Breast implants after mastectomy advice

jlscherme · August 2018

Hi all,

I'm looking for fitness and lifestyle advice for post-implant reconstruction following a mastectomy... I could not find any recent discussions on this topic when i searched, forgive me if there was and please link me to it.

I realize my dr's would be the most reliable and proper persons to ask, but I wanted to get a survivor's advice, or from someone who has had augmentation with an implant.

I was expected to have DIEP surgery but am now not a good candidate for it. I'm pretty freaked out about having a foreign body inside me. I had looked at the cancer as an alien-being that had to be removed, but now that I can no longer have a lumpectomy or DIEP, an implant is my option or prosthesis. The dr's keep saying that i'm too young (36yo) to not have reconstruction. And, I agree for my mental well-being.

I'm really scared of lymphedema, & people (lab techs and nurses) keep on scaring me with their patient horror stories.

I have about 2 weeks until surgery and plan on exercise but not overdoing it in the meantime. I've been pretty depressed and haven't done much in the past 2 months. I'll be lucky to maintain my weight until surgery, hoping for no gains or losses.

When can i expect realistically to return to yoga or running?

They, the dr's and nurses, have not said to stay away from the gym due to germs, but others have advised me to do this. I don't want to put my membership on hold, I'd like to keep going as I don't get out much or socialize/see people often.

Please friend me if you'd like, I can use support. I've been logging daily for 580 some-odd days and have lost 30# since joining MFP.

Hope this message makes sense to someone. Thanks in advance.

kshama2001 · August 2018

@AnnPT77 thought you might like to chime in.

MostlyWater · August 2018

You want to discuss the pros and cons, or do you want to discuss size?

Talan79 · August 2018

I’m sorry for what you went through. I’ll share my experience. I had my BA in February of this year. I had wanted to do this surgery since my early 20’s but was too scared to. So I I finally got boobs this year. My recovery was pretty easy. I was able to shower and wash my own hair after 48 hours. The first three weeks post OP you shouldn’t get your heart rate up bc that can cause hematoma. I was cleared for cardio after 3 weeks, and weights after 1 month. I went on a run at my four week mark & was fine. No issues. It did feel weird, I think I was able to feel the implant move? Idk, I’m still getting used to having them. I held off on weights for 3 months bc I didn’t want to start off with 7.5lbs and 10lbs dumbbells. I was used to going heavy and just waited a full three months til I was all healed up. I did lose definition from the break but got it back within three weeks of consistency. Good luck. Sending positive thoughts your way.

LKArgh · August 2018

jlscherme wrote: »

Hi all,

I'm looking for fitness and lifestyle advice for post-implant reconstruction following a mastectomy... I could not find any recent discussions on this topic when i searched, forgive me if there was and please link me to it.

I realize my dr's would be the most reliable and proper persons to ask, but I wanted to get a survivor's advice, or from someone who has had augmentation with an implant.

I was expected to have DIEP surgery but am now not a good candidate for it. I'm pretty freaked out about having a foreign body inside me. I had looked at the cancer as an alien-being that had to be removed, but now that I can no longer have a lumpectomy or DIEP, an implant is my option or prosthesis. The dr's keep saying that i'm too young (36yo) to not have reconstruction. And, I agree for my mental well-being.

I'm really scared of lymphedema, & people (lab techs and nurses) keep on scaring me with their patient horror stories.

I have about 2 weeks until surgery and plan on exercise but not overdoing it in the meantime. I've been pretty depressed and haven't done much in the past 2 months. I'll be lucky to maintain my weight until surgery, hoping for no gains or losses.

When can i expect realistically to return to yoga or running?

They, the dr's and nurses, have not said to stay away from the gym due to germs, but others have advised me to do this. I don't want to put my membership on hold, I'd like to keep going as I don't get out much or socialize/see people often.

Please friend me if you'd like, I can use support. I've been logging daily for 580 some-odd days and have lost 30# since joining MFP.

Hope this message makes sense to someone. Thanks in advance.

My best friend went through it a while ago. I can tell you some of the pros and some of the cons, as I have seen them, based on this very limited personal experience from supporting her through this. Both her mother and sister are also cancer survivors and have decided not to proceed with reconstruction.
The obvious pro: looking "normal", which plays a huge role in mental well-being. And I understand it is a huge factor and I know that for my friend, it was something that she really hated, looking "different". Her sister has the opposite attitude, is proud of surviving and ok with her body now, so I think it all is very personal.
The big con (I consider recovery I minor issue in the big picture): it is a foreign body. It might trigger negative and not only positive feelings, which I have seen with my friend too. It might pose limitations in what further diagnostic tests can be done (has already happened to my friend when there was a scare after a slightly abnormal blood test and some of the recommended tests could not be done after having implants).

