Has anyone had skin saving MX with immediate implant?

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I would love to hear from others as to their experience.

I had this operation on Nov 3rd and unfortunately things have gone wrong.

The way this op is done is by cutting out the nipple and, for want of a better word, dig out all the breast tissue through a relatively small hole. Then the implant is inserted.

In my case I kept having fluid build up which kept having to be drained and after a month I developed a massive infection and the implant had to be taken out. I am still having trouble with the would healing as a hole opened up and I constantly have fluid draining.

My surgeon has now suggested that I have all the skin removed and it sounds like he is not prepared to give me another implant. I do have very mild diabetes and I smoke, but had reduced my smoking to 4-5 roll ups prior to the op and did not smoke for a time afterwards.

I was actually diagnosed in 2008 but was in Letrazol. Considering that I don’t need any other treatment like chemo or radio I now regret that I let myself be scared into having the op done now.

I would love to hear from anyone who had this procedure done and what their experiences were.

In my view putting an implant in straight away with that op was not a good thing to do.

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Hi Angela, I’m really sorry to hear you’ve had this trouble. I had same op 6 oct on left side plus reduction on right side and my wound has only just closed due to haematoma/infection. I’ve managed to keep the implant so can’t share that part of your experience but I’m sending you healing thoughts and hope someone can help you soon x.

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Hi Angela.
I’m so sorry that you’ve had such a tough time. I had bi-lateral skin sparing mastectomies with Beckers implants (expandable)and it went fine. I had reduction at the same time, with ‘anchor’ scars, so my surgeon had better access than you describe. I had a haematoma the night of my surgery which needed an operation the following day to fix it, but then it was fine. I’m 2 years down the line now.
Have you asked for a second opinion? - you are entitled to it.

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Angela, so sorry to hear of your problem. I had the same op as River a month ago so cannot help unfortunately but hope someone else can.

River, may I ask a quick question please as you have had exactly the same as me, including the haematoma straight after requiring a further op ? My biggest issue now are the nerves as they knit back. I am assured by my Surgeon and GP that this is normal as the nerves and bits knit back together and that it may take time. I have had to resort to Amitriptyline to help but not noticed much difference yet after a week’s use so going to increase dosage. I do still have a few dressings left which may be creating some of the discomfort and irritation but I can’t wear a bra for long and even a soft top starts rubbing and irritating everything after a while and the top of my breast is really sensitive (this is where the haematoma was) How long should I really expect this to last and any tips for how to ease these sensations. It really distracts me and at this point I don’t know how I will ever be able to concentrate enough to get back to work but am probably being very impatient ??!!
Thank you and apologies to Angela for asking another question.

L x

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Hi Lelly
It’s a while ago but I remember those nerve pains - they were quite shocking and left me speechless, they were so acute. I don’t think anything helped in terms of pain relief, but they tended to only last for short periods - real stabbing pains. I certainly didn’t wear a bra for some time - it was too uncomfortable. I wore secret support vests for a long time, and went up a size. Give it time - it’s the best healer.

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Thank you River, that does help and glad it is not just me. It seems so strange when most of the boob is numb, especially when I got an “itch” last night that I couldn’t scratch !! Will invest in more support vests. Dreading the inflations as well but think that will be delayed until all dressings gone and I feel ready emotionally. One stp at a time…

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Sorry Angela, just re-read your thread (I’ve got Tamoxifen brain!) and realised although I had nipple removed and my wound leaked from there, I have anchor scars like River & Lelly (plus scar from separate lymph node biopsy).

Lelly, I can’t wear a bra yet as my haemotoma wound was all across lower ‘breast’ but started wearing hidden support vests recently or soft crop tops. I haven’t got much feeling yet on the outside skin but have felt pains inside where nerve endings are coming back. Can you get a prescription for non-adherent silk dressings to protect where your skin is tender? I’m also thinking of getting Genie bras recommended by the practice nurse which include pads you can insert.

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Know how you feel Lelly. Had my last dressing removed today and first shower last week. Was supposed to be expanded this week but the skin’s not strong enough. Worried about going back to work before I’m ready and know I need to sort out the emotional side. It’s helpful to see that River has come through this.

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Thanks Turquoise and sorry to hear you have had extended problems. I think I saw someone else recommend the Genie bras on another that so will look into that as well. Not heard of silk dressings but will ask my GP when I next see her as anything is worth a try as it can really restrict “normal” life and I am really keen to do more walking but difficult when everything rubs.
Thanks again x

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Angela,

I had the same as you with an LD flap too, and mine went wrong too.

I had the nipple removed and the skin taken out, then an LD flap pulled under my arm and put into the ‘saved’ skin, and, because there wasn’t enough fat, I had an implant in there too.

