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Bilateral Breast Reconstruction Following Mastectomy - Vancouver, WA

UPDATED FROM spagel
10 months post

Complications with fluid building up following scar revision surgery

WORTH IT$75,000
I recently underwent some internal scar revision surgery to fix an issue with my right implant, remove a suspicious growth on top of one of my implants, and also had some liposuction to fill in some fat around my implants to give them a more natural appearance. While the surgery and initial recovery went just as expected, I did develop some complications following the removal of the drain on my right side. A few days following the removal of that drain, I developed a sudden fluid build-up around that implant. My temperature was over 100, I had severe pain on that side, and the area under my right breast was hot to the touch and bright red. I contacted Dr. Gabriel's office before it was even open the next morning to report that I was having issues. The answering service relayed this information to Dr. Gabriel, who contacted me immediately, verified my symptoms, and told me to meet him at the hospital so that he could get me in right away for an emergency procedure to remove the fluid building up around my right implant. Even though I thought I just needed more antibiotics, Dr. Gabriel knew that this was a more serious situation that required immediate action -- which he took with no hesitation. Within just a couple of hours, I was back in surgery. Half an hour later, the fluid was out, the area was flushed clean, I was stitched back up with a new drain, and sent off to recovery to wake up and get ready to head for home.

I took the next week and a half off from work to recover. My new drain was ready to come out about eight days later, and things were progressing normally. The night before I planned to return to work, I noticed the same soreness and swelling on that side that I'd noticed before when the fluid started to build up before following drain removal. I'd made it a couple more days after drain removal before this started to happen again, but it was still alarming to know that the same thing was indeed taking place. The next morning, my breast was again red, hot to the touch, and the swelling was much worse. I made an appointment to see Dr. Gabriel right away. After seeing this same event taking place yet again, Dr. Gabriel determined to change the strategy so that we would have a successful outcome. While we both knew I was headed back into surgery again -- just 10 days after my last emergency procedure -- he made the decision to change out my implant in case it was the implant or something adhering to it that was causing the issue. Dr. Gabriel jumped through numerous arduous hoops to ensure that my new implant would be overnighted and delivered to the hospital the next morning in time for my surgery. The next morning, I showed up for my surgery, and Dr. Gabriel and his fabulous OR team changed out my implant and installed a new drain. Dr. Gabriel also decided that, once my new drain was ready to be removed (which happened a week later), he would wrap me from my upper abdomen to the top of my breasts in an ace bandage to provide some additional compression while I continued to heal. I'm thrilled to report that following the new implant and utilizing the Ace bandage wrap therapy around my chest, I'm fluid-free and healing up great! What a blessing it is to have a surgeon who looks carefully at what's not working and makes logical and reasonable decisions to make changes in procedure that will enable his patients to heal and recover when there's a problem. We still do not know why my body reacted this way following my scar revision; nothing wrong was found with the original implant after it was removed. But I'm glad Dr. Gabriel made the decisions he did for my surgery as well as for after my drain removal to ensure that I would not have to return to the OR any time soon with this same issue.

And in the meantime, my right breast is healing up and looks fabulous again, especially after the scar revision! It's no longer trying to shift sideways over to my left side.

A NOTE to other women having reconstruction surgery: Never hesitate to contact your surgeon right away when you see anything abnormal or suspicious going on. Get to know your reconstructed body so you recognize what's normal and what's not. Because I contacted Dr. Gabriel right away both times I had this issue, we were able to act quickly and this saved me from far more serious medical conditions and further debilitating surgeries. If you're not sure about how you feel or what you see in the mirror, call your doctor!

