Hi~
I was dx'd Stage IV - liver mets @my primary dx (May '02)too. Since then, my journey w/this disease has been a bit bumpy at times, including just a lumpectomy when I was first dx'd, but eventually including a liver resection in Dec '05. Shortly after the liver resection, we discovered local disease in my breast again, including a 1cm invasive tumor + lots of high grade dcis, so I had to have a mastectomy.
I opted for immediate, staged reconstruction - w/saline expander, then finally, silicone implants. The expander filled w/100cc's saline was placed during the mastectomy & honestly i didn't notice a huge difference b/c I was pretty small on top. The gradual expansion was a little weird & I was SO GLAD to swap over to the permanent silicone implant ("dual plane" placement of the implant)- much lighter, much more natural feeling. Recovery time was minimal, pain minimal & I'm fortunate to not have had any complications - except for a bad reaction to the surgical tape, so the incision scars are more significant than they should be. The breasts-shape & size -themselves are great.
Tram/Lat flap recon was not an option for me b/c I didn't have sufficient tissue to create a breast mound, and also my docs discouraged this choice b/c I'm very active, teaching pilates & training private clients, & these procedures would alter my anatomy too much, making it hard for me to do my job.
In addition, I have worked with a few BC survivors, post tram flap reconstruction to help them restore strength, flexibility & balance of their core. To be totally honest, I'm not fan of this type of reconstruction. I have found that my clients were not aware how significantly this surgery would change their functional strength & ultimately, the "bonus tummy-tuck" is just not worth it.
If you haven't had radiation & the result from your previous MRM hasn't left you with a significant deficit, my vote is for reconstruction w/implant only-it is the least invasive of the reconstruction options.
Ultimately, your surgeon will guide you towards the best option for your body.
My breasts are a little bigger now than they were before, they're certainly higher than they were before, but ultimately they are still proportionate to my body size. On a totally superficial note, I certainly fill out a t-shirt better than I did before, & that's not a bad thing
While I'm still dealing with the complexities of Stage IV disease, I don't regret my choice & the time invested to have the reconstruction.
There is no "right" choice, but there is the "right" choice for YOU.
Best of luck!
Keep the Faith~