Direct to Implant and AlloDerm Breast Reconstruction

This is what I had done.  I had no problems with any out of the ordinary issues.  I think that it was emotionally beneficial to wake up with a breast, although not attractive.  I am so relieved that I didn't have to go through the TE process - one less thing to deal with.  My surgical team does this process routinely as long as the patient has healthy skin and was a non-smoker.  Anything that can make this BC crap a little easier, I am all in!  I will say that the only negative was my new boob is actually a bit, little bit, bigger than my real side even after the reduction/lift.  But, they weren't perfect to begin with either.

I had a UMX/direct implant with alloderm in June.  Even though I did not have to have an exchange surgery, I did have another operation 5 mos. later.  We did a lift on my remaining natural breast and made a nipple for the foob from the MX scar.  Right before I was being wheeled into the OR, I mentioned to my doc that I was not real happy with the position of the implant and that it would move toward my armpit when I lifted my arm.  He agreed and while I was in surgery, he removed the implant, took some internal stitches along the outside edge of the implant pocket and then put the implant back in.  It looks much better.  

As far as pain goes....I had a skin sparing MX and I was a D cup size and I am now about a full C. So I went down just a tad.  I don't think my pecs would have stretched any more to accommodate a D size implant and I had just enough skin left to cover the C size implant.  I used Soma (muscle relaxer) for several weeks to help with the discomfort.  I had almost full range of motion on that side within 3 days.  But, I am pretty "Gumby"....very limber and hyper-mobile and I practice yoga pretty regularly.

I'm all done except for the tattoo.  They really look pretty good.  The lifted natural breast looks amazing.  I've never had perky girls until now!  If you have confidence in your sugeon's ability,  and they feel like you are a good candidate size wise I think you should consider going that way.  Just know that you may still need some tweaking at a later time.  Best of luck!

I had BMX direct to implant on 1-23-12- my non- cancer side came out great - my nipple from that side is in my belly my PS is going to create 2 new nipples out of it. My cancer side did not go so well -the implant is not postioned correctly and I have a large area with nothing and my skin has folded. The PS said it is  fixable and I also saw my BS who said it was fixable just another surgery I did not plan on. I would do it again if that helps I am so happy with the other side and I am sure once this side is fixed I will be happy. 

Greenmonkey - FYI -  Mentor also makes cohesive gel implants and they are readily available from any plastic surgeon.

SpecialK... you are everywhere! I love you!!!

I am scheduled to get the Mentor Cohesive Gel, is that what you have?

I wish I would have heard about the direct implant before my surgery. But given the problems I have had, maybe it is better I went the route I did.

Greenmonkey - what a path you are on!  I agree this site is a lifesaver, will be looking out for your progress  

Greenmonkey,

I had the same procedure and am happy with the results. It's pretty, but not perfect - slightly different shape and a little smaller. But as they say, in clothes no one knows. The surgery gave me almost no problems and I was happy not to have the wait for tissue expanders - quick and "easy" (or at least easier).

You should know that you are in very very good hands. Dr. Salzberg is a pioneer in the one step direct to implant surgery, so you have an expert surgeon. He should give you great results.

And yes, the decision process is so hard. It gets better, and you have friends here. 

Green Monkey

I am holding my own, but the date is creeping up on me  -Feb 23.  I happen to be dealing with a cold so I hope that is gone in plenty of time as to not change the surgery date.   I am sure I will be a whole lot more nervous in the week to come.    As I go to some of these sights that show pictures it all looks just a bit grotesque.  I know I am going to have to toughen up and deal with the visual aspect of it. 

What is the determing factor whether a doctor can do direct to implant?  Or whether he has to use expanders?  The size of your boob?  I would also prefer not use the TE.   

 I have also found that my insurance BCBS of MN, says that they only pay for reduction of the natural breast to achieve symmetry, therefore if you need to be tweeked a bit bigger they won't pay because it is then considered Cosmetic.  Isn't that just ridiculous? 

GM,

In my case, my PS thought he could do direct to implant reconstruction, but said he would not be certain until he got a look at me in the OR.  He said that size wise, I was a candidate.  I was about a D cup going in, but my remaining right breast was a little smaller, so he thought he would be able to use a full C size implant.  That is as large as he will go with direct to implant.  He explained to me that it all depends on how much skin you have, how flexible your pec muscles are...can they stretch enough to accommodate the implant... plus some misc. things that he sees in the OR.   He has been doing these kind of implants using alloderm along the bottom of the pocket for a long time and he just has a feel for what will work.  He told me that he takes the right size TE with him into the OR just in case he can't do a direct implant.  So, I did not know what I had until I woke up.  I looked down and I had what looked like a boob under the bandage.  

Just know that if you go the direct route, that a muscle relaxer like Soma will be your friend for some time.  I took the Soma for a long time after I quit needing the pain meds.  

Again, this was just my experience and your PS may say and do things very differently.  That is one thing I have learned from these boards.  There does not seem to be much "protocol" for a lot of things that our doctors do.  They all have their own ways.  

Try to stay calm if you can.  All that stress is not helpful for healing and preparing for surgery.   Hang in there! 

Alloderm is donor tissue.  It is used to stregthen the pectoral muscle to hold up the implant and/or tissue expander which is heavier than breast tissue.

diana - no, there is no tissue matching.  Here is a link to their website that explains what it is and how it is made.  They explain it better than I do!

http://www.lifecell.com/alloderm-regenerative-tissue-matrix/95/

I am allergic to EVERYTHING and I had no problems with this.

Allergan Natrelle is a line of cohesive gels as well, avaiable in 3 profiles. Implants are not sized as cup sizes, i.e. There is no c cup implant but by cc's. Two people can have implants that are the same cc weight but end up with different cup size. I have Natrelle style 15 , direct to implant, 457 cc's. My bra size is now a 36B or small C, depending on the brand. The Alloderm creates an internal sling so I often don't wear a bra at all!

Caryn
PS: gummies, considered true cohesive gels, are tear drop shaped. Natrelle's are round. Some have had trouble with the gummies turning but I don't think it's a major issue.
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