Advice/opinions following implant reconstruction please.

[delly]

Yeh, ordinarily implant surgery would be an easier experience than yours has so unfortunately been. So you've a few weeks yet until you're seen again and able to get more info. Keep in mind having a chat to the nurses on the helpline no. on here, or posting on their section if you're needing or wanting some independent advice, suggestions if you're struggling to obtain more info. 

So did you tell your girls that they're to blame for your not being able to have the Diepp??!! 😆 

I never wanted self tissue recon. Skinny, so only lat flap possible. Didn't want to compromise/weaken my back muscles, have extra scars to heal, extra infection risks, chaffing from rucksack straps to scars with being a walker etc. But it's quite a lengthy slog and multiple procedures from mastectomy flatness. A year or so in all, and other things kept getting in the way, knocking me off the horse.

I love all animals, but cats definitely make me go all soft. Just think they're such beautiful creatures, whether domestic mogs or lions and all inbetween. Sorry yours was only young. Have you ever watched cat behaviourist, Jackson Galaxy's tv prog "My Cat From Hell"? It amazes me what he comes up with/knows how to solve difficult behaviours. If you haven't, it's on the Really channel daily at 4pm. I also love "The Dog House" where they match up suitable rescue dogs to people's wishes and then show you how they are later, and "happily ever after". Or "happily doggy after"! 😊

Please will you keep us informed with how things are going with your boob. What's happening, and how you go on at your appointment.   

Lots of love,  Dellycat-Delly  x❤️x         

[DestinyIsAll]

I’ll definitely get another, we have a great big soppy boy cat who is really missing her too, so I’m sure he’d benefit from another companion too. They really are family to us and my daughter is heartbroken. They bring so much joy but it’s really hard when you lost them, especially when young. She did really comfort me when I was recovering from the mastectomy, and having some dark old days there for a while. They’re really therapeutic aren’t they?  We live out in the countryside and the garden is cat proofed too so nice and safe here. My first cat lived to 20 too, what a great age, lots of lovely memories, but I’m sure your still miss her very much. ❤️

My operation choices were taken out of my hands really, advised mastectomy immediately in my first appointment and then no DIEP as I had full-term twins (21 now) and my tummy skin was too stretched so wasn’t good enough quality 😊. To be fair I was keen on the idea of immediate reconstruction, and realistically I didn’t expect perfect results but I did imagine an implant would be an easier process than what I’ve experienced in reality. I’m sure it is for a lot of women. 

[delly]

Yeh DestinyIsAll, I'd wondered whether all a bit of a rush for you and why I'd said I'd had a lot more more time with mine, it being from a delayed point of view, so then more of a cosmetic thing, as opposed to yours also being to directly also deal with the beast at the same time. So many decisions and operation options to have to deal with. And flippin Covid complications on top of it all for you.

Awww darlin, I'm sooo sorry to hear you've lost your beloved pet too, and it also being to cancer. Not surprised your head's been all over the place. It's like losing a member of your family, isn't it. People told me to get another soon after I'd lost my cat after 20 yrs of having her, and her being my last remaining member of my family. Adored that creature, so I can empathise with you. She had been such a comfort and solace through both my BC experiences and a load of other of life's brown stuff (s**t!!), but moving to a house on a very busy main road prevented it, otherwise I would have. Do you think you may get another?? xXx     

[DestinyIsAll]

Thanks so much Delly, and bookish.

I feel I may have been a bit naïve and not asked enough when my surgeon hasn’t volunteered info, I’m usually one who researches everything to the nth degree and asks loads of questions but my diagnosis was a shock (in that I had been repeatedly reassured it was nothing sinister and was completely unprepared) and going through everything on my own with Covid measures and dealing with two separate teams (onc and plastics) was sometimes a bit tricky, I don’t think I had as clear a head as I’d wish in some appointments. Plus appointments were minimal, via phone or video a lot of the time and then not seeing anyone after surgery and ‘shipped’ out as quickly as possible. 

