Visible ripples in implants

I just had a 6 month follow up with my PS on Thursday.  I asked her again about fat grafting for the rippling.  She said she has to use a more labor intensive fat extraction process than lipo, insurance doesn't pay for it, and the results are not very consistent.  She said often the fat gets reabsorbed so it takes multiple treatments and can leave hard permanent lumps. She seemed to feel it truly hadn't been perfected, yet, and was more effective for filling in divots than overall rippling.

PB22- I'm glad you were able to fix the rippling by going to a larger implant.  Unfortunately, I don't want to go any bigger and actually wish I was a little smaller, so I guess this isn't an option for me.  I agree with you about being physically stronger but less so emotionally.  I am amazed how many different threads there are about PTSD and other post-treatment issues.  I've been posting on a few of them and it's helped to know I'm not the only one dealing with this.

whitedove- I've read that they don't want you to working out your pec muscles prior to MX, either, as this only makes it that much harder to stretch it with the TE's.   

I think all of us would be doing much better accepting everything if only doctors would better prepare us.  I never even knew my pec muscle would be altered with MX until after the fact and I never was told about rippling issues.  So many women are led to believe that it's just like a boob job.  

I had my exchange four weeks ago tomorrow 400cc on one side 450cc on the other. The one with the smaller amount has pretty significant rippling when I bend over. I find that part of me says I just have to deal with it and part of me says no why can't I expect better!  I was suppose to have nipple sparing but infections in both incisions and one incision that broke open. Lost both nipples. The side with the most rippling is the side where the incision broke open. I am thinking if he went just one size up it would help.  I should be happy at this point.  Getting closer to the end of reconstruction. I had my mastectomy Dec. 29th 2009 but due to all the complications delayed reconstruction for months. Why am I so teary and sad?  I use to be such a go getter and a fighter but all I am now is sad.

Thank you whitedove, but does it ever get better?  This is such a hideous disease and I get so angry when people think because the incision is healed it is over.

leeinfl  thanks so much! 

 I had heard that about anesthesia, I had forgotten about that.  It is just so different for me to be so down.  I know that all the complications have added to all of it.

 I went to talk to a counselor who happened to have had BC and a mastectomy and she said with all the complications surgically. I had to infuse two antibiotics 14 hours a day for 6.5 weeks while waiting months for the open incision to heal doing dressing changes every day, not knowing if I was going to keep the tissue expanders or not. and things that happened that were bad like them forgetting to send my tumor for the Oncotype test like they should, old man volunteer coming in my hospital room questioning me about my diagnosis in front of someone I had just met, my breast surgeon saying "I heard you had a meltdown" when talking about me having tears on my face when my PS was cutting away my nipples in his office because they were necrotic etc that I was experiencing what was similar to post traumatic stress. I had a good friend yell at me when I told her I got teary when I walked by the lingerie dept. at the store the first time about 2 months after my mastectomy. She said "well did you wear sexy things to bed before" When I challenged her on that response saying "you can go in and chose anything you want I can't because my breasts have been cut off she asked why I lashed out at people!  Like I have no right to be sad that my body has been so mutilated! I no longer keep in close touch with her to say the least. Sorry I am ranting guess still angry about all that went wrong.

 I find it hard to know who to go to for a second opinion. I know my PS won't do fat injections. He already said that. He also said when I first brought up the rippling at my second post op visit that he would wait to Spring to do anything. I don't want to wait that long! I want it done before the end of the year. Do they have to wait a certain amount of time?  I am also concerned because I was suppose to be nipple sparing, lost the nipples but have all of the areola on the left and most on the right. I am wondering how they are going to handle adding the nipple part?

 Okay I am done, sorry for writing so much. I value all that I read here.

Determined - it's alright to vent.  I'm sorry you had all those complications along with the insensitivity of some people, including "friends".  You really get to know who your friends are, don't you?  I can relate to that.  It's sad.  Maybe some people just don't know what to say so the wrong thing comes out, but I've chosen to distance myself from them.  I don't want negative people, or fair weather friends in my life.  If anything, this has taught me how precious life is and who is special in mine.  It may sound cruel, but those who have failed me no longer are welcome.  I don't blame you for doing the same.  We have enough to deal with!  The flip side is true as well, a friend that I had lost touch with came back into my life and we are very close again.  Surround yourself with true and supportive people.