Lots of drainage problems and a seroma in my back that has still not gone, but it is hardly visible now (since Nov 2009), and the scar in my back stuck to me, so I don’t have much movement in my back. (that’s not the ‘wrong bit’!).

3 months (Feb/March) later, I found a pea-sized lump in the breast. Went to doctor and he said it was nothing. Long-story-short: another 3 months later, I presented myself to the breast clinic with no appointment; cheated the system and was diagnosed with a 2x5 cm cancer in the recon.

So, usual treatment: 6 rounds of Chemo, Herceptin (18 sessions over a year) 25 x rads and a lumpectomy in the recon. (looks lovely! not), hardened implant. Arm was painful and swollen, so I wore a lymphodema sleeve for 4 months until I couldn’t use my arm (38cms around it vs 26 in normal arm) - but was then diagnosed with blood clot in jugular/arm from Tamoxifen blah, blah, blah. 10 days in hospital over Christmas, now on Warfarin to keep the blood thin.

Having a rest before I go back to see if I now need the implant removed, but have lost so much money (and had to downsize and move house in the middle of all this - from a lovely family home, to a filthy house that had been let to some exploited foreign workers), that I haven’t got time as I have to work (didn’t get sick pay).

So, that’s my story, not sure whether this is a ‘went wrong’, or whether it is part of the awful mess of this disease: it all started with a simple mx and reconstruction for DCIS - but 2 and an half years later, the journey is nearly over I hope.

I know what you mean about being scared into making a decision. But once it’s done all we can do is live through it and get to the end. My philosophy now is 'it will be all right in the end, and if it isn’t all right, it isn’t the end)

Annie

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Hi Annie, I’m so sorry to hear you’ve had such a long hard journey. I really hope you get sorted out soon x

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Thank you all for your replies.

I have one question. Do any of you smoke? My surgeon keeps on about it being my smoking that keeps it from healing properly though as I stated before I now smoke a lot less than I used to. He is an ex smoker though.

I could not have the skin flap surgery as I had 2 spinal surgeries 5 years ago and a knee replacement 3 years ago.

I am disabled with an Incomplete Spinal Injury. This means that I am partially paralyzed. I can walk with crutches for short distances. The problem there is that I am left handed and it was my left breast that was affected. When I want to stand up I have to push myself up with the crutches on my left and the side of the settee on my right. I had asked them prior to the op if that will affect the healing and they said no, but I think it does as the skin gets pulled every time I do that and that must cause a problem as well.

What worries me most is that he will refuse another implant, though I intend to stop smoking in time for that to be done and that it will be more difficult because all the skin will be gone.

Just to add, with all the operations I had in the last 5 years I have never had a problem with healing.

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Hi Angela I don’t smoke. Really hope you get the answers you need soon x

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Angela, I don’t smoke either. Really feel for you and hope you get some answers and help soon.

Turquoise, fully agree, it really helps to know there are others feeling the same and to see great examples like River who has got through it.

L x

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I’m so sorry to hear you’ve had such a bad experience with your mx and recon and hope that your surgeon can get you through this soon.
I had a skin-sparing mx 9 years ago with an immediate LD flap and implant reconstruction and had no problems with healing. I then went on to have chemo and rads and my skin and scars were fine throughout.
Fingers crossed for a more positive experience this time. Take care, Angelfalls xx

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Hi Angela
Don’t people say that ex-smokers are the worst?! I’m no expert on all of this but I expect that if you weren’t smoking, it might help the healing.

We all heal in different ways and at different rates, but eating the right things and taking a few supplements to boost repair is a good idea. Are you taking any vit supplements? Vit C especially. Surgeons don’t always have an interest in nutrition, but I think it would be worth talking to somebody about good foods for healing. Lots of fruit and veg, not too much sugar, low alcohol… these things can help. (But they can be difficult to do!)

It does sound as though you are pulling the skin when you get up and down. Can you raise the seat height a bit? (I only ask cos I had to put extra cushions on the settee for my Mum in law who finds it hard to get up)

I don’t come into BCC very often these days, but I’ll look out for your progress.

River

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Thank you for you reply river and you are right that ex smokers are the worst.

Well my diet has always been good. Most of my breakfast is fruit. Might take some extra Vit C. I don’t use sugar, but I do like licorice and sour sweets, but very sparingly as I tend to put on weight which I really can’t afford and I drink alcohol only once in a blue moon when I have a meal at friends. So the reason cannot be there.

I also don’t smoke anywhere near as much as I used to, 15 thin roll ups now compared to 30 regular ciggs before.

It was all quite a shock as I have had several operations in the last 5 years and I never had a problem with healing.

I am very careful when I stand up so as not to pull the skin, but as I don’t have any balance that can be difficult.

Whatever went wrong there I feel the surgeon had to find something to blame it on and my little bit of smoking was just very convenient.