May 2016 Surgeries

Angtee - so good to here from you! I'm glad you are doing well. So now there are 4 of us with surgery planned at the end of Oct! It will be nice to share this experience. Right now I'm filled to 260ccs but my PS won't go any further because of thin skin. I'm exchanging for smooth round silicone. After asking multiple times, I was finally told that the PS would probably take a range of 300-350 cc implants into the surgery to try out on me. This was after she initially said that she would use the same size implants as the TEs (275ccs). So this makes me feel a bit better as I've never heard of anyone going that small. I'm not really anxious about the surgery or the outcome - just hoping that they are not cockeyed like my TEs!

It must just be an unspoken coping mechanism, ladies, now that you've mentioned it. I also did something rather dramatically different with my hair a couple weeks back. It's just part of everything changing.

Grandma - since I already went through everything right up to exchange surgery (canceled) including agreeing on implant size, I can add - my PS is pointed about starting at the same size implant as TE fill size. I pressed him on how that doesn't make sense, and I came pre-armed with measurements for my TEs (you'll need the serial number & brand) and which implants (you'll need the brand your surgeon likes to use & their product guide) most closely fit that size, as well as a preference for going larger or smaller if an exact match wasn't possible (which it wasn't), and what matters more, projection or overall volume. He also pointed out that on smaller TE, like you and I have, the port is NOT accounted for in the volume, and it takes up a much larger proportion of the actual TE volume in the chest versus someone with, say, an 800cc TE. So if you do a direct cc translation to squishies, you will be smaller, not just because they're squishy and lack the rigid backing but because the port volume is not taken into account.

So there's some math for you. We were going to do anatomicals for me, to start with, and use rounds as backup. I like the idea of rounds more, because they can't rotate out of place and require more surgery to correct, but my PS was emphatic about anatomicals giving a more natural shape for me. *sigh* Since we had to pause indefinitely, I imagine I'll get to go over all this again at my next pre-op.

Makes me wish I could be awakened so I could give MY opinion in action before I'm all glued back together and it's too late!

Good luck to you.

Hi Angtee!

Angtee, good to hear from you. Sorry about the capsular contraction. What are they doing to treat that? I'm on Singulair in advance of my TE replacement surgery which my PS says he often prescribes for people with CC; just wondering if you're taking that.

Val, thanks for checking in! Slow and steady wins the race. Don't push yourself, but I'm glad your improving in baby steps.

I've suddenly been hit with the most melancholy mood today and I'm truly struggling. I could burst into tears at any moment. May be a side effect of the Singulair or it may just be that I'm exhausted from mentally dealing with all this crap on a daily basis. Either way, it sucks.

Happy Birthday, MyToyStory!

I had my first "stress dream" about the upcoming exchange surgery next month. I dreamed that they fed me a very large breakfast right before going into surgery. The next thing I knew, I was waking up with these itty bitty foobs. I was very disappointed. Then the PS was giving me a shot of Botox in my forehead telling me that I will thank her in the long run. 😊

GreyKat - you are right about the injection port. I can feel the ones on my TEs and they take up quite a bit of space! Someone on the exchange city thread was kind enough to send me photos of her exchange (we have the same build) and I liked how they turned out. I think they are at the high end of the range my PS plans to use.

Raven- I hope you are doing better and feeling less melancholy.

GreyKat - the NP in my PS's office told me the implants would range about 300-350 cc's. They will try them out in surgery until they find the size that looks (fits) best, based on my build: 5'7", 120lbs, 29" rib cage. My TEs are 275 cc's, filled to 260. I wanted one more fill but the PS said my skin would not tolerate it. She recommended the smooth round silicone. I had heard that anatomicals have more upper pole fullness, but with my small size I think that would look funny. Also, I think the edges of anatomicals may be more visible, but don't quote me on that. Have you asked Whippetmom about your implant size? She has a thread called BREASTIMPLANT SIZING 101.

Hi all - have not been posting here but have been reading along. I am sorry to read of those who are still experiencing issues healing, and new health concerns - certainly hoping there is improvement soon for you. I think of all of you daily.

Just wanted to post this graphic for Grandmax3 - GreyKat is correct - more upper pole fullness with a round. Most choose anatomical for the more natural shape it provides.

raven - FG after radiation is more prevalent in Europe according to my first PS, but there are more and more people having it done - you can find some here on BCO. I had two of them since my fragile skin was treated as if it was radiated. The FG were to my flat side and they were done 6 months apart, but you can definitely do them with more frequency (more like 90 days) than that. There has to be healing at both the donor and graft site - some docs will use a different donor site since the harvest is the more aggressive aspect of the surgery. I switched docs in between and that was why I had the delay. It is recommended to do a couple, particularly if you have some absorption after the first one, and you might be able to get a couple in before the end of the year. With FG to a flat side they do not take as much from the donor site as is done for aesthetics with implant recon. I have had both and there was a marked difference - the recovery from the FG to the flat side was much easier - pain from FG is directly proportionate to how much fat is harvested. The graft amounts were much less for those two procedures than they were when the fat was being applied around an implant. I can definitely say though, it made a HUGE difference in the health of my skin and its ability to stretch over a new TE and implant after so much additional repair surgery - I am amazed that I was able to go that route - both PS brought up lat flap because both thought it was how things would end up. I could not do it because I have had numerous skin cancers on my upper back, didn't want to bring that around to the front. I also have bi-lat lymphedema and didn't want to compromise my better arm with that type of surgery. I am very relieved that it worked out and I credit doing the FG.

