Beware: Athletes who choose reconstruction may regret it

Hi Granis!

  I don't have time to read all the responses here, but have read many. I think your post is very helpful to many women.  We all go into this blindly, just following the doctors orders because we don't know what to do.  BC doesn't come with a guide to explain your options and how this will all effect the rest of your life.  I wish someone had told me that pushups and pull-ups would be so difficult with implants.  It has been 3.5 years since my BMX and it still hurts at times.  I see that many women with implants have similar issues because of the way we are cut up and then sewn back together.  It seems like the flap reconstructions are easier in some ways over the long haul.  But when you have an athletic build, there isn't much fat on you to make into breasts.  Hopefully they come up with better alternatives for women like us that would like to remain active while still looking somewhat like their former selves.  

I think the key thing is to discuss all the options with the breast surgeon and the plastic surgeon prior to making any decisions.  They should inform all patients regardless of activity level what the down sides to each surgery could be so that we can make informed decisions. 

Kstillie, I want to throw up when I think of what your (ex) PS said to you.  "Think of it as a trick you can do now."  You are NOT the only one complaining.  I am tempted to ask you for his address so I can go over and give him a piece of my mind!

XXXX

Kstillie - Boo on your PS saying it's a "trick" you can do now - what an insenstive idiot!  Bobo - I'll be right behind you in giving him a piece of my mind as well!  K - one thing you said was that you chose implants because other options involved taking muscle.  If your PS told you that, he was wrong - a DIEP flap does NOT involve the taking of any muscle.  Not everyone has enough belly fat for a DIEP, but it's an option you may want to consider researching if you want to pursue alternate recon.  I had a DIEP and my abs and core are rock solid, and I can do crunches and other core work as much I want.  Unfortunately, it seems that PS that do only implant recon tend to push implants and may give incomplete or misleading info about DIEP and other recon surgeries they don't perform. 

Gran - thanks for correcting that the muscle is not attached to the implant. 

kstillie I got this from the cancer society site - This one use tummy muscles:

TRAM (transverse rectus abdominis muscle) flapThe TRAM flap procedure uses tissue and muscle from the tummy (the lower abdominal wall). The tissue from this area alone is often enough to shape the breast, so that an implant may not be needed. The skin, fat, blood vessels, and at least one abdominal muscle are moved from the belly (abdomen) to the chest. The TRAM flap can decrease the strength in your belly, and may not be possible in women who have had abdominal tissue removed in previous surgeries. The procedure also results in a tightening of the lower belly, or a “tummy tuck.”

There are 2 types of TRAM flaps:

• A pedicle flap leaves the flap attached to its original blood supply and tunnels it under the skin to the breast area. This can leave an area of fullness under the skin where the tissue is tunneled.
• In a free flap, the surgeon cuts the flap of skin, fat, blood vessels, and muscle for the implant free from its original location and then attaches it to blood vessels in the chest. This requires the use of a microscope (microsurgery) to connect the tiny vessels and takes longer than a pedicle flap. The free flap is not done as often as the pedicle flap, but some doctors think that it can result in a more natural shape.

The TRAM flap procedure uses tissue and muscle from the tummy (the lower abdominal wall). The tissue from this area alone is often enough to shape the breast, so that an implant may not be needed. The skin, fat, blood vessels, and at least one abdominal muscle are moved from the belly (abdomen) to the chest. The TRAM flap can decrease the strength in your belly, and may not be possible in women who have had abdominal tissue removed in previous surgeries. The procedure also results in a tightening of the lower belly, or a “tummy tuck.”

This one does not as Nansfan stated:

DIEP (deep inferior epigastric artery perforator) flap

The DIEP flap uses fat and skin from the same area as in the TRAM flap but does not use the muscle to form the breast mound. This results in less skin and fat in the lower belly (abdomen), or a “tummy tuck.” This method uses a free flap, meaning that the tissue is completely cut free from the tummy and then moved to the chest area. Use of a microscope (microsurgery) is needed to connect the tiny vessels. The procedure takes longer than the TRAM pedicle flap discussed above, but leaves less muscle weakness and causes fewer hernias. It isn’t available in all areas.

Oh, and my doctor NEVER told me I would lose the ability to really use my pecs but when I brought it up the way it was feeling he was like "yup".  I'm not saying I wouldn't have gone that way anyway but it's kind of a big deal to not mention it.  He did tell me about the TRAM flap but not the DIEP flap.

I just had surgery again yesterday on my right implant. it was getting pulled and misshapen, not form excersize but scar tissue and the pocket was flat on the bottom.  Can't wait to see how it turned out.

hello ladies, I am actually aware of the DIEP, my sister had it done (she is BRAC2 + as well), but my ps didn't do that kind of surgery (micro-surgery) and I wasn't keen on having a scar across my belly (for some reason scars and me don't get along - always painful).  Also didn't want to be put under for that long.  I am now reconsidering this option though.  

