Hi I have a thread on the Reconstruction Boards about this very topic. Stop on by and ask your questions and meet some other ladies who have been through this Prepectoral Implant Reconstruction.

Topic: TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!

Forum: Breast Reconstruction — Is it right for you? Discuss timing and various procedures and techniques.

I am 10 year survivor. My initial diagnosis was IDC, Stage 2b. I had bilateral mastecomies in 2007 with immediate reconstruction. Expanders were placed and then I had my exchange for permanent implants - the implants are the shaped 410 "gummies" and were placed below my chest muscle. I then had chemotherapy and radiation to my cancer side. For the last 5 plus years I have been experiencing pain and discomfort on the radiated side, including this "vice-like" feeling - it's pretty uncomfortable. In addition, my implants are too small for my body size so I would like slightly larger implants I have consulted for 3 plastic surgeons about a revision. I am hoping you could give me your thoughts...

One doctor recommends that he remove the current implants, place expanders to create more space, then exchange for permanent smooth round implants above the muscle. This doctor does not want to use the shaped implants because of their connection to increased risk of a type of lymphoma. He also would not do the fat grafting Iwould need until after I recover from the exchange procedure. 3 total procedures

Another doctor recommends he remove the current implants, take my latissimus muscle on the cancer side and bring in forward, place expanders to create more space, then exchange for permanent implants. And then do fat grafting in a 3rd procedure.

Last doctor recommends that he remove the current implant, replace with the newer better projecting implants below the chest muscle and do fat grafting all in one procedure. This doctor also says no drains will be needed following this procedure. The other 2 doctors say absolutely yes to drains.

My questions for you is:

- has anyone had a revision like any described above after radiation? What procedure did you have and are you happy with the results?

- Is there any down side to having the implant placed above the chest muscle?

- Is doctor number 3 too good to be true?

Sorry this is so long...I really look forward to your comments.

Marcy S

Hi Marcys,

I had a TE under my poor pectoral initally and then took it out because I was doing Fat Grafting (that PS wasn't good at it) not enough survived several procedures to make me a breast, so then went onto getting a Prepectoral (over my Pectoral) TE with a different PS. Eventually had an implant exchange. I had severe radiation fibrosis which caused me difficulties in healing. The Fat Grafting didnt work to make a breast, but was enough to completely cushion the edges of my implant, and improve the woody texture of my skin. My skin was just like boot leather. I also took Pentoxifylline 400mg/tablet (3 times per day) plus Vitamin E 400IU per capsule (three times per day). I am sure that the Fat Grafting/Pentoxifylline works together to greatly heal radiation fibrosis damage. No Animation Deformity. My reconstructed breast is not cold either, which a lot of people with implants complain of. Is a much faster recovery than Subpectoral or any of your other surgery options.

Good Luck

Hi. Thank you for your reply. I did try to search for other women experiences like mine, but I am struggling to find anything very close to my situation. Specifically, I am looking to find someone who had radiation to their initial implant and then had them removed, expanders placed and then permanent exchange. I will keep searching. Thank you again:)

Hi Marcys

I just got my implant taken out that was placed under my muscle. I was having extreme pain and within a six month period my implant was moving toward my under arm. My shoulder is now completely messed up from the original surgeries. Unfortunately, I was told I only had one choice for surgery, and after going to PT for several months my PS finally referrered me to his colleague who could do the prepectoral surgery. I found out after the fact that there are more reconstruction surgeries available. I asked but did not get the information I needed from surgeons. Now moving on, I found the thread that macb04 created which helped me to advocate to get something done. I had surgery Jan 22, 2018. I still have a drain, but I can tell you the constant feeling that I had a pulled muscle is gone. My shoulder is still bad, but I also am in the stage where I can’t lift above 90 degrees/ 5 lbs. I will have one more, possibly two more revision/fat grafting surgeries. I do have radiated skin/tissue so my PS is concerned about healing and has asked me to restrain from driving, lifting, or raising my arm. He said that radiated tissue hasless blood flow and takes longer to heal.

Hope that helps!

Nursepatient35, the TE's under skin were uncomfortable for me for a week or two, then each time I had a fill it was a new uncomfortable feeling and a crampy muscle pain the day of the fill. I never wound up liking the Subpectoral. I am sorry they couldn't do Prepectoral for you. Not every PS is experienced enough to do Prepectoral because it is a newer method. Go on one of the longer standing Implant forums and ask your questions, there will be more women who had Subpectoral to answer your questions.