I have had bilateral mastectomy 6 years ago with implants under the muscle immediately. They had to be replaced 6 months later . They never have been right. They go under my armpit and are very uncomfortable - placement is to high , not even and I have at lease 4 inches between them. I went to a PS for a second opinion. He recommends Tissue expander surgery . I am having second thoughts . I am afraid the pain will be as bad as the first surgery. Should i just suffer with what i have or have the surgery.?
Expander Surgery Question?
Doctor Answers (5)
Alloderm to improve shape with breast reconstruction
The type of problem you describe was unfortunately common with tissue expansion before the use of Alloderm became more common. Alloderm makes an internal bra so the expanders and implants can be held in the desired position, and muscle tightness minimized. It should not be nearly as painful as having to exapand with total muscle coverage as was certainly done in your case, and the shape could be much improved.
I am sorry that you are having issues with your reconstruction, but without an exam I can not suggest what would be best for you.
most probably the first time the expander was put under the muscle, too high now. The muscle has probably contracted up, may be by now fibrosed.
The implant needs good coverage. Consider the latismus dorsi flap with implant. the latismus dorsi will give good coverage and provide the lost skin.
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Expander Surgery Question
I would recommend that you have the tissue expander placed above the muscle if possible
This will feel more confortable ,the implant will be in a lower position and you wont have the abnormal displacement when you contract your muscle
A photograph would be helpful to assessf
Can tissue expanders be removed and DIEP flaps performed?
I have had several patients not feel comfortable with implants for a variety of reseaons. Many times if plan A didn't work for them I don't repeat plan A. I look for other options that may or may not been provided to the patient. Specifically I discuss a wide variety of tissue options including the DIEP, TUG, GAp and SIEA flap surgeries.