (Or send me a private message with the info)

I would sure appreciate it as I'm willing to travel outside Seattle to get this done and I have a sister in California:)

Thanks so much this is such an overwhelming time having been newly diagnosed and needing to pick a surgeon stat. I have met with two so far in Seattle one of which is supposed to be really good but does the whole delayed TE procedure and thinks the other one is highly risky especially for me . and the other one was so incredibly negative and pessimistic Icould barely listen to her for more than 15 minutes without wanting to walk out the door. Meanwhile I feel like the clock is ticking and I need to find someone excellent soon :-)

Thanks much,

Marina

exbrnxgrl

Hi Marina,

I belong to Kaiser Permanente. If you're not familiar with it, it's a large all inclusive HMO. On it's larger campuses, everything, from hospitals, medical offices, labs, scanning facilities, pharmacies, classes and even a farmers market are available in one location. I must stay within the Kaiser system for all services. So, I just began interviewing Kaiser plastic surgeons (at the time all of their ps's only did reconstructive surgery, no cosmetic). My ps (Dr. John Eggleston) has moved to Texas, so that doesn't help you much.

As for age, I was 55 at the time of surgery but despite pregnancies and nursing, still had the breasts of a much younger woman. Save for cancer, they were perfect!

Sorry I couldn't be of more help. One steps seem to be the exception with most doctors going the TE route. There don't seem to be many doctors with experience in this type of recon. I think I just lucked in to the right ps at the right time. There is so much to learn and sort out regarding all of this, and the pressure of time and treatment decisionsI will say that I would run far away from someone who is negative and doesn't spend time with you. Regardless of the type of recon you end up with, you really need to find a ps that you feel comfortable and confident with. Perhaps you could start another thread asking for ps recommendations in the Seattle area. Wishing you the best .

gracie22

I had one-step in early 2015 and was satisfied with the outcome, but I did have a post op infection in the non-cancer side (I had a BMX) which led to an undoing of the original surgery since the breast can't overcome a serious infection while the implant or expander is in place. The infection itself went deep in the tissue and was likely due to a contaminated surgical implement (or hand) per the infectious disease doc who treated me for it so I don't blame the one-step procedure itself; infection is scarily common during reconstruction using implants and/or tissue expanders and can be very serious--I was on IV antibiotics for 3 weeks and in the hospital for a week--a much bigger ordeal than the BMX! In fact, I was happy that at least I did not have to deal with expander pain and fills while recuperating from the infection. So in general, I am still a proponent for one-step. You do need to talk to a PS that does a lot of them, because I found that most do not, and can be needlessly disparaging about the possibility since they don't do it themselves. For patients like me that simply want to be done with surgery (and have read too many posts about expander pain), I think it is a good choice; I needed pain control for about 2 weeks post op, and it was never bad.

My doc did tell me he would do the TEs if there were issues during the surgery that led him to believe it was the better way (the BC surgeon won't know how much tissue/skin needs to come out until they are in there) but I really had no interest in that process, and he agreed to my adding a line to the surgical consent that I did not want TEs, and would "go flat" if the one-step procedure was found to be not doable during the BMX. Having big breasts initially is actually a good thing--there is more skin to work with and I too, had large breasts; big breasted women are better candidates since some skin is lost of course during the surgery (depending on tumor location) and the bigger you are, the more skin left. As far as sizing goes, most implants are placed under the pec muscles, so there is a limit to how big or small the implants can be. Ask to see the actual implant your doc wants to use and hold it against your chest to get an idea of how big you will be post-op to avoid any big surprises. I was very happy to go from an F-ish cup (which was way too big for my frame) to a small D/big C.

I would also ask about your doc's approximation of infection rate in his own practice, and check on the facility infection rate in advance, and be very loud about your concerns about infection. Might not help but it can't hurt and may encourage them to take additional steps to avoid infection, e.g. personally checking on sterilization procedures, running through checklists pre surgery, etc.; it should always happen but it does not, and infection is the most serious overall issue with reconstruction.

