Question for women who have over the muscle implants

mnsotamom74

My question is specifically for the women who have over the muscle implants. I'm currently in the expanders phase. I waited one year to do delayed reconstruction, I just wasn't sure if I wanted to have reconstruction or remain flat. My surgeon also does plastic surgery ( as well as all other surgeries) he flies in once a month from the Mayo in Rochester.

He pretty much didn't give me an option for under/over, I was actually terrified of it. I'm a google person ( even though all of my team tell me to knock that off, it gets me really anxious reading worst case scenarios) so of course I was scared that if he did over the muscle implants it could potentially hide any recurrence. My surgeon said that is a myth and irresponsible for any doctor to say that. He said if that was true? No doctor would do it because the risk would never be worth it and the lawsuits would be ridiculous. He said I will be having yearly breast mri's to check the integrity of the implants. I still wasn't convinced so I went and spoke with two more surgeons at completely different practices and asked them the same question, they concurred that the facts don't back it at all and they said if over the muscle was hiding recurrence no surgeon would risk it. So I felt pretty good about it.
I love Instagram and enjoy following a lot of fellow breast cancer warriors. Last night one of them did a live video, she had been having some issues with her implants, long story short, she said her doctor told her it's so good she has under the muscle implants, because over can hide recurrence. Well, as someone with severe anxiety? That absolutely set me off. Now I'm back in panic mode and worried. Why does one doctor, surgeon, oncologist say one thing and then another says something completely opposite? Honestly, this has to be one of my biggest pet peeves.

I'm sorry this is so long. I would just like to hear from others who had over the muscle implants and what your doctor told you.

In advance... Thank You for all replies

Magari

I have over the muscle, aka prepectoral implants, as do many of us here. There are several threads on the topic, which you should be able to find via a search.

My oncoplastic surgeon actually doesn't do under the muscle implants unless the patient isn't a candidate for prepectoral. This would certainly not be the case if there were any increased risk associated with this type of reconstruction.

Not all surgeons do prepec reconstruction. Maybe the woman in the video you saw had one of those surgeons. Maybe the doctor who told her that prepec can hide recurrence doesn't know what s/he is talking about. Or was saying something technically incorrect to make her feel better. Maybe she misunderstood. Who knows?

Try not to panic based on a video. You got three different medical opinions telling you there is no basis for concern.

mnsotamom74

Magari, thank you so much. I don’t know why I let myself get set off like this. I needed a voice of reason to help me work through this. I so appreciate you replying.

SimoneRC

Hi mnsotamom74,

Seconding Magari’s point and adding that with implants, prepectoral included, you will have MRI’s every couple of years (2 - 3 depending on your doctors) to check the implants. That also helps to see anything else that may be going on in there!

SpunkyGirl

Well, I’m a 13 year (and tremendously grateful) survivor, and I haven’t had an MRI since I was diagnosed. I’m not bragging, but I was told by a wise doctor a long time ago that those tests can have a double-edged sword, meaning that they think something’s going on and run you through the mill only to find out it was nothing. I’m just not interested in that. I hope my instincts are right! I wish you peace and healing in your journey, and for the wisdom to pursue what is right for you

JRNJ

mnsotamom74, I also starting stressing about this and have severe anxiety. And I am frustrated with egotistical, opinionated medical professionals that don't discuss different options and risks, they just tell you what they want to do. And I also realized Drs. can have polar opposite opinions on surgery, chemo, radiation, etc.... I asked my PS and he said it depends on where the original cancer was. He does over the muscle. In fact, I had no idea there was an option, he never told me, put TEs in, but they were removed due to infection. Then I had time to think and research. I was also told by my new BS that the old one left tissue behind. I will now have DIEP, with possible implants also in the fall due to radiation and was told they would have to be over the muscle in this scenario by my second opinion who does under the muscle normally. As over the muscle is fairly new, I don't think there is enough research, and are they tracking recurrences over and under the muscle? I doubt it. After hearing all the opinions and thinking about it, my opinion is that yes, of course an implant can mask a recurrence on the chest wall in-between the muscle and the implant. But this type of recurrence is probably rare and people are probably more likely to have a local recurrence outside the implant. I have ILC, which is harder to detect as it doesn't always form lumps, causing me more anxiety. I also was very disturbed by everyone telling me no more scans of any sort unless you are getting silicone implants or have symptoms. I wanted saline. So I actually considered/am considering silicone just to get the mris. So you may be able to take comfort knowing you will be scanned regularly.

