Need Reconstruction Advice

[Shirley]

Hello all,

I am going to have a unilateral mx in mid August. I've met with a plastic surgeon recommended by my breast surgeon, and he tells me that he can do (or at least start) immediate reconstruction using expander/implant even if it turns out I need radiation. There is something different he does which I don't recall, but it might just be that he waits until after radiation to fill the expanders or something. I liked him and would be perfectly fine choosing him to do implant surgery.

The DIEP surgery is not available in my town, so I'd have to travel about an hour (or more) to Seattle to have it done. This is a big inconvenience, but not impossible. I do have an appt to meet with a surgeon that does DIEP for a consult. I was told by the RN at that hospital that their docs won't consider doing implants on patients that have had radiation. So I'm very confused. One doc says yes to implants after radiation and the other says "no", and you have to wait a year to (maybe) have a DIEP recon if your abdominal blood supply looks good.

I've read the Seligo book and read some of your comments on this board. I am torn because so many women enthusiastically recommend DIEP and would do it all over again. But being numb from the chest down doesn't sound good to me (though obviously the right side of my chest would be numb with implant surgery). And I'm told the docs prefer to wait until 12 months after radiation to perform the DIEP surgery (w/out radiation they will do it as soon as 2 weeks after the mx). It sounds like a grueling process. And implants sound much easier.

Then on the other hand a tummy tuck, while not something I would do on an elective basis, might be kind of nice...but the scar and numbness? The plastic surgeon I talked to about the implants said that the tummy tuck you get with DIEP isn't as good as the elective kind.

A fake DIEP breast would probably look superior in the long run and would age (gracefully I hope!) along with the remaining breast. The implant guy said I'd get a lift on the remaining breast; I'm thinking the DIEP guys would do the same.

I'm interested in any feedback you have about your reconstruction with implants or DIEP. Are any of you enthusiastic about your implants? What about time off from work? There are so many things to consider and so many tradeoffs!

Shirley

[JennyB]

Shirley

I haven't had reconstruction but will probably try to do it next year when we have settled in our forevermore home the other side of Australia anyway I will be interested to read your replies.
There are lots of other posts about reconstruction on the boards too if you want to read more.

Jenny

[sarah]

Hello shirley,
tough decision. people tolerate pain differently. I had a mx and reconstruction done at the same time in 1999 so a long time ago but I found it tough and would not have said oh go ahead it's easy. in fact when I woke up if I could have died right then, I'd have checked out! the morphine drip did zilch for me - it's right beside the bed and you press it to get a certain amount over a 3 hour period. That said it feels exactly like your own breast. They thought I had more tummy fat and muscles than I did! so maybe be sure that's not a problem. the op was 8 hours for both surgeries.
take your time and ask the hospital if you can speak to women who've done both types of surgeries. don't talk to people the surgeon suggests because they'll all say it's easy!!!
I was in hospital for 6 days. the insurance said 4 days was normal but there was no way I could have gotten out of bed after 4 days. the 5th day I got out of bed with lots of help and the 6th day I went home. don't expect to return to work any time soon after this. I found the recovery long.
take care, there are no wrong decisions. getting rid of the cancer is the most important one.
In France they take flesh from the back, the consider the stomach "primitive!" but I'm not sure the back doesn't have problems also - maybe the thighs!!!!
Anyway research well, talk to lots of people.
take care, be well, love
sarah

[snolan]

Some surgeons will do implants with radiation but the skin does not form well and the breast may take on funny shapes when you raise your arm, or may sage a different way compared to the other side. That is why some will only do flap reconstruction after radation the flap skin holds its shape better. I did the latissimus flap, I didn't have enought fat on my tummy (I tend to disagree :) I also didn't want the DIEP due to the fact that I am very active and would have a weaker stomach which helps with core strenth with lifing etc. I have a friend who had an implant before radiation and I did it after we both have issues with how the breast is shaped when whe lie down or raise our arms so either way it can come out a little different.
If you have any more questions don't hesistate to ask.
Suzanne

[sarah]

Yes, snolan you're right, I can't do abominal exercises properly, still no strength on that side.
The good thing today is that they don't just take out lots of lymph nodes in case of progression there. That also handicapped me - they took out 15 and my lymphs were clear!!! but now my arm has periodic problems. when they said sentinel node I thought they meant one!!!! Also I hate to say, and I think I constantly the rare one (lucky me!) my cancer came back in that breast (after a mx!!) on the chest wall side but I didn't have radiation or Herceptin (not given then to DCIS people).
research and ask around.
good luck
health and happiness
sarah

[Cat]

I thought the DIEP saved your abs and that was the reason they started them. They were newer when i had mine and I had bmx with TRAM which means I have no rectus either side. The Dr. put in a hernia support. I did lots of ab work before surgery and got moving as quick as my PS would let me. Eventually I used a compression sleeve for lifting heavy things and resumed yard work including work with flagstone and have learned my limits. I don't use my sleeve as much and using my right arm more I can carry a case of bottled water etc. I did work up to things slowly and have always been active so depending on you may depend on results. I'm just saying it can be done. I also didn't have any problem with infection etc. Can't do a sit up from flat on the floor but stomach is strong.
Good luck with your decision and let is know.

