SGAP: Results & Recovery
Comments
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He did not touch my gluteal folds one bit. You can either sue the doctor or file a complaint at the hospital. I agree that we can be treated just like numbers. I am so sorry you are having this experience. Where do you live? I was told that I would have dent at the top of my right buttocks. It was more severe due to the fluid retention and subsequent staph infection. The skin just got ruined there. I had to wait until everything calmed down before he did the revision. There is definitely and small dent there. The only reason I had the SGAP was because the implant was wrong. I got my SGAP done in Zurich Switzerland where I live. I had my mx in the states.
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Similar to LAStar, my sGAP surgery also did not disturb the gluteal fold. The incisions are much, much higher. (I also had sGAP surgery done at the Breast Center in New Orleans - my plastic surgeon was Dr. Frank Dellacroce.)
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Hi greenjay,
I am not sure what stage II is but it took for 8-weeks to recover. Remember, you will have two sites that are painful. The site on my hip made it hard to sleep and sit. It is a major surgery, and it is in your best interest to take time off for the whole two months. Be sure to eat protein, and before your surgery too. I had no iron in my iron/protein in blood due to such a limited diet. It did contribute to the contraction of the infection. I do not mean to scare you but I wish I had known about how much diet would contribute to my recovery.
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Greenjay- did you ever have the SGAP procedure? I am thinking about scheduling the same procedure. How did it go for you? Are you happy with the results? What was your recovery like?
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Hi All, I've been reading over this thread and it seems like most people had challenges with the SGAP.
Are things better now? Would you do it over again? Any success stories out there?
I'm half flat and very concave on the mastectomy side so I'm starting to consider reconstruction. I don't like being this way. My PS says SGAP is probably my best option, but I'm also fearful of complications, and the results not being worth it.
Any feedback is appreciated!
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Hi Buttons - hopefully someone will chime in soon for you that had SGAP. Most of the NOLA patients that had SGAP are happy with their results. I had DIEP and I'm thrilled with my results. Make sure you see the surgeon's before & after photos before agreeing to the surgery and make sure you would be happy with the same results you see in the photos (not just happy with the results considering where you're at now). If you wouldnt be happy with the results, move onto the next surgeon. Are you thin and that's why your PS is recommending SGAP? What center/doc are you considering?
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Buttonsmachine, there were lots of people with successful SGAP surgeries on this board. The ones with no complications waltzed off into the sunset. My impression is that the complication rate is slightly higher for SGAP than for DIEP because the blood vessels are smaller. I think shooting for smaller rather than very large breasts is helpful (I saw a paper once on this), but I don't think surgeons ever take us seriously when we say we want smaller breasts. It was a long recovery and then I had to deal with a complication, but my results are fantastic. They feel like part of me now, and even with DD breasts I can wear a backless dress. Silver linings where we find them.
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Hi Lula - I'm on the thinner side, so that's why they are recommending SGAP. My doctors want me to wait before reconstructing anyway, just to make sure the cancer is under control. It seems like the NOLA doctors are top notch, although they don't take my insurance so I'm not sure whether that would be feasible for me. The PS who did my skin graft specializes in microsurgery and breast reconstruction, although I have not seen photos of the results. Definitely something to ask about if/when the time comes! I'm glad you're happy with your DIEP reconstruction.
LAstar - Thanks for that info! My original breasts were large, and I have thought that if I did reconstruct I might go smaller just so they can take less tissue from the donor site. However, I do like the idea of having my curves back, so I'm glad you were able to go larger and have a good result. A backless dress was completely out of the question with my original boobs due to the effects of gravity, so yes, silver linings where we can find them! :-)
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HI! Here is my summary:
I got implants and mast. from sloan in NYC -- My sloan surgeon was, frankly, a jerk and ended up doing a HORRIBLE job, e.g., made mistakes. One implant almost burst through - very scary. Both the sloan breast surgeon and plastic surgeon lied about the implants - they told me I would be able to do 'everything I always did' and without pain. Total, stunning lie. It was quite the opposite.
When I finally got insurance that Nola took, I made my surgery date. I'm too thin for DIEP so hip flap was for me.
My results were very good to excellent. Along with the flap, my Nola surgeon had to do major repair work (see above, sloan).