I don't know about the amount of time and I know there are quite a few posts that reference "fluffing".   Not sure what that is supposed to be, but I felt the same as you.  I didn't want to wait.  If Dr. Khouri had suggested waiting or had given me any hint of this being as good as it will get, I would have accepted that.  The fact that he was so enthusiastic and confident made me feel that I did in fact DESERVE to have pretty breasts.  That I don't have to SETTLE.  

Sweetie - Thanks, but I've felt everything you have felt.  If I allow it, I can get into a real slump, especially with the extra surgery.   Just like you, I thought this would be quicker.  I really thought that by June/July everything would be done and over.  I'd have perky boobs and everything would be wonderful.  Obviously that wasn't to be, but then I remind myself that things could be worse and now I am being treated by a PS who wants me to look the best I possibly can.  Even if it did mean more surgery and pain.   You will get through this - one step at a time.

We are strong!

sweetie 2040  you deserve to be satisfied.  I think we have to accept a small amount of rippling but there is absolutely no reason we can't seek out more information.  I have done so much reading and my husband found a wonderful article written by a counselor and breast cancer survivor who wrote about the stages of grief related specifically to losing a breast. She said in the hundreds of people she has worked with she noted it takes about two years to full acceptance. So I guess we are experiencing the sadness, anxiety, depression and anger that are all part of the stages. I am determined after seeing everyone's post to believe I have the right to question and get a second opinion. This is after all what we are going to have to live with for the next 15 years before they have to be replaced. 

 My favorite quote Courage doesn't always roar.

Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow"

So we need to be gentle with ourselves I think, I know that but do not practice it often enough. And we need to seek out answers until we are satisfied. You all help me feel stronger thank you so much.

ladies-this thread is turning out to be very,very good. You are all so supportive and I am relating to what you are all saying.

Kate33 I know you had a hard time after your exchange but has it gotten any better? Have you excepted things as they are or do you still have concerns that you want addressed?

Determined-what you wrote was so eloquently stated. Thank you for sharing that, I needed to hear that especially today.

leeinfl-your so lucky to have such a wonderful PS who is using new techniques. I will follow your advice and I hope I will either make peace with things or find resolution.

Have any of you considered posting "ripple" pics on the pic thread. It may help us and others to know what is normal rippling and what is just to much. Next week when I have time I will take more pics and post them.

sweetie- Am still having issues with the implants but am indecisive as to what to do about it. For me, it isn't so much the rippling as it is how uncomfortable the implants are.  Everyone says how soft and natural they feel but I'm not feeling that way.  They feel heavy and my breasts ache constantly.  So going with a larger implant doesn't appeal to me at all.  I've been trying to research but there are so many different things it could be.  Post mastectomy pain syndrome, the PS may have made the pocket too small, the PS may not have made the Alloderm sling secure enough or it's just my fibromyalgia symptoms going crazy which I've read can happen when getting implants.  So it's hard to know how to fix it.  

Kate - no, I had a different PS who did my reconstruction.  I had my double mastectomy and TEs placed in the initial surgery back in January.  All along I felt that I had too much space between my breasts and there was this big dent (no fat) along the medial side of my right breast.  I remember asking my PS before the exchange surgery if this would look any better once the TEs were out.   His answer wasn't very reassuring and maybe I should have looked for a better solution right there and then.  Well, after the exchange and nipple reconstruction I asked him if he could do fat grafting to fill the area.  He said that the only way to fix that would be to take tissue from my back (basically a lat flap) since he didn't think a fat graft would work.  My right implant also would slide quite a bit to the side. That's when I did more research into fat grafting and found out about Dr. Khouri.  I can't turn back time, but obviously I also wish I had known about this before my MX.  At least by posting on this forum more women will find out that this is an option.

