Beware: Athletes who choose reconstruction may regret it
Comments
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Hi Linda. This is interesting! Can you tell us more about thus procedure? I've not heard about this. Thx
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I live in the UK. The surgeon wrapped the implant in an ADM (acellular dermal matrix) made of collagen. Apparently starts from pig skin! And it was sewn onto the pec. muscle. So the muscle wasn't cut or expanded or anything. I haven't noticed any difference in strength or anything now it's healed. Won't get capsular contraction, which I understand is one of the main put-offs for reconstruction. All done at the same time as the mastectomy.
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If I could have had that kind of reconstruction, I probably would have done it. As it is, I am supposed to be flat, but am just plain lumpy.
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I completely understand how miserable TE can be. After having a uni mx I was going to have a DIEP, so I had a TE put in at the same time as the mx. Then they poisoned and fried the crap out of me so I wound up with radiation fibrosis. Talk about iron bra, AAAAH! I then found out about fat grafting with BRAVA. I hated that subpectoral TE, couldn't even open bag of potato chips, all my strength was gone. Took out the TE. Did fat grafting 5 times, but lost most of the fat to 2 severe infections. Ran out of fat, but still wanted to reconstruct, so found great PS to put TE in OVER my PECTORAL.
I had a really good covering of fat left from all my fat grafting, so my PS didn't need to use the Acellular Dermal Matrix stuff.
Big difference having TE over versus under my pectoral muscle. I have had 360cc's saline put in so far and it isn't bothering me at all, except for very minor little twitches. Having had a TE both over and under my pectoral muscle, I way prefer it over my pectoral. I am surprised more people don't do it that way. I was very afraid I wouldn't be able to stand having it under my muscle again once I had the radiation fibrosis, I was afraid I would feel miserable and trapped. I had to beg my PS to do it over my muscle. He really didn't believe in doing it that way. Now he is starting to think outside the box. I will be getting a silicone implant put in later this summer or early in the fall. Cross my fingers that I have no more problems and finally finish this madness. I just want to look kind of like a normal woman again.
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I never heard of putting an implant over the pec muscle, especially with radiated skin. Interesting. They had to remove my pec muscle, so an implant was not possible for me. I don't really think I want any recon anyway.... Just don't like to be told I don't have any options. lol
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Post pectoral implants...please! Has anyone heard of the Braxon Technique? Something similar? was mentioned earlier here, I think.
As for me...
I've just had the final fill of my TE's and am now waiting for my exchange surgery on 6th November to have these incredibly painful rock hard lumps replaced with Mentor MemoryShape gummies.
I avoided having lat dorsi flaps plus implants (which my first PS was trying to sell me) and instead went with partial sub-pectoral with acellular dermal matricies (Flex HD) because I use my upper body in my daily work activities and hoped to avoid the loss of use and inevitable upper body weakness caused when these muscles have their nerve supply cut.
Well, right now I'm having pain, not only in my newly stretched pecs but also near constant spasms and in my neck, shoulders and back and I feel a constricting band across my chest whenever I do something that engages my pecs.
I assumed that most of this would be sorted after exchange but, after reading this thread ladies, I'm not so sure.
There may be hope on the horizon though...
I've just read some publications with the results of clinical trials in which the new "Braxon Technique" was used. Here, at the time of Mx (only for those with sufficient skin envelope such as NSMx), the silicone implant or permanent expandable saline implant, is completely enveloped in a specially shaped acellular dermal matrix which is then placed ON TOP OF THE PECTORALIS MUSCLE, just under the skin, and attached with a few absorbable sutures leaving the muscle unaffected.
Recovery post operatively is reported to be short with little pain and complete use of the muscles are preserved. No PT necessary. A bit of fat grafting can be done if needed but they've been getting great results without for those with healthy skin of sufficient thickness.
It's good to know that there's a "Plan B" on the horizon if this all goes pear-shaped!
