One and done prepectoral breast reconstructon w/o TEs

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ctgirl14
ctgirl14 Member Posts: 10
edited July 2017 in Breast Reconstruction

I am BRCA2 positive and after two years of living with this information and a mother who died at 45 from bc, I finally found the courage to pursue a PBM. I am on the surgical calendar for Aug 3rd, but am struggling with the decision to go under or over the chest muscle. I'm wondering if anyone has had a one and done above the chest muscle w/o tissue expanders? My intuition is telling me to go above the chest muscle to feel as normal as possible. I also want a pleasing aesthetic result...don't we all ; ) Any thoughts would be so very appreciated. Thank you!

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  • ashell
    ashell Member Posts: 108
    edited July 2017

    I haven't had the one and done surgery, but if possible I would recommend over the muscle. I had implants put under the muscle, and as a young active woman I really hate how they affect my upper body strength. I'm looking into removing my implants and going with a flap myself.

    Have you talked with your surgeon about it?

    Good luck with your surgery!

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  • NotVeryBrave
    NotVeryBrave Member Posts: 1,287
    edited July 2017

    I had the "one and done" with skin and nipple sparing mastectomy and above the muscle anatomical silicone implants. I chose this method to avoid repeat surgeries and thought it seemed to make the most sense - putting the implant where the breast tissue used to be.

    I'm only 9 weeks out so can't give you long term results. One advantage to under the muscle is probably better contours. After mastectomy, you really only have skin with maybe a tiny bit of fat covering the implant. As a result - rippling, dents, edges are probably more apparent. Fat grafting to help is an option down the road.

    Also - TE's let you see kind of what you'll look like before you're committed. I feel like I ended up bigger than I wanted - in a wide way.

    However - I feel pretty good these days and don't have to have more surgery unless I want to. My PS calls that "icing on the cake" in his lingo!


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  • candles1
    candles1 Member Posts: 77
    edited July 2017

    I had one-and-done over the muscle. It was a largely painless and easy recovery for me. I had full range of motion and strength almost immediately. As soon as the drains came out (about a week), I was out and about; driving, attending events, shopping, etc. I feel pretty much like the implants are "all me" now and none of my activities or sleep habits have been altered.

    What NotVeryBrave says about the appearance is true though. While my result is cosmetically very, very good...there is visible rippling that shows through the skin. I am now 4.5 months out. I will be having fat grafting done later in the year.

    It is tempting to just ignore the rippling because I feel so great and the rippling can't be seen under clothing (but if I wear something low cut, the rippling is visible at the cleavage). So, while I hate to have another procedure that I don't really need health-wise, I feel like I should at least try to fix the defect while I'm still within a single insurance policy year (and OOP max has been paid).

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  • ctgirl14
    ctgirl14 Member Posts: 10
    edited July 2017

    Thank you "ashell" for sharing your experience with me. I am definitely leaning towards implants above the muscle as I have concerns like what you have expressed. I just wanted to share my sister had a DIEP flap surgery four weeks ago as she is BRCA positive as well. Though it was a very long and delicate surgery, she looks and feels amazing!!! She couldn't be happier with her outcome. Unfortunately I'm not a good flap candidate, but I do want to feel as "normal" as possible.

    I wish you the best of luck too!

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  • ctgirl14
    ctgirl14 Member Posts: 10
    edited July 2017

    Thank you "notverybrave" for sharing your experience. Prepectoral placement just makes sense to me too and seems so much less invasive. I'm actually not going much larger than I am now (too petite to pull off a c cup), so TEs seem like more aggravation than they're worth. WRT your size, at 9 weeks I'm guessing there's still swelling to go down before your breasts settle. I'm glad you are feeling well and you are very brave.

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  • dcdrogers
    dcdrogers Member Posts: 115
    edited July 2017

    I also had the one and done procedure 9 weeks ago as wellland couldn't be happier with the results. I opted for the round silicone implant and they look pretty good. I'm currently doing radiation and have 4 more treatments to go. Other than some tanning the implant on the cancer still looks and feels soft. I can see some very ery slight rippling, but that's ONLY if I'm leaning over and bra less. Going by their appearance today I will not opt for any additional surgeries.

    I was very scared to go forward with this procedure (skin and nipple sparing), but like others have pointed out, I really wanted to go with the option that would allow me to possibly forgoe any additional surgeries. I also did NOT want TE's. The biggest annoyance for me (aside from chemo) were the drains. Mine weren't painful, but I ended up keeping one of the 3 drains in for 4 weeks because the daily output refused to go below 30. I HATED not being able to shower and the twice daily measuring of output was annoying.

    ~Dee

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  • Sunrisefish
    Sunrisefish Member Posts: 67
    edited July 2017

    Hi Ladies, just chiming in. I also had above the muscle, skin and nipple sparing, with direct anatomical implants. My surgery was 7 weeks ago. Recovery was pretty easy and I have full feeling in the skin of my breasts. Nipples are numb. I had very little pain and had full arm movement in days. I would definitely recommend over the muscle if you are looking for the most non invasive option. The anatomical implants I think are a little wide and flat on top, but they arent too bad and are probably still settling. I have read you need to give anatomical 6 months to fully settle. I also plan to do fat grafting down the road to fix some flat parts on the upper part. Plus I had radiation 2.5 years ago and fat grafting is recommended for radiated tissue. Good luck! Keep us posted!

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  • ashell
    ashell Member Posts: 108
    edited July 2017

    OP, thanks for the info about your sister. I was originally told I'm not a good flap candidate by my PS, but I've since discovered there are the TUG and PAP flaps that I should qualify for. And I might be able to do a stacked DIEP since I'm unilateral, so I'm considering that as well. The diep kind of scares me because of the huge scar across the abs and possible ab tightness.

    I like the idea of over the muscle implants, but the implants would still need to be exchanged every 10 years or so right?

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  • NotVeryBrave
    NotVeryBrave Member Posts: 1,287
    edited July 2017

    Apparently that's an old idea about exchanging implants every 10 years. The implants used these days may last 20 years or more.


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  • MinusTwo
    MinusTwo Member Posts: 16,634
    edited July 2017

    Agreed - my PS said there is no need to replace sub-pectoral implants at 10 years.

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  • ashell
    ashell Member Posts: 108
    edited July 2017

    Oh interesting. What about over-pectoral? Definitely something for me to consider, but I do like the idea of never having to go back under for breast stuff. Decisions decisions

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  • ctgirl14
    ctgirl14 Member Posts: 10
    edited August 2017

    Yes, my PS told me he has patients with implants older than 20 years!!! I find that so reassuring as I was reading 7 - 10 years on the internet.

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  • ctgirl14
    ctgirl14 Member Posts: 10
    edited July 2017

    I guess it's good to have choices, but it can be paralyzing!!! I look forward to updating this forum with the details of my experience after my surgery.

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  • ctgirl14
    ctgirl14 Member Posts: 10
    edited August 2017

    I'm now faced with the decision of saline vs. silicone. My PS is pushing silicone, but I don't like the idea of future MRI monitoring or worrying if every lump is a silent leak. Has anyone done prepectoral reconstruction using saline implants? If so, I'd LOVE to hear about your experience. Thank you all so much for sharing.

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