March 2014 Surgery

I guess it's your call what you feel comfortable with.  If you have a season pass, you know which of the roller coasters have a smoother ride and which ones don't.  I think I would definitely avoid the Mean Streak - lol.  Some of them have a smoother ride, but a lot of them have the flipping upside down too, which I'm not quite sure how that would be, and Jullie's right, the restraints might be located in a bad place.

I don't even want to cut grass on our riding mower, we have 3 acres of rough land, and I remember last year when we got the new mower, I was bouncing around all over the place.  I made a comment to my b/f then (now husband) how the tightest of sports bras wouldn't have helped.  Needless to say, he is on his own with the grass cutting this year.  It's too bad, because I rather enjoy it.  I may give it a try in a month or so, if I go really slow. 

I hope all of my March 2014 Surgery Sisters are doing well. I was visiting the June 2014 Surgeries forum and they were talking about nips. So that made me think about something. If I had nipple-sparing, will my nips stay flat like they are now? I thought they would be raised, but if I understood the PS nurse correctly yesterday at my second fill, they will stay flat. What are your surgeons telling you about nipple-sparing? I don't see the PS until my last fill, and at 50ccs that will be a while!

southern - I had nip sparing - they stretch out a bit as you expand and have no retraction mechanism as that has been removed. I would imagine they are a bit different for everyone depending on how they looked prior to surgery, but mine a pretty flat. 

Morning March sisters - just dropping in to say hi to all that I don't see in the other forums.   Hope everyone is doing well with their recoveries.   Funny my TE's start bothering me the middle week after chemo - and they they go back to not bothering me at all.  I guess chemo makes the muscles less elastic as a SE - don't know if that is medically correct but that is what it feels like.  

Fighting a UTI right now - not feeling bad just a little back pain - but hate that I have an infection at all ugh - oh well - at least my system is strong enough that I am battling it at home and not in the hospital.  

Saw the nip conversation in the June forum and also in here.  I originally thought I was going to have nipple sparing but my PS did not feel comfortable leaving behind that little bit of breast tissue in my case.  I thought it was odd that my BS was comfortable with the idea and in fact suggested it, but my PS did not want to do that.  He does them and I saw pics of ones that he has done and they looked great to me, but I went with his gut.  I am glad now that I did based on my little healing issues - I fear those might have been worse.  

I had kind of decided that I would have nipple reconstruction, as that is what my PS was suggesting, and then a tattoo.  But I am now leaning towards the 3d tattoo only - I really don't think I want any more cutting on my skin than needed and I really don't care if I have nips or not.  My PS says he does the 3d tattoos also and also has his book of pics of those - and again they looked great to me - so I think I will trust him to do them.  I really love him - he is such a kind man and his staff is wonderful and even though I know that when I see him - he is going stick me with needles and shoot liquid into to me - I really look forward to seeing him and his staff.  He is definitely someone that I will miss after this is over.   

Re: nipple sparing and nipple projection

I had nipple sparing, direct-to-implant on April 24, so no expansion. Before surgery, my right nipple was flat/inverse; it has been so my entire life. It would only project a bit if cold or if I manipulated it. My left nipple had more projection and was not inverse, but really I have to state that both my nipples pre-surgery were kind of unimpressive as far as nipples go - I have never had "pencil eraser" nipples, more like wrinkly bits of pale pink tissue gathered in a sort of circular shape...you can see pictures in the picture forum of them pre-surgery. 

My right nipple after surgery is no longer inverse. I understand that this is because when nipples are "naturally inverse" it can be due to short or tight ducts/connective tissue or something pulling it in. So, when that tissue was removed it was released. It has more projection now (I was actually surprised by this!). My left one is a little flatter than it was before surgery at this point, but in part this may be due to fact I had some scabbing/healing happen so lost a bit of tissue on it.

I would not call mine flat, at least not any flatter than they were before surgery. One has more projection than it did before, one has a little less than it did before - now they are actually more even! Both react to cold and still project as they did before surgery in cold. I do however notice that they are more sensitive to pressure, so if I am wearing a bra with some compression in it, they will be "flattened" down unless it is very cold and won't pop back out again until I release the compression.

I think it really does vary, as I certainly have seen some women end up with flatter nipples, and others with nipples that do not appear to have any less projection than they did before surgery.