I wonder too, for ladies with insufficient skin, or compromised skin from rads, whether this technique could be applied in a staged manner?
I can't see why, after skin and or fat grafting, a TE (with suture tabs to anchor the expander in place on top of the muscle prevent unwanted tension on the overlying skin) couldn't be used and slowly filled to the required volume before being replaced with a fully ADM covered implant ?
Maybe I'm oversimplifying everything here with my rambling but I do like to live in hope!
Gentle hugs and best wishes to all of my BC sisters. xo
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Hello Erica!
This is only my second post on the website and my experience with breast cancer and radiation were like yours. I had attempted a recon back in 2001 , actually had two infections, the last one almost killed me. Here it is almost 15 years later and I want to try to have another surgery to replace my breast---why? Still feel that I am less of a woman I suppose but I was same as you , thin and could not have a tram flap. Now, my PS and I have discussed the lat flap procedure and after reading all the postings here, especially by Gran, I won't attempt to do it again. My surgeon made it seem as if it was no problem with the lat flap, you will have full range of motion, just go to physical therapy yada , yada. I am not a serious athlete like Gran, but I work out six days a week at the gym and do a lot of weight, only light ones but still, I want to be able to lift and reach for things when necessary.
I thank all of you that posted your experiences and I have made the decision to not undergo any more surgery and will just wear my form. I truly had no idea that so many of your dear ladies had residual problems with implants affecting your life. I wish I had the advantage of knowing about this wonderful blog years ago. God bless you all!
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Hi Gran and all -
First of all, I am so sorry for all of the problems you've all had with reconstruction affecting your physical activity. It makes me feel sad to think about how frustrated you all have felt! I've been there too. I know everyone heals differently, and everyone's body reacts to things differently. And I totally agree that there are times where having reconstruction has made my athletic life difficult. Just to offer another view - it does get better, improve over time for some of us. And the odd feelings and "scrunching" feeling of the pec muscle over the implant, for me, has just been something I've gotten used to. I had TE and then implant on the right, and a lift/implant for symmetry on the left in 2013. I have been doing Crossfit for a little over a year. It's not easy, but I didn't expect it to be. I can do pushups, bench press, ring dips, etc. without pain. I do get the "scrunching" for lack of a better term, on my mastectomy side, but its something that I am so much more conscious of than anyone else. It doesn't limit me, and I feel no pain nor weakness related to it. I do Olympic weightlifting movements, gymnastics (handstands, ring dips), rope climbs, tire flips and am trying my hardest to do pull-ups. I am absolutely aware that no-one's situation is the same, and I am "lucky" in that my muscle was not compromised and I only had 3 nodes removed. I was also relatively young at diagnosis (37) and in good shape.
I wish you all the best in finding your comfort level with your abilities, taking into account your own personal situation as it relates to pain and limitations. Just chiming in to support everyone, and willing to share my experiences as well!
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Hello Ladies. So I am biting the bullet and having my implants taken out almost 2 years to the day that I had them put in. I've tried to adapt and adjust but I'm so uncomfortable and in pain all the time. I've found a love for powerlifting and these things are just getting in the way and it's getting harder and harder to find reasons to keep them. My surgery is Dec.4th and I'm feeling anxious. I know I'm making the right decision for me, however I can't help feeling like I'm having a mastectomy all over again. We are keeping the skin in case I decide to do reconstruction again. It's hard to find support for this decision as it's not common. I asked my PS if the women he's done this for were happy and he said yes. As a matter of fact he had just "deconstructed" a bodybuilder/powerlifter about a month ago and she is much happier. I hope you are all doing well and are happy with whatever decision you've made. XOXO
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Hi Kstillie,
I understand that deconstruction can be a difficult choice even when we are suffering and having terrible problems with our implants. I had my deconstruction done in December of 2013 -- after 3 1/2 years of suffering with no upper body strength due to significant cutting of my pec muscles for sub-pectoral implants. If anything, I wish I'd had the implants taken out years earlier! I am extremely happy with the deconstruction. My (new) plastic surgeon reattached the atrophied pec muscles back to my sternum and so now I have regained much of my upper body strength and am back to spearfishing again and doing all of the things that I love. This winter I will start lifting weights again and focusing on rehab of the pecs and the entire upper body (hopefully with the help of a physical therapist if my insurance will pay!) Last year I was in school full time and working too, so I did not do a full rehab of my pecs at that time, but now I do have the time to focus on a total rehab program.
