Ask plastic surgeon Scott Sullivan, M.D., your recon questions!

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  • L00Sparrow
    L00Sparrow Member Posts: 17
    edited July 2015

    I am meeting with surgeon this week on what to pick and I am very clueless I want more information on do not know name the one you do when doctor takes fat from other parts of body and insert into new breast pocket I need to know What are odds with this one ," Is it the best one to use if not what are some other ones please let me know thanks

  • theziz
    theziz Member Posts: 159
    edited July 2015

    Hi,

    I'm currently taking ibrance, femara, zoladex and xgeva and would like to finish my reconstruction but both my oncologist and PS say I should wait.

    Regards

  • Shannonscp
    Shannonscp Member Posts: 1
    edited July 2015

    I am all finished with reconstruction. I'm handling the constant muscle contractions pretty well, but I had Goetex nipples and tattoos done. The tattoos are fading badly and differently. I want new tattoos.

    My plastic surgeon says I cannot have them. Not enough blood flow For healing. Any thoughts?

  • Moderators
    Moderators Member Posts: 25,912
    edited July 2015

    Shannonscp, sorry to hear about the issue with the tattoos. You may want to reach out to another person for a second opinion as well. Please keep us posted, and hoping others may be able to chime in!

  • justamy
    justamy Member Posts: 532
    edited July 2015

    Does one just have to " live with" rippling after reconstruction with silicone implants or are there steps that can be taken to improve or get rid of it?

  • WarriorVixen
    WarriorVixen Member Posts: 4
    edited July 2015

    I have it and I don't want it. My body didn't take the fat grafting. I have round silicone. They said maybe tear drop textured implants.

  • MidLifeCrisis
    MidLifeCrisis Member Posts: 68
    edited August 2015

    I have the teardrop and have rippling- most noticeably on the cancer-side (thinner, less residual tissue). I hate it and am seeking 2nd opinion formy options. I've heard fat grafting can be so 50/50. I'm not sure it's worth going through with it. Beyond that, what are the options...??

  • lovevt
    lovevt Member Posts: 46
    edited August 2015

    I have a question for Dr Sullivan on the recovery after fat grafting. I am scheduled to have my Phase 2 on August 19. I will be having fat grafting to fill in the upper poles and a few divots . My question is about the recovery afterwards. I have a physical job- I am a Chiropractor and when treating patients I do put pressure on my upper chest. Will this pressure cause more of the fat to be reabsorbed? How much time should I take off to maximize my results from the fat grafting. I appreciate any information you have on this topic. Thank you.

  • B123
    B123 Member Posts: 730
    edited August 2015

    hello I hope that there are surgeons here who can help or answer my question? I had bmx almost 4 yrs ago, with implants

  • B123
    B123 Member Posts: 730
    edited August 2015

    hello I'm hoping there are surgeons here to answer my question?? I had a BMX 4 years ago with silicone implants 3 years ago. My good side is bothering me lately, not painful not red not swollen but it feels fluttery in front part under or near incision going to side near armpit, if I push in an area on the side into breast I feel like something is edgy, like a scratching your leg almost like a pull tugging feeling. Is this scar tissue, is it something I need to worry about? I feel it more when I use my arm but when I'm just sitting I feel little spasms at times. My arm has been pulled on about a month ago and I do lift on patients when needed, but this was never felt before. I began to wear my gauntlet at night which helps to support .

  • Moderators
    Moderators Member Posts: 25,912
    edited August 2015

    Hi all,

    Please check out the latest blog, where Dr. Sullivan answers more questions!

    Breast Reconstruction Q&A with Scott Sullivan, M.D., F.A.C.S.: Implant vs. Using Your Own Tissue, August 13, 2015

    Please keep submitting your questions for upcoming blogs!

    Thanks to all who participate.

    --The Mods

  • Jillybee
    Jillybee Member Posts: 32
    edited August 2015

    Mr.Sullivan,can you help? I have popped a question here,and the moderators are bumping it,as had no reply.Had DIEP last summer....following failed implants due to DCIS. Seroma In abdomen has been persistent since.now capsulated and loculated.Have had guided aspirations with ultrasound,2 operations,last one in May,using blue dye and leaks cauterised.

    Still returned,now waiting for drains to be inserted then steroid injection.I live in the UK,and with the most super surgeon....oncoplastic....she is trying her best.....but I am feeling so alone,there must be someone who has had this.Have you come across this at all,and what as the outcome?

    Looking forward to hearing from you.

