Breast reconstruction, capsulectomy, implant exchange, mastopexy, level 5 pathology

Revised Edited Review: I'm 61. At age 20 I had 2 lumpectomies & tissue removal. Mastectomy implants for symmetry. Had the same implants 40 yrs, then both ruptured. Bilateral Multiple masses, and my mother is a breast cancer survivor. I had a 2 needle biopsies, Level 5 Pathology biopsy, Capsulectomy, Breast Implant Exchange from under the muscle to over the muscle in the glandular tissue, and a Mastopexy Breast Lift. Before my surgery I communicated that I wanted Ultra High Profile Implants because I didn't want "fat boy tits" . I liked the way Ultra High Implants are flatter on the sides and frontally more projectile. I repeatedly explained I wanted my new breast implants to be overstuffed and my nipples to be centered. I meant really centered. At one point, I refused to even consider a breast lift because to be honest I thought the scars look like a patch quilt and said I would never do that thinking a extra full implant would center the nipple much like if you were stuffing a teddy bear's face and needed the snout to raise, instead, a nipple, that the more you stuff it, you'd center the snout or nipple. My surgeon explained a breast implant alone would NOT raise the nipple. After massive research, I came to the conclusion that I had to have the breast lift and endure the ugly vertical scars if I expected my nipples to rise higher and be centered. I even found case studies where a large glandular tissue implant could even cause more ptosis by dragging down the nipple after surgery and I couldn't risk that, so I informed my surgeon that I changed my mind and now wanted the lift she suggested on the first consultation.  I stressed over and over, it was of great significance to me for my nipples to be centered. Otherwise what is the point of a lift and those horrible scars? I couldn't have been more descriptive in telling my surgical team my expectations, and I even told them I do NOT want moderate implants, I want Ultra High Profile, and I emphatically want centered nipples. I am a size 14, 200lbs, because I gained 50lbs, but plan on losing the 50lbs, but because of the ruptured 40 yr old silicone implants and the surgeon's schedule I couldn't post-pone breast reconstruction until after I lost weight. So I chose very large 700-775 cc High Profile implants for a dramatic fullness. I expected very visible rounded cleavage. I expected very projectile stuffed breasts. I expected to wake up the day of surgery with centered nipples, not later, immediately. I would like to note that I have very thick dense breasts even at age 61. My breasts were not really saggy, but did have mild ptosis. My issue was multiple masses, and bilateral 40 yr old implant ruptures that had to be removed then exchanged. If I had to go through that kind of reconstruction I felt I should be able to get the reconstruction I visioned. When I woke up from surgery and felt my breasts,  I felt immediately disappointed that they felt too flat. I didn't know that the first days after the surgery that the breasts are so swollen that there's no cleavage, and the breasts are stretched horizontally to the sides and everything is distorted, but most notable the nipples were insanely too low. I felt immediately like I didn't get a lift at all, and worse got massive scaring but zero lift. The nipples were so grotesquely low I felt the whole surgery looked botched. I hated it. I felt like crying. My surgery was 6 hrs long, 5 hrs recovery and 24 hrs hospital stay and I hated my breast result. When a woman says "I want a breast lift." we mean a real breast lift and that means centering the nipple. We want to wake up with a dramatic centered look on the first day of surgery. I read where one surgeon, in someone else's Realself story, wrote, "It's better that the nipples came out too low than too high" and that's completely counteractive to what most women would think. I'd rather have the nipples too high than too low. I made 5-6 repeat consultation appts, and sent messages to the clinic about the importance of Ultra High Profile Implants, exaggerated fullness and my unwavering request to center my nipples. After my experience of not getting the fullness I expected, not getting the implant I requested, and not getting the lift I expected, I'm wondering should Plastic Surgeons insist on patients providing a photo image of their expectation so that the expectation is visible and not verbally miscommunicated? To say that I'm depressed and disappointed by the result is an understatement.  