I feel somewhat reassured by both your experiences and explanations that things may settle and improve at least some. I just need to allow some time and see where things are in a few weeks, rather than being so upset at this early stage. I had to have a much loved pet put to sleep the day before my surgery last week (bloody cancer also) and I haven’t been in a great head space at all. xx

[delly]

Sorry, took so long with my last reply, I clashed with Bookish (Hellooo sweetie, good to see and hear you again and hope you're doing well xxx)

Yeh, @DestinyIsAll, I can understand your thinking there ref mesh and extra support, but that's two of us on the droop/drape. My understanding of the "mesh", was, Yes it's extra support, but more to keep the implants from moving or displacing in other directions over time, and to prevent "rippling" occurring when raising your arms. xXx 

[delly]

Hi again @DestinyIsAll 

Yeh, it's likely to develop "some" drape with time, once the skin and tissues have settled more with the weight of the implant. But is it likely to drop 2"?? Dunno, flower.

My experience of implant surgery was coming from a seven year delayed recon from both mastectomies a year apart, so yes, different than one recon and having to match up to an existing boob. Unfortunately, I fell off the horse after expanders installed and going through the required expansions, so didn't get to having the expanders replaced with the permanent silicone implants. I'd gone through all the options and minute details with the surgeon before any of it. Had done a load of research (had had the time to), and specifically asked if I could have the mesh support (was a newish procedure back then, 2014), which he was more than happy to do. I don't know if he would have offered it without me asking, as standard procedure for him, so to speak. (When I mentioned costs to you before, I wasn't talking about the costs of using mesh. Though it may have come into it? I was just meaning whether costs and priorities may currently affect you, Covid wise, in whether able to see another NHS surgeon.)

But, had I had the permanent silicons installed, he said I'd have to wait 3 months before nipple recon, to allow scars to fully heal AND the boobs to settle, develop a "drape/droop" beforehand, so that the nipples could be more accurately lined up. Also, after my first mast and when discussing recon then, again the previous surgeon had said, once the implant side had had time to "settle/droop", we can always "tittivate" your other side to match at a later point if necessary. So these are where I was taking the possible "settling/drooping" from in your case and me mentioning it. But again, I don't know about 2" though.

I'm just surprised these various things weren't discussed with you beforehand, as in the mesh option, and or at least immediately after surgery, as in "droop", so that you were better informed what to expect. But maybe you didn't see him immed after surgery either? We had to stay in hospital for a few days, back then, not released soon after, so had a post op check whilst still in hospital.

I'm wondering if the breast nurses on here may be able to help and advise you? May be well worth discussing it with them if you can't with your own BCN, which is another frustration for you. But again may be down to time and prioritising with Covid and reduced staff??

It's such a shame things weren't right for you the first time and you've gone from too low to too high!! One op's bad enough, isn't it.  xXx 

[bookish]

Hi Destiny

Can confirm, 'droop' is very expected. I had my bilateral mastectomy just over a year ago, immediate implant recon on top of the muscle with mesh. They warned me at the time that the new pair would be sitting higher than they'd eventually settle to - and sure enough, they have headed a little south (but still perky :)). I didn't have the obvious comparison of the 'normal' other side, so I didn't notice it so much at the time, but it did happen for me, and I was told it was what happens (all the time, it sounded like).

[DestinyIsAll]

Just to add, the reason I would be sceptical about the sort of settling you might see on, e.g., a more ‘standard’ cosmetic procedure as opposed to the type of reconstruction op I’ve had is because of the additional support from the mesh, which I imagine essentially creates a barrier preventing that. x

[DestinyIsAll]

Hi Delly,

Thanks for the reply. Do you know how if there is a real likelihood of settling or ‘drape’. I wasn’t aware of this possibility, and my previous implant was so affected by being displaced and a seroma so never behaved in a ‘typical’ fashion. This new one just seems so firmly located and so high on the chest..I can’t see how it would droop enough to make any difference, but maybe it will, a bit at least?

Logically I know I’ll need to wait and discuss it at my post op check. He did mention costs this time which is why I feel that I will be expected to accept this as ‘the best result I’m likely to get’ on the NHS. I wouldn’t have a problem if it genuinely was, but I personally think I’ve been unlucky and the op hasn’t been done correctly…again. Assuming the situation remains the same in 5 weeks (post op check) I’m just unsure what approach to take with the surgeon. Going private is a lot of money that in our family could be spent on so many other important things.  
My BC nurses seem to defer to the surgeons on almost any question and unfortunately I haven’t found them very helpful, I’ve only spoken to my allocated nurse briefly once, as she’s never been in clinic when I’ve been there or been available if I’ve queried something by phone. I did ask my surgeon why he didn’t use mesh the first time, my understanding is it’s fairly commonly used, but no proper explanation, he just didn’t think it was necessary at the time 😐. 
I just feel a bit fed up, I’d probably put too much emphasis on ‘moving on’ after this final surgery so now I’m maybe disproportionately disappointed. 

