Why do I need tissue expanders?

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HopeWins
HopeWins Member Posts: 181
edited July 2019 in Breast Reconstruction

Met with PS yesterday. In discussing implant procedure, he said direct to implant depends on the condition of the skin after mastectomy. In 1-5% of cases, skin is really beaten up and they just sew you up. In 80% of cases the skin is in ok shape and they put in tissue expanders. In <20% of cases the skin is healthy enough to do direct to implant.

I have never heard this before... has anyone else? FYI - implant is going over pec muscle, I have not had and will not need rads, non smoker, 47, not going bigger (I'm a B/C)

I started out wanting DIEP but am hesitant due to recovery period. But then I was thinking... is DIEP recovery really worse than 4-8w of tissue expanders?

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  • exbrnxgrl
    exbrnxgrl Member Posts: 12,424
    edited July 2019

    HopeWins,

    I am not familiar with the stats your ps quoted, but I did have one step implants, no TE's, placed almost eight years ago. I had a skin and nipple sparing bmx, and just wanted to look as much like my natural self as possible, i.e. stay the same size. . Since they were able to preserve my skin, there was nothing to expand, so my permanent implants were placed. Remember, some mastectomies require skin removal, so TE’s stretch the skin with each fill.My ps was experienced with this type of recon, but there was specific criteria for patients to be eligible. If you've searched through bco then you'll have noticed that this type of recon is less commonly done than the more traditional TE to permanent implants.

    As for DIEP and pain, sorry, but I have no experience with that. If you have any questions about one step implants, I'd be happy to try to answer them. Take care.

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  • HopeWins
    HopeWins Member Posts: 181
    edited July 2019

    Not expecting any skin removal. Definitely skin and nipple sparing. So I'm perplexed why he can't give me a higher chance of getting my implants right then and there. And he works with the BS all the time. She's excellent, head of the breast center, highly recommended so it's not like he doesn't know what to expect from the BS.

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  • LisaK12
    LisaK12 Member Posts: 107
    edited July 2019

    I would consider meeting with another PS. Mine's statistics were nothing like what you were quoted. I know it varies by physician and by patient. I was also told that they would not know for sure if I could go direct-to-implant or if I would need TEs until after the mastectomy, to ensure that there was sufficient blood flow to the skin. But some doctors prefer to use TEs for various reasons (some think they get better results using them, some find it more profitable to go that route, etc.).

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  • SummerAngel
    SummerAngel Member Posts: 1,006
    edited July 2019

    I saw multiple plastic surgeons for consultations before my BMX. The ones who did implants all told me that I would need TEs because of "laxity" in my skin - meaning they weren't as perky as they had once been. The TEs were quite painful for me but the finished result is very nice, so for me it was worth it.

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  • Runrcrb
    Runrcrb Member Posts: 577
    edited July 2019

    Hopewins, I never questioned the TE. I had mastectomy with TE under the pec. Then chemo and radiation. Radiation did a number on me so happy for you to skip that. I felt my TE and the displaced pec every day for the 15 months it was in. I had DIEP. Recovery was easier than the mastectomy. I had one night in the ICU for monitoring (take earplugs) one night in the surgical recovery floor and then home. I had nothing stronger that Tylenol after 8am when I left the ICU. I was back at work 5 weeks later. Mastectomy and immediate DIEP won’t be easy but given your (other than cancer) healthy stats, I wouldn’t rule out DIEP for perceived recovery length. Private message me if you want more or pi

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  • exbrnxgrl
    exbrnxgrl Member Posts: 12,424
    edited July 2019

    Hope,

    If you are interested in one step implants, no TE’s, I think you need to find a ps who has experience with this type of recon. BTW, skin laxity was never mentioned, perhaps because I was going for a look that was as close as possible to my native breasts

    As LisaK12 mentioned, my ps also brought TE’s into surgery as he said that even with the best plan, surgery doesn’t always go according to plan. He said that if he felt that a one step procedure didn’t yield good cosmetic results after the bmx, he would go with TE’s. As I came to after surgery, the first question I asked was if I had gotten my permanent implants or TE’s!

    Based on nothing but anecdotal evidence, it just seems that many ps’s do not have experience with the one step procedure. Why this is, I don’t know.

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  • HopeWins
    HopeWins Member Posts: 181
    edited July 2019

    I think you're both right about the experience level of the PS with this procedure. I suspect that the PS does way more cosmetic surgery than breast reconstruction. I think it makes sense that the condition of the site after mastectomy has to be considered and could prevent the direct to implant option. I was just surprised that he can't do direct implant >80% of the time. I would have expected the stats to be the other way around, like ~20% of the time the skin/blood flow is not good enough for direct implants and would present a risk of necrosis but 80% of the time he does direct given my circumstances.

    I'm seeing a different PS tomorrow that was recommended by a friend who is a gynecological surgeon so I'm hoping I come out of that appt with a higher comfort level. I don't necessarily want to change my BS but for what I'm doing, I think the comfort level with the PS is super important. Plus, there is an excellent, highly recommended BS who works with the new PS so I would be fine changing.

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  • SummerAngel
    SummerAngel Member Posts: 1,006
    edited July 2019

    I really don't believe that it is because of the quality of the skin or blood flow. I had fantastic blood flow and skin quality, even it my breasts weren't as perky as they had been at 20. I loved my breasts as they were, actually. I also wanted a look similar to my original breasts, so I doubt that has anything to do with it, either. I suspect that lack of experience with direct-to-implant has a lot to do with it, though.

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  • SimoneRC
    SimoneRC Member Posts: 419
    edited July 2019

    Tried to post a link but it did not work. Good article on this site. Search “Necrosis of the breast skin related to mastectomy”.

    The Breast Surgeon does the mastectomy. That surgeon wants to take as much breast tissue as possible so the Plastic Surgeon gets to work with what was left.

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  • exbrnxgrl
    exbrnxgrl Member Posts: 12,424
    edited July 2019

    HopeWins,

    You’ve made a good point that I had forgotten. At the time of my bmx, my self contained HMO ( kind of like an all inclusive resort, but no vacations there, just medical! ) did not do any cosmetic surgery. They only did reconstruction and corrective plastic surgery (Not just breast). Finding a ps who only/mainly does recon sounds like a good step toward finding a recon option that you’re comfortable with.

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