mnsotamom74

thank you ladies!! It’s so helpful to get your thoughts and know I’m not alone:-

AngieB92

I'm having under the muscle implant but when listing the pros and cons of each type, my plastic surgeon never once said over the muscle could hide recurrence.

mnsotamom74

AngieB92, my surgeon said if there was a concern, they would never do them this way. I want to believe him, but when I hear someone else say, but my doctor said this... it’s just my personality, I get anxiety. I’ve stopped short of questioning my surgeon, we discussed it at length before I had the surgery, I don’t want him to think I’m loony. I know I’m the absolute worst kind of patient. I doubt and second guess non stop. I’ve been that way long before I was ever diagnosed, but the diagnosis brought this to a whole new level for me

AngieB92

I completely understand and you’re not wrong for questioning. All it takes is one seed of doubt and our minds are racing

mnsotamom74

AngieB92.. the seeds of doubt that come from having cancer are the very worst:

JRNJ

Agreed, the worst part. We have to make decisions and move on, no other choice. I keep second guessing......

lightningblue

Hi mnsotamom74, I can't speak from experience yet, but my surgeons both told me that there is no additional risk having OTM implants. Both my surgical oncologist and plastic surgeon said that over the muscle is a preferred option and they tend to do under the muscle only when a patient is not a candidate for over the muscle. They assured me (a generally anxious person, especially with medical stuff like this, yikes) that there is no difference in safety or monitoring between over or under the muscle. It's strange how much conflicting info is out there, I'm happy that I like and trust my surgeons.

I don't want to hijack your thread, but if you're willing to answer, may I ask how your experience with delayed reconstruction is? I went flat after mastectomy about a year ago, and decided a few months ago that I definitely want to do implant reconstruction. I'm wondering how the TE placement surgery compares to original mastectomy (more painful? longer recovery? any other major differences?). Thank you for any thoughts!

mnsotamom74

lightningblue, I'm so glad you asked, don't worry about hijacking at all :-)

My experience has been really amazing! My surgeon did leave enough flab after my mastectomy to begin with (simple mastectomy) at first I was kinda ticked because I was thinking I would need revision to get super flat. I decided to wait on that and give it time to make sure I really wanted to stay flat. I just haven't been happy, I tried using the prosthesis and couldn't stand how they felt. I went to talk to my surgeons partner in November, he said I was an excellent candidate to have reconstruction. He said we could have done it even if I would have gone super flat, but it would have taken more time to stretch the skin, and possibly needing to do some fat grafting as well. I had the surgery to place the expanders Dec 17, my surgeon said I had to stay at least one night in the hospital to make sure my pain was under control. Right after I was a little freaked because the pain seemed pretty bad, I was thinking at first it was going to be like the mastectomy, thankfully it wasn't nearly that bad. After 48 hours it wasn't bad at all, just tender, but not the extreme pain I had after my mastectomy. I had to of course take it easy for a week, I had drains for about five days. I was unable to lift anything over 10 pounds for 2 weeks, but as far as pain? I was off pain meds two days post op.

The expansion process has been fairly pain free. When he adds the saline it doesn't hurt, but it definitely feels like the skin is stretching and a little uncomfortable for a few days after.

I was back to work as soon as my drains were removed on day 5 or 6, I don't regret it at all, I wish I wouldn't have been scared to just get them at the time of the mastectomy, I was just too overwhelmed at the time to even think about it.

Hope that helps