spagel's provider

Allen Gabriel, MD, FACS

Allen Gabriel, MD, FACS

Board Certified Plastic Surgeon

4.9 | 237 Reviews
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Dr. Gabriel is an amazing combination of brilliance, incredible medical expertise and skill, artistic perfectionism, strong integrity, tremendous compassion, and an unparelleled depth of understanding of the overall impacts of a breast cancer diagnosis for a woman and her husband. Dr. Gabriel's "whole body" approach to easing the anguish of a woman who has just received a cancer diagnosis is a very rare trait that sets him so far apart from other surgeons in the industry who may have great skill but lack the depth of compassion and understanding of how life has changed for a woman in this circumstance. I have so appreciated how incredibly caring, understanding, and compassionate Dr. Gabriel has been to both me and my husband as we have struggled with life's changes following my cancer diagnosis. His drive to ensure that "all of me" is doing well -- not just the reconstructed part -- is a trait that I cherish because I know just how real his passion is that I be made whole, in every sense of the word. He is dedicated completely to doing whatever he can to help my life return to normal. Dr. Gabriel remembered the date of the consultation I had with my oncologist when I was to receive my oncotype score that would determine whether or not I would have to have chemotherapy; he called me before I was even out of that consultation because he cared about this result and the impact it would have on me and my reconstruction, and quite simply just because he wanted to let me know that he was thinking about me . . . . and then we both celebrated when the results showed that I would not need any chemotherapy. Dr. Gabriel calls me immediately to let me know the results of any new suspicious growths he removes, because he doesn't want me to worry a minute longer than I have to about the results. He asks how my husband is doing if we're not both present at a follow-up appointment, and he always talks to my husband during each appointment so that my husband feels completely included in my care and the decisions we're making together. Dr. Gabriel seeks to ensure that I'm absolutely satisfied with the results and always talks about the options we have for making any needed changes. He looks me in the eye with such focus and concentration that I know I'm the only patient he has right at that moment and my entire health and welfare are his only concern. His reassurances throughout this difficult journey have kept me from panic more times than I can count, and the results I've received are nothing short of amazing when I look in the mirror. To be enhanced rather than deformed, to look normal rather than butchered or even compromised is a GIFT that Dr. Gabriel gave to me with the incredible skill of his hands, the sharp intelligence of his mind, and the genuine compassion in his heart that no woman should go through the rest of her life with devasting daily reminders in the mirror that cancer invaded her life. I have also been the grateful recipient of Dr. Gabriel's innovative and highly-successful surgical techniques and advances in silicone implants. Dr. Gabriel remains on the cutting edge (no pun intended) of new reconstruction techniques and implant innovations that will reduce the intense pain and enhance the natural appearance for women undergoing breast reconstruction, and I'm a walking testament to his commitment to continue to improve the reconstruction process for women. My results are amazing, and I walk with my posture erect and my head held high because I am proud that I survived well and blessed that I had an amazing doctor on my side to help make this happen for me.

Replies (4)

WOW! and then you have GREAT Doctors out there.
Congratulations on both outcome . I totally agree with about paying attention to your body . Unfortunately there are surgeons and staff that do not pay close attention to patient's symptoms until things are obviously worse. You were blessed to have such caring doctor!!
I had some similar issues. We are doing a tram flap procedure instead of another implant. What do you mean by your implant was shifting? My left one kind of goes sideways a little. I wonder if it's shifting?
I'm happy your getting better
Thank you for your comment -- and great question! Let me clarify: my implant wasn't actually shifting in its scar pocket. Rather it had a "pushed over" appearance, as if an invisible hand was pushing it from the right side towards the middle of my chest. The implant was not shaped correctly in this "pushed over" position. It wasn't actually moving, but rather the scar tissue was binding it on one side and causing it to appear as if it was being pushed that direction. It's hard to explain and it looked really odd, which is why we needed to address the scar tissue on that side and free it up so that the implant would not be bound by the scar tissue and appear misshapen.

I hope that answers your question, but let me know if you have other questions. I'm now almost a year out of my last surgery in July of 2014, and every day just gets better and better! My implants look amazing -- so natural in appearance! I am blessed to have such great results after a rough journey!
ORIGINAL POST

I chose to have immediate bilateral breast...

I chose to have immediate bilateral breast reconstruction with tissue expanders following my double mastectomy in October of 2013. Following tissue expansion over the next several months, I was later fitted with Allergan silicone-filled ("gummy bear"), high-projection breast implants which are anatomically shaped and were selected to be proportionate for my build and frame. I am extremely happy with the results! My implants are comfortable and feel natural, and they look very natural and proportionate for my physique. I am amazed that I can look so incredibly "normal" following a double mastectomy, since this was not the case with either my mother or my sister following their mastectomies. I do not have constant devastating reminders of my cancer when I look in the mirror each day. Rather, I see beautiful breasts that look and feel natural to my body -- something I never expected to have after my cancer diagnosis. Having such an excellent result with my reconstruction has enabled me to remain positive throughout my journey with breast cancer, since I never felt that I was ever physically deformed in this process. Being able to maintain a normal appearance through tissue expansion and final implant surgery enabled me to carry on my very public work without feeling self-conscious or "on stage" with my cancer. Having that normalcy in my life during the past year of treatments and surgeries has made a world of difference in how well I've healed both physically and emotionally.

