nipple and skin sparring bilateral mastectomy

finally draining stopped after 6 days a after the drains were removed! The Dr should have prepared me for this.

I am not DCIS but have read this post as I am leaning towards skin and nipple sparing BMX. Had my first consult with a PS today. I have existing implants. He doesn't think I'm a candidate for flaps as I don't have enough fat. I wasn't really interested in that route anyway. He said I am a good candidate of either of these options: Direct Implant or TE first with exchange later. Thing is, radiation is on the table... which he did not realize and he encouraged me to question the benefit of the radiation. Like, how much does it improve my odds against recurrence. He feels TE first would lead to a better cosmetic result. He would overfill the TE which would lead to a more softened / relaxed droop. The timeline of TE vs. direct implant has me thinking UGH!!! but we are talking a few more months for something I may like more over an extended period of my life. I know it's up to me, but what do you ladies think? What have you experienced or heard? He said with direct implant followed by radiation, there's a greater chance of tightening, assemmetry, etc... there really is no fix. More surgery would create more scar tissue. With TE he could clear the initial scar tissue and though it would come back, it should not come back as much.

SugarCakes - I had nsbmx with direct implants. I too, had cosmetic implants from 1998. Initially there were C but grew over the years (weight gain) to a D. I told my PS I wanted a high B, low C, which allowed for the direct implant.

Sigh. I think I may have an A cup - can't fill the cups on a B bra. I would go for the TE's.

I have pics of my progress in the picture forum under the same name. You can peruse many before and after's there and also on RealSelf.com. They should help give you an idea, but we are all different.

Hi jilly59!  Perhaps because my implants are so new and perfect and fresh off $6K (LOL), I do not want to be smaller.  In fact, I think I want to go a little larger.  I thought I would settle into a D, but I'm more a C now.  And to think, I went in thinking I'd be happy with a full B or low C.  PS convinced me to go larger.   I didn't say anything to the next PS about going a little larger.   It seems a little shallow, like it should not be a priority at this time.  Still...

I am going to look for your pics on the picture forum.  If I wasn't facing radiation, I might would still consider direct implant.  PS  had said he would do a bigger implant to compensate for the tissue loss, hopefully keeping me the same size.  I can see ending up smaller, however.  He also said they would be more balls-y than what I have now, which I don't want.  Hope he's right about TE leading to a better cosmetic result.

What a difference a day and a consult with a different plastic surgeon makes!  So the guy I had already pretty much dismissed because of his youthful look WOW'd me this morning and sent me off practically singing.  He spent 1.5 hours with me and had a presentation complete with pictures to walk me through what he would do with my particular set of circumstances.  I feel much better with the plan of TEs followed by implants and likely radiation.  Also, he had some additional things already on the table like use of alloderm from the beginning and later fat grafting if needed to improve the appearance of the implant - things the other PS did not mention, even though I asked about possible fixes to some of the potential problems.  There was not this doom and gloom reaction to me having to have radiation.  He has worked with my BS and MO a lot.  He will have likely worked with the RO I'll eventually have.  He says my breasts look great now and he thinks we can achieve a reconstruction I will be quiet happy with. 

I calmed down over the radiation questions that had me in tears yesterday.  It's really a conversation to be had after surgery and after the final pathology report. 

I have diagnoses of DCIS, LCIS and Stage I IDC and the plan is for a NSBMX with immediate reconstruction. My BS said I'm a great candidate for it and I see the PS on the 27th (she's just back from maternity leave and totally booked). She specializes in breast reconstruction and from what I've heard her work is impeccable. Hoping to maybe have some fat grafting done at the same time. MO says I probably won't need radiation but would probably need Tamoxifen for 10 years rather than the usual 5 years. I don't feel I'm a very vain person, but being able to keep some semblance of my self is important to me and my husband. It's encouraging to see some women still have some nipple and/or breast sensation afterwards. I'm hoping I can be that lucky.

Jilly did some searching but can't seem to find the picture forum people refer to. Is there some sort of verification needed before I can see them?

DH is wondering (rough ballpark) how long the surgery takes. He's already a nervous wreck thinking about me being under at all so I thought I'd try to give him some peace of mind. We'll find out more information when we see the PS and BS but that isn't until next week.

Jilly thanks for the info. I usually don't have nausea or vomiting afterwards but will ask for that because it's better to ask before than find out later that this time I'll have issues. I work as a bedside RN at the moment so probably won't be able to go back as quickly but perhaps I can transfer to a clinic position when I come back.

I'll ask the moderators for access, let DH see pictures so he knows what we're getting into.

I PM'd the Mods for the picture forum and they gave me access lickity-split. Guess it was a good day!

I agree, SugarCakes - the picture forum can be difficult to navigate.

mizmimi - yes, you will lose all sensation in the nipple.  You may develop peripheral sensation to the breast skin but that's about it.  Your nipples will not react to cold.  However, depending on the size of the your nipples, you may look like you're permanently in the frozen food section.  Good luck!!

I had my NSBMX on 6/11 and after a little hiccup with necrosis I finally feel like I'm getting back to "normal" whatever that is. Saw the PS this past Wednesday after outpatient debridement of the necrosis around both nipple areas and more had to be taken from the right than the left. I lost the top of the aereola and most of the nipple bud on the right and just a sliver off the top of the aereola on the left. After the original surgery, they were more concerned with the left side and turns out it was the right that was the bigger issue in the end. Good news is that I have all pink there now and even some sensation!! I was able to feel the cold and sting of the antibiotic ointment the PS placed on Wednesday and have some touch sensation. I know it's still early but hoping that I get back more.