Direct to Implant (DTI) Options?

Travel_Girl

In early august I was dx with my second breast cancer (the first was in 2006). I had a lump and radiation. Now, with my second bc dx in my other breast, I have made the decision for a double mx w/ immediate reconstruction.

I am doing chemo first as part of my protocol so I have been researching surgical options - specifically reconstruction. After a month of chasing DIEP, as my first choice -- and finding out that I do not have enough fat at the donor site (I would have to use two sites and that would be mean two scars, recovery, etc -- no thank you). I have settled on the implant route.

Now, I am researching DTI options. As I would like to get the healing done and move on with this - life as we know is short - I am not looking for extreme perfection, just something that looks evenish in clothes. When you have a lump on one side -- you get use to not having twin breasts, more like distant cousins ....

My questions are -- why aren't these done more? How do i find the best options? I have my first surgical consult with the best in my area, however, I am also willing to travel for this surgery.

My next best option for a major city is the NYC area -- any tips and successes in this area?

If you had it done, would you do it again?

Any help and guidance appreciated. I have tried to find other posts on this, so i you have one -- please share the link - I am happy to dig around.

NotVeryBrave

There is a post "TE/Implant over pectoral" that has a list of doctors who are doing this and a lot of info. You might check it out.

I have no idea why more are not done this way. It made a lot of sense to me. One advantage of the TE is that you can gradually expand to the volume you want. But if you're doing skin sparing and staying about the same size then you don't need expansion.

One reason that I went with BMX was because I could do this in one step. Would I do it again? Yes. It wasn't easy, but multiple surgeries, or radiation, or chemo, or lots of what we go through isn't either.

On a side note - I've read good things about both fat grafting and hyperbaric treatment and healing of radiated tissue.

Travel_Girl

NotveryBrave - thank you!

Tara17

travel girl ....I wasn't offered DTi although I did have skin sparing. The way I understood it is that the skin flaps re very thin after mastectomy and need to heal and not have necrosis. The implant or TE puts pressure on the skin flaps at a most sensitive time of healing. So gradual expansion wit Te not only stretches the tissues readying them for implant , but also doesn't put literal pressure on the skin flaps right after surgery. Other advantage of TE first , is the ability to discuss the type of implant with the PS while undergoing pension

All the best to you

dtad

travel girl...I had DTI reconstruction after a BMX. I was treated at a major university based teaching hospital in NYC. IMO the reason it isn't done more is because its fairly new and not a lot of PS have experience with it. Also they typically cannot do larger than a full C which might be an issue for some women. I'm as happy as you can be about the reconstruction. I wanted to avoid the TEs, fills and second surgery. I did not have any additional surgeries to tweak it. My foobs look great in clothes, not so great in the nude. I knew that going in and was ok with it. Please let me know if you would like the name of my PS. She was brilliant! Good luck to all.

Travel_Girl

dtad -- yes, please on the referral. I am looking for a B size or B+. I have C+ now (implants to even out a prior lump) and they are too big for me. I have no illusion of pefection for the foobs - either. In clothes is good for me.

candles1

Travel Girl, I also had dti, skin and nipple sparing, over the muscle. When I woke up, I looked pretty much like I did before - plus some swelling, bruising and new scars. I was told going into surgery that, while this was the plan, the PS would have to assess the skin in the middle of surgery. If it wasn't oxygenating or something like that, I would have gotten TE's.

So, I gather that over the muscle dti is something that even a very experienced PS can't guarantee, because it in part depends upon factors that aren't knowable until the surgery has already begun. Good luck!

dtad

Yes my PS said she could not guarantee she could do this kind of reconstruction until she actually got in there. Luckily she could! I used Dr. Christine Rohde form Columbia University Medical Center in the upper east side NYC. She is a brilliant surgeon however not warm and fuzzy. I would highly recommend her. Good luck

NotVeryBrave

Yes - the PS told me that his intent was to place the implants at the time of surgery, but he would do the TE's if it looked like my skin would be under too much strain with an implant. The goal was first and foremost - good healing. It's true that all you are left with is skin and a bit of fat - maybe.

As far as size goes - I was wearing a 36B bra and had never been fitted for a bra in my life. I probably should have been wearing a 34C. I know that now since having been fit post BMX. I'm now in a 32E or 34DD. And I wanted to stay the same size! So I don't think that it's true that you need to be less than a certain size. They create an internal "bra" with Alloderm to help support the implants and it's not all up to your skin and your incision lines.

beach2beach

Hi,

I also had direct implant after BMX using Alloderm also. I was not a candidate for the DIEP either due to not enough fat and then would be scars if they took from thighs or butt. Nixed that. I had nipple sparing also. I could not go bigger than a B(tight skin) , though I was not more than a B- before. Due to my skin being tight the PS said using the TE would hurt like heck and I wanted to avoid that if possible. He did not know what he would be able to do exactly until he was in there.

In the end, I'm good with the way they look. Not like I'm walking around topless so no one sees it but me mostly. They are under the muscle. I've healed well. Nipples are centered. I have a full look now to my boobs which I did not have before. I would do it again. It took about 4 hours for the BMX and implant to be done. I had very little swelling either.

If this was groundhog day and I had to choose again, I'd make the same choice again. I'm in NY but in Long Island area, right over the border of Queens. I was very happy with my BS and PS.

DakotaGirl

Unfortunately, breast implants and radiated tissue do not always work well together. I have tried two implants after radiation, and both became super hard and painful and my skin rippled. There is just a lack of blood, healthy cells and oxygen that is needed to heal properly. I'm currently doing hyperbaric oxygen therapy to help heal the radiated tissue.

Travel_Girl

DakotaGirl -- yes, I am saving the fat I have for DIEP (enough for one breast not two @ this point) -- in case of rejection. Thank you for your response.

I will look into the therapy you mention pre-surgery - I have all of oct & nov to get my self in shape (while going through chemo!) for surgery. I have added acupuncture to the plan and asked about increasing blood flow to that skin over the breast, etc. Also looking into lymphatic massage and anything else that may help. It is all one can do ...

I wanted a dual DIEP because of what you say about radiation and rejection and having my own fat would make me feel a bit more connected with the foobs I think - I will keep digging with my ps and push options.

I only want a B size when all said and done, where is the 'easy' button