So 4 weeks ago Dr. Khouri switched the implants to much smaller ones (300 cc) and did fat grafting all around my breasts to make them look very natural.  He's obviously a tremendously skilled and innovative surgeon, but it's his enthusiasm that makes you feel so much better about yourself.  It's hard to explain, but all of you know what I mean - that it's OK to want our breasts to look good, that you aren't somehow "ungrateful" for plowing forward and wanting better results.  Rather he feels strongly that we should have beautiful, natural looking and feeling breasts.

leeinFL- Oh my gosh! What you described about your breasts before your recent revision is exactly my issues, exactly. I felt they were too far apart, I have the indent on the right and the right slides to the side. When I lay down they look REALLY far apart and I have a ton of ripples. I also asked him about moving them closer together and he said he couldn't because of where my muscle end. It has perplexed me though because I have seen so pictures of women who had TE far apart and yet the Dr was able to move they so much closer together. A lat flap procedure would be the last thing I'd want to do! That is more surgery affecting other parts of your body. You are so fortunate to have gotten to see the new Dr who does that procedure. I think that would be hard to find someone like around here. Does your Dr have a website with pictures?  One more week and we'll see what type of solutions my Dr. orders.

Kate33-I'm so sorry. I just hate when Dr's give you no answers. They expect you to just go home and deal with it?! You need to know definitively what's causing it and how to treat it. Once again we find that we must be our own advocates.It's so frustrating isn't it.

Claire-don't get me started-what happened to you is totally unacceptable, totally!

Kate - I had Mentor high profile smooth surface implants.  All along I thought they were 600 cc, I just double checked and they were actually 500 cc.  Yes, Dr. Khouri took out the original implants, placed the 300 cc implants and did the fat grafting all in the same surgery.  He took fat from my outer and inner thighs.  I know he lipo'd 600 cc of fat (actually they suction more, but 600 cc is the amount of condensed fat used for the fat grafting).

Sweetie - I couldn't help but constantly feel that dent.  I'd push the right implant towards the center when I was laying down and sadly watch it roll back down to the side.  Every photo of myself, I immediately looked toward what should be cleavage and notice that boney look.  There was no way I was going to have lat flap surgery!

Dr. Khouri does workshops almost every month and trains surgeons in this technique.  Maybe you can find out if someone in your area has been trained and is doing this?  It's worth a try - email Dr. Khouri or call Cindy, his assistant at the Miami Breast Center: 305-365-5595.  Yes, there is a website with plenty of photos:     http://www.miamibreastcenter.com/

One of the ladies that has posted here also has a web forum dedicated to fat grafting.  Most of the members are patients of Dr. Khouri's and there are several personal stories and photos.  I have photos posted there as well.  Feel free to PM me - I'll send you the link.

Sweetie - yes, so frustrating!  Not only do different doctors do things differently, but they also don't prepare you enough.  We all have to bring lists of questions, but there are so many things that we learn "after"....

One thing that I wish someone would have told me is how much of an impact this all has on the pec muscles.  To have your boobs move up and down every time you use your muscles....noone warned me about that.  I hope that this will be less noticeable now.  Time will tell.

LeeinFL-you are so right! Why are we learning all this stuff after the fact! It's funny you mentioned the pec muscles. I was just noticing that yesterday when I had a V neck top on and I used my upper body for something how I saw my boobs contort in the weirdest way, One went one way and the other the other way, looked so strange. Maybe with the fat grafting you will not notice it as much because of the fat tissue covering the area. That seems it would be a big advantage.

Determined-I'm sorry you had a such a hard time. I too had a problem 5 weeks after my BMX and had to have my TE replaced because of wound problems. He also put me on Neurontin for pain too. I had a pain on the right side that wouldn't go away. It went away after he changed the TE so I wonder if it was sitting on a nerve. Question on the tummy tuck-do you have feeling in that area or is it numb?

Determined-I think it is good that you did what makes your happy, age has nothing to do with it. I think we have every right to feel good about ourself at any age!! No I wouldn't be getting one, but I was just wondering what affect it had on your stomach. I was wondering because if you used that tissue to make breasts would the procedure have had to been a lot different therefore the area may have been numb.

I don't think you should feel nervous about asking your Dr about the ripples, but I do relate. It's not that I am nervous I am just worried that he will take my concerns seriously. Of course you know how Dr's are. You don't want them to feel you are not happy with their work. I do like his work, I just don't like the ripples, so therefore I am not happy. I'm not blaming him, it is something that can just happen,but what I do want to know is what can he do about it now. It sounds like your Dr is very compassionate so it would seem he would be very open to helping you resolve your issues.