[delly]

Hi @DestinyIsAll - I can so understand your disappointment and how frustrating for you. Did he ever say why he wasn't using "mesh" for your first op?

Have you yet had your post-op review appointment with him, this 2nd op only having been a week ago? May it be that it takes a while to settle or "drape" (polite word for developing a "droop") and just early days yet?

Ordinarily, Covid aside, you'd be entitled to a second opinion with another NHS surgeon. But I don't know how possible that would be, given the current Covid circs and priorities. Or how quickly to be seen. If it isn't just a question of it "settling" and gradually lowering itself with time, it would be a shame to have to go down the private route, rather than a second NHS surgeons opinion if it were possible to.

If you haven't done already, do you have you a Breast Care Nurse you could have a chat with about it? Air your views and concerns to/with about it, diplomatically and independently from your surgeon, to see what she thinks and says about it? Plus may be able to advise what to do, and/or recommend a different surgeon to you for a second opinion if necessary.

Hope you can get somewhere with it soon. Lots of love, Delly x❤️x 

[DestinyIsAll]

Hi everyone. I’d like to get a feel for whether my thoughts are reasonable and my expectations realistic. I’m perhaps not always the most objective. Sorry, I know it’ll be long 😊  

Diag Jun ‘20, with IDC, 2 tumours in right breast, different quadrants, largest attached to the nipple so immediately told mastectomy was my only option. Had SLNB first and also Covid obviously and I wasn’t suitable for DIEP so I opted for immediate recon with implant which takes longer to organise (at my hospital), meaning quite a wait for the mastectomy, and I’d totally got my head around the surgery side of things by time it came around in Sept.

My plastic surgeon opted for implant only, no support measure e.g., mesh, and following surgery it very quickly became clear the implant was not where it should be, having slipped far too low, and it was very uncomfortable, in fact quite painful a lot of the time and very heavy, couldn’t wear even a post surgery bra. I’ve seen my surgeon a few times in the last year as I had a persistent seroma and he fully agreed I needed a revision where he would add a mesh support, and after delays and a previous cancellation I had this last week.

Just to be clear, an anywhere near perfect cosmetic result didn’t feel a priority for me, I’m 52 and happily married, I care about my appearance but personally never had any issues with losing my nipple, or accepting scarring, I had a different incision point this time so another big scar, or the lumpy texture, none of that, but I did hope for symmetry if possible.

He did spend a while marking me up and I’m not a surgeon obviously so appreciate it might be challenging to achieve good symmetry but I’m now just so unhappy with the result. The operation has done its job and the implant (which was replaced) is the right volume and clearly well supported, but it’s now sitting so, what seems ridiculously, high up on my chest, it’s like completely the other extreme. I’m still recovering but the bit of swelling I had has gone, it looks so weirdly out of place and the outline and top third is now very visible above the line of any T shirts and tops I’m wearing. It sits a good 2” higher than the left side and so again I think there will be issues with bras so I think it’s a comfort and practical issue as well as cosmetic.

I’m due a follow up with my surgeon in a few weeks. I had a good rapport with him but now don’t know what to think or say.

Am I unrealistic here? I had really hoped to put the surgical element of this behind me with this op and I am by nature a pragmatic and level headed person, but I don’t think I can accept it as it is. I can’t imagine the NHS would support doing it again, or, I feel a bit rude saying this, even if so maybe my surgeon doesn’t quite have the experience or skill to to achieved a better result. I’m an average C cup and have no sagging on the other (good) side. I’m just surprised and very disappointed he couldn’t get a better ‘match’. 

We’re not wealthy and it wouldn’t be ideal but I could fund a private operation if necessary and my husband would completely support this if that’s what I wanted. I think I will have a private ‘second opinion’ consultation anyway to try to understand what’s realistic, I feel back to square one, but wondering if I’m being unreasonable and I need a reality check here  

I would really appreciate some understanding of other peoples experiences and outcomes from implant reconstruction.

Thanks,

Louise x