Fitness after BMX and implant reconstruction question

Hi Martha, I am the same height but heavier and not as sporty as you are. In fact, I hadn't exercsied much until I turned 50. I was cup size DDD before surgery and am size C now with 500 ml silicone implants. I had the same surgery you are planning. I believe a lot depends on the surgeons experience and whether they will have to take out any lymph nodes. If no lymph nodes are involved it is much easier to go back to whatever sports you like doing. If lymph nodes are involved it is still very possible but would require more time and more caution. I now lift about the same weights I was able to lift before surgery but I am doing it cautiously.

There are women on this site who are much more experienced athletes than I am and I am sure they will add their tips.
The reconstructed breast will not feel the same but will look good and will make you feel good. I am glad I had reconstruction.

Hello Martha,

I am slightly younger than you (41) but I had a NSBMX, 10th June, 2015, so tomorrow is my 8th week post op. I am 5'6" and weigh 115. I had no issues with my nipples surviving. My BS here in the US is very experienced with this technique and told me that there was a 5% chance of nipple necrosis - she has done this operation many, many times though - I had to sign something saying I did not smoke because if I did, all bets were off as that increases your risk of necrosis. I was a B cup prior to my surgery and I have TE in place presently - I am currently filled to 450cc which relates to a C cup on me. This is what I was pre-breastfeeding 3 children for a total of 6 years. My exchange will be in October.  My drains were in for 2 weeks and did not hinder my excercise routine.

My plastic surgeon was absolutely adament that I should get reconstruction for psychological benefit - I know it is easy to say that he has his own interest at heart, but the fact is he has tons of women that just want bigger boobs, and can make his money there....which he does. He feels reconstruction is his chance to pay it forward.He told me, "post mastectomy can be a very dark place, if you can avoid it - don't go there.....". I will be honest with you, I actually quite like my new boobs even with the TE's and I do feel the mental benefit, for me will pay off. I know many opt out of recon, and I admire those people for being that strong, but that was not for me and I knew that up front. It is all a very personal decision, I would never judge or convice as it can ONLY be your own decision, based on knowing yourself and your processes.

I am not sure if it is down to my surgeons - I have a BS and a PS, myself, just good luck or a combination of the 3, but I have had very little pain, spasming or problems healing (not sure if I jinx myself writing that). I run 3+ miles per day and was back to walking that far the first week, back to jogging on the eliptical the 2nd week and running on week 3. I started PT for my chest and arms at week 6 per my PS and now I have full range of motion and no pain, the TE's are a little uncomfortable but I just seem to block that out. My scars are just thin lines under my 'foobs'. I am back to running 3 miles daily plus exercising after. I also do tennis with my children but only started that back up recently, I am a very active person by nature. I feel fitter and stronger than pre-op and hope that continues.

I have several things that I believe were paramount to my recovery:

1. the anesthesiologist gave me a paravertebral block with OnQ pain balls in my back - it contastly drips local anesthetic into your back. Mine lasted 3 days and post op my pain was a 1-2. Thus, one avoids using the opiate medicines and the SE's that they can have. That block was in place for 3 days and I took 1 Oxycontin the first night (because that was what the nurse discharging me told me to do and I was in sheep mode!), before I switched to Tylenol (Paracetamol) which I took for the first week - 2 in the morning, 2 at night. I was also prescribed celebrex but the insurance refused to pay for it, and since I did not need it I did not persue it with them.

2. the BS gave me 'intercostal nerve block' between the ribs - my tricep on the left is still a little numb but no pain and the sensation is coming back.

3. The PS told me to take a multivitamin with iron for 1 month post surgery along with 2000 mg of Vitamin C. I also took 50mg of zinc and arnica pills 1 week prior and 2 weeks post op. I had very little bruising.

4. The BS used Xeroform occlusive gauze on my nipples - I cringed at the ingredients as I am a organic, no petroleum products kind of gal, but that stuff is magic... so I sucked it up!!

5. I eat lots of fresh foods, green veggies, salads, vegetable smoothies. I also ate slightly more protein than I normally would for the first 2 weeks.