[jaykay]

I had a bilateral mx with tissue expanders before I knew I would need radiation. Expansion was complete before my first chemo (c cup sizing). My ps was not concerned about the effects of radiation, said we would deal with it when we did the exchange.

Finished rads May 22 and have an appt with ps next month to get a ballpark as to when I can do the final exchange (skin needs to heal from radiation). Radiated breast is still a bit swollen.

I absolutely did not want extensive surgery for reconstruction, no tram or diep. Silicon is fine with me. The expanders feel like bowling balls on your chest but mainly discomfort, not really pain. Can't wait to get rid of them:-). They look fine in clothes and really not too bad without.

Best,

Janis

[jaykay]

Forgot to mention that I had nipple sparing surgery.

[LeahM]

Hi Shirley

I had a BMX with expanders immediately placed. I found the time period after surgery to be quite difficult, pain, lack of mobility etc but it truly does pass....My PS surgeon said normally when getting the expanders filled they used 120ml of saline each time. I found that uncomfortable so only had 60ml at a time...I wasn't in a hurry.

Noone thought I would need rads at the time of my surgery but they found micromets in my SLN and suddenly rads was on my table. It was my choice really, and I chose to have rads. My PS wasn't too concerned altho there were some risks/problems he advised me of. I was told I would wait at least 6 months after rads for my exchange surgery, that its possible my body would reject the implant or that it wouldn't look right.

My first time on the rads table they couldn't get the xray to match the mapping and there was talk of un-expanding me...oh..my...god....I was able to convince rad onc to re-map me, to start at square one again...and went thru rads without any trouble after that.

I finished rads Jan 23 and got my implants on May 8. Doesn't quite add up to 6 months or more...does it? I credit my skin behaving well during rads to the use of Callendula (sp?) Cream, Eucerin Cream and my daily Curcumin supplement. I never ever rubbed in the creams, just laid them on thick and ruined my shirts. I also had Betamethazone Cream for the itchy areas.

Also, when my implants were implanted my PS did lipo and moved that fat up into the breast area. I found that to be the most painful thing with regards to that surgery. My abdomen was black and blue from one side to the other and so swollen my belly button closed! I had some numbness in my abdomen but now, 2 months later, that is almost gone.

I have absolutely no feeling in my breasts...at least not the kind of feeling I had for the first half of my life.

My implants look good. The incision line on the right side is a bit weird (the radiated) looking and I have yet to decide what I will do (or not do) about nipples.

I had the expanders for the better part of a year...I didn't like them at all but they didn't hurt unless one was bumped, which it often was considering I have a young daughter. The implants feel much better and the recovery time was small.

It's a personal decision but one you need to make. What helped me was really liking and trusting my PS...however...DIEP wasn't an option for me, I didn't have enough tummy to make two boobs...only one....

Best
Leah

['lizbeth]

Hey,

I did the TRAM flap, as the DIEP wasn't offered to me. Any little thing (like an implant) in my body would drive me nuts.

The TRAM was a huge surgery, major, much more so than a mastectomy. The DIEP saves the rectus abdominus muscle from being used as a blood supply.

The reconstructed breast look horrible at first, because with using natural tissue comes the risk of a partial or full loss due to inadequate blood supply. Techniques have advanced since I had the surgery 6 years ago (when some bright surgeons realized they could have more than one blood supply - jolly good idea!).

I have an enormous scar that goes from hip to hip, and it is not subtle like a tummy tuck.

The revised breast looks and feels like a real breast. The 2nd revised result looks pretty good, but I can still see the area of the loss.

With complications from a loss you either must have an additional surgery or a debridement that takes almost daily doctor visits, packing twice daily, and I had a Vac pump for 5 weeks to help heal a palm sized wound in my inferior medial breast. Quite the ordeal.

The benefit of the implants is the ability to undo. So they aren't working for you? Have them removed. Not so with your own tissue - no do overs (rats!).

If you get a fabulous plastic surgeon, the DIEP will look awesome. If you get a good plastic surgeon, the implants will look awesome.

I wish you a beautiful reconstruction.

[Miss Lesley]

I had a mastectomy with an expander. Got an infection and doc took expander out. I need en more radiation tx. Can I get an implant or must do a flap. Thanks. Miss Lesley

[fralein]

Good luck with your surgery. I am trying to post a question. Could you tell me how you did your post?

[NEDenise]

Hey fralein -
Go to the main page for the HER2 forum (where you found this thread on the list, and selected it)
At the top left side of that page (above the list) there is a tab marked - New Thread
Click on that and you're on your way!
Good luck! and WELCOME!
Denise