Since you mentioned lymphedema, this is something both my friend and her relatives have experienced, but it was explained to them by the drs as a common side effect of the lymph nodes removal, regardless of reconstruction therapy, that happens eventually to about half the women who have undergone mastectomy. From what my friend has experienced so far, physical therapy is a must, heat (e.g. sun bathing) makes it worse, and there are some limitations in physical activities, that her physical therapist told her will be for life (e.g. lifting weights, even as part of normal life, like carrying heavy grocery bags, makes swelling worse in her case). She was also told that controlling her weight helps.
Exercise is recommended in general after all procedures are finished. For example prior to her cancer adventure, my friend was a swimmer and she was strongly encouraged by her dr to resume training (she was competing, swimmign marathons). She had limitations initially while the expanders where used to get the breast to stretch to desired size and up until the second final surgery, and then a couple more months, until drains were removed, swelling disappeared etc. During this period (I think it was about half a year or so in total) she had regular physical therapy and her therapist had recommended pilates.

AnnPT77 · August 2018

kshama2001 wrote: »

@AnnPT77 thought you might like to chime in.

Yes, thank you, @kshama2001, I would. I'll reply for real when I get home and off the annoying mobile device.

One quick comment: Not sure where OP is, but US numbers for lymphedema post-mastectomy are way less than 50% with current treatments, and extreme restrictions on physical activity to minimize lymphedema risk (beyond limitations in the post - surgical recovery period) are out-of-date guidance IMU (more about that later).

(I am post mastectomy/multi lymph node removal/radiation on same side - a risk-increase trifecta - and an athlete, so this is something I've researched carefully. Eighteen years on, I have no lymphedema . . . so far. I know a number - dozen or so? - of post-mastectomy women, most of them post-implant-reconstruction, very active/athletic, only one of whom has lymphedema, and athletic activity didn't trigger hers. Actually, it's not mastectomy, but rather axillary dissection - lymph mode removal, especially when it goes well beyond sentinel node - that more importantly increases risk, and axillary dissection happens with some lumpectomies as well.)

MostlyWater wrote: »

You want to discuss the pros and cons, or do you want to discuss size?

Sounds like OP is uni, not bi, so likely irrelevant. If you're bringing up size as a "joke" . . . irrelevant and mega-jerky.

jlscherme · August 2018

Thank you @AnnPT77 and @LKArgh for your thoughts and advice.

Yes, my plastic surgeon has said the risk for lymphedema is 10-20% which seems like a lot and wide range. But in the scheme of things ain't half bad. And the 1st thing out of the Resident's mouth was "bigger, smaller or the same?" Lol. I hadn't given it a thought until that moment.

It'll be a unilateral boob job with a lift to the other boobie for symmetry at some point later on.

And yes, lymph node removal, i was told 10-15 nodes. The dr said they'd have me up and moving as soon as possible after surgery. As of now, no radiation but I will need another round of chemo after.

I guess I needed to hear from someone who is an athlete or active that they haven't had restrictions to their activities post surgery. Thanks again @AnnPT77.

youngmomtaz · August 2018

My mother has gone through double mastectomy and reconstruction(same surgery), they were able to reconstruct using a flap from her abdomen. This all happened about a year ago. She had minor repairs done just weeks ago and is healing well once again. Her lymphedema is moderate on the side where over 30 axillary nodes were removed and that is common according to her doctor, with the extent of the surgery she had and had little to do with the reconstruction and more to do with the number of nodes removed. She wears a compression sleeve while at work now and occasionally at night to help reduce the swelling but her activity keeps it at bay for the most part. Radiation seemed to have made the lymphedema worse, but that is hard to know as it was a progression of events that she went through while healing from surgery. She remained extremely active being fairly young(53yo), and just found as long as she rested when tired but before she was very tired her healing was not hindered and she did not seem any higher risk for viruses.

Your medical team is obviously the best place to ask about return to activity times. In my moms case after double mastectomy with same surgery reconstruction(tummy tuck flap relocation style) her healing went like this: first week in hospital, could not hold down food and fighting severe migraine. Second week home, refused pain meds and started to feel better. Third week still had drains in place but out in garden and walking a mile at a time. Week four, last drain removed, still tired easily but walking and biking normally, back to yard work with rest.