I think you could recover well, and be just as fit and sporty. I would think it is better to do it at 52 than at 62? I know there are no guarantees on how this surgery will go but my surgeons told me the fitter you are going in to it, the easier it is generally, to recover. For me, I have no history of BC in my family, and was extremely low risk but if I had known this would be the path, I would have finished breastfeeding my youngest and done a prophylatic double mastectomy, even if I had to pay for it myself. IMHO I think you are being very prudent to consider doing this with a family history but like I said previously, it is all a personal choice...my opinions are just that...mine

I am from Essex originally and moved to Colorado almost 20 years ago. I still miss home. None of my mates there knew there was an option to keep your nipples with mastectomy, so I think that the UK is a little more reluctant to do this kind of surgery? You are lucky to have found a surgeon.

I know this is really long, but I wanted to give you as much info as possible, if you want to PM me for more or with questions, feel free to do so.

Good Luck!

Martha, I forgot one other thing that my PS thought imperative, for 3 days prior to my surgery he had me wash my chest area with hibiscrub (their medical cleanser - pre op scrub) and then again on the morning of surgery. He feels that it lowers the risk of infection, could be true, I did do it religiously.

I did not really have much pain with my fills - I was filled at 250cc in surgery, then I did 4 weekly fills of 50cc. I took 2 paracetamol 20 mins prior to fills and had no problems. They were tight for 2 days, a couple of spasms (which just feel strange, but mine did not hurt) and then, well they are just weird - but as I said, my brain has blocked them out I really have only been marginally uncomfortable the whole time. The PS told me that no one ever says," these TE's are so comfortable, let's just leave them in!" True story there! 

My surgeon wants to use gummi bears, anatomically shaped for me - he is the best surgeon of this type in southern Colorado he does around 275 of these ops per year and just over half are recons, so I trust his advice....I can't remember why he said that now as the shock of being really fit and only 41 and diagnosed with bi-lateral BC made my brain mush! I had a major hang up about silicon in my body but I don't think the saline look as good just my opinion....I go on August 20 for my consult so will chat with him then and I guess make final choices.In my first consult,  I held a 375cc, a 400cc, 450 and a 475cc as those were the sizes he measured me best for - I did not notice a vast difference in weight (it was there but not like I held the 475 and my hand fell to the floor!). I was going to stop at 2 fills just to be done (I homeschool my 3 children and I hated all my appointments, so bloody inconvenient!) but he told me most women wish they had gone bigger and his nurse, whom I love, confirmed that in private so I did the last 2 and am thrilled I did. Don't sell yourself short thinking the shortest route is best, you want to have a great result that you can live with for many years....If you ride horses, you will be able to take uncomfortable! I felt no different on the first week of fills to the last, but remember that is just my experience.

A reference point for the weight of implants question is that a 450cc breast implant weighs just over a pound. Your surgical and/or path report should show information regarding the weight of the removed breast tissue when submitted to the lab. I had approximately 450g of breast tissue removed, which is also about one pound. So, for me, a 450cc implant should feel about the same weight as my natural breast did, and I was a full B, small C, depending on the bra manufacturer.

I am 52 and an athlete. 5'7" 108lbs of lean muscle. I compete at the masters level in two sports, play in competitive leagues for 3 other sports, participate in various other fitness pursuits and work out regularly. I considered the warnings in the thread linked in the post above pre-sx, but knew that I wouldn't be happy without recon. I sought out a PS who had considerable experience with augmentations on body builders, blended with a solid track record with NSBMX direct to implant recon. Body builders for their need to return to performance training and posing, as well as achieving great aesthetic outcomes on their low fat bodies. My sx was 3 1/2 months ago. I worked with a bc rehab PT who is also a certified lymphedema specialist to return to my pre-sx performance levels as fully and quickly as possible. So far in all my sports (haven't tested out ski racing yet), I have returned to pre-sx performance levels with a full range of motion and no limitations. I can do pull ups, push ups, dips, chest presses and flies, and other pec intensive exercises, but not with as many reps as pre-sx. I could not do a single push up at 4 wks, when all my restrictions were lifted and had to start on my knees. Now I can do 90 real ones non-stop, which is fewer than before. I am still working on one arm push ups and can only go halfway on my non-dominant side. Most of my weight exercises and routines I can do at pre-sx levels, but I find about 20% of the time for a particular exercise, I don't feel I have it in me or it feels weird, so I pick a lower weight or do fewer reps that day. The next day I can be back at 100%. Since my pecs were dissected and reattached higher at 3:00 and 9:00 with Alloderm slings below, I had to learn to become accustomed to a new kinesthetic awareness of pec muscle movement. I hated the feeling of engaging my pecs but pushed through the yuck feeling. Even though the Alloderm slings were sutured to my abs, I had no problems in returning quickly to intensive ab exercises at pre-sx levels.