    Jilly.......

  • theziz
    theziz Member Posts: 159
    edited August 2015

    Dr. Sullivan,

    Can please advise me on finishing breast reconstruction while new on ibrance/ Gemara.

    Thank you

  • Pointvalue
    Pointvalue Member Posts: 146
    edited August 2015

    Dear Doctor Sullivan:

    Today I took a direct kick to my silicone 550cc Mentor implant from a 6 year old! Should I be concerned with ruptures? I have had my implants for 2.5 years. The skin tissue is thin because I had a nipple sparing pbmx and had an infection that resulted in the loss of my nipple 3 years ago; at time of surgery.

    I am a little sore.

    Thanks so much!

  • a11nel
    a11nel Member Posts: 2
    edited September 2015

    Hi i was diagnosed with breast cancer back in june 2014 and had a single mastectomy because i was asked to wait a year for the second elective mastectomy. I was happy to wait for the second mastectomy and received some counselling as advised to make sure it was the right thing for me. I had my appointment with the plastic surgeon who treated me like a ten year old who didn't know my own mind. I am a 56 year old woman with a terrible history of family history. Three Aunts myself and my sister and various cousins who have all had breast cancer. We might not have the braca gene but we defiantly carry some gene that is passed on through our family that is what i was told by the Family history clinic. Each one of my Aunts and my elder sister had breast cancer twice. This made me want the elective second mastectomy. When i went for the plastic surgery appointment i feel i was treated with no respect what so ever. I have had trouble with my weight previous to my diagnosis and had a gastric band to loose weight (private operation) The reason for the weight problems is an under active thyroid i found this out when i had my parathyroid removed because two of them were malfunctioning and creating too much calcium. They said my thyroid had shut down and was not working properly either. This was approx 5 years ago and once i found out why i was gaining so much unexplained weight i have never put on a single pound since. I have the gastric band and have lost 4 stone which has been very hard because my metabolism is very low even with thyroxin. Now sorry to drone on but the plastic surgeon said he did not think the second mastectomy was necessary and he would not do the reconstruction until i lost over a stone in weight. I am a non smoking vegetarian. I left the appointment very upset. I have lost so much weight already and i am really struggling to get even a pound off. I did not even receive a follow up letter from the plastic surgeon so i know he has no plans to do the operation (second mastectomy and reconstruction) Just to finish i am 13.5 stone 5'3" .

  • momten
    momten Member Posts: 3
    edited September 2015

    I had bilateral mastectomy with implant reconstruction about a year ago. The implant exchange was done 3 months ago. I am very unhappy with the silicone implants, although they look fine and healed well.

    My question is: if I choose to have the implants removed and to 'go flat', how difficult is that surgery? Will the function of the pectoral muscles ever be back to normal? Are the alloderm grafts removed? How is the excess skin/tissue handled?

    My plastic surgeon has never removed implants and so can't answer these questions.

  • Edommey1
    Edommey1 Member Posts: 3
    edited September 2015

    I am 9 days post op from my expander to implant exchange. I have a drain in each side. Why do some women luck out and not have to have drains following this surgery? What determines drain placement and also when will drainage slow and is there something I am doing that is making my body produce more fluid.Still having close to 30 cc. A day

  • Jillybee
    Jillybee Member Posts: 32
    edited September 2015

    Had a DIEP. last summer.Had seroma in abdomen,drained twice,then capsulated,and loculated...have had further 2 operations to remove capsule,last op,blue dye was inserted and leakages cauterised.Still,problematic ....due fir even more surgery.Have you come across this before and what was the outcome?

  • chimp1
    chimp1 Member Posts: 4
    edited September 2015

    help! my situation is that i had breast cancer in 2005. i had a lumpectomy and radiation. i was left with a severely burned right breast , a pretty big hard lump where the lump was taken out, constant redness on the left side of my breast, swelling, pain and the breast with the cancer now is much smaller than the one that had no cancer. both breasts are very large. i wear a 48dd bra.....i also had neck pain and upper back pain for years but just didnt make the connection between that pain and my cancer....so i went to a plastic surgeon today. they took pictures and all but then gave me a list of information i would need to get from my ortho pedic doc, my primary care doc and notes from my surgery. i actually already have quite a bit of documentation because of horrible back pain and the surgery i had to have last april because of severe lower back injury in late March. i felt a little slighted by the doctor, that is to say, they are putting the bulk of the 'proof' and retrieving of documentation on me....it is almost like they dont seem that interested in helping me. i really need this surgery and i dont know what to do. i have 2 huge breasts, and one of them is smaller than the other. i have neck pain and pain in my upper back in my shoulder blades. i dont know what to do...i dont feel like they genuinely want to help me and there are not that many plastic surgeons in my insurance plan (united healthcare) do you have any advice for me
    right breast , a pretty big hard lump where the lump was taken out, constant redness on the left side of my breast, swelling, pain and the breast with the cancer now is much smaller than the one that had no cancer. both breasts are very large. i wear a 48dd bra.....i also had neck pain and upper back pain for years but just didnt make the connection between that pain and my cancer....so i went to a plastic surgeon today. they took pictures and all but then gave me a list of information i would need to get from my ortho pedic rance plan (united healthcare) do you have any advice for me

