Nipple Sparing Mastectomy with immediate reconstruction

Thanks Tampa,

My GP said it was hard to say what was happening at this point but agreed that I should probably stay on the antibiotics so he wrote me another prescription.  It did appear a little less angry looking to me today, I am taking everything I can think of to help with wound healing, but I will give my PS a call in the morning anyway just to be sure!

Lisette hope everything is OK

Lisette- Just want to wish you luck for your PS appointment tomorrow.  Hope it all turns out o.k

Nightnurse- I haven't heard of this before.  I tried googling it but couldn't find any information.  Does your surgeons have a lot of experience with NS?  If so, I guess you'd have to accept they know what they are talking about.  If they haven't done that many I would try to schedule a consult with someone else who has.  Is there a reason they couldn't at least try with your understanding that there would be a much higher risk of failure?  If the nipples don't survive they could remove them at that time but at least you would know you tried everything possible to get the results you wanted.  So sorry.  I hope you can find a way to work it out.  (((hugs)))

Nightnurse and Kate33 - I got a response from my BS.  According to her, breast lift and breast reduction are contraindications for straightforward NSM.  The NAC (nipple areola complex) would be unlikely to survive if left intact on the breast skin flap.  However, it may be possible to remove the NAC and use it as a graft. 

Nightnurse - Good luck with whatever decision you make!

Hmm... confusing, since when I had a breast reduction last year, I specifically asked my PS if this would still make it possible to do a NSM, should I need one in the future.  She said that the reduction made me a better candidate for the prospective NSM, since being large breasted can often compromise the blood supply to the nipple.  She does a lot of reconstruction in her practice.

I've seen some women do either lifts or reductions on one side in combination with a MX on the other.  If it's more difficult, if not impossible, to do NS after this I have to wonder if these women are being told this.  There's always the possibility of having to do a MX on the healthy side down the road.  I would be extremely upset to find out that NS was off the table at that point.  Again, surgeons need to be sharing all this information with their patients.  They also need to advise if something can be done but they, personally, don't have the training or experience to provide it.  I found an article by the NY Times where they said breast reconstruction patients are not being given the full picture of all of their options.  I posted this on another thread but want to share it here, too.  Please don't assume that your BS or PS will tell you all the options out there.  Mine certainly didn't.  Do your research, ask questions and time permitting have several consultations.

http://www.nytimes.com/2008/12/23/health/23beauty.html?_r=1&pagewanted=all 

Tina- Unfortunately was just dx with LE in both arms and truncal which I believe was caused by surgeon error during my revision.  It's very painful and will require life long management.  There's a great LE thread on here, though, which has been extremely helpful and I've found a wonderful physical therapist.  Anyone who has had nodes removed, even SNB, I would advise you to educate yourself on preventing LE (lymphdema) and follow the protocol.  Don't trust your doctors will do what's necessary to prevent it.

Hi girls im back,,I had my NS and Ss BMX with immediate reconstruction on monday..The first few days the pain was the worse..My nurseing wasnt the best .i couldnt move my arms very well and getting in and out of bed on my own was impossible..I feel i could have had way better help..Thank god i was able to come home Wednesday..My DH and children have taken far better care of me then thoses nurses did..So far so good Skin and nipple apear to be doing great..The TEs are a little uncomforatable but are new and i seem to be getting better with that by the day..I will say i cannot wait for the drains to come out,,they really bother me and my DH was told to strip the lines onces a day and i hate that i can feel the suction and were they are running against my TEs ..I seen my PS yesterday and he wants to keep them there untill next week ,,only they couldnt fit me in untill next friday..I think once they are out i will feel soooo much better and i will say i am really looking foward to my first fill..Thank you all for your support threw this journey..This site and all of your persanol stories have been very helpful

Hi, I'm doing my BMX with 1 step to implants on May 7th and was wondering about ladies who did that and went up in size. I'm a 34B and wanted to go up to a C, not a full C just a C, so I was just wondering if any of you ladies went up and your experience in that.

Soyandpepper-I had NS with direct to TE.  They have not been bad at all.  I have had one fill since surgery and will get one more for sure maybe two.  I was a A cup before and would like to be a full B when done.  I love the fact that I got to keep my nipples.  Took me three PS's before I found one who thought they were worth saving.

Shawna,

I had a NS SS left mastectomy with DIEP reconstruction in January. I cannot speak to TEs but I can speak to having the top of the nipple turn dark and then get hard. I was frightened that I was going to lose the nipple because I was not aware that this could occur. Since I already had an appointment with a physician's assistant to check my drains I didn't have to make a separate one. Based on her examination, the PA assured me that in my case this would flake off like a scab and my nipple would be fine underneath. It did in fact become a small scab and then came off and my nipple was fine. I was actually trying on a top in a fitting room when that little booger dropped to the floor. 

When it comes to reconstruction I believe it's better that someone takes a look at it. But that's me ... I felt better because I wasn't describing something over the phone and having the PA visualize it. She could see it and touch it and make an assessment.  

shawna32 - Chances are the nipple will be just fine.  Many PSs are open to emails and I often was asked to send a good photo or two rather than try to describe over the phone.  It helped them decide if the situation was worthy of an office visit. 

The PA did comment, however, that if the patient can't take great photos it can be difficult for them.  Good, natural light and macro settings are best.

Good luck!

Kate33. Could you explain where the PS put the incisions. Where exactly they were supposed to be ... What is IF? And why you believe this contributed to or caused your lymphedema if that is what you mean?



I am continually attempting to educate myself about lymphedema. I see a specialist for PT regarding cording, manual drainage, and le prevention. Following chemo I am supposed to have radiation but am concerned about how this will increase the likelihood of my developing le. This is a lifelong vigilance I know I will have to embrace. Tonight I am just tired of thinking about it all

Kate - so sorry about the LE!!!!  I haven't been on here much lately - so are we still at risk for LE even 2 years out from surgery!!!  That's just crappy

Hugs, Valerie