I had direct to implant anatomical gummies 295cc (2/3 lb). These are a full B on me and I was an A pre-sx. I am thrilled with my results. I never experienced the iron-bra feeling and have been lucky to have no pain, spasms or twinges. I am not even aware of my implants and they just seem a part of me. Weightwise, I think silicone is probably pretty similar to dense breast tissue. Pre-sx I did 6 wks of dedicated pec workouts to lengthen them and give my PS more to work with. I do believe that this prevented me from experiencing the iron bra band of tightness. As for dynamic distortion, it's unnoticeable on my dominant side and there is still some on my left side with pec intensive movements, which I am working to eliminate via strengthening that side.

You need a skilled BS to perform the NSBMX and provide even flap thickness with excellent vascularization for your skin flaps and nipples to survive. My flaps were under 2mm in thickness and I had great colour and healthy looking flaps and nipples throughout my recovery. The surgeons all have their own way of doing things and pre- and post-sx instructions. My PS did not use Xeroform, nor was I asked to use any kind of medical cleanser. I just showered with my regular soap the morning of sx and they swabbed me with antiseptic in the OR (operating theatre). It's just personal preferences of the individual surgeon. I'm not knocking anyone's recommendations, but believe that there are multiple avenues to achieve superior outcomes. My nipples were bare when I woke up (under the surgical bra), but I was given Arnica cream to massage on my nipples and breasts to minimize swelling and bruising. I never had any bruising. I wore a surgical bra for 6 wks day and night and was instructed to not wear a running bra until wk 4, so I couldn't run until then. Cycling started at 3 wks, but 4 wks was the magic time when all my restrictions were lifted. I only walked and did leg lunges the first two weeks, which was extremely restrained for me. My drains came out at 4 days.

One thing that was important to me was that although I was increasing in size, I wanted to be certain that my implants would not get in the way. I didn't want to swing a racket, or move my arm across my body and whack my foob while doing so. Front view, my real breasts did not extend beyond my ribcage. I did not want wider implants that would. If you are very lean, anatomical implants will yield less of a step off effect than rounds. My PS would not even consider rounds on me. If you have anatomicals, your PS has to do precise pocket work to prevent rotation and rippling.

My surgeons told me that I would bounce back quickly because of my fitness level, so I echo what Englishmummy says above. Since you are bi-lat prophy, you won't have nodes removed and won't need to work up incrementally and gradually to higher weights, which will enable you to regain your previous strength levels much more quickly. With your fitness level and intact nodes, you will be at extremely low risk for lymphedema. You may want to consider consulting with PSs who do direct to implant as well as TEs. If you're a candidate, you'll save yourself the expansion process and an exchange sx. Pick your surgeons wisely and good luck.

I've read this thread with great interest, it highlights all the thing I have to look forward to and thus being very reassured. I'm in the UK and I'm nearly 4 weeks post op for Prophylactic NSBMX. My surgeon was absolutely brilliant in that I didn't have a single bruise, my drains were removed on day 3 and my range of movement post op is much better than other people have experienced, my pain levels have also been manageable.

I was over the moon when my surgeon told me I was a candidate for nipple sparing, she also used the strattice mesh sling to support the implant. I didn't have a TE and went instead for direct to implant. My surgeon told me that she estimated my breast tissue (pre op) to weigh about 300g's and she would decide in theatre whether to use 300cc, 325cc, 350cc or 400cc. She went with 325cc. I was a D before and I have no clue what I'll be now as I have iron boobs. Cosmetically, my foobs look great, good shape but with no bounce yet.

Martha - if you haven't had your surgery yet and are interested in my consultants info then just PM me.