  • chimp1
    chimp1 Member Posts: 4
    edited September 2015

    reply to a11nel from chimp1

    i feel for you...i went to a plastic surgeon today to discuss getting breast reduction because my lumpectomy and radiation left me with the 'cancer' breast considerably smaller than the noncancer breast. i had the distinct impression, even though the surgeon didnt say it, that because i am a large woman with really large breasts, that my situation didnt matter. my health insurance is limited as to the number of plastic surgeons in the plan so i dont know what to do. the federal laws give preference to women with mastectomies saying that they are entitled to reconstruction but a woman who has had a lumpectomy does not have the same rights. what do i do? anyway i hope somehow you will get your approval. chimp1 in the U.S.A.

  • kjana
    kjana Member Posts: 2
    edited September 2015

    What is the usual recovery period after recin with implants that required a revision

  • shiane2
    shiane2 Member Posts: 12
    edited November 2015

    Wondering if LSGAP or SGAP is better option for pear shaped, I have very small stomach(big enough for very small B) with bilat DIEP and may need implant to radiated/lumpectomy side per my PS due to lack of volume, but most of my extra tissue is on my outer hips and buttocks. I am trying to avoid implants if possible. PS said LSGAP is not the preferred method as the surgery is longer, more difficult due to having to turn during surgery and the tissue back there does not look like "breast" tissue as much as abdomen. My question, are there long term mobility complications from LSGAP and SGAP or is the surgery still too new to know, like PAP flap-just now there seems to be emerging stories of disability occuring from PAP flap. I am 37,5'1, 114lbs,small waisted, a hard working RN and very fit and active, runner, aerobics, core strengthening, etc. I am s/p radiation w/lumpectomy 2008 to left breast and now with palpable mass of atypical ductal hyperplasia in right breast with newly dx ATM genetic mutation, so bilat mx with TE placement first, then free flap recon is the plan of my surgeon. Just want to do the surgery that promises the least loss of strength and that will not leave me with "swelly belly" or mobility/gait problems. Seems like DIEP is the first line surgery option and LSGAP/SGAP is only used if definetly not enough abdominal tissue, but why is that? Instead of incision across my abdomen, I would rather have the bilateral incisions to lower back area also, and feel this surgery would at the same time improve my backside by decreasing the size as this is an area I have never been very thrilled about anyways-too much "extra" there for someone my size. Thank you so much for your time!! Any opinion on latissmis dorsi flaps btw?

  • zinny
    zinny Member Posts: 281
    edited October 2015

    Hi - I am looking for a magic "right answer" which I know doesn't exist - but would appreciate your perspective. I am 45, 5'10" and an athletic 164 lbs. I have bilateral DCIS as well as ILC on the right side with pos nodes. My cancer is ER/PR pos and HER2 neg, Grade 1. I have had bilateral lumpectomies, am to start radiation on the right shortly, as well as aggressive hormonal therapy. The plan after we are done the treatment bit is to do bilateral mastectomies. My margins on the left side aren't perfect, so we are waiting 8 weeks after the 28 rad protocol, but not leaving it longer, as I am not having chemo, and we'd like all of that tissue out.

    My dilemma is this. Currently 34DD, only got that big after IVF and pregnancies 9 and a creep of my apparent "set point", used to be a C cup. Not attached to any size at all. Would prefer a C to my current size. My surgeon says I'm "skinny" ( ha) but there is not enough abdominal tissue to give me more than an A cup (also, have a pfannensteil from a remote laparotomy.) She says this may be out of proportion with my frame, and so cosmetically not be as pleasing as a larger breast.

    The other option is an expander on the left and a latissimus flap around an implant on the right to protect the implant from the less welcoming irradiated tissue, with gradual expansion to get symmetry.

