Reconstruction after RADIATION
Comments
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I am another pre-FG success story after radiation. I still have the tissue expanders and will have my exchange after the first of the year (for convenience, not healing issue). So far the pre-FG (2 FGs with 2 months in between then 4 months before expander placement) has made a huge difference in the integrity and the acceptance of the expansion and stretching of the expanders on radiated tissue. It is not the fast way to get breasts but it is the safest and least invasive after mastectomy and radiation. After failed immediate reconstruction even before radiation, and the major depression and hopelessness that followed, this method has given me so much hope. Thus far, even with hard, square expanders, I'm pretty thrilled and excited that soon I will have breasts again!!! Slow and steady with the fills is the key. God bless you. None of us like being here, but we sure have it better than out sisters even 10 years ago had it!!
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Sorry for interrupting but QUILTRUNNER, please change your settings to accept PM's. You PM'd me but I couldn't respond and was told you weren't accepting PM's.
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I've got some weird voodoo going on apparently!
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Bayoubabe
Just to let you know that I did talk to my ps and she does do the fat grafting at the time of exchange. And I will have mine at the end of december. She said that she does that to even out the skin after the exchange. I have one more fill and then some rest time before the big day. Thanks for the info. Will let you know how that goes.
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dishlady - hope all goes well! Hang in there - the end of the TE is in sight!
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Hello All and Hello Patricia (I remember you from last summer's column- was it summer rads?)I had a lumpectomy plus rads last year; this year was dx'd with cancer in the other breast. So I had a double this year with implants. Radiated side doesn't look so hot- will get fat grafting next year. Anyone have any tips, stories to tell about scarring, lumpiness on the radiated side?
Thanks!
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So tell me more about the procedure of FG? Is it general anesthesia? It is horribly uncomfortable/painful? What is the recovery time?
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Hi Ladies.
I will be having a fat graft done to my radiated breast Dec 19. I had a lumpectomy and radiation Summer/Fall 2013. I had trouble with the incision healing due to radiation or all would have been fine. After a recision I still had trouble healing so I had HBO therapy for 25 treatments. That was the magic ticket. I am healed but have a very strange looking breast.
My PS said the graft will be done under general anesthesia not local. The description of what she will do is interesting and I am looking forward to sharing more details once it's done. I was informed this is not a one time procedure in my case; it may be 2 or 3 grafts to get the results we wants. I will let you know how it goes.
Hugs,
Cakes
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Hi Cakes,
Great news, very happy for you with the FG. I was not able to get that approved thru insurance. I did a lot of research on FG and I am a very strong supporter of the procedure. I can't wait to hear all about your experience.
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Dogsneverlie, I will ask about the insurance aspect and get info for you. I believe it is considered reconstructive surgery and therefore should be covered. My PS did tell me is was covered but I am going to call today to check for sure. I will ask if they will give me the ins codes so I can pass them along to you; that may help.
Just called my PS office and was told my BCBS Ins didn't require a pre-authorization. I will push a little more and see if I can get more info for you when the out patient clinic calls to get my ins info. I believe the insurance codes are the key.
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Hello, ladies!
I started my recon process on 11/17. Prior to that I had rads in August of 2012 (and chemo earlier). I had expander put in before rads, which kind of stuck very high up, because skin was damaged by rads so much that it will not stretch to let it come down a bit.
I got anatomical implant on my healthy side, and expander on bc breast. It was done lower, my PS did some pocket work, I can even see stitches under expander. My MX scar moved up the breast this way, but not to much and I don't care about it. So, I was healing up nicely, even had excursions on Black Friday (just took kids to the store, not a true BF shopping!). Then, since I was so good I had a bright idea to go get my teeth cleaned, I was way overdue an also has to go back to work on Monday. After that there is usually no chance to get things done :-)
this is where it goes wrong. On Sunday I started having pain in my rad breast, spend evening in pain and when I woke up to go to work I was shivering, had muscle pains, felt awful! Saw my doctor that evening, he prescribed strong antibiotic. It did help ME, I felt good day later, but my breast still hurts, and red :-(. I am supposed to go tonight to be admitted and have 48 hours if antibiotics via IV.
Really don't wont to spend my weekend this way, but I am afraid that if 5 doses out of 7 didn't clear that up, I don't have a chance of it getting better over these two days? I don't know. I can get at least some sleep , and rest so may be it will help still? Just don't wont to make it worse, and may be go next week and miss work on top of that. I couldn't catch up being sick as it is after my initial two week off for this surgery.
I guess I am looking for similar stories, who had an infection/inflammation? Anything, just being really down about this whole thing and my stupidity!