Replies (11)

So happy to hear that you feel confident again and love your breasts!
Thanks for sharing your story. It is good to hear that this part of your journey has been positive. There are so many challenges in fighting this disease, and a positive results helps us continue to choose life! So happy for you!
It was good to read that you had such a good result. I have expanders in at this time and will have silicone implants put in in August. did you have nipple tattoos or did they spare your nipples?
Congratulations on your upcoming new silicone implants!! I was so happy to get out of my expanders and into my new "girls," since they feel and look much more natural.

As for your question about my nipples, I was able to have nipple-sparing mastectomy on both sides. There were no cancer cells present under either nipple, so I was able to keep them. However, that being said, I ALSO had both nipples tattooed! Why, you ask??? I discovered (little known or discussed fact, as it turns out), that spared nipples lose their color following a mastectomy. The reason is due to the reduced lack of blood flow to the nipples following mastectomy. Eventually, over the course of several months, the nipples begin to lose their color and become more neutral or flesh-toned. It's a little depressing . . . so my surgeon, Dr. Gabriel, referred me to a medical tattoo artist who works mostly with women who have had mastectomies. She creates tattoos over surgically-created nipples, but she also brings back the color to nipples that have lost color due to this surgery. I had two sessions with this practitioner, and the results are AMAZING! She is not only a gifted tattoo artist, but she also has color-matching down to a science. My nipples look just as they should for my skin tones! And it's great to have everything looking normal and natural again. It's amazing what a simple thing like adding color to nipples can do to make a woman feel complete in every way.

Good luck with your upcoming implants, and if you were able to keep your nipples, just know that there are workarounds for bringing back the color if they begin to fade out, which they inevitably will. Check into a great medical tattoo specialist in your area, and I'm sure they'll be able to help you out.
I could not keep my nipples as some cells were too near to them. I will ask my plastic surgeon about tattoos. thank you so much for the info.
My pleasure! Best wishes to you and may you have a great outcome!
Did you have a skin sparing double mastectomy?
Did you have a skin sparing mastectomy? I just got gummy bear implants last week after a delayed double mastectomy and I don't feel they look right! Some dimpling and an outward spot sticking out of one. The doctor thinks they look great!
Please know that what you see after only one week with your new implants is not the "end result" of your surgery. I have a new kind of gummy implants known as "high projection" implants, and I remember telling my PS after my surgery that I thought these were going to be bigger than what they looked like initially. They were smaller than my tissue expanders! However, my PS told me that it would take several months for my new gummies to form their pockets and begin to fill out into their full form as my body healed from the surgery. And true to his word, that's exactly what happened! It was a very long, gradual process, but eventually, my gummies did smooth out and project quite a bit more -- so now they look like the perfect size for me! I have a bit of rippling on the underneath side of my right breast where we had to change out the implant several months later. The rippling is not pronounced, but it's there and I notice it. There's nothing we can do about this, since the skin over the implant is extremely thin and compromised due to having to remove the original implant and change it out for a new one. The skin is transparent, almost, and it's so thin that you can see the shape of the implant underneath where the implant is pressed right up against my skin. It's something I'll have to live with because there's no good/easy way to fix this unless we start over on that side and do a tram flap or something like that, which is not really necessary. The appearance is only mildly different from a real breast, and the shape is perfect -- so we're not going to mess with it.

I'd recommend that you give this several months to "settle" before thinking about revisions. Your gummies will change as your body heals from the surgery, and some of this may correct itself. However, if you get several months down the road and you're still unhappy with how things look, then express this to your PS so you both can work out a reasonable solution to the problem. These are your new girls, and you have the right to be completely satisfied with the results! If you're not, then continue to speak up until things are made right!
You made my night. I had nipple sparring and so far so good. I have expanders in and they are so hard but I know the soft ones are in the future.
You will love the new gummy bear implants! They're amazing! I hated the expanders and was so glad to finally get them replaced with my permanent implants. I've been extremely happy with the gummies, and they feel very natural to my body. I also have my nipples tattooed, since they became colorless (due to lack of blood flow) in a short time. The nipples now look amazingly real -- the color is a great match for what used to be there! It's hard to tell that I've had all of this surgery done in the past several years. My new "girls" look AMAZING!!!!

Good luck to you -- you have good things to look forward to!