Reconstruction with TE and implants placed over the muscle

Nursepatient35

I just met with my PS. I'm having a BMX with reconstruction soon. He talked about he typically places the TE over the pectoral muscles and then uses a mesh material to hold them in place. He sounded like this is the newer more common approach. The implants stay in place with the mesh and there's no cutting muscles, therefore recovery goes better. Has anyone experienced this? Before meeting with him, I was thinking I won't be able to lift my arms, wash my hair, etc. Now I feel like I can get back to life a bit quicker. Do I have false hope? Am I still going to be pretty miserable for a while? I'm a surgery nurse but never seen these types of cases. I also know the surgeon doesn't always give the full recovery picture to patients when they do a consult.

XXXGGGYYY

I had a UNX in September. I had the TE over the pec muscle and the mesh material put in. I will be having the TE removed a replaced with an implant next week. I only had to take one week off from work. I had no problems with lifting arms, etc. They just asked me not to lift anything over than 10 pounds for a few weeks. It really wasn't bad at all.

macb04

Hi I have a thread on the Reconstruction Boards about this very topic. Stop on by and ask your questions and meet some other ladies who have been through this Prepectoral Implant Reconstruction.

Topic: TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!

Forum: Breast Reconstruction — Is it right for you? Discuss timing and various procedures and techniques.

amtreb

Nursepatient35-

The other TE over the muscle thread is very long and hard to sort thru all the entries so I thought I'd chime in here

I had nipple sparing BMX in Sept w TE placed pre-pec (above the pec muscle) with the alloderm. I just had my expander swap out 2 weeks ago. The recovery has been very smooth from what I can tell in comparison to under the pec. I am very active and do a lot of yoga and training and I was back to regular work outs 6 weeks post mastectomy with no issues with range of motion or pain. The swap out surgery for my implants was really easy and I was only really sore from where the PS did fat grafting.

I think the main down side from what I gather so far is that the implant is more obvious bc there is no other tissue over it. Like I said the PS did fat grafting so we will see how much fat survives and my have to have more grafting in a few months.

Happy to talk more if you want to PM me

-A

marcys

I am 10 year survivor. My initial diagnosis was IDC, Stage 2b. I had bilateral mastecomies in 2007 with immediate reconstruction. Expanders were placed and then I had my exchange for permanent implants - the implants are the shaped 410 "gummies" and were placed below my chest muscle. I then had chemotherapy and radiation to my cancer side. For the last 5 plus years I have been experiencing pain and discomfort on the radiated side, including this "vice-like" feeling - it's pretty uncomfortable. In addition, my implants are too small for my body size so I would like slightly larger implants I have consulted for 3 plastic surgeons about a revision. I am hoping you could give me your thoughts...

One doctor recommends that he remove the current implants, place expanders to create more space, then exchange for permanent smooth round implants above the muscle. This doctor does not want to use the shaped implants because of their connection to increased risk of a type of lymphoma. He also would not do the fat grafting Iwould need until after I recover from the exchange procedure. 3 total procedures

Another doctor recommends he remove the current implants, take my latissimus muscle on the cancer side and bring in forward, place expanders to create more space, then exchange for permanent implants. And then do fat grafting in a 3rd procedure.

Last doctor recommends that he remove the current implant, replace with the newer better projecting implants below the chest muscle and do fat grafting all in one procedure. This doctor also says no drains will be needed following this procedure. The other 2 doctors say absolutely yes to drains.

My questions for you is:

- has anyone had a revision like any described above after radiation? What procedure did you have and are you happy with the results?

- Is there any down side to having the implant placed above the chest muscle?

- Is doctor number 3 too good to be true?

Sorry this is so long...I really look forward to your comments.

Marcy S

Moderators

Hi Marcys-

Welcome to BCO! That's quite a lot of information to process, but kudos on getting several opinions! We have a very extensive thread with members who've gotten implants over the pectoral muscle. There's a lot of info there, and firsthand experiences from other members that you might find interesting and helpful! https://community.breastcancer.org/forum/44/topics...