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Zenlt - I hope the antibiotics helped and you are infection free. I had radiation in 2008 right side and then another cancer in 2012 with bilateral mastectomy and immediate reconstruction. Right didn't take ended up septic and in the hospital for a week in Jan 2013 and had TE removed. Decided last year to give it another try. Did HBO 2 weeks before and two weeks after my May 1 TE Surgery. After the second fill skin burst open where radiation was done. TE removed and another put in June 25 and did another 30 HBO. Had a couple fills then fought infection Aug 14 - Oct 9 when I had it removed for good. Just cleared from the wound clinic after healing a seroma. Back to wearing stick on prosthesis and I feel well and will be happy with this.
I gave it a good try but the rads just did a lot more damage than anyone thought. Good luck to you
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Zenit, I've not been around for a while. I hope you are feeling better. First I have to scold you. You are entitled to feel down but not stupid. You did nothing stupid or wrong. CANCER IS STUPID, NOT YOU!!!
I'm so sorry for everyone's failure. I had failure which is why I'm still at it 2 years later. For me FG has made the difference. Miscraw, because the procedure is under general there is a bit of recovery to get rid of the drugs but I was back doing anything I wanted, including running 6 miles, 24 hours later. Minimal pain - more discomfort but for me it didn't last long at all.
Dogsneverlie, cakes, FG is part of reconstruction and insurance has to cover it. I didn't have one issue with my insurance company and I was pretty certain I would.
I'm still in my expanders but my skin looks look because of FG. The rads side feels tighter and has a few divots but my PS will be repaired at exchange with more FG. I was able to have the exchange in November but some office changes with my surgeon are taking place and he's moving from Missoula which is 2 1/2 hrs away to my town and starting here January 5. It's a huge deal for our town and me so I chose to wait for him to get here and now I'm thinking of waiting until the end of ski season to have the exchange. I've been dealing with this for 2 years, and I'm 58 years old. I want to ski while I can and what's another 2-3 months waiting for the exchange at this point?
Good luck sweet ladies. This is no fun but I am still a big lover of FG!! I think it has made me a rads/expander/implant success story - against the odds.
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Guilt runner, you are absolutely right! What is another 2-3 months, especially when you are spending it doing something that you enjoy? Breast cancer disrupts so many other aspects of our lives. I have waited 6 years since radiation to decide that I want fat grafting. Now my breasts are starting to get a little saggy and I think that would boost things a bit, and fill in the divot that is now a little more noticeable.. I was told by one doctor to absolutely not do fat grafting, that implants would make me happier. But the stories of failed implants due to radiation damage have me scared, and I really think I will go for the fat grafting, but not until February, after my daughter's wedding. Didn't want to be distracted from the wedding tasks by getting involved in fat grafting, and there are plenty of enchancement bras out there to help in the meantime.
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Quiltrunner- I'm with you- waiting a few months to do what you enjoy sounds right to me. With the detours I've had it's been 2 years 3 months from diagnosis to being done with reconstruction. There were times in the process that I opted to take a trip and put the process on hold for a week or two-doing what we love is way more important!!!!l
Babs
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I have not had radiation but have had skin healing issues that have caused multiple surgeries and the loss of an expander, and now the loss of the implant on the same side. I am currently undergoing multiple FG to boost the vascularization and thickness of the skin in hopes of attempting another expander, then implant. I am having some issues with insurance over this - most likely because I did not have rads, but I am feeling that they will eventually cover the FG I had done last month, which they also authorized in advance, once my PS does a peer to peer with them. They did pay for revision FG to add fullness to the upper pole bi-laterally a couple of years ago when I still had both implants. I am interested in this thread since the successful end result of FG after rads is what my PS is hoping for in my situation.
quiltrunner - insurance does not have to cover FG - although most do, only reconstruction, and only for those who have had mastectomy. This is federal law (WHCRA 1998) and does not apply to lumpectomy, only to reconstruction after a covered mastectomy. The two members you referred to in your post are both lumpectomy patients so this does not apply to them. There are some individual states that have passed legislation that offers some coverage regarding aesthetic fixes for lumpectomy patients, but this is not universal.
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SpecialK, thank you for setting me straight. I did make that assumption. And, I would venture to say that rads and mastectomy are the defining factors in determination for insurance coverage. I am glad you caught that!!!
Dogsneverlie and Cakes, I apologize! I assumed you were looking for FG to help with the integrity of the skin to avoid rejection of tissue expanders and implants after mastectomies. Fortunately you don't have the stress and discomfort of these awful TE!!! They are like Medieval torture devices!!!
