I feel I must declare that I am a man and not a sufferer. I had previously some saved material on breast conservation BCT v masectomy which I attach below. (rewrite I had just finished and lost my reply).
I have also today done some research on the risks of masectomy surgery and reconstrution surgery and options which I attach below.
This would be my view point based on a quick assessment of the links below. I am not an expert in any sense. Ultimately as you are no doubt very well aware it is your life and they are your breasts.
1. If there is a family history there is a higher risk of contrallateral reoccurence. It is suggested that this does not necessarily impact on long term survival. The risks are covered below in the links.
2. The trials posted suggest that there is little difference in overall survival between BCT and masectomy, which if correct removes an argument for any future treatment gain out weighing the risks.
3. The masectomy surgery for one and a half breasts is not minimal.
4. There appear to be very significant potential side effects of a masectomy if things do not work perfectly - long term nerve pain etc. (see posts on "Cancer Lynx" sites which make salutory reading).
5. In a masectomy there are the issues of loss of ability to breast feed - loss of sensations - complications of nipple retention etc, which must have a big impact from a mental standpoint, sensation being part of the nuturing process both from the point of view of child rearing and sex (breast attention without a any sense of possible pleasure - mental response?).
6. There appear to be some serious risks in the tram flap / adominal / muscle surgery etc. I was taken aback by the figures and scope of risks. Some procedures appear fairly new which would be a concern if it was me - what are the long term implications for muscular skeleture - strength - posture.
7. Double implants even ignoring the nipple complications would seem to carry their own risks, in addition to significant general surgery and specific masectomy risks. Saline do not from what I have read does not provide a perfect solution, and the risks even if low from silicone to presumably a recovering immune system must be considered, both from reaction to the implant and the unlikey possibility of leakage.
8. The surgery is not minor. If you are still recovering possible chemo herceptin etc the possibility of a less than 100 % immune system recovery and the additional strain of the body of recovery / possibility of implant rejection etc. must surely be considered.
9. It has been postulated on this site that the operations involved in masectomies / BCT might by virtue of exciting the bodies infamatory repair response cause increase of levels of Cox 2 wich several trials have suggested is implicated in both local and distant BC.
10, If it were me I would want reassurance that the options of imaging spect/ct/pet MRI etc are not compromised.
11. What ever you have - nothing to full bilateral masectomy and reconstruction the result is not going to be perfect and has long term consequences as to different changes over time in each breast, or both depending on the options chosen.
My perspective would be based on the links below that unless there were pressing arguments on grounds of familly risk, the potential risks and complications of a masectomy and reconstruction are simply not tenable, the outcome uncertain, the result imperfect, with loss of potential ability to breast feed, sensation, self image etc. The option of a small saline implant in one breast if it is absolutely necessary is the logical preferred option (whichever of silicone or saline provides the best match a present the situation will change and will the match be perfect in either option?) ( possible caution- I saw a documentary where a girl had an immune reaction - I have no idea how common they are or why it happened - and had to have the implants removed which it seems to me would be potential bad news for a recovering immune system.).
At the end of the day with an appropriate bra who except you and you partner are going to know, and you could always reassess once you have a bit more distance from your treatment
- and so back to where we started its your life and their your breasts.
A "bloke's" perspective if that helps.
I would stress I have no expertise and you must read it all for yourself.
I hope everything works out for you, and this external contribution helps your consideration of your decision which is very obviously of some significant concern to you.
RB
Reconstruction options risks side effects outcomes etc.
http://www.cancer.org/docroot/CRI/co...stectomy_5.asp
http://www.mayoclinic.com/health/mastectomy/WO00113
http://www.cancerhelp.org.uk/help/default.asp?page=3351
http://www.nlm.nih.gov/medlineplus/e...cle/002919.htm
http://hcd2.bupa.co.uk/fact_sheets/html/mastectomy.html
BCT v reconstruction
http://www.obgynsurvey.com/pt/re/obgynsurv/abstract.00006254-200405000-00018.htm;jsessionid=CyQ9S3EUeLIZc5krsUWHxdxSglhpH 0TTO5Pn6n0JmR31NGoico9Q!1988335901!-949856145!9001!-1
http://content.nejm.org/cgi/content/...ct/347/16/1233
http://www.jco.org/cgi/content/abstract/16/6/2045
http://www.breastcancer.org/research_surgery_young.html
http://www.thedoctorslounge.net/onco...ditary_breast/
http://www.obgynsurvey.com/pt/re/obgynsurv/abstract.00006254-200405000-00018.htm;jsessionid=CyQ9S3EUeLIZc5krsUWHxdxSglhpH 0TTO5Pn6n0JmR31NGoico9Q!1988335901!-949856145!9001!-1