When I told my new PS that I wanted the implants removed, I sent him a very intense krav maga martial arts video and said. "I want to be able to do THAT when you fix me!" He was great. He said he reattached the pec muscles to two different tissues on the sternum to make the reattachment extra strong, and I am very happy with his work. I felt so relieved immediately after the implants were out that the recovery time was easy to handle. I did not have the surgeon leave any skin because I knew I did not want to ever have implants again. In fact, I asked the PS to keep my implants and give them back to me after the surgery. I paid dearly for them (monetarily and otherwise) and I felt they were mine to keep. Now I show them to women who want to see them. They are always shocked at how something so big (400cc implants) could fit under the pec muscle. Well, that is why so much pec was cut! I had asked my original PS for 300cc implants, but the female triathlete PS put in 400cc implants because, as she explained to me, they took a vote in the operating room and the staff decided the bigger ones looked better because of my broad shoulders. Can you even believe that?! I fired her and found someone who would follow my wishes. Anyway...
I congratulate you on your decision and support you 100%. It is always hard to have surgery but if you are anything like me, you will be over the moon with joy once the implants are removed! I send you my best wishes and lots of healing energy for December 4th!!! Please keep in touch and let us all know how everything is going. I know that your courage to do what is right for you will also help other women to do whatever is right for each of them.
Big hugs and cheers!
Gran
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Hi Gran, That's so great to hear! I'm so glad you are now on your way to lifting and doing whatever you want to do! Thanks so much for the support and thank you for starting this thread way back when!! I've come back to it over and over again through the last year or so.
XOXO
Karen
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not an athlete,however,love the gym,Pilates yoga etc and always felt my silicone implant when using my arms.Muscle had torn above the beast,Used to ignore it after a while,however,your description brought back so many memories.Have since had implant removed,as Dx other side...long story,now have had a DIEP ...top half fine,tummy,another story with seroma...😥😥
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Hi just a follow up post. I had my implant exchange on August 6th with my 420cc Mentor Anatomic implant placed ON TOP OF MY PECTORAL. Yes that's right, ON TOP OF THE PECTORAL! No Acellular Dermal Matrix stuff, just some of my grafted fat. I can not see the implant edges AT ALL. There is no odd feeling or "scrunching", as Ami1026 mentioned when I flex. My strength is completely normal, I can do any arm movement, pushups or whatever I want without any tightness or pain. I guess you could say my marvelous PS here in Seattle did a modified "Braxton Technique", just without the ADM stuff. I am really pleased with it, and so very glad I got it over my pectoral, had a TE under it initially and was in pain and miserable. This is infinitely more comfortable, I think it should be an option for athletic women who want implant reconstruction. I had terrible rad damage from fibrosis, so if I can do it that way over the Pec , most rad patients can also. I also fixed the rad damage with Hyperbaric Oxygen therapy as I went through the numerous surgeries tohelp with healing.
I had R breast lift done on September 17th. I am a little more than 3 weeks out at this point and doing well. I plan to have nipple reconstruction done first week of December 2015. I am going to Vinnie in the spring to have areola tattooing done. That should be it. I am getting closer. Looks pretty good now, got very close to symmetrical. I got an really excellent prosthetic nipple made for me by Paul at FeelingWholeAgain.com. Was so real looking fooled my other PS who did my breast lift. I glue on the nipple every day, which makes me feel better, but I still want a permanent solution so onward to surgery to make a nipple and improve the scar a little bit in December.