Rgiuff, I will still get implants! The fat grafting is to do as I stated above - HOPEFULLY allow the radiated skin to hang on to the expanders and then I will be following with implants. Remember, a percentage of the fat is reabsorbed.
I had immediate 1-stage reconstruction before it was known I would need chemo and radiation. I lost the implants from infection early in chemo - even before radiation. It was the only time in this mess I thought I might actually die. I was very ill!!! As you all know, after radiation the recommended and gold standard for reconstruction are flaps. However, new research is showing that it is the stem cells from the FG that improves the chances of success. It is a very slow process and to me was worth a shot before I jumped into the flap surgeries.
It is my understanding, and I'm no expert by any means, that FG can fill in some divots and plump up some but to get volume to speak of after a mastectomy implants are required. I'm doing FG as a measure to hopefully keep risk of infection and rejection at bay. Even with FG I still have to reduce the size of my breasts significantly. So far, my TE are hanging in. It's been almost 13 months since the 1st FG. TE were put in on July 3rd and I was filled to 400 cc. Last fill was in late October. 400 cc was the maximum my surgeon would go. After that it is too risky. Those last two fills were absolutely miserable!!! I was disappointed at first about my little bitty titties, but have decided I'm just fine with 'sporty' boobs. It's a very very sloooooowwwww process ladies! To me it's worth it if I can avoid flaps!!!
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In my case FG is covered by insurance and was pre-authorizied before I had it done. The insurance code is to ask your doctor to submit is 20926. I had FG done 11 days ago and so far so good. It may take 2 or 3 more to fill in the divet but I feel that is the best venue for me to pursue. Good luck my friends.
Hugs,
Cakes
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I really wanted FG - read so many wonderful things about it. My new PS took one look at me and we discussed and I am glad now mine did not get approved. I have tubular shaped breast, now the rad breast is half the size as well so I'm looking forward to a lift and implants.
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Hi this sounds like the right site for me. Here is the chronology of the crazy long mess of my reconstruction :
Left masect. with TE put inplace for planned DIEP, July 9th, 2012
,L axillary node disect August 2012,
chemo/rad/chemo finished May 2013
Found out about Brava/fat grafting so July 2013 had 1st Fat grafting with BRAVA
PS took out TE September 23rd 2013, huge infection 300cc's of pus taken off my L chest. Surgery 1week later to"clean out" the area. Then was nasty looking crater of adhesions.
Did Brava with Fat grafting number 2 in November 2013. Not very successful, still a crater of adhesions.
Fat grafting number 3 February 2014. Looks better but PS cut open and restitched area to loosen adhesions, butnow he tells mehe won't do more Fat grafting because I have so much scar tissue in my breast area. HE CREATED MOST OF IT! I was really upset and disappointed he just abandonded me after messing around and wasting so much of my time and my fat.
Found a new PS and did Fat grafting number 4 Sept. 21, 2014. Got massive infection number 2. Started Hyperbaric Oxygen therapy just 1 week before surgery because my skin tight, like shoeleather. Due to insurance SNAFU didn't start Hyperbaric until 1 week before the September fat grafting, which is why I got that infection . Was on the right antibiotic, but it couldn't get into the area due to the really poor tissue perfusion so lost almost all of that fat.
December 1st, 2014 had Fat grafting number 5. Had total of 60 Hyperbaric Oxygen treatments, 50 before fg, 10 after. Was successful, but only now at an A plus cup size and my real Right side is a saggy C cup.
I have decided to try a TE and then an implant. Really wanted Brava/Fat grafting to work completely, but am running out of fat after 5 fat grafting sessions and 2 serious infections where I lost most of my gains. F***ing radiation! I get so pissed and furious that they lied and told me my skin would be fine.
Now I am noticing what feel like small firm lymph nodes on the upper, outter corner of fat grafted breast. Hope this is just a left over from huge infection there in September 2014. Worried, but trying not to get too freaked out. Just desperately want to have a breast. No more biopsies /other invasive nonsense for me. I Have Had ENOUGH, just let me get the damn TE and implant by this summer.
Plan to push up PS visit to ASAP instead of February 4th, so I can get TE surgery sooner rather than later.
Cross your fingers for me ladies.
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Hi Ladies!!
I just had my 3rd grafting session. My thighs are not happy with me!!! Belly either!!
After losing my implant on the radiated side to an infection in February my PS did a fat grafting in May. Then because the results were so positive, he did another fat grafting at the end of August and placed a TE at the same time but left it empty. We waited 6 weeks and then started small fills. It was up to 260cc and a couple weeks ago, 12/22 he did another round of fat grafting where he removed 50cc from the TE and then grafted fat into that space and more. He did the left side as well for upper pole and cleavage and altogether moved over 500cc.
