Appearance of ribcage and sternum.

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CrawfordsMommy
CrawfordsMommy Member Posts: 68
edited July 2016 in Living Without Reconstruction After a Mastectomy

I'm scheduled for BMX June 2 with no recon. Quick history: My tumor is right under and possibly growing into my nipple, so lumpectomy, skin-sparing, or nipple-sparing surgeries were not an option for me. I was ok with that... When I discovered I had cancer, I said right away that I wanted BMX anyway due to my fairly young age (45) and an elevated risk of getting cancer in the opposite breast. So [L] is going, and [R] (which is healthy) is a casualty of war. I really didn't want to have a uni.

I keep getting asked by doctors, nurses, etc. if I understand what it means to not get recon. As if I don't know what I asked for. I really don't mind the idea of not having boobs. I think it's ok to be a little different. So that's not my concern.

I do worry about my appearance afterwards. I'm quite bony already and fret a little bit about my shape. You can see my ribcage from the front THROUGH my boobs; how bad is it going to look after surgery? I have always wanted to "bulk up" and try to fix this but never seemed to find the time - I think I have a new goal after treatment - to put a little bit of flesh there. What do I say to my surgeon about making the scars look as flat as possible? Can he even do that? Should I consult with a dietician? If so, when? Will I be able to hide my ribs and sternum a little bit? So many questions.

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  • floaton
    floaton Member Posts: 181
    edited May 2016

    crawfordsmommy, hi! I'm a uni, and have a bmi around 20-21, and a bony chest with visible ribs on the right. I can see some outline of my ribs above my remaining breast on the left. Some of the prominence on the right is due to the fact that I had the fascia removed from the top of my pec (I'm guessing due to a close margin). I was very clear with my surgeon I would not be doing recon and I have a very nice looking, flat, very thin scar. I wear higher neck shirts now, and up until recently a prosthetic daily, and my ribs are not visible through clothes. It would probably be a good idea to work with a physical therapist with some knowledge of lymphedema and its prevention before going into an intensive workout program to build up your chest muscles post-op as sudden stress on your arm/chest could be a trigger for swelling, and quite a few of us have also had shoulder problems post-op too, so technique will be important!
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  • CrawfordsMommy
    CrawfordsMommy Member Posts: 68
    edited May 2016
    Prior to my BC diagnosis, I had FINALLY, after much procrastination, started working intensely with a strict diet and weight lifting to recover my body from the effects of the eating disorder I've always struggled with. It's very difficult for me to digest normal meals (yay! I trashed my digestive and organ systems FTW) and put on muscle mass, so I was really happy with my progress. Yeah, I could eat carbs all day and get a big belly, anyone can, but that's not what I'm after, it doesn't put the weight where I need it, and I understand that the steroids and hormones we end up taking tend to give us a big tummy anyway.

    Thanks for the advice of not going right back in and throwing 90 pounds up over my head right away. I wasnt planning on it, but you made a good point about the LE. I don't want to get that stuff fired up especially if I have radiation following surgery. Reading through here, and listening to my doctor, slow and gradual is the way to go, and walking (even if you go slow) is always advised. I'm a little frustrated because my arms were starting to look good right before dx and I was hoping my prominent sternum/ribs would become less noticeable in time but yeah, I suppose it's time to shop for higher cut necklines... and a personal trainer... and a dietician... and most likely a good therapist. My mind's been weird ever since all this started.
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  • Erica3681
    Erica3681 Member Posts: 1,916
    edited May 2016

    I'm thin and my ribs do show after a bilateral mastectomy. My surgeon told me (sadly) that I would not be able to gain fat in that area, even if I put on weight, since in order to make sure she removed all my breast tissue, she also had to remove virtually all the fat cells in the area. I'm in good shape (and still thin), but have accepted that my chest will always look bony. Of course, as floaton said, I look fine in clothes. I normally wear breast forms but if I go flat while wearing a camisole underneath even a fitted tee shirt, you can't see anything but a smooth flat chest. I'm able to wear reasonably low-cut tops.

    floaton is also right that you should begin working out again very gradually. It used to be thought that women shouldn't lift more than five pound weights after surgery to avoid lymphedema. While that's been debunked, it's still considered advisable to regain strength slowly. But, as with fat cells, it's unlikely that improving pectoral strength will make a noticeable difference in your chest appearance. :-(

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  • CrawfordsMommy
    CrawfordsMommy Member Posts: 68
    edited May 2016

    Oh, dang. Well, it's better to get a realistic picture of what things will likely be going forward so I can plan my wardrobe accordingly. I'll just have to accept that my chest will (still) not be my best feature. It's ok... I happen to like accessorizing with scarves.