Goodluck to you all
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Have been watching this with interest. Upcoming bilateral mastectomy Nov/Dec/Jan. Wanted a DIEP after reading about implants being placed under the muscle and the issues. Not sure I want to go there. Not a serious athlete, but I do own and ride a challenging horse, currently have good core strength, and have a home in the country that requires a lot - wood stove, etc. (I understand wood heat probably not practical this year, but don't want things worse after I heal.)
Due to recovery time and current work restraints, now will hold off for reconstruction. Kept the PS appt last week, however, and as I was concerned about feeling out of balance, he suggested the implants. But then mentioned they would be placed below the muscle. The PS was a bit intimidating, so I hesitated -it sounded like the implants might be ok. But I fear cutting the muscle. Surgery date not certain.
Surgery will be at a hospital associated w/ a top 5 nationally rated cancer center. Had a lumpectomy and my BC surgeon is excellent - had a very quick recovery and she's easy to talk with.
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I have implants above the muscle. My surgeon placed adjustable saline implants in the pocket of the mastectomy and behind the gland on my healthy side. She filled them over several weeks just as TE's under the muscle are expanded. There was a little discomfort, mostly tightness. The ports are a little uncomfortable as they are right on the bra band line. The pectoral muscle is left alone. The result is very natural with maybe some minor rippling. I did not have radiation. The only thing is that with this technique you can't go up too big-- I was a big a/small b and I'll get to a big b/small c. After the fills you can choose to switch to silicone OR just have the port removed and keep the saline.
Unfortunately I had a small area of delayed wound healing and required a few stitches just as everything was looking great. The saline implant was ruptured with the lidocaine needle and now I'm flat on the mastectomy side. I've also got capsular contracture/scar tissue but my PS says it's no problem and will be corrected at the exchange. My healthy breast looks and feels amazing-- though it hurt more than I thought it would (I can't believe people do that to themselves willingly--ouch). I'm in a fight with insurance so I'm waiting for exchange to silicone. My PS is the only one (in my area anyway) who does this so I'm hanging on hoping to be able to use her-- turned out she was out of network.
I'm not a pro athlete, I just do hip hop cardio dance and row almost every day. I've had NO problems getting back to where I was prior to surgery-- though I do have some cording from my sentinel node biopsy so things are a little tight. I'm also planning to get back to skiing (praying for snow) and dressage horseback riding. I'm fairly slim and have very little upper body fat.
So anyway, that's my story, thought I'd add it here since it's an option even though not too many PSs do it. Of course I'm not an "after" yet-- the results prior to the puncture were pretty spectacular. If she can get me close to that I will be extremely pleased.
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Hi Calidancer, saw you posted like me about having implant placed above your pectoral muscle. Sorry to hear about your implant rupture. I have a silicone implant under my L reconstructed "breast" and got a lift for symmetry on my right side 4 weeks ago. It is healing well and looks much closer to symmetrical. I plan to reconstruct a nipple in December 2015. I think I will starta thread about doing implants over the pectoral. It is so much more comfortable having them leave your pectoral muscle alone. Initially I had an under my pectoral TE and it was so horribly miserable that I had it taken out. Then I talked my new PS into putting the TE/implant above my pectoral. Wow, such an improvement. I had some fat from fat grafting which helped completely conceal the implant edges.No rippling and am 2 months out.
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Congrats to all of you who are now being given the option of having your implants placed above the pectoral muscle. Back in 2010 none of the plastic surgeons were doing that and they said it was impossible. Look at the wonderful new possibilities that 5 years have given us! I think it would be great to inform as many women as possible about the new techniques -- especially once they've proven to be appropriate for hard core athletes. As more and more women have their implants placed above the pec we will find out more about how that option plays out during various forms of exercise and also over time. Thanks to all of you who have posted about this new technique! God bless.