I woke up with a normal chest again, and wishing I had gone to Nola from the start. I was SO happy to get the horrible implants out. I have large B cups, nearly a C. I am not obsessed with size and honestly could have gone smaller. But I would be lying if I was not impressed with how met chest looked.
The dents in my hips were pretty obvious after stage I, and my pants would fall right off, however I am slim and very fit to begin with. I was willing to risk 'shark bites' to have a normal chest.
Stage II: this was easier but not totally easy. It's still a lot of tissue being moved around in my body, but again, it was worth it.The nipples came out nicely and my Nola Dr. evened out and fined tuned the breasts.
However, the dents in my hips have not really improved much. It is 6 months later, and my hip dents are only 10-20% fuller than after stage I. The liposuction did next to nothing. I think this was a waste of time.
My one complaint is that the dr. did not spend enough time discussing how the amount of tissue I took from my hips would appear; in other words, he just said, 'You can keep the B cups that you have' when he should have said, "You tell me what you WANT, and I will show you what your hips will *END UP* looking like."
That's a big difference.
So, anyone reading this, I URGE YOU: be firm and 1) ask what the hips will look like afterwards and 2) decide before surgery if you are willing to be maybe have smaller breasts for more natural looking hips. Everyone is different in terms of what they want but you have to decide this in advance.
I knew in advance that being thin, I would not have perfect results, but I admit I was not prepared for dents remaining in my hips. That said, everyone compliments me and many people have seen me naked
upon my request for their honest opinion, and they almost always say the same thing, "Yes, I see the dents, yes your rear end is now small, no it's not excellent looking, but overall your body looks good, and your breasts look amazing, so buy a belt."So: I am still quite happy with both Nola surgeries. I feel repaired and healed.
Unless I end up with some unforeseen problem like necrosis, I will not get any fixes.
I think the worst part of stage I and II was not the results or pain or drains or anything like that, but that I reacted badly to the Rx Versed, which is used prior to anesthetic. It made me so groggy I felt disoriented and for 24 hrs after - I could not even read because of double vision. They overdid it with the pain meds, in my opinion. I had less pain meds for stage 2, but not less enough!
A final word:
In my case, one big issue with this entire process was that I could never get on with my life after implants. I woke up thinking about breast cancer and went to sleep the same way. They were a constant reminder.
But the flap surgery made me feel whole and normal, and I now feel passed a trauma.
I wish implants were illegal, and given the risk for lymphoma, they may be some day.
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Thanks for the info greenjay! It helps to hear from people who have been through it. Glad to hear you are also happy with your results. When you say you had a hip flap - was that the same as an SGAP or slightly different? Everyone says such good things about NOLA, maybe I'll go for a consult one day. My recon is complicated because of my skin resection and graft, so I definitely want to make sure I do it right the first time!
Can anyone explain more about the shark bites? I'm just having trouble envisioning this. The before and after pics I have seen from SGAP are usually a horizontal/diagonal scar high across the buttock. But no one ever shows how it looks from the side! So confusing.
How does everyone feel about their proportions after SGAP? I wonder whether an SGAP surgery would make my butt smaller, give me smallish boobs, and then my stomach would look bigger...right? Or no? Anyone have experience with this?
Thanks to everyone for your responses!
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the shark bites are indentations where thevtissue was harvested. In stage 2, they do a butt lift and may do some fat grafting there to restore it. Your last questions are the reason why you need to see the PS’s before and after photos of that specific procedure. Keep in mind that not all PSs touch the lower half of your body in stage 2 and only focus on your breasts after stage 1. They’re reasoning is that you were having the procedure to do breast recon not a body makeover. They also say insurance won’t pay for it. Both inaccurate statements: harvest site is just as important as the breasts and insurance will cover it (if the doc knows how to code it properly). NOLA is the whole package-PSs that are highly skilled with an artists’ eye, that approach the procedure from a whole body perspective and they get it covered by insurance.
Just like with any other career, you have some PSs that can do the work but they dont have an eye for the final result and then you have those that do. Those before and after pics speak 1,000 words. SGAP is typically not performed as often as DIEP flap so its important to find ones that do a significant numbers number of sgaps a year. Also, their SGAP failure rate.