I'm the victim that has to suffer an additional 6 months of healing to have this surgery completely revised again. It's not fair. I can't stress enough, when a woman says they want a breast lift we expect you to lift our nipples centered & very high. Even if they are too high, in my opinion that could turn out great in 10 yrs when they begin to drop. My surgeon said she tried to use the 700 -775 CC implants, but when they inserted them,  my skin was too tight, and in that case they could NOT do a lift, so she removed those and used one 675 cc Mentor moderate high profile implant (which was the implant I said I did not want because it was too flat) in my smaller breast, and one 635 CC implant in my larger breast, and then did the Mastopexy. I woke up with the most retarded looking low nipples. I immediately panicked. I felt devastated. I really thought the surgeon heard me say I expected centered nipples. I felt so cheated. I'm at 6 week post op, and even though the surgery team tells me that my nipples will shift upwards over 6 months, I can tell you that I don't believe they will shift enough. They'd have to shift one inch or more for me to be happy, and I still don't have the fullness I expected. So I had told the entire team @ the 6 month post-op, I want a full revision to remove these implants and put in the 700CC Ultra High Profile Implants, and to surgically cut off my nipple and move it up one full inch. There is nothing that can change my mind. My expectation is visually completely different from the result I got. It doesn't matter that I'm 61, I look young for my age and don't even have facial cosmetic surgery, no botox, no filler. I still wanted to look as attractive as possible. And I shouldn't have to accept having my nipples too low. It really matters when I look in the mirror at myself that I look the way I hoped to look after a 21,000 surgery. I forgot to tell women, it was a 6 hr surgery, it was very painful. I didn't have anyone to help me because I live alone. I ended up having wound dehiscence @ the inverted T, and dime size gaping holes. I tried to be careful to not lift anything over 5 lbs, but did still have to do light things around the house. You really do need 6-8 weeks off for recovery, and that inverted T zone can split very easily. It started looking infected at about 3-4 weeks, a nurse from the clinic told me "just put bacitracin on it" and come into the office. My sister, a RN for 30 yrs said, "No, do not put any antibiotic on it before you go in to see them because antibiotic ointment of any kind will hinder a culture. Tell them you want a culture done because the pictures you sent to me look like the wound is infected." I said, "What if they won't do a culture?" She said "Advocate for yourself, you tell them, I want you to do a culture." So sure enough,  I went to the clinic and requested a culture. The Nurse Practitioner said, "I don't think you really need a culture" I replied, "I want you to do a culture." The NP said, "Ok, I'll do a culture, I don't think you need it, but I'll do it." So she did it and told me it would take a couple of days to get results. Results:  "Abnormal" I had 4-5 gram negative and gram positive bacteria in the wounds, resulting in Mupirocin Ointment and Sulfamethoxazol E-TMP DS. The inverted T wounds took over 2 weeks to granulate and slightly close and are still healing. I sent pictures to the surgeon expressing my disappointment with the nipples being too low, and the surgeon agreed with me that the nipples look too low. The surgical team tried to minimize my concern, saying the nipples will rise over 6 months when the implant drops and settles. I don't anticipate the nipples will rise enough even at the 6 month post op healing, and that makes me more upset.  I researched and couldn't find a single site showing nipple metamorphosis from day one through 1-6 months.  That would be so helpful so we could see the nipple movement in real photos.   I want them to validate that this is not the result I wanted, not try to talk me into accepting that this result is okay for a person my age, or "wait and see in 6 months" because I know that I know there's no possible way this result is going to produce the idea I envisioned, and any future visit conversation should be sympathizing with how I feel, and discussing my revision options.  Also no one discusses the arm nerve pain and tingling following breast reconstruction and I have significant weakness, nerve pains and tingling in both arms.  I read it can be temporary, last months or permanent.  I added over 3lbs of weight in implants to my chest and I feel it.  My whole chest and center of my upper back feels sore even at 6 weeks.  No one tells you there will be intense itching for many weeks as new nerves and tissues and healing happens.  It's maddening.  I actually cheated a little and used some lidocaine spray then air dried it.  It did help. I did this surgery without narcotics only because UTMB will not prescribe them, I thought that was wrong because in 30 yrs I've never had even (1) narcotic prescription, and to base my case on other case studies fearing addiction wasn't fair.  I firmly believe in using known narcotics that have worked for pain for years. I will tell you that Journavx, muscle relaxers, celecoxib, Montelukast x 90 days to prevent Capsular Contraction  and a few other things did NOT alleviate pain.  I felt like I was in a lot of unnecessary pain.  I don't understand how giving a person who never asks or never has received  mild narcotics like Tylenol #3-4 for major surgery for 10 days is too risky?  I was miserable.  The only time narcotic drugs were administered was after surgery. My sister, a R.N,  said I was crying in recovery in massive pain.  My sister insisted they give me real pain medicine.  They gave me (2) doses of  Dilaudid Hydromorphone.  I've never taken that drug ever.  I was vomiting after surgery for hours, so they admitted me.  The overall experience was rough.