Here are some links for you:

http://www.plasticsurgery.org/news/press-releases/technique-provides-new-option-for-breast-reconstruction-after-radiation-therapy

https://www.ncbi.nlm.nih.gov/pubmed/21987041

grandma - how much of a natural shape is formed by a round implant depends on each individual size, frame, skin/muscle laxity, implant size, pocket size, alloderm used, etc. I believe generally, and it Ian my experience personally, that the graphic is pretty representative of the look. I did not have a teardrop shape with rounds, I had enough upper pole fullness that I definitely needed fat grafting to soften the step off to make the implants look more natural. Not having had anatomicals I can't speak to them personally, but having been on BCO for quite some time, what I have read indicates less upper pole fullness, more firmness, but I have not read about feeling edges. I think the edges question would be individualized and dependent on skin and pectoral thickness. Anatomicals do require a snug pocket to control rotation so you might need more pocket work, or a larger implant - which could cause symmetry issues with your other side

MyToyStory2- my PS is the same way - the only decision I had to make was silicone or saline. It's frustrating to hear other women talk about their discussions with their PS about size and projection because I have not been able to get my PS to discuss any of this. The more I read, though, the more I realize that there is a real science behind this and the PS is going to use a variety of factors to calculate the correct fit for my particular height, build, and overall shape. I've decided to just trust her and hope for the best.

mytoystory - the FG after rads or skin issues to a flat side is to improve the integrity of the skin so it can stretch over a TE or implant. Rads damaged skin doesn't stretch, it tears. FG for aesthetics is usually to soften the ridges or full out dents or divots, or to add volume or smooth ripples. You can reconstruct totally out of fat, I think mostly using Brava, but that is a whole other kettle of fish. There are a couple of threads devoted to it here on BCO, it is a fairly long term process.

Anatomicals have not been used as long as rounds and some PS don't use them because they have no experience. When they first came out I believe they were only used by the docs in the trial. Other PS who have interest, or feel like some of their patients would like them, have come on board and started to use them, but they have not been available that long. After being around this subject, and thie site and having a lot of my own surgery with two different PS - I have found that a lot of docs will only talk to you about what they do, or know, and if you don't have any independent info of your own there are some procedures or products you would never hear about if it is not their particular expertise.

Also, for those worried about implant size - it is important to note that there is less difference between sizes than you think - I had implants that were different sizes from each other by 100ccs and you could not tell - my new implants are different sizes and the smaller one actually looks bigger. In Mentor the difference in projection from the smallest to the largest is about 2cm - so, about an inch. I am talking about the difference between a 175cc implant and an 800cc. They are larger in diameter of course, but not so different in projection. I am saying that because I think people worry prior to exchange about very small differences in implant size - I don't think you can tell the difference between 300ccs and 350ccs - I dropped from 650ccs to 445ccs and still wear the same size bra.

GreyKat - I am 5'2" and wear a size 2/4 shirt jacket - I am petite and small boned, and there is very little visual difference between my first set of implants and the ones I have now. I am visually a C cup with the 445cc. As I said, I had a 100cc difference between implants after original exchange - the left had a 550cc and the right had a 650cc, no visual difference. At one point while still trying to salvage my original reconstruction the left was replaced with a 500cc implant - so a difference of 150ccs, hoping to stress the skin less - still couldn't see the difference unless you knew about it.

valstim - since you had rads you might consider talking to a PS earlier about having some small fat grafts done in prep for expander based recon if that is what you are interested in. It is best to do them prior to any other procedure and they are relatively easy procedures if the amounts of fat used are smaller- can be done in an outpatient center. I know that you may need to approach this differently/more gently due to your other recent health challenges. Some small FG initially could go a ways in successful recon later. Something to consider.

myToyStory2, no, in my case the goal is not to do fat grafting in lieu of the TE. As SpecialK noted, the intent is to shore up the radiated breast PRIOR to the TE replacement.

SpecialK, thanks so much for the info and the links. I'm pretty sure my PS was only thinking of doing one round of FG, but I'll ask him if he thinks we should do more than one. And this is also to my flat side, so I don't anticipate that he'll have to take too much. He's currently planning to use my tummy. I'm not obese by any means but there's certainly plenty of post-baby, perimenopausal excess there for the harvesting. I certainly don't want him to take more than he needs, however.

Moreshoes, just checking my options.My MO says possibly a year, but that was pre stroke so who knows. Just keeping hope alive.

Aha - fat grafting just for strengthening the skin...got it! (Forgot your infection side was your radiated side, Raven.) Impressed with your efforts toward ensuring success with your reconstruction!

Special K - "I will never look good" - that's kind where I think I'm headed, too. I mentioned earlier in this thread that my PS told me his goal was just to make them 'sisters' at this point - forget 'twins'. After 3 months of flat, which was NOT for me, I'll be fine with 'cousins' or whatever else he's able to achieve.

My TE's are totally different shapes. I call Rightie my 'fun side' and Leftie my 'mom side'. It's almost like having a high profile round implant on the right and an anatomical implant on the left, so I feel like I've got a sneak peak with both styles. I'm happy with rounds - that's the shape my hubby and I prefer!

GreyKat - Do you have any goal dates for your procedures? Just wondering what sort of timeline you're looking at. I think I'm anxious for you to get some good news!

Keep on healing, Valstim and MoreShoes! Hope your radiation pains are lessening! Fingers crossed it works out for you to get your reconstruction some day!