If you select a doc who doesn’t approach from a whole body perspective, isn’t concerned about you being able to conceal scars in a skimpy bikini, is only focused on your breasts after stage1, then the description you gave at the end is likely to happen. If you select a doc who does the approach from whole body perspective, is meticulous about scar placement, and focuses on restoring your proportions with an artists eye, you will likely not have the results you describe/fear, but rather a nicely proportioned shape front/back/side that you are comfortable enough with to proudly wear a skimpy bikini. NOLA is worth the consult at the very least - it’s typically done over the phone initially then photos via email. Many women still go even if their insurance is out of network as the results are worth the extra amount out of pocket. Also, if you checked your insurance on the NOLA website, note that the insurance listing order is a little backwards - they list the insurances that are out of network that theyve typically worked with in the past and further down the page they list the ones they are in network with.
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Hi
I am so happy I found this thread. I am trying to figure out what is the best course for me. I have had 4 surgeries, the last was to remove my implant due to infection. I am also, concave on my right side, but the PS at UCSF is recommending taking skin and muscle from my back right shoulder and moving it around. I am not eligible for a DIEP because I do not have enough abdominal fat. He is a microsurgeon and said this surgery would leave me with a smaller breast. He would do a combination implant and shoulder surgery. I already have shoulder issues on my right side, so I am scared this would make everything worse. I will ask if he can do this surgery, but it looks as if I better get someone very experienced. Thank you LUla for your insight. I will call NOLA and check out their website. How though do we go about finding PS close to where we live. I have asked MO, Radiation oncologist and they just don't know.
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Hey Lula, thank you for all of the info and for your perspectives. I'll undoubtedly refer back to this thread as I go through this process. :-)
Gocancergone, in my experience it seems like if a PS can't do the ordinary implant, the next step is to suggest a latissimus flap. I also had issues on my right side before breast cancer, and so I always had misgivings about that surgery. I think you are right for being concerned - and quality of life is SO important. I hope you can get more opinions before proceeding. Please keep us posted on what you find out!
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I have had the hip flap surgery at Nola. (sgap) I drove all the way from NYC to get this done after implant failures.
I cannot urge you strongly enough NOT to do a LAT./back muscle flap and implant. Your doctor is advising this bc he does not know how to do a hip flap.
1) Remember: Lat. surgery *CUTS MUSCLE FROM YOUR BACK* and moves it to the front. (!) How can that ever be a good thing??
At Sloan, they also wanted to do a Lat flap on me because I am lean and they were baffled by hip flap surgery. Lat surgery is easier for PSs who don't know how to do hip flaps.
Luckily I saw through their song and dance and went right to Nola.
You don't need fat on your hips in the same way you will need shoulder/back (Latis.) MUSCLE.
2) Implants have a high failure rate - Most Drs are not fully honest about it because they are either ignorant about stats or don't care because they get paid for implant surgery whether it fails or not.
3) Have you read the NYtimes articles about lymphoma from implants? It's small but the research is growing.
I had implants first, and the pain never goes away. They are lodged UNDER YOUR CHEST MUSCLES. I think that people feel comfortable about implants because they are a popular item; it's a word they have heard a million times, and considered something like a luxury item - get bigger breast with implants - but that does not make them safe or good.
End of story: I went to Nola, got implants out, got hip flaps and am exceedingly happy. It was worth the expense. I wish I had started there, it would have saved me so much pain, time and emotional trauma.
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Hi ladies
I have an update. I am scheduled for surgery at NOLA in July with Dr. Sullivan. Based on the pictures I sent to them, they are suggesting a SGAP procedure. I got nowhere with my local PS. He said he was going to do a consult backed out, after I drove an hour and half to see him. His nurse said I needed to heal, and that a GAP procedure would be too painful over the long term. They would discuss it with me in 3 months. Honestly, I think it was their way of giving up on me. I am a bit scared, but I so want to be whole again, and I have had too many botched surgeries. Thanks again for this thread. Oh and anything you feel I should know? I do need to fly out to New Orleans from CA, I assume yoga pants and loose top for ride home. I have another call with the patient educator, so I plan to ask her what others do. Also, they got me hooked up with the Hope house which helps to cut down on the expense of this surgery.