After a minor flap and “dog ear” revision earlier this month: day one again with the inability to keep food down. Day two refused pain meds and back to walking. Day three, drove an hour each direction and shopped for four hours in between. Day four, canning garden produce and holding the heavy garden hose to water everything once again.

Different surgeries than you will be having, but you can read tons of both horror and fast healing stories online. Your docs are the best people to speak to. Plan to be sore, plan to put essentials in easy to reach places, I pray that you can be a quick healer!!

AnnPT77 · August 2018

jlscherme wrote: »

Thank you @AnnPT77 and @LKArgh for your thoughts and advice.

Yes, my plastic surgeon has said the risk for lymphedema is 10-20% which seems like a lot and wide range. But in the scheme of things ain't half bad. And the 1st thing out of the Resident's mouth was "bigger, smaller or the same?" Lol. I hadn't given it a thought until that moment.

It'll be a unilateral boob job with a lift to the other boobie for symmetry at some point later on.

And yes, lymph node removal, i was told 10-15 nodes. The dr said they'd have me up and moving as soon as possible after surgery. As of now, no radiation but I will need another round of chemo after.

I guess I needed to hear from someone who is an athlete or active that they haven't had restrictions to their activities post surgery. Thanks again @AnnPT77.

More later, for realz. I hate finger typing. Real keyboard at home, and I touch type: Brace yourself for wordy.

(They took 9 nodes, for me, BTW. I know of up to 15 in lymphedema-free athletic friends, post-radiation).

AnnPT77 · August 2018

I'm not sure how much advice I can offer about reconstruction, other than anecdotal things from observing several close friends; I've discussed it in detail with a couple of them. One observation: If you're not sure what you want, you don't have to decide right away. One of my friends had reconstruction 20 years after her mastectomy! (Not that I'm saying you should wait that long.

).

Most of my friends who've had reconstruction have implants. You probably know that they first put in expanders, which are gradually filled with water to stretch out the overlying chest tissue. (Some liquid is added every week or two - I forget the exact timing or number of fillings, but that's what I mean by "gradual", more or less.) After there's enough room, there's a second procedure to replace the expander with the actual implant. The expanders can be uncomfortable when newly filled, and some friends have taken a little time off from workouts, but not given them up altogether. Of course there's some downtime around the surgery. Nipple reconstruction has been part of the process for some, including tattooing, but not chosen by all. Full normal sensation is not restored. They've all returned to normal workouts after recovery from the final implant procedures.

Myself, I'm unreconstructed after bilateral mastectomies (one simple, one modified radical), which was my affirmative choice. Later I learned I probably wasn't a great candidate for reconstruction anyway (had radiation therapy on the modified radical side, because it turns out I was really good at getting breast cancer: Stage III, 5 tumors on that side, largest 3.1cm, one tumor on the other side.)

So, if you have questions about prostheses, I can likely answer those. I wore them nearly daily for 6 years or so, until I retired (at 51) and now mostly only wear them for dress up (because women's dress clothes fit for c**p when you're flat), otherwise I just go around flat (well, more like slightly concave

). It works for me, and I'm now very comfortable with my body . . . and you'd be surprised how rarely people notice - not just that they just politely don't say anything, but that they're visibly surprised when I say I had breast cancer. I feel like I should just stand sideways and point at my chest (occasionally, I do

).

Modern prostheses are relatively light, and feel very natural. I'm 100% certain that if someone hugs me when I'm wearing them, they don't feel anything odd. One reason I chose the type I did (there are various materials) is that they felt reasonably natural even to me: Right away, when I folded my arms over my chest, it didn't feel odd from the outside, to my arms. I could easily ignore it. It was a long time before I found any bras I liked, so I got t-shirt fabric and made prosthesis pockets for regular bras I did like. The prostheses stay in place nicely, and the cotton pocket keeps them from feeling warm or sticky against my chest wall. (Some people prefer a type that sort of self-adheres to the chest wall. Like I said, there are lots of types. There are even special ones for swimming. (I don't use them; I just find swimsuits that work OK when flat.))

What I like about no reconstruction is that it's less surgery (and avoids the admittedly minor risk of implant rupture or encapsulation, and perhaps eventual replacement); I feel more authentically me this way (other people would feel just the opposite!