Gran
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It looks like you might be from Seattle? Do you mind me asking who your plastic surgeon was? Thanks for your help!
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Hi Ljgrace,
If your question was for me, I live between Boston and New York. The PS that I think is great has a practice on Long Island, NY. PM me if you want more info!
Gran
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I'm from Northern California. Dr. Karen Horton in SF is my PS. I'm 5 weeks out from exchange. The result is so far pretty good. I definitely have rippling which I may or may not have fixed with fat grafting. I'm going to wait and see. I still have cording under my arm and down to the IMF scar, but I think that's bad luck from the MX and SNB. I'm going to try PT and see if it can be lessened. I haven't gone back to the gym yet either so everything just feels tight. Recovery wasn't as easy for me as a regular exchange as she had to take out lots of scar tissue, again bad luck. I had two drains and was very sore.
The left side is higher than the right because it didn't have as much time with the TE due to the rupture. I'm hoping it drops. Overall I'm still glad I didn't cut my pec. The right side looks totally natural and is just a bit firmer the a natural breast. I'll update as time passes as I assume it will get better with exception of the rippling.
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Oh I forgot to mention that the foobs look awesome in clothes. I'm being very picky! Turn down the lights and things are looking very very good. Heck, my breasts weren't symmetrical before BC... 😆😝
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Just bumping this up. I found it very helpful.
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I am scheduled for implants on Dec 27 and am starting to chicken out. I have been unhappy with the asymmetry and scar from lumpectomy in 2010, and had fat grafting done in 2014. It helped a bit, and did add some vascularity to my breast, thereby decreasing some itchy skin problems in winter time and improving overall look.
For background, I am an age grouper triathlete, very, very active woman. I have always been small busted, but the 2 inches taken off during lumpectomy really did a number on the sizing on my left.
I am 47, 3 kids, and feeling like a real buzzkill because I am lucky to be here, thankful for good health, yet obsessing over the appearance of my breasts 7 years post diagnosis and treatment.
My surgeon wants to do submuscular placement of silicone implants, and is not sure how my radiated breast will do (he told me that it's unpredictable how that flesh reacts to surgery, et al).
Seeing these posts here makes me so scared, because I think I have a very nice physique despite my age, my diagnosis, my assymetry. It's shallow, but a concern that I won't be able to move properly afterwards. Lifting weights, working out, running, cycling, swimming and dancing are my outlets and my sanity. I don't know what I would do without these.
Please give me your inputs, as I'd like to make a decision in the next few days. I am really freaking out.
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Hi Marianna,
I can only tell you how I feel. Others may disagree as we have all had different experiences. You should make your own independent decision about what to do.
For me, cosmetics never mattered, but they mattered to my boyfriend whom I have since dumped. If it weren't for him, I would not have even considered implants.
I wanted function and the PS (a female triathlete) told me I would be able to go back to my extreme sports no problem. Well, in my case that was not true at all. I could not even do one push-up for the 3.5 years I had the silicone implants -- no matter how hard I tried (let alone do any extreme sports!). Muscle cannot work when it is not attached. After all those years of suffering with the implants (I lost all of my athletic ability) I had them removed and am now flat. I am totally comfortable being flat and I rarely even use my prostheses. However, even though the new PS did a great job reattaching my pecs to the sternum where they had been cut, I have not been able to return to my former state of physicality. Also, where they made the cuts in my pecs at my bra line they could not reattach the muscle to muscle - they had to sew it to my chest because muscle cannot be re-sewn to muscle.
To make a long story short, every second of every day of my life I regret having had the implant surgery. Every time I attempt to do back or chest exercises I feel the muscles not functioning properly. The joy I used to feel when exercising pre-cancer has been replaced by a deep and profound sorrow. Had I simply had the mastectomies without reconstruction I would have breezed through the cancer no problem. But the implant surgery (even after having them removed) has stopped me from living my athletic life. The boyfriend is gone, but now I have to live with the fact that I did not follow my own heart and make my own decision. I did what he wanted me to do.