If I was young enough to do it, I would devote myself to this issue--so much needless suffering and pain is caused by hospital acquired infection (related to all procedures, not just BC surgery)--it is a real crime.

AmyQ

Caryn,

If you don't mind me asking, have you ever had any pain or pressure/squeezing feeling or neuropathy with your implants? I went through hell and am now flat but still no relief from the iron bra feeling.

Thanks and if you wish not to answer, I certainly understand.

Amy

Mom_of_twins

I had direct implants, and it was the best decision I've ever made. I even had 33 radiation treatments, and there were only nominal aesthetic effects on radiated side (it's a bit tighter, but still looks fine). I know there's criteria and parameters that need to me met in order to be able to get direct implants. I was told that it was "Plan A," but they might learn things in the operating room where I would end up getting traditional expanders. I was so happy Plan A was able to happen.

My PS told me if I'd be happy to stay at my current size or smaller, direct implants were a viable option. She said if I'd want to go bigger, then I'd have to do expanders. I was a D cup to begin with, and am about the same size as before. In clothes, I don't think I look any different.

I'm so happy with the result! They're not perfect, but am very happy and they look good in clothes!! Also, my PS is very forward thinking, and she also did my implants above the pectoral muscles. She said my anatomy made me a good candidate for that...and it made recovery a lot more tolerable.

exbrnxgrl

Hi Amy,

If I think about it, there is a bit of tightness on the undersides, where the Alloderm is. It is not painful and there is no feeling of pressure or squeezing. But, I don't notice anything unless I focus on it (which I don't!). I'm sorry that you had such a rough time of it and hope you get some relief soon.

Caryn

AmyQ

Hi Caryn,

I'm happy to hear your results were so great. Thank you for sharing.

I must be hypersensitive in the chest wall as even my port caused constant pain and discomfort, which is why I had it removed as soon as possible.

Happy New Year to you and your beautiful family. Grandchildren are simply the BEST!

Amy

reneeCA

Hi 9lives - I am late on the thread but I had 1 step with Alloderm 11/23/16. I chose my PS because he was an upbeat, positive person that seemed confident about doing 1 step, but mainly I chose him because he was my BC surgeons recommendation. MY BS is kind of a rock star of female BC surgeon so her rec was immensely important to me.

PS turned out to be ill-equipped, almost unethical. He never measured me before surgery. When I called his office to ask when he would take measurements, his coordinator got back to me to say he had everything he needed.

I was a large C cup with slight droop from breastfeeding and age (50) and asked to be an A or B cup as I felt less is more with implants. I am 5"10" and weigh ~127 but have very long legs. The PS eyeballed me and decided I was a "high profile" anatomical implant. I am not. One implant feels like it is pushing my pec muscle into collar bone and I can feel the implants in my armpit.

That said, having excess skin from large breasts, being a non-smoker and willing to go smaller are the main criteria for 1 step. Just find a doctor who has tons of experience with it. I believe with another PS who put in correct size for my body, I would have less pain, better aesthetics and gotten away with 1 surgery instead of 2. You also save yourself the risk of infection from 2 surgeries.

Wishing you the best!

Jezikah

I did 1 step reconstruction with Alloderm 9/30/16 and I think they look great. I was a B cup before (and pretty uneven) and now probably a C, although I just wear sports bras and haven't been properly measured for cup size. I am 33 and had dense breasts with no sag/stretch marks. He went as large as he could based on my skin tightness, I would have had to do expanders if I went bigger, but didn't want to, I just wanted them a little fuller. My PS was amazing and a perfectionist (Dr. Alan Muskett in Billings, MT - he's a former cardio-thoracic surgeon). He has done several 1-step recons - he showed me one he did a couple months before mine with a larger chested woman (at least a D) who did go bigger - she had more sag in her skin so was able to accommodate larger implants. Overall, I am so glad I did the one-step surgery for the decreased recovery time and I am very pleased with the results.

