Immediate Expanders vs 2 Week Delay- What has best outcomes?

123meesha · August 2017

Hello

I am planning my BMX surgery :-( and reconstruction. I will go with nipple sparing infra-mamary incision and have decided on implants with either low profile expanders or temporary adjustable saline implants (in place of expanders). I am thinking I want cohesive rounds because I am reading comments from people who are unhappy with the shaped implants. I also have concerns about the shaped implants either rotating or not aligning well with my skin/nipple envelope. I have read a few times that people think their new gummy bear breast looks like a hamburgur bun, and I wonder what it means.

Anyway, here's my current dilemma and question: Several PS have told me that they get better results and less risk with a 2 week delay after MX before placing expanders. Others say the cosmetic result is better with immediate placement because there is less scarring and less shrinkage of the tissue envelope. Some like to expand the expanders right away. From what I have read and heard, it sounds like patients prefer immediate. It is definitely psychologically more appealing. I also would like to have less surgeries and less rounds of recovery. So I would like to know what people think: Is it cosmetically better and less risky to wait 2 weeks or do immediate expanders?

Here's another dilemma: I have not fully selected a surgical team but my preferred PS says he prefers the 2 week delay but would be willing to do immediate if I get the MX from a surgeon he can coordinate with. However, my preferred BS does not have rights at his hospital and vice versa. So if I wanted to use a team of my current favorite surgeons, that would mean that Id have to go with the delay. But, I worry the delay will leave me with sub-optimal results, extra scarring, and extended pain and recovery.

One more thing: I have not had radiation or chemo, and so far it looks like I should not need them (fingers crossed!!).

I feel I need to so this soon, but I'm also feeling stuck on these issues. Any thoughts or advice would be appreciated.

VegGal · August 2017

My vote would be immediate placement of expanders. I can't imagine going back to surgery at two weeks. That's when I started to feel better.

I am one with "burger bun" implants. They appear flat and wide and one did rotate a bit. I'm getting round cohesive in a couple of weeks.

Good luck with your decision.

C

Artista928 · August 2017

I think you answered your own question with this:

"I also would like to have less surgeries and less rounds of recovery." I've never heard of this magical 2 weeks waiting for better results. TEs are temporary. Eventually they will come out and you'll get implants. That's what you want to have the best results with.

NotVeryBrave · August 2017

I've never heard of a 2 week delay for placing TE's. I can't imagine going back to the OR after only 2 weeks! Is there a reason why you can't go with implants from the get go?

Artista928 · August 2017

The surgeons I know won't open you up just 2 short weeks after a surgery unless it's life threatening. Too much risk for infection if you're not fully healed before undergoing the knife again. In order to have surgery you need to be in good shape and how can he say you won't need more than 2 weeks to heal from the first? Sounds sketchy to me. Maybe he's going by $s. It would be more $ to do 2 surgeries than just 1..

123meesha · August 2017

Thank you all for your replies! I am going to make sure to build a surgical team that will give me immediate expanders or implants. I have done a bit more research and all of says that better cosmetic results come from the immediate reconstruction either with expanders or implants, and that more scarring occurs with delay. It also makes more sense.

I don't know what it is with the doctors around here. I have been told by 4 "top docs" who say the delay provides a better outcome. I think they have all convinced each other of this. They actually say the delay reduces infection risk. None of it makes sense to me, and I'm not going to buy it. I agree it seems fishy but I think they believe it is best to wait. I'm glad you are all here to chime in on this, you're all helping me to have confidence in making this tough decision!

Carla, thank you for explaining about your results with the shaped implants. I'm sorry you're having to go through yet another surgery. I hope you get great results this time!

exercise_guru · August 2017

I read your post. I noticed that you were having nipple sparing not skin sparing. I suspect that they do the mastectomy and then try to get as much blood supply to retain the nipple. I am sorry I do not know a lot about this surgery.

My PS was deeply concerned that I would not go under anesthesia less than 90 days apart. I would start a new thread with the title "nipple sparing" I had read that angelina jolie had her surgery in several stages so she could save her nipples. I do not know exactly how it was done. My PS told me that it only works on small breasts so I was not a candidate. I had skin sparing with immediate TE inserted. my surgery was very long and my PS told me he had to clean everything up from the removal of the sentinal nodes.

You are doing the right thing getting the information you need.

VegGal · August 2017

I had nipple sparing. I did not have small breasts and did not do the "nipple saving" pre-surgery like Jolie. That surgery is a quick surgery where some of the blood supply is cut off to the nipple a couple of weeks before the mastectomy to allow the body to form collateral veins and capillaries, thus increasing the chance of success at MX.

In my case, I had largish, droopy, breasts. I also had thin skin and was on a moderate dosage of steroids for an autoimmune disease. I was a pretty horrible candidate for nipple sparing but I wanted to try. My PS said I had 75% chance of success, but to expect some degree of necrosis.

Surprise! It was 100% successful. In addition, both nips respond normally to cold and touch, although the sensation is almost nothing.

Thanks 123Meesha! My surgeon is very confident I will be happier with the new implants. Needless to say, I am nervous. I want to be DONE!

Have a good week everyone.

Immediate Expanders vs 2 Week Delay- What has best outcomes?

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