Kstillie, your photo is CUTE

does anyone have implants over pecs?I'm not much of an athlete, but I was and my overdeveloped pecs distorted the implant. New PS says he can put implants over muscle - I hope this works!

wolfhoundmom, I have *heard* of women getting their implants over the pectoral in reconstruction (and I know there are a couple women around BCO who had that done in certain circumstances) but I would be very concerned in the long run about the wear and tear on the tissues that have to "hold" that implant (you don't get to totally ignore the laws of gravity with implants!), and the higher risks of capsular contracture, migration (both bottoming out past the IMF and lateral migration into armpit), explantation, tissue necrosis, and so forth. Even if your surgeon uses a dermal matrix like Alloderm, it can only do so much. Oh, and then there are the more cosmetic factors like rippling, divots, and I can only imagine what the implant would feel to touch like to be only covered by such a thin layer! So yeah, I would really encourage you to talk to your PS and I would also want to speak to some of his patients who had this done YEARS ago. And find out what the plan is. Perhaps it is more feasible if he was using a lat flap or something but that has its own concerns and such, especially if you are athletic. 

Gran, I am so pleased that you are doing so well! It sounds like implants definitely did not work for you that removing them was the right choice for you. I am very glad you are back to doing the things you enjoy, be it spearfishing or pushups!

I am now almost 9 weeks out from my surgery with direct-to-implant (435cc Allergan's). I don't have any pain issues/discomfort from the implants, and am back to almost all my regular athletic activities, but admittedly most of them are primarily lower body so can't be expected to be much of a strain on the pectorals anyway (running, hiking in the mountains, etc) as would rock climbing (which I have not done in years anyway) or something of that nature. I do some weight training about 4-5x a week, but am avoiding anything that works the pectorals directly right now and personally I am okay avoiding them even though I used to love "chest days" (not everyone would be, so I understand that). Aside from that precaution, I honestly don't really feel the implants really...sometimes I feel a little flex or whatever, but nothing crazy. I actually am relieved and more comfortable now that I can get away with only 1 sports bra....I used to need to wear at least 2 for my former 32DD. It is nice to have a lot less bounce!

I have not tried getting back to kayaking yet, and am waiting until 3-4 months out to do so to give my chest more time to heal before adding that kind of repetitive upper body movement back in. Also will be going back to scuba diving (cold water right now) this weekend or next. I have been cleared to try for the last couple weeks but there has been a lot going on the last couple weeks.  I did test picking up my steel tanks and weights, and putting on my drysuit, hood, etc though to make sure I had no issues with movement! I'd have very little concerns about it if I was diving in warm water and doing giant strides off the back of a boat where, but the cold water drysuit/shore diving involves a LOT of weight, equipment, and even when I am not a few weeks out of surgery I find it tiring (especially when the water is lower...means more walking to the shore...ha ha). My concern to date has also been being able to handle emergencies underwater (like having to rescue a dive buddy or deal with a tempermental dry suit) but I feel quite ready at this point and itching to get in the water.

What I can tell you about my surgery is that the implants are under my pectoral muscle, with Alloderm on the bottom as a sling which is stitched to the pectoral, ribs, and I think a bit to the serratus anterior muscle, but he did not cut/lift the serratus anterior muscle at all. I believe in more traditional TE/implant surgery they do sometimes do something to the serratus muscle as well to form the pocket...raise part of it or a layer or it and suture it to the pectoralis major to give the implant coverage. Maybe that also makes a difference?

Gran, I honestly don't worry about much "puncturing" my implant! These babies seem pretty solid. I am not spearfishing, but I do let my cat and her sharp claws crawl and knead over my chest every morning, ha! If anything is going to puncture my implant it has to also puncture ME, and I am more worried about that then the implants. The implants can be replaced, something like my eye or spleen can't be! But, I'll still watch out for those barracudas on my next dive trip (last time I had some come awfully close, which was actually pretty cool but kind of scary as I have the photos of what they can do to people!).

wolfhound - From reading several threads here, I believe that implants
over the pecs are used for "augmentation" (in addition to the natural
breasts) and not for reconstruction after mastectomy. Yes to what divecat & gran said!!  You could post your question on the Breast Implant Sizing 101 thread and see what WhippetMom says.

Oh yes, Gran, I was not trying to say scuba was the same as spearfishing, in any way. I am quite aware it is very different. Sorry if the chronology of my post led you to think that! Oops!

I was wondering if anyone has noticed little "pains" from upper body exercising.  I'm almost 4 years out from reconstruction and started taking a core class about 6 months ago and am doing a lot of upper body work. (I was just mostly running before that)  I recently noticed that I get little "pings of pain/pinching" in the breast area...usually feels like it's right underneath my nipple. (not really sure how to describe it.. it's not necessarily painful...just annoying) 

I had a nipple sparing bmx.  (left side BC side, right side prophylactic)  It's the left side getting the "pinging".  Could it be the nerves coming ot life after all this time?  I know they really "scraped out" a lot of tissue underneath the nipple of that side to examine for cancer.  I don't know if I should be concerned?  See a doctor?  for what really?  and which doctor?  The MO, the BS or the PS??  I don't know if it will go away after awhile?  I notice the iron bra feeling more now that i'm working out the upper body more.   I'm trying to make sure to stretch and that feels good.  Just wondering if anymore has had similar experience...especially the "pinging/pinching" sensation.

I don't get mammos because of the bmx, though I have gotten an MRI to check the implants for leakage (because ins would pay, and I wanted peace of mind).  I can't imagine pinging pain would be a recurrence issue...but who the hell knows?

Thanks Estel!  I don't have another doc appt for at least another 6 months maybe.  And that's with the MO.  I don't see the BS or PS for follow ups anymore.  I'm thinking I might make an appt with one of them.  I'm leaning towards the PS only because his specialty is reconstruction and breast cancer.