    Recently I made major gains in pectoral strength, but yeah, it didn't "fill out" my chest or change my appearance that much in the torso. My arms plumped up though, and that was nice.

    I don't think I would be able to stick to a 5-pound restriction on lifting! I'm glad they don't say THAT anymore.

    My surgeon is telling me that I can return to my previous activities, but slowly. He even said I am cleared to do as much damn cycling as I feel like once I'm healed up. (Some days I will get bored and ride 50 miles) He's one of those who believes the more activity, the better.

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  • LisaAlissa
    LisaAlissa Member Posts: 1,092
    edited May 2016

    Part of the reason you want to resume exercise slowly (as in, not lift arms above shoulders for 2+ weeks) is to allow your lymphatic system to have it's best chance to heal. You want to give yourself your best chance to avoid lymphedema.

    Take a look on the Lymphedema board (and the StepUp-SpeakOut site) for more information on resuming exercise, and lymphedema risk-reduction.

    HTH,

    LisaAlissa


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  • coraleliz
    coraleliz Member Posts: 1,523
    edited May 2016

    I'm thin & my ribs are very prominent. Visible with most necklines. I wear a sports bra most of the time because it bothers my chest to have cloth rub against it. At the gym,(mirrors everywhere) I sometimes notice my ribs are visible through my shirt or tank I wear over my sports bra. It doesn't really bother me. I'm there to work out not be fashionable. The gym is where I feel the best. Gym clothes are made for thin people. I spent way to much time & money initially after my BMX on clothes. The clothes I bought thinking I needed to hide my flat chest, I almost never wore. I didn't do well with ruffles, prints, large jewelry or scarfs. Back to my old ways of dressing, with a few exceptions(no darts......). Hope you continue to heal & get back to working out. It does take time. You'll get there.

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  • hsant
    hsant Member Posts: 790
    edited May 2016

    I'm very thin, and have always been small on top. Small breasts, and no fat around my sternum. My BMX , isn't perfectly smooth, because the scar cuts right into my ribs. Also, because I'm thin, it's not symmetrical. The right rib right below my mastectomy scar protrudes more than my left. My surgeon told me that it's near impossible to get perfect symmetry, especially when you're skinny. I'm still happy with my choice, and the results

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  • CrawfordsMommy
    CrawfordsMommy Member Posts: 68
    edited May 2016

    Thank you everyone for your kind replies. I'm a little selfconscious so I wear loose shirts when I'm exercising especially while cycling, to hide the ribs. I'm not expecting perfect symmetry or even smooth scarring... if it bothers me I will follow up with a plastic surgeon later.

    Since the breast runs up to the collar bone and they must remove that tissue too, did any of you thin ladies also notice if your collar bones got more prominent?

    ...I may go clothes shopping a few months AFTER BMX to see what looks good on me... I hate stuff that shows too many of my weird bones.

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  • CrawfordsMommy
    CrawfordsMommy Member Posts: 68
    edited July 2016

    Yup, I ended up with an even more scary looking, prominent ribcage with hollow spots where my breasts were. It's a bit painful to watch me flex my pectorals. I'm consulting with a plastic surgeon next week to see if there is anything he can do to fill things in and smooth things out here and there. The skin around my incisions is loose and drapey - the surgeon left some extra, which I specifically asked him not to do.

    My mother, always concerned about my weight ever since I was a scary-skinny kid, came over and fed me right up for a while. I now have a big tummy and 5 extra pounds, but not where I want them. I feel so fat, and when I feel fat, I start to do weird things. I began doing weird things today for the first time in months.

    In spite of my history of ED, we're going forward with chemo because of an Oncotype of like 26 or something (I reacted kind of bad to the news, so, that part got fuzzy for me). It's pretty much a done deal. Chemo will probably trigger me right down into a messed up spiral of ED behaviors, obsessions and suicidal ideation. You know, stuff that I've finally been getting away from! I had only been having suicidal thoughts 2-3 times a day as compared to like, constantly throughout 2014 and most of 2015. My MO has prescribed me a shed load of Ativan and if things get bad she'll hit me up with stronger stuff. If I have to muddle through 4 months of chemo in a semi-sedated, vegetative state, it's still better than counting peas, doing pushups in the bathroom and wearing another hole in the carpet doing aerobics in front of the TV. We just got that carpet replaced late last year.

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