reconstruction questions

AliciaB · 06-12-2012, 07:59 PM

Hi ladies-
Now that I am 2/3 through chemo- Yippeee- I am looking at reconstruction. I went from surgery directly into chemo. I did not have expanders put in right away. Did I overlook something? I still have to go through radiation, but I am wondering if doctors neglected to give me option of expanders immediately when I had.surgery. has anyone had reconstruction after radiation? How did it work? At the time of.the surgery they said I was a candidate for the flap reconstruction, ie tummy tuck and new boobs. Any one have this surgery after radiation?

LeahM · 06-13-2012, 03:10 AM

Alicia,
I am not a expert on these matters but the way I understood the reconstruction options was that the expanders were only for if you would be getting saline implants.
Are you going to have the DIEP (DIEP?) reconstruction? That takes tissue and fat from abdomen area but not muscle. The other procedure takes abd. muscle. My plastics guy told me the recovery from the DEIP was much easier.
Were you given a choice re: rads or were you told you have to do it? I ask that question for my own benefit.

chekmark · 06-13-2012, 04:42 AM

I also am not an expert. I went with implants due to recovery time. I had an expander placed in a year after mast. (that was pretty uncomfortable but doable). My oncologist wanted me to wait until after I was finished with herceptin. I did not have rads so I was a candidate for implants. Denise may be a good one to talk to. I went with silicon instead of saline, I was told that they feel more natural and have a better chance of lasting longer. Its a personal decision, weigh out all your options and do what you are comfortable with and what is right for you. I know my self esteem is much better since I finally had reconstruction, not completely done yet but almost. Good luck. Darlene

NEDenise · 06-13-2012, 05:15 AM

Hi Alicia,
Darlene's right, I did have the DIEP flap recon done. But mine was done at the same time as my Mx and it was all before rads...so I don't think my experience is going to answer your question.

Good luck to you though!
Denise

LuckyLinda · 06-13-2012, 05:29 AM

I had immediate reconstruction at time of mastectomy. I'm about to start radiation, so I'll let you know how that effects the reconstruction. My right breast has been over-expanded to counteract the possibility that radiation will cause the skin to shrink. I am under the impression that my doc will remove the expander and place the silicone implant 4-6 months after radiation ends. (Great Christmas gift!). That will be a year since my mastectomy. Clearly, Rome was not built in a day and neither is the reinvented breast. I chose not to have the DIEP procedure because it entailed a longer recovery time. It's all a personal decision, but having a plastic surgeon who is willing to spend a lot of time counselling you about the various options is critical.

snolan · 06-13-2012, 07:13 AM

I originally had expanders in after mastectomy but had to take the left one out due to infection. So 6 months after radiation I had reconstruction with the lat dorsi flap and all had gone well but it is a little harder recovery since you have 2 wound sites. Still working on strengthing my L arm and stretching the scar tissue. I just had my nipples done and should have the tatoo done end of June or beginning of July. Its been 2 years since my mastectomy definetly a slow process.
Suzanne

Westcoastgirl · 06-13-2012, 09:35 AM

My plastic surgeon wanted me to wait until everything was finished so he could get the best result. I had skin sparing mastectomies so was able to go directly to implants. I have silicone and I also had radiation so it is doable. I waited a year after radiation as I wanted to feel healed. I am pleased with the results. The radiation side is adequate but the unaffected side is a lovely result.

yanyan · 06-13-2012, 10:23 AM

A friend of mine had IBC and she was flat for 1.5 years. The doctor didn't recommend reconstruction at the time and 1.5 years later after radiation she had the diep flap with amazing results. The recovery was tough and there is a very small chance that the tissue does not survive. But it is your own tissue and it feels natural from what i heard. Here is a website that you can find more info on reconstruction.

http://www.breastreconstruction.org

roz123 · 06-13-2012, 02:56 PM

hi there
some hospitals/doctors do not like to put in expanders if you are having rads - the failure rate is quite high. I know at my hospital here in canada they would not do expanders/rads for this reason.
I had a lumpectomy and rads. I am going ahead with a bmsx. I was told the minimum wait after rads for placing expanders is 6mos and 1yr is optimal. I have already consulted with a PS and she is going to do my surgery in sept - 6mos after I completed my rads

roz123 · 06-13-2012, 02:58 PM

and edit to add...your reconstruction options will have to include either lat dorsi flap (back flap) or alloderm or tram flap because your radiated side will need something to "support" the expander/implant. I am having the lat dorsi flap even tho i am not thrilled at having a scar on my back. Alloderm is only available in a clinical trial here but it may be available to you at your hospital