Please, just make sure that if you have the surgery that it is YOUR decision and you are not being influenced by others. I think that is the most important thing.
I hope this helps you gain some clarity. If I had seen a post like this from an athlete, I personally would never have allowed the PS to touch me. My whole life was based around my physicality.
I hope that others will weigh-in here and share their stories, too.
Hugs to you. I am wishing you clarity in your decision. Please keep us posted.
Gran
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Hi,
I have a thread going on the reconstruction forum about going from under pectoral TE to an OVER pectoral implant reconstruction. I am not an extreme athlete, never did more than a 5k, walking/swimming /rowing, for exercise. I had no strength with under pectoral TE'S. I couldn't open a bag of paper chips. Now I can do pushups, I can row and do some weight lifting at the gym. I am at about 90 % of my arm strength as I was before all this insanity started. I can also open a bag of chips with ease. It was quite a long road, fat grafting, ect., but now I change in the locker room at the gym, instead of hiding in the toilet.
So over pectoral implant reconstruction is a viable alternative for athletic women. Come have a look on the thread.
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Hi Marianna, As macb04 did, I have implants that are OVER my pectoral. They are not large - 290cc, which maybe puts be in a 30D give or take on bra brand. I think I'm actually smaller but I've learned implants often make you select a bigger size than a natural breast (in my case I needed underwire and had to get the D cup size so the wire didn't sit on my implant).
I think I'm athletic - I never had a strong upper body, but I do what I can with what I have.
After healing from my BMX and having TEs placed above, I returned to all my activities with comfort. Then when I had my implants placed and healed from that, I again returned to all my activities with comfort. The only thing I can say I do differently now is avoiding something where I lay on my implants heavily. I really don't think about them during the day anymore. In part I think it's because they are smaller. A normal sport bra provides adequate support during bouncing.
I have complete range of motion and do upper body exercise as I used to.
Aesthetics were important to me but also comfort, which I ended up putting ahead of aesthetics. I think my implants look good-enough, but better yet, I feel pretty normal about them.
I hope that helps in your decision making.
I'm currently healing from a 2nd round of fat grafting to help blend the upper pole of my implant which was kind of visible through my skin. This would be a con to over pec implants.
Good luck!
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Gran (and others),
Thanks for creating this thread. While not as wildly active as some of you, running, swimming and road biking are crucial to my mental well being. After much research and discussion (two plastic surgeons) I set my path for unilateral mastectomy and immediate reconstruction with tissue expander. I knew going in that chemotherapy and radiation were in the cards. Chemo is done and radiation will start next month. DIEP flap is planned for December to allow time for healing. And I can't wait. I feel that expander every single day. I'm left handed yet still need that right pec to get through the day. Reading this thread validated my concerns.
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I posted this in the other forum but want to mention it here too. For those getting implants over your pecs....
Make sure your doctors have a plan in place to monitor you for local recurrence. After BMX, mammography is not done "because breast tissue has been removed. Local recurrence still occurs in approximately 2% of cases. For me, I could feel the recurrence because it was between my pec and my skin. If there was an implant there on top of the tumor, I likely would not have felt it. Understand I am NOT discouraging you from getting this type of implant. Not at all; I think it's exciting and applaud all of you for being willing to try something new which may benefit women for years to come! But when new things like this come into practice, there are no standards for monitoring for recurrence in place because no precedent has been set. As trailblazers, you need to advocate for yourselves to have MRIs or whatever your docs deem suitable, to monitor for local recurrence. Self exams and clinical breast exams will NOT pick up a tumor under an implant until it's grown quite a bit. So just make note to bring it up with your docs and be sure to advocate for yourself. You're worth it.
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Thanks for your wise input, Kbeee!
Gran
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Good luck, Runrcrb! Keep us posted. ((Hugs!))
Gran
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