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greenjay & buttons - I so wish there was a like button on here. I’d like each of your posts 10 times if I could! I wish more women could see through the song and dance from docs who can’t/don’t do particular surgeries steering you away from them. Lat flap is old technique from before muscle sparing techniques were developed. Medicine is a business first and foremost today especially in the larger institutions. I cannot stress that enough.
Gocancergone- so glad you’ve got a date at NOLA! Dr Sullivan is a wonderful man who does amazing work. You are in very good hands. On the clothing...I wore yoga pants (not low rise ones) during my entire recovery and when I went back to work, I’d change into them as soon as I got home. Button up shirts or crisscross shirts work well. I got the crisscross shirts at the maternity store in the breast feeding section. 1 button on each shoulder and all was good. You may want to purchase some long tank tops from Target. You’ll be in a girdle after surgery and the long tank tops help give additional cushion between your skin and the fasteners. If you have sensitive skin it will also help protect your skin from irritation. Good luck!!🍀
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Lula73 - thank you!
I am so glad my post might be helpful. You are right about the business first. And to that i would add that in the huge hospitals, I felt more like a statistic and part of a machine - "WE do it THIS WAY here, the end!" rather than Nola's "we can do ANYTHING, and we will do what is right for you, to make you feel your best."Gocancergone - you are right with the clothing.
And other things I strongly recommend:
1) TRAVEL - strongly advise NOT to stay anywhere in the French Qtr. I have heard some patients love it because they hear about this famous tourist area so much, but remember that you are recovering from a big surgery, not there to drink and dance.
For my stage I, I stayed at Hotel Monteleone -- major mistake - yes, it's charming *looking* but extremely busy, crowded, and a tourist trap: i.e., LOUD (street parties below you every night and loud often drunk guests) and the rooms are tiny.
It's an old-fashioned, historical kind of luxury and not designed for post-surgery needs. You will have drains and bandages and need lots of room to move around. We ended up leaving and checking in at Hotel Indigo - much more quiet and roomy (and much better A/C), with a step-in shower - crucial! Loved it there, AND - bonus!! - it was closer to St Charles Hospital.
For my stage II, we rented via VRBO and LOVED the house we found. My partner took the street car to whole foods and brought back groceries, and that was better than any room service for me. Plus, I needed the kitchen to make lots of tea and other things that helped me post-surgically.
2) the month before your surgery, really beef up some stress reducers: exercise, deep breathing, meditation - all shown in research to improve surgery outcomes.
3) Eat a low inflammatory diet (see DrWeil.com), which helps reduce post-surgery swelling and take probiotics because you will have antibiotics during/after surgery.
4) Discuss carefully with the Dr. when you arrive how much hip fat you will lose vs. breast tissue you want. Remember, the bigger the breasts, the bigger the hip dents. Yes, they can fix most dents in stage II, but in my case, because I had such slim hips, there was no way to return my hips to the way they were, so I dropped a pant size.
I am okay with it now, but would probably choose smaller breasts if I did it all over again. That said, having larger breasts was/is not important to me, but for many women, it is extremely important to either retain the size they have or have a larger chest.
And also other women have plenty of hip fat, so they end up virtually the same when all surgeries are done. This is why you have to discuss it with it with your surgeon in detail.
They take great care of you at Nola, you will be in good hands!
Hope that helps.
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hey ladies what is the time frame between stage one and stage two? I might be interested in the hybrid version as I want to keep implants but have the fat flap transfer. I have a call set up with them later this month
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Mucki1991-typically 3 months between stages. I’m curious now...why keep the implants?
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I want the volume and pole projection that they provide. I was pretty large before and even a D cup looks small to me. I'm sure body image is playing a part in that. I'm not even sure if they can do what I would want which would be the fat flap over the implant I don't know enough about the procedure to know if connecting blood supply that way is an option.
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gotcha! How large were you before? I know NOLA does hybrid flaps with implants. The docs there really do some amazing things without implants too. I’d see what they say based on your wants (projection and volume).and what they have to work with. Are you thin? If not, volume is usually not an issue. Projection can be an issue in some cases but not all. Sometimes you do have to wait for stage 2 to complete the projection part usually with a lift.