NotHerToo

I just had one step bilateral in December, and went from a DD to a C and couldn't be happier with how they look.I have a very experienced PS who also made nipples during the surgery that look real, even without tattoos. The surgical nurse and the Oncologist both asked if I'd had nipple sparing surgery. I also have that tight bra feeling, but it may be because I'm wearing a tight bra, even to bed, lol. Unfortunately, my original diagnosis was DCIS stage 0, but they found another site that had been undetected and was Her2 positive. The upcoming chemo and herceptin treatment are now my focus.

tapwhite

I've had implants for 17 years (augmentation) and since being diagnosed with ILC am considering BMX with recon w/implants although PS wants to do "the natural way" autologous. PS said they would put implants over the muscle instead of under like they are now. Anyone else have implants over the muscle?

Krma

I'm having a full mastectomy with reconstruction in a few weeks. My plastic surgeon says she can go straight to implants at the time of mastectomy. BS says she can do nipple sparing and skin sparing surgery. My PS says my breasts will be smaller with my implants. I am not happy about that and am thinking about using TEs instead so I can pick my size. Am I crazy to consider TEs if I could go straight to implants? I am very worried about the pain of filling TEs. I need advice. Did anyone go straight to implants? Were you disappointed with the size afterwards? Are TE fillings as bad as I've read? On a side note, I passed out during my core biopsy (I was sitting up). Hopefuly this isn't an indication of my pain tolerance or I'm in trouble

exbrnxgrl

I had one step implants over 5 years ago. I am exactly the same size as before surgery, though the implants are a bit wider set than my natural breasts were. It worked out well for me. Best of luck to you

Jezikah

My breasts ended up about a cup size larger. I was a size B and now size C. The PS told me they would be a little larger since the surgery would stretch the skin when they removed the tissue. I'm very happy with the results and glad I only had to go through one surgery.

Azjs

I had a unilateral mastectomy with immediate reconstruction a few weeks ago.  The plastic surgeon used a tear shaped Mentor implant above the muscle.  It is almost exactly the same size as my other (natural) breast and looks quite natural!  It is a bit perkier than the natural breast, but I'm okay with that.  I had very little pain.  Obviously, I don't know how I will feel long-term, but right now I am very pleased with the result.

DandilionWishes

tapwhite I got Tissue Expanders over my pectoral muscles - there's a whole forum dedicated to it & I'd encourage you check it out.

Krma For what it's worth, I don't feel any pain during or after any of the expansions, just a full / stretched feeling. But I do find the TEs really uncomfortable for day to day living, sleeping, chores, etc.

I tried to go direct in one surgery - mastectomy to implants - but, I had complications (necrosis) so the PS had to pull them out and put in TE's within 9 days. Could have been because I was a very light smoker until diagnosis, or low blood pressure, or infection, or just drew the short straw... I was pretty large (DD?) and willing to be smaller. Really looking forward to trading the TEs for implants.

AbbyG

Hi all! I had one-step done in December, and other than some very slight rippling (was told about beforehand, and will have some fat-grafting after chemo), I'm quite pleased with how they are so far. I was a "A+/B-" before and am probably a solid B now, as I did have some extra skin even with small breasts to begin with. Wishing all here the very best❤️❤️

Krma

Thank you everyone. I still haven't decided for sure but I'm leaning toward 1 step implants. I just need to make sure my PS understands I want to be as large as possible. Hopefully all works out wrll

MinusTwo

KMA - if you're looking at larger, I would think that having TEs and expanding gradually would give you a better chance. Just my opinion.

dtad

Krma...Hi everyone. I had direct to implant reconstruction about 18 months ago. I was a DDD and I'm now a full C. My PS warned me beforehand that was the biggest I could hope for. It took me awhile to get used to my smaller size but now I'm OK with them. It will never be the same but I was happy to avoid the TEs and the second surgery. My advice would be to make sure your PS has a lot of experience with this type of construction. Good luck.