Avoiding the horizontal scars

I had nipple and skin sparing bi-lateral mastectomies with the incision in the IMF (inframammary fold) under the breast. If you are not a candidate for nipple sparing, which is usually when the IMF incision is used, you might inquire about having your main incision placed there and a smaller horizontal, or possibly a purse string incision, done to remove just the nipples. I just had my right nipple removed almost six years after my original surgery and have a small horizontal incision there which could be obscured by a 3D tattoo. I have had a significant number of surgeries bi-laterally, but mostly on the left, and the surgeon has gone through the initial incision every time. You can minimize scarring with silicone tape or gel, but how much you scar is dependent on both your skin, and how you scar as an individual, and the skill of the surgeon.

elise - The reason for the right nip removal is complex! The right side was my cancer side and I had no significant issues with it after BMX, other than a bit of scattered necrosis that resolved with Silvadene and time. The left side was a different story. I had extensive necrosis across the skin, not on the nipple, where many have it. I had a large area just to the inside and slightly below the nipple that burst open and the tissue expander ruptured through the pectoral, allograft and skin. I had an emergency surgery to repair keeping the TE intact, but it failed and after two more skin repair surgeries the TE had to come out. The TE was out for the duration of chemo and replaced seven months after removal. I was able to expand very slowly and exchange with no issues. The only surgery I did after that was aesthetic fat grafting a year later to fill hollows above my implants - I am petite and had fairly large implants and there was a noticeable step-off and the fat grafting fixed it. A couple of years later I was starting to experience some bottoming out and perforating of the allograft material so had a bi-lat repair done to install new synthetic matrix material. During that surgery the previous area on the left tore open in two spots. It was repaired during surgery but did not hold, had two more tries at skin repair and then lost the left implant. I was flat on the one side for 18 months and had two fat graft surgeries to try to improve the skin integrity during that time. I had an expander placed in Dec. of last year, was able to expand successfully, but decided that because the left side was so compromised to go with smaller implants. This meant that the right had to be downsized by more than 200ccs. I also had nipple asymmetry, so it made sense to remove the right nipple to allow for the removal and tightening of skin to achieve smoothness over the smaller implant, and to eliminate the assymmetry. It is possible for me to have a 3D tattoo on the right to place a nipple closer to where it is on the left side, and I could not have the nipple removed from the left because of that weak and previously compromised area of skin adjacent to the nipple, it is too risky to do anything to that area. I have had a total of 16 surgeries since diagnosis, and honestly losing the right nipple is a non-event, it bothers me less than having both, but not having them match. If I had it to do over I would not have had nipple sparing, I would have asked to do what I described above - IMF incisions with nipple removal, then 3D tattoos. Pursestring is a method sometimes done with breast lifts and recon - the NAC (nipple areolar complex) is removed and then stitched closed around the circular incision, which is gathered together like a drawstring.

I did have a nipple sparing surgery with only an IMF (under the breast) incision. I went straight to 475 cc Implants. I told my surgeon I wanted to look as normal as possible. I also had 3 cc tumor far away from the surface. My left breast looks and feels almost normal. The right had a small amount of tissue trimmed from the flap because it wasn't getting a blood supply so I have a small scar under the nipple, but it's much smaller than the horizontal ones.

If you're larger, you'll end up with vertical scars from nipple realignment. The good new is you have a large amount of flap tissue to work with, so going straight to a smaller implant should be a breeze.

Now one thing I must say is that I didn't have radiation. I started out as a B+ with good shape -- no drooping. One of the requirements for immediate implant was not being too large to begin, and staying close to my size. 3 weeks were very painful after surgery, but it eased up after that. That's nothing compared to expanders.

I did have a lymph node disection, which is challenging along with the sub muscular placement and pain and animation. Foobs look great as long as I don't weight lift, but there's always trade-offs.

I'd recommend studying up on your cancer type and risk of recurrance from multiple studies before making treatment decisions. With an MX you don't need radiation unless you had large and/or aggressive tumors. And if you have a lymph node disection, you shouldn't need rads. Overtreatment is more common in the US than Europe, and the consequences limit our options.

Plastic surgeons often will steer you away from procedures they don't know how to perform so it's also important you get one who specializes in breast reconstruction and is up on the latest techniques. Ask to see their pics of reconstructions too. That scared me away from 2 PS. I ended up with #4 I interviewed.

It is possible to have a BMX with good aesthetic outcomes. If that's very important to you, look at the overall choices you make for treatment. I'm happy to answer questions here or in PM about nipple sparing and straight to implant MX's.