We are again waiting for the fat to settle in and then we will start the small fills again. Usually around 60 at a time until we match the other side that I replaced with a 600cc implant. Because of the fat grafting the right implant will be considerably smaller than that though!
I can tell such a difference in the radiated tissue and my PS is really pleased. He was a little reserved and cautious at first, but he is really pleased and may offer a friend of mine fat grafting on her radiated MX site. She had no recon at the time of MX and he is willing to try implants for her to with fat grafting!
Best wishes to all of you working through treatment, recon or getting back on your feet!
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YAY 4sewwhat!! Thats good news!
I chickened out of nipple recon and more grafting in December - just didnt want to wreck the holidays. I do need to finish up sometime soon though. I definitely will call your guy too. If it can be done without anasthesia it would be so much easier for me.
Keep us posted!
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Thanks GeeWhiz!!
I only did December because insurance was paying at 100% !!! I had my ankle hardware removed in November for same reason. Turned out the screws were loose and moving around. Feels SO much better now. Was out of air boot about 5 days when I went for the fat grafting!!
My guy told me he def will do nipples with no anesthesia and I think I sent you the info on the tatoo lady he uses in Woodstock. If not I can get that to you.
Maybe we can actually get to coffee or that lunch soon!!
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Just to let you ladies that I just had my exchange on dec 31. Just made it in 2014. All went well, my ps did some lipo and fat grafts. I had 3 drains, one was pulled on 1/2. I still have 2 more and waiting for liquid amounts to go down before she pulls these 2. I am pretty bruised right now and sore but that will go away. Still some swelling and hard to see what the new girls look like. I am sure there will be some fine tuning yet to come. I can see the light at the end of the tunnel now and waiting for our big trip this summer. I will keep in touch with any changes. Take care and hope 2015 goes well for all.
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4sewwhat: That is great news!!!!!! THANK YOU for posting about your reconstruction. I am not having FG done before the implant so fingers crossed I do not have any issues!
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Thank you ladies for all the good wishes!
I, unfortunately, couldn't fight off that infection. Went to be admitted to the hospital for IV meds on 12/05 and had another surgery on 7th. He took the expander out, put new one in and two drains to go alone with it. My work was really understanding, thankfully and I could stay home, again, whole week to recover.
On 12/29 I woke up feeling pain in my foob again. I just don't know if this expander is going to stay in without antibiotics, and not have a problem.
My last drain was taken out this past Friday only because the tube got damaged and it lost suction! Now, who ever heard of this! I was still draining at about 40, no less a day! It got me really upset, I was having problems with infection and draining for long time, and don't want to add to this by having to take that drain our prematurely, you know? My PS put tight compression band to be worn for a week and I will see him this Friday. It hurts, and I am thinking if that radiated area is that bad, it doesn't have enough blood circulation, and I am now restricting it even more? At the same time it is supposed to help with seroma? I am lost and upset.
Sorry to be the downer, I have to constantly remind myself that this is not, by far, the worst thing that I may be facing. But to be in constant pain and not able to move forward with recon is very upsetting too.
Wish everybody much better luck!! will keep on keeping on :-)
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hi ladies...i am pretty certain i will be having my lift and implants this summer/fall ( i also have to have 2 wrist surgeries, not sure which surgery i should do first...??). I am wondering how many drains i might have with this? Also, if in the future a biopsy is necessary( i had a small pappiloma last Fall)...can it be done with implants ??
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How is everyone doing? I had my exchange yesterday for righty. It went well. Hopefully I will not develope another infection. I really like how it looks and I don't even mind my drain:)
That's how much I wanted to get the TE exchanged.
I sent Patricia a text to see how she is doing (op for this thread)
Take care - Michele
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I thought I'd update everyone on my progress so far. Last Tuesday I had my exchange from TE to implants. He was able to use 420cc Mentor MemoryShape implants. It's too early to really have much to comment on about the shape but they feel so much softer even through the tight surgical bra. The radiated side is more uncomfortable and having some significant muscle spasms. Still taking antibiotics and just being very careful to not disturb the rads side while it heals soon. I assumed he would put in more fat but he said there would be no added benefit at this time. So I'm in wait and see healing mode hoping and praying I do stay awayfrom an infection.
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Quiltrunner, happy to hear you are on the squishy side. Our exchange was the same day. Radiated side is doing well and the swelling is going down. I think the fact that my ps went really slow with fills helped a lot. My last fill was in November so he wanted to wait a couple of months for mt TE to drop. It did in January. Now it's just a wait and see. Boy do I want to look at the incision so bad.
Michele
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