Exchange City

Oxbury - I had to wait 3 months, mostly due to insurance requirements between before I could get my implant. My PS did say if I had to have radiation I would have had to wait 6 months before I could have the implant.

Just made an appointment to replace my imlplants (origially put in 10 years ago). My pre-op appointment is next week. I feel more nervous now about the upcoming proceedure than I remember feeling back then. Would like to gets your thoughts on the following:

• placing implants over or under muscle
  • My current implants are under the muscle and 1 breast becomes concave when my muscle flexes. Both methods have pros / cons.
• if you had nipple reconstruction, did your Dr. "save" the reconstructed nipple OR did you have another proceedure to recreate them?
• What was your recovery like?
• Did you need an overnight(s) at the hospital?
• Any other advice?

Dearest ladies,

I thought of sharing my experience with implant exchange here, as I have browsed this thread many times ahead of surgery to know what to expect.

I had an expander for over 15 months due to Covid-related delays and it wasn't fun. The TE was placed over the muscle during my skin and nipple sparing mastectomy in July 2020. The edges always hurt. But its appearance was always more than acceptable to me. Then, after 8.5 months I had a first round of fat grafting. The PS deflated the expander a bit, took 250 ml of fat from hips and inner thighs and placed it around the TE. The fat grafting was much more painful than I expected and I also had a huge hematoma on one leg, but I was ultimately relieved to have had it, as it greatly reduced the pain/discomfort caused by the TE. And the cleavage looked natural enough afterwards to be able to wear nearly all my summer clothes!

Finally, on 20 October I had implant exchange and a second round of fat grafting. The surgeons took fat from upper thigh and knees and injected all around the implant. They used a 190 ml tear drop, textured sylicon implant (I'm a B cup). I can't comment on the looks as it is still early days but it is already much much more comfortable than the TE ever was. The surgery was less heavy than the first, I felt much less weak, and didn't need much analgesia afterwards. I had one drain which was removed earlier today (day 9). The bruising from fat grafting is significant but nowhere near as scary as the first time! I have to wear a compression band to keep the implant in place and post-surgical bra for 3 to 4 weeks, I have been told not to lift my arm for the time being and to avoid lifting anything heavier than 5 kg for 4-6 weeks. They used the same incision as the first time (inframmamary fold) and closed it with stitches and glue. They plan to remove the stitches on day 13.

Best wishes to you all!

I finished radiation in May of 2021 and was told that I needed to wait at least 6 months before having my TEs exchanged for permanent implants. I have had the TEs in since October of 2020, going through multiple fills, chemo and radiation during that timeframe.. My PS says that her approach with radiation patients is to "overfill" the radiated side and have it be slightly lower than the non-radiated side because over time, the radiated side lifts up as the skin tightens and this allows the result to be more even. So far (at least with the TEs, she seems to be right).

I will be having silicone implants placed during my 12/9 implant exchange surgery.

I guess every PS has their own way of doing it. I will try to wait patiently for the 6 month mark. My non-radiated breast is 1/2 inch lower than the radiated. He even said the radiated side will not "droop" like the non. I thought it was weird that he didn't err on the side of caution and make the non-rad side higher or at least even to begin with if they tend to droop. I'm sure hubby would rather them look more "normal", but he will defer to me since he's not the one having surgery.

Lalbo - Not the same situation. I had my exchange to implants in July 2021, but was diagnosed with a recurrence a few days after. I did 25 sessions of radiation and finished on 10/11/21. PS told me back in July that I would have to wait at least 6 months before we could do any corrective surgery as it takes the tissue about that much time, if not more, to return to normal. I'm not happy with how my breast look either, but I was told from the beginning that I would require several surgeries to get them to where I will like them. I hope everything works out for you.

Lalbo - I'm so happy your husband is so supportive! It makes things a little easier to deal with.

I don't understand why the immediate exchange to implant after radiation. I'm a bit new to all all of this and learning a lot, but I would think that because radiation works from the inside out your tissue would have been too fragile for surgery. My skin reacted very quickly, I went into rads day 3 or 4 already a little pink. Again, I realize everyone is different (and my lack of knowledge), but never would've thought surgery so soon after rads.

All of my doctors and surgeons told me from the beginning that they wanted me to feel comfortable with myself at the end of all of this. My PS even went as far as having me go get a second opinion, even though I had already decided to have her do my surgeries. She wanted to make sure that I was being given all the information from different sources. The second PS confirmed everything my PS had told me, there were would more than one surgery.

Good luck and keep us posted.

My foobs came out too big IMO. I'm hoping the PS will agree to put smaller implants in. I lost quite a bit of weight during treatment and then had the fat graft grafting done during the exchange and cannot seem to gain it back. When I first met with PS I wanted to be as close to my size as possible, well I didn't take perkiness or weightless into consideration...I'm huge! The size I was when I had the TE's was just right, so I thought. I didn't realize that the aldoderm didn't hold up, literally, and both breasts were sagging (I didn't and still don't like looking at them too much) I actually like the way the radiated breast looks compared to left. Didn't you say that too?