The Mods

macb04

Hi Marcys,

I had a TE under my poor pectoral initally and then took it out because I was doing Fat Grafting (that PS wasn't good at it) not enough survived several procedures to make me a breast, so then went onto getting a Prepectoral (over my Pectoral) TE with a different PS. Eventually had an implant exchange. I had severe radiation fibrosis which caused me difficulties in healing. The Fat Grafting didnt work to make a breast, but was enough to completely cushion the edges of my implant, and improve the woody texture of my skin. My skin was just like boot leather. I also took Pentoxifylline 400mg/tablet (3 times per day) plus Vitamin E 400IU per capsule (three times per day). I am sure that the Fat Grafting/Pentoxifylline works together to greatly heal radiation fibrosis damage. No Animation Deformity. My reconstructed breast is not cold either, which a lot of people with implants complain of. Is a much faster recovery than Subpectoral or any of your other surgery options.

Good Luck

marcys

Thank you so much for your reply! I really appreciate it:)

marcys

Hi. Thank you for your reply. I did try to search for other women experiences like mine, but I am struggling to find anything very close to my situation. Specifically, I am looking to find someone who had radiation to their initial implant and then had them removed, expanders placed and then permanent exchange. I will keep searching. Thank you again:)

macb04

Well Marcy, I did have rads to the TE before it was taken out.

gocancergone

Hi Marcys

I just got my implant taken out that was placed under my muscle. I was having extreme pain and within a six month period my implant was moving toward my under arm. My shoulder is now completely messed up from the original surgeries. Unfortunately, I was told I only had one choice for surgery, and after going to PT for several months my PS finally referrered me to his colleague who could do the prepectoral surgery. I found out after the fact that there are more reconstruction surgeries available. I asked but did not get the information I needed from surgeons. Now moving on, I found the thread that macb04 created which helped me to advocate to get something done. I had surgery Jan 22, 2018. I still have a drain, but I can tell you the constant feeling that I had a pulled muscle is gone. My shoulder is still bad, but I also am in the stage where I can’t lift above 90 degrees/ 5 lbs. I will have one more, possibly two more revision/fat grafting surgeries. I do have radiated skin/tissue so my PS is concerned about healing and has asked me to restrain from driving, lifting, or raising my arm. He said that radiated tissue hasless blood flow and takes longer to heal.

Hope that helps!

Nursepatient35

I just got done with my bmx with tissue expanders yesterday. When I woke up though they told me they had to go under the pec muscles because there wasn't enough skin and fat to cover the implant. So......now I feel like I did the bench press with lots of weight all day long. Anyone know how long these aches take to go away?

macb04

Nursepatient35, the TE's under skin were uncomfortable for me for a week or two, then each time I had a fill it was a new uncomfortable feeling and a crampy muscle pain the day of the fill. I never wound up liking the Subpectoral. I am sorry they couldn't do Prepectoral for you. Not every PS is experienced enough to do Prepectoral because it is a newer method. Go on one of the longer standing Implant forums and ask your questions, there will be more women who had Subpectoral to answer your questions.

Imkopy2

Marcys my situation is different than yours but I’m throwing this your way to possibly help you. I had a BMX and TEs I had chemo and rads, 3 months after completing rads I had my expanders removed and implants put in. There were things I wasn’t happy with and my original PS wouldn’t do any revisions. I went looking for a new one. I had one who promised me the sun, moon and stars, another wanted Lat flap which I wasn’t sure I wanted to do another 2 years and then I found my current surgeon. He specializes in breast reconstruction especially after radiation. He is highly skilled and I have no doubt he will get me the results I’m looking for. I researched and found the top guy in my area. I’m in Chicago and if your close can give you the info, if not use these ladies as a place to find your surgeon. Whippetmom, Special K, Minus two, Coach Vicky and Shoregirl have knowledge of various surgeons and can pu you in the right direction, do not settle for second best. Good luck!