    I am worried about capsular issues. I am athletic, no triathlete, but love to run and hike and bike and ski and paddle board, and would like to surf and more, and I am worried about all that I read about implants causing problems with pec discomfort and mobility, not to mention repeat surgeries every 10 years or so...

    What is your best advice?

  • PinkHeart
    PinkHeart Member Posts: 1,193
    edited October 2015

    Zinny,

    My opinion? Get a second opinion. I went through seriously failed implants and radiation damage and ran from a doc suggesting lat flap, had another inexperienced surgeon say I was too thin for DIEP.

    Yes I am very thin but I am very fortunate that in my extensive research to have found

    Dr. Richard Kline, The Center for Natural Breast Reconstruction in Charleston, SC.

    I started with sending pics and med records for a free phone consult with him. I was complicated case and many patients like me seek him out because of his extensive experience.

    I had SGAP flaps and am now a C cup. I had fat grafting to breasts using thighs and my belly. And I am thin!

    I am 5'6" During radiation was at 110 lbs. At time of first SGAP surgery was 118 pounds. He asked me to work on gaining weight and got up to 130 lbs for additional surgeries. Currently 130-135.


  • Trvler
    Trvler Member Posts: 3,159
    edited October 2015

    I second the second opinion. My local PS thought I could be an A at most. I wanted large B or small C. I was probably a full B at the time. Went to see Dr. S in NOLA and he made me exactly the size I was and I had even lost weight while on chemo. My old bras fit perfectly. I at least expected to be a little lopsided. But I wasn't. He did and extended DIEP meaning my incision goes from hip to hip.

  • Girlstrong
    Girlstrong Member Posts: 438
    edited December 2015

    Any Suggestions for reconstruction of the breast that does not include Fat Grafting? I know that alternatives are available in Europe but how about here in the US? I have had a bilateral mastectomy, bilateral gummy implants, nipple reconstruction but also have indentations and such because of no fat grafting (my choice due to fear of fatty necrosis and I didn't want to face lumpectomies etc. all over again). Any suggestions?

  • Jillybee
    Jillybee Member Posts: 32
    edited December 2015

    following my DIEP summer last year,have encapsulated seroma in abdomen.2 questions...have been told it may re-absorb,but can it be absorbed through the membrane?and......2 what will happen to fluid long term?Can it get infected,or just sit there,forever

  • Rosa_Aurora184161
    Rosa_Aurora184161 Member Posts: 73
    edited December 2015

    Good evening! I'd be grateful if a PS could answer my questions. I was diagnosed with bilateral breast cancer at 42. I had modified radical mastectomies, DMX. NO RADIATION NEEDED! NON SMOKER. I've got breast expanders in (133MX-13 Allergan) at present. Expansion was painful sometimes (due to stretching of pectoral muscles) I'd be having anatomical silicone implants. I'm waiting for having exchange surgery to silicone implants. I'm going public, so I have to wait a bit long. My questions: How long would it be safe to have expanders in? What complications, risks, are there with anatomical silicone implants? I haven't gor enough projection (it's a bit flat in the centre) with expanders at present, would this change with the anatomical implants? What is the best and cheaper way of checking for silicone implants ruptures? Would an ultrasound be enough? Thanks.

  • DocBabs
    DocBabs Member Posts: 775
    edited December 2015

    I had. BMX , nipple and skin sparring in April 2011. Both scars run from the areola,touching it on one side, out towards my armpits. I noticed after a few months that my nipples were being pulled outwards on both breasts and mentioned this to both my BS and PS. BS said to wait a few months that things would change . She was right, they got worse. My PS said that it looked good and did not acknowledge any problem. He said that he didn't touch my nipples. Now after almost 5 years as the scars continue to contract my nipples are being pulled further and further outwards. Can anything be done about this ? Also when I first had surgery I was covered by private health insurance and am now on Medicare with UnitedHealth as my secondary . Will Medicare pay for corrections?

    Thank you

  • Ramonica60
    Ramonica60 Member Posts: 23
    edited December 2015

    That is great that Dr. Sullivan is answering questions. I may need to see him in 6 months for a revision! Just had bilateral free tram(prophylactic).

    It was supposed to be bilateral diep. I have a concave area the size of a silver dollar in my sternum. PS said he had to remove a piece of rib cartilage. Left breast looks like a squashed hamburger near the armpit. PS says anything and everything can be fixed. Can it?

    Hoping the surgeons at NOLA can do a revision!

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