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I was a 34 G and weighed 140. now weighing in at 150 I have a little extra since I'm short 5'1..
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Gocancergone, this is an old thread but there is a lot of great information on what to pack and expect at NOLA. St Charles Surgical Hospital is top-notch! I echo greenjay's advice. I was on a very clean diet and doing lots of core exercises before my SGAP, and I was so glad that I did after surgery. Getting out of bed was easier with some ab strength.
https://community.breastcancer.org/forum/44/topics...
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Mucki-one of the big things you can’t see right now is that your tummy area is going to be quite flat after surgery. With breasts cup size G, you may look out of proportion at that point. One thing they can do is to put a dermal matrix “sling” or “internal bra” in place in stage 1 but no implants. Then at stage 2 after you’ve gotten to see where you’re at, they can add implants or not. Remember on the projection that a lift during stage 2 (which is pretty common) significantly improves projection. That dermal matrix and waiting until after stage 1 in the implant decisionkeeps your options open.
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They are not that big now because I had the BMX. I'm a D now I can't tell you how many more clothes I can wear now that my boobs are a normal size!!!! My issue is that my insurance ends in December and if I have an issue or the surgery goes wrong I may be "stuck" with a crappy out come until I can go back to work and get health insurance. I'm not totally unhappy with my boobs now but I would love it if they felt more natural and were not cold most of the time. It's a big surgery and I'm not sure if the reward is worth the risk . I'm sure I'll be able to make a descicion after I have my phone consultation.
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At Nola, I think that they bill for all surgeries all at once, at the time of the stage I, so your revisions are covered... but I am not sure, so make sure to ask!
To add to the freaky cold feeling from implants - Ugh, I remember that! - in my opinion:
1) I don't see how any woman can feel 100% worry-free with implants because they are lodged behind your chest muscle and therefore cause some pain, limited movement and scar tissue
2) there is a small risk of lymphoma, and I suspect worse than we know, as we are learning about it + I do not trust the big Pharma corps that make the implants & I personally do not think any implant is worth this risk.
https://www.fda.gov/MedicalDevices/ProductsandMedi...
3) Implants are NOT a lifetime product, so every 10 years forever, they have to be replaced. I do not want to be 80 having unnecessary surgery & I want to be away from hospitals as much as I can anyway. Yes, Flaps = more time up front but best investment in the long run.
I have a large B to C cup, but I would rather have REAL kiwi-sized breasts out of my own tissue than grapefruits that hurt all my life, or could kill me. But that's me.
Yes, I know the feeling of worry related to getting rid of implants for a big flap surgery, but I believe now, having had both, that this is 99% due to the persuasive techniques used by implant-addicted surgeons who do not have Nola's knowledge or skill and spend so much time trying too make women believe that Flap surgery is scary and implant surgery is a cakewalk - both untrue.
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LAstar, where is this facebook group? Not on Facebook but will check it out!
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It's called Breast Cancer (NOLA/Charleston)
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greenjay- you won’t be able to find the group on FB. It’s listed as a secret group to keep all the looky-loos away. If you’d like to be added, I can help with that. But you will have to have a Facebook account first. Just let me know.
Mucki- I can get you added to the FB group too if you like. Stage 2 is usually done as early as 3 months after stage 1, so there is still time to get both stages done this year. Depending on your insurance you may have to pay some for each stage or just for stage 1. Depends on in network vs out of network, deductibles, copays, and out of pocket maximums. The rewards are so worth the risks. My breasts now feel like my breasts before all this happened (keeping in mind I had a reduction in stage 2). The morning after my stage 2 I couldn’t believe how great my chest felt from the inside. I was back to feeling like me again. Don’t get me wrong, I felt good after stage 1, but I was 1 1/2 - 2 cup sizes larger than before and they were heavy (size DD). Read through the 2017 & 2018 DIEP pages here on BCO for what women who have gone to NOLA have to say (besides me that is).
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Mine are two cup sizes larger than I wanted also. I think breast surgeons think we all want huge breasts, even though I started with huge breasts and was very clear I wanted a C cup. There is greater risk for restricted blood flow and necrosis for larger flaps.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC41840...
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