I had nipple sparing direct to implants but then had to lose the right nipple a month after my BMX because the margins were positive.  My foobs were 10 weeks old yesterday and my remaining nipple isn't flat, it looks just a little bigger than it was before because it's stretched out some.  I have decided to get a 3D tattoo instead of nipple reconstruction.  I'm trying to get an appointment with Vinnie Myers in New Orleans but he's booked solid through the end of the year and they aren't booking for 2015 yet.

Sandra, that's too bad you have a delay but understandable in this case, and I'm sorry you continue to have problems with the left side.  I have the anatomicals and so far I really like them but wish there was a little more projection.  I really need to get back on a diet and lose some weight - I think that will help make my implants stand out a little more.    I think I've taken out my frustrations at having these medical issues this year by eating too much and not getting enough exercise.

ever - direct to implant is done basically the same way as TE placement. Generally, surgeons do this type of surgery when they feel confident that you will not have issues with clear margins, and will not need radiation. It is often done if the patient is willing to stay on the smaller side - there is only so much room under the pectoral muscle, but some can go larger if their pectoral muscles are more lax. If a patient already had implants prior to a diagnosis they can sometimes have this surgery. Some doctors are reluctant to do direct to implant as it is a bit more prone to capsular contracture. There are a couple of threads on this site devoted to this surgery.

Everforward...

Usually direct to implant it is done with a tissue matrix - like Alloderm, Stattice, etc. The surgeon can then make a "pocket" at the IMF using the matrix that makes more room available for the implant without needing to expand and it also means they usually do not need to dissect the serratus muscle. The Alloderm is sewn along IMF to chest wall, and to pectoral and serratus, which also reduces risk of lateral migration and bottoming out, and adds protection, coverage and support to the implant. Think of it as an internal bra. Eventually your own body tissues integrate with the Alloderm. Alloderm also may decrease risk of capsular contracture and it allows the surgeon to create some natural looking ptosis.

You do need a large enough, healthy tissue flap. The direct to implant can be a bit harder on the skin and tissues compared to expansion. Location of cancer, or planned treatments such as radiation, may mean it is not available as an option. Sometimes women can go a bit larger, especially if they had more deflated breasts but lots of skin, but usually you should be willing to stay the same size or a bit smaller. If you do nipple sparing rather than skin sparing, then very ptotic breasts or very large breasts can limit it as an option. 

I was a natural 32DD before surgery and had 435cc Allergan high profile silicone round implants placed immediately after my mastectomy, and Alloderm was used. I had a very, very good recovery with very little pain and discomfort. It does take a while for the implants to drop into their new pockets, and when I woke up they were at my neck and very firm! However, they have already changed a lot in 5 weeks and will do so over next few weeks and months. I have not had crazy spasms (though I too had strong pectorals from being very physically active and weight training...I was doing pectoral exercises in the days before surgery too) nor had the discomfort of hard backed TEs. I have honestly never felt uncomfortably "stretched" in my chest. Swollen initially yes, but not "tight" or anything. Even if I need a revision later (not sure if I will) I am very happy, and happy I was able to avoid weeks or months of tissue expansion. I will probably end up around a 32D which is great as I wanted to be smaller and asked my PS to try and achieve that! I was very pleased to find an experienced and skilled PS who suggested I was a great candidate for direct to implant. 

Thank you. I will add this to my list of questions when I consult with the breast and plastic surgeons.

southern - omg, you poor thing! I can't imagine how scary that was - brown recluse is a bad news spider. Glad you were proactive!

Southernbling, Oh my, how scary!!!  So are they treating you as if it was a brown recluse spider?  You said the urgent care people didn't think it was a brown recluse spider bite?  Is there an anivenom you should have?  I hope it gets better soon.  Sorry it delayed your fills.

Sandra:

Sounds like your husband had a much more severe reaction than I did. My husband is still not convinced the spider was a brown recluse even though the post control guy said it was. Maybe I just didn't have too bad of a reaction. It is barely red now and was never swollen. After reading about your husband's experience, I will definitely keep a close eye on my bite.

Hope you fabulous ladies have an awesome weekend! 

Sandra - tell him to be careful with the energy from steroids, because when they wear off he may crash.  Hope it does the trick and he starts to produce healthy red cells on his own.  May be a "tincture of time" thing.