), I don't have to have mammograms or other breast scans; and any (unlikely) local recurrence would be very easy for me to detect on my chest wall, which is reassuring.

I don't encourage others to follow my example of no reconstruction, although it was the right choice for me. I encourage others to make their own personal choice, and not to be sold on a particular choice by other people, all of whom seem to have opinions.

Your body, your decision! So many people these days seem to say "You must do X, because otherwise you will feel blah, blah, blah". That's their theory. It's your call.

I've done quite a bit of research about lymphedema as it applies to me - I'm at especially elevated risk on the left side, because of the surgery (modified radical mastectomy, then 9 lymph nodes removed) followed by radiation. The right side (simple mastectomy, no nodes removed, no radiation) has much lower risk.

It's been 18 years, and I don't have lymphedema. I row (boats, machines), lift weights, garden (sometimes without gloves), and generally do lots of things that some medical practitioners warn against . . . some of which warnings, frankly, are not well supported by science. I literally do whatever I want to do. (One of my friends who had many nodes removed, but lumpectomy + radiation, has done things so extreme that she's felt surgical staples, still in place, pop . . . not that I'm recommending that. But no lymphedema for her, either - 20 years after stage III.)

I have a couple of friends who have lymphedema. They have no idea how or why they got it. It seemed to come from nowhere. There's been solid research showing that women with physical jobs don't have more lymphedema than women who don't have physical jobs. I was part of a research study of breast cancer survivor rowers; though I don't think it reached publication (ironically (?), the principal investigator got breast cancer), the evidence, over several years, was shaping up very clearly that the traditional idea we should avoid repetitive resistance upper body exercise was not only incorrect, but actually destructive - there's now some theorizing that exercise helps lymph flow, through a pumping-type action, because exercise appears beneficial.

In my reading (of actual research studies, as much as possible), it's understood that removal of lymph nodes is the important risk factor in developing lymphedema (the more nodes, the higher risk - but yet I've known women who had many removed, but didn't get lymphedema, so it's not inevitable). As you know, radiation to that same area increases the risk. Beyond that base risk level, my reading suggests that factors that correlate with developing lymphedema are injury to the affected arm, and weight gain after surgery. (Correlation is not proven causation, of course; it's statistical association.)

My surgeon said what turned out to be the most sensible summary of the situation I've heard, in response to my questions about those "don't lift over 15 pounds ever" kinds of rules, though most of my reading of evidence happened after he told me this: "The lymphedema clinics see the people who get lymphedema, then try to figure out why they got it, and make these lists of precautions. They don't see all the many people who do those exact same things and don't get lymphedema." His guidance, when it came to things like weight training, was to go slow and build up gradually (to avoid injuring the arm), but to go ahead and do things (once cleared post surgery). So I have.

I try to take sensible measures to avoid injury, and I make it a point to clean any significant cuts/scrapes as soon as I can, and apply an antibiotic cream. I keep a tube of antibiotic cream in my purse and car, so I have it available readily.

I'm part of a breast cancer support group, and also on a breast cancer survivors' rowing team (that has connections to several other such teams around the country, and some of whose members I've also met and worked out with). I've participated in a breast cancer survivor exercise program that's in all our local YMCAs. So, I've met a bunch of breast cancer survivors who are active and athletic, some of them very athletic: Crossfit, Iron Man Triathlon, many rowers (including competitive ones, which I've also been), weight lifters (serious weight, regular training), and more. Like I said, I do know a couple of women with lymphedema, but neither of them are on the most active end of that spectrum, just kind of average active (I'm thinking that's a coincidence, not a pattern).

If you do experience any arm swelling, it's very, very important to get skilled, specialized treatment as quickly as feasible. The symptoms can be managed if it's treated early, but can be more serious/long-term if left untreated for a long time.

I'm not trying to sell you on my understanding of any of this; I'm just explaining what my understanding is. I encourage you to do your own wide-ranging research, and content yourself with what you find. But, IMO, if you're getting super conservative guidance (never ever lift heavy things again, for one) then it would be good to seek further advice and insight, because I believe that you'll find that evidence-based medicine experts these days consider exercise (including sensible weight training progression) to be a positive, not a negative.

Jeesh. This should be a chapter in my future book, or something. Sorry for the ramble.

TL;DR: There's certainly hope that you can be active after surgery; many people are active after surgery without developing lymphedema. Either reconstruction or non-reconstruction can be a valid choice; learn lots, think lots, make your own list of pros and cons.

Breast implants after mastectomy advice

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