Prepmom- thank you for the post. I feel like I have a tight bra on all the time. I'm glad they were able to take care of the infection. I was diagnosed the day of the shutdown in my state and was lucky to have started treatment nit even a week later. I was worried going in for the BMX as it was right in the middle of the craziness anreven more terrified of being in the hospital.

Nipples...that's the other thing; I don't have any. I think I wouldn't have such a hard time looking if they were there. I'll have 3D nipples tattooed on, but that's not going to be for at least another year to year and half depending on the how many revisions. SIGH!

Update - I have a pre-consultation phone call with the Breast Cancer Center in NOLA this Friday. This is to get preliminary health information from me. They are out of my BCBS network. I believe BCBS will pay 80% after deductible. They will put it through their billing department to let me know how much it would be so I can make a decision on whether or not I can afford it. I wouldn't be having surgery until after 6/27 (when I get my vacation time). They specialize in DIEP flap, I have implants, so...

I have seen on here, or somewhere else, someone has had a combination of DIEP and smaller implants. I'd be ok with smaller FOOBS at this point in time. I went from an A to D. That's a big change, plus laying on my side is very uncomfortable. I thought I was going to get B, maybe small C.. I think I'm on the larger size of D (at least on the left side).

Serendipity09 - I hadn’t thought about my implant being too heavy as a cause of my shoulder and neck pain. I did lots of PT last year. I don’t see my PS until next month, when I schedule my exchange surgery for my left side. I’ll have to ask him about it. I plan to go smaller in both breasts.

Serendipity - I live in Central Alabama, but I am willing to travel (not too far) to get good results, and New Orleans is not too far away. About as far away as going to the beaches in Mobile, AL. I just do not have confidence that my PS would do a good enough job. He and I kind of butted heads when I would ask him questions. He would say one thing in one appointment and something else in another and I would question it and I could tell he would get irritated with me. I even said something to the nurse about us being irritated with each other and that's not what I was trying to do, but this is very important and I wanted to make sure I understood everything. Then the next time I go in he was more understanding, roller coaster ride. Up....down....up....down. I wish I had gotten a second opinion on the reconstruction but it all was happening so fast. Dx 4/6/21, BMX 5/12/21, Radiation, then implant exchange on 9/22/21. If I had one week of no doctor's appointment during this time it would have been rare. The PS also said he was surprised I remembered so much of what he said, most people heard "cancer" and couldn't focus. Well, that's not me, and this was very important to me, so I had a notebook with notes and questions every time I went in.

My right shoulder is "acting up". I cannot reach back behind me as far or as easily as I used to. I read something about rotator cuff problems from laying on the operating table with your arms out for an extended period of time. I haven't seen anyone about it yet.

My thoughts are racing all over the map on any given day. I'm not happy with my foobs, looking at them can cause me to be depressed because they look so wrong. I want to get them fixed so they look better. I'm pretty much over my surgery pain, do I really want to go through that again? Will something wrong happen this next time, should I leave well enough alone? ETC....

I'm an overthinker to the max. Then I read horror stories on here and get scared of possible problems with additional surgeries.

I will take it one step at a time. Next step is conversation on Friday...

Serendipity… - I think I did well emotionally all the way through radiation treatments and the fill of the left TE, it hit me right before the implant exchange surgery. Now that I think on it, during one rad treatment near the end I remember having tears run down my face. I was just tired of it all. After the exchange surgery, when I tried on real bras for the first time (and nothing fit right)..I went home and sobbed for a good long while.

Nsbrown54 - please keep us updated on your progress!

Lalbo - trying on bras triggered me. I really don't have to wear them, but I feel awkward at times. I've become more accustomed to not wearing them lately.

I talked with a nurse at the CENTER FOR RESTORATIVE BREAST SURGERY in NOLA. She was very nice and informative. I felt much better about having a follow up surgery after talking with her. She said she thought the surgeon would most likely recommend the APEX Flap procedure:

The APEX FlapSM breast reconstruction is a highly sophisticated microsurgical technique that is used to rebuild the breast lost to mastectomy. Like the DIEP Flap, excess living fat from below the belly button is transplanted to the chest to restore volume and shape. The APEX FlapSM differs from an ordinary DIEP however, as it allows for the natural anatomy and blood vessels to be rearranged to perfectly preserve the abdominal muscles and improve blood flow to the tissue transplant when necessary. This technique is an advancement over the DIEP procedure and has very specific indications and benefits. Link - https://www.breastcenter.com/breast-reconstruction...

I sent my insurance information to them and am waiting to find out how much I would have to pay for the surgery. They are out of network, I believe my insurance would pay 80%, but if I get the results then I would be willing to pay that.

They did say they have worked on people with radiated skin, so that was not an issue for them.

Overall, very positive.