LuckyLinda · 06-13-2012, 05:26 PM

Wish I had known all of this before starting the process. Why do I learn more from this forum than I do from my doctors? I saw my radiation oncologist today and she did not say anything about a high failure rate with expanders. She did advise me to have 200cc's of saline removed before I have the mapping done. Now I'm even more apprehensive than I was before. I'm eating oatmeal cookies to cope with my anxiety attack.

AliciaB · 06-13-2012, 07:40 PM

Wow, such great information. Yes, I will have radiation on the effected side, left. I was told that implants was not an option.it the time of surgery the Dr said I was a candidate for the tram flat. I am not sure what that entail. I will have to look at that website that Yanyan suggested. I have been "boobless" for 4 months now. I just got my prosthetics last week. I didn't realize how much having boobs affects your outfits.

Susan can you tell me more about the process? What is a "slow" recovery time? Will I be able to do reconstruction after radiation if I don't have expanders now?

Alicia

AliciaB · 06-13-2012, 07:46 PM

BTW I had a skin sparing bi lateral mastectomy. Does that make a difference?

Aliciab

AliciaB · 06-13-2012, 07:51 PM

leah- I was told I had to do radiation. Since I had one positive lymph node and some cancer was escaping from it AND the fact that I am young (who knew 38 was young) they are "throwing the kitchen sink at me" (my surgeon's exact words). I just got my start date today- August 6.

How is surgery recovery going? how is you child handling the change?
aliciab

LeahM · 06-14-2012, 04:01 AM

Hi Alecia,

My surgery went well. 2 weeks post op today. Feeling better each day and cutting back on pain meds. I had no idea how immobile I would be. I am still sleeping in a recliner because I can't get comfy in bed. My daughter is doing well. She spent the majority of the past 2 weeks with my parents. I am so lucky they are local! She has been home since Sunday but goes to day camp daily 9 to 4 all this week. So next week life will get back to being "real". Today I meet with Med. Onc. and I believe chemo will start somewhere around July 1.

I asked about the rads b/c my final path came back with a 0.35mm cancerous spot in my sentinel lymph node. Rads is now on the table but to be honest I don't know if I want to do it. Will meet with rad onc, then get 2nd opinion, then 3rd. My biggest fear is they will want "proof" that there is more nodal involvement and I really don't want to lose more nodes.

I know I should also throw the kitchen sink at this cancer but I really just want to be done.

And if I didn't have rads i could be "done" by the end of the year.

I know, I know, that is a whiney way to look at it. But someone recently told me "feelings aren't wrong, they just are". And that is how I feel today. Could feel different tomorrow.

Hope you make the right decision for you re: reconstruction. I think the DIEP is a good idea. It wasn't an option for me, had it been I would have done it.

snolan · 06-14-2012, 07:12 AM

I had skin sparing mastectomy but since I had to take expanders out it didn't matter. My PS suggested taking it out before radiation, (they didn't know I was going to need it prior to my surgery long story) but the radiologiest said to leave them in and just over expand them. There's a lot of discussion on that between PS. The recovery I felt was a little harder than the mastectomy since I had a muscle taken from my back it affects how my shoulder was functioning, but went to physical therapy. I had my surgery in Dec and am still stretching scar tissue and working on getting my rotator cuff strengthen as it now has to help support my shoulder more. I had a drain in my back for 2 weeks and had to have another put in for my breast swelling for 5 weeks. It fell out on its own and the swelling went away. Some people have more trouble with seromas (I did with both surgeries). I liked watching the youtube videos on the surgeries some may not. But it gave me a good idea as to what I would be dealing with after surgery for recovery. I couldn't get the stomach flat not enough fat (I disagree) but I didn't like the invassivness of the surgery and being athletic didn't want to go without a stomach muscle and couldn't afford to travel to a place that would only do the skin transplant. Anyway, just be prepaired to have to take it easy for a while and let your body heal. I love my new girls and would go through it again to have them.
Suzanne