Prior augmentation before BC, reconstruction options

Hi,

I had a direct to implant, and I'm pleased I did. It's been the easiest option psychologically, as I still feel I'm whole. Having all my pain at once made it easier too. I was in a lot of pain, as my surgeon put in 475 cc gummies. I was about a B+ before. Now I'm a C. You can't size up too much. My pain greatly subsided within a month.

I was able to do the surgery because they thought I wouldn't need rads. Nothing was imaged in my lymph nodes. After surgery they found 3 micromets (under 1 mm), so there was debate about rads. I have ILC so I decided not to, and 23 lymph nodes were removed. I hope I don't regret the decision, but my PS was adamant rads could ruin the affected implant.

With a 2 cm IDC grade 3 tumor, it may call for more aggressive treatment. And you've already had augmentation. Another major reason I chose straight to implant is because I have chronic pain from arthritis, including a hip that badly needs replacement - I can hardly walk, so another long-term pain source wouldn't be good.

TE's give you more options and a higher success rate. Straight to implant has a 25% + rate of failure. They have to get a blood supply to your entire flap, including nipples or you'll develop necrosis and the surgery fails with a big repair needed. I had a small piece of tissue removed under my nipple that didn't, so I have about a 1.5 inch scar that needs work in reconstruction. If I didn't have the pain issues, I think TE's would have been a better choice

lawyer - what some surgeons do with patients for whom rads is a certainty, or likely possibility, is to place expanders and overfill them to compensate for any tightening caused by radiation.  Rads is done and exchange takes place after a waiting period for healing.  The issue with rads is that skin doesn't stretch well after radiation, so if it is already overstretched by the expander in advance you are not attempting this afterward. 

Lawyer, I had prior augmentation also; silicon, submuscular. My BS/PS was able to do a skin-sparing, nipple-sparing unilateral MX and immediate reconstruction with a 500cc implant. We expected rads and were pleasantly surprised that it's not needed. However, the surgical procedure for me was the same either way. My pre-op size is D, but will augment them both at final reconstruction to a C. So skin tightening with rads wasn't a huge concern, and if the implant was damaged, it would be replaced during final reconstruction.

Because I was able to receive 500cc, I'm able to dress with little concern about my breast appearance. The implant sits high and matches the other side fairly well above the nipple. As long as I wear loose tops that don't hug, most people can't tell. (If they can, they're looking too close!)

I'm 3.5 weeks post-op with chemo still ahead of me, so I don't know when my surgical journey will conclude. But I do expect a positive outcome because I was a candidate for immediate reconstruction.

No two of us are alike, but I hope this helps. Feel free to ask anything!

I know there were a few factors that made it possible for me where it would not be possible for others.

1. I had prior implants placed submuscular.

2. I am perfectly okay with going down in size.

3. Clear margins. If it had been discovered during the surgery that skin was at risk, the plan would have changed.

4. I don't know how much this plays a part, but I only have one surgeon who is board certified in General and Plastic surgery, and she will continue to manage my care as a Leader at the Moores Cancer Center.

Good luck at your appointment next week! I hope your BS doesn't tell you to stay off the internet because of this!