Plastic Surgeon appointment

Louise O'Brien · 10-29-2007, 10:10 AM

I have an appointment with a plastic surgeon tomorrow to discuss reconstruction surgery. I had a left breast mastectomy Sept. 23/06 (diagnosed in August 2006) and am currently on Herceptin which I wrap up on March 20 2008. The tumour was 1.5 cm and there was no spread to the lymph or sentinel nodes.

Any advice? Any questions I should be asking? The surgeon who did the mastectomy has told me the plastic surgeon will probably want to do a reduction on the remaining right breast and frankly that makes me quite happy. I don't want to be as large since right now I'm between a C & D cup. A "B" would suit me just fine.

One of the chemo nurses suggested the surgeon might take tissue from the remaining breast but is that a good idea given that I'm Her2 positive? My husband also worries that a reduction to the right breast might make mammograms more difficult to read.

There could be questions I don't even know to ask. I'm guessing the surgery can't take place until late next spring or early fall when Herceptin is done and the port is out (given that there will probably be surgery to reduce the right breast.) The delay will also be due to the fact that this is the most in-demand plastic surgeon in our area. All the chemo nurses have told me - if they were in the same boat - this is the guy they would want.

And then there's recovery. I have this awful feeling that this surgery will be far worse in terms of recovery than the mastectomy. (Love the people who like to tell me how awful it will be, the hell their friends went through etc. etc.)

That's my big worry. I feel pretty good now after wraping up chemo and I'd hate to slip back. I feel strongly though that reconstruction surgery would be a good idea for me - I'd just like to feel and look more normal.

So whatever observations you have would be most welcome.

julierene · 10-29-2007, 01:49 PM

IF I had to do it all over again, I would have the propholatic mastectomy on the other breast. I would get a DIEP flap reconstruction and you would probably have to fight HARD for it. But it gives the nicest results, uses tummy fat, AND you reduce the risk of developing anything in the other breast. I hope this helps.

Lauriesh · 10-29-2007, 06:45 PM

I had a diep flap a year ago. If you didn't have radiation, you can have an implant, which is the easiest surgery.

The diep is a major surgery. I had a unilateral with a reduction on the other side and I am very happy with the results. I have not had any problems with having a mammogram on the reduced breast.

If you are thinking of having a diep, make sure you ask the surgeon how many he has done and his failure rate. I traveled to New Orleans for my surgery because the local surgeon had only done 50 and I was not comfortable with that.

I would be happy to answer any more questions you have about the diep.

Laurie

Soccermom · 10-29-2007, 10:54 PM

I also had the DIEP in NOLA, I am happy with having natural tissue breasts which will be easy to image and palpate,if necessary,
Good luck with your decision making and post if you need more info,
Marcia

Louise O'Brien · 10-30-2007, 05:51 AM

Thanks for your suggestions. I have pretty well decided that if it's not the Diep flap - and if he's not experienced at it - I won't do it.

I did not have radiation but I've heard that implants can "migrate" or move and that they can be cold - not something anyone wants to go through during a cold Canadian winter.

Lauriesh - since your surgery sounds so much like what I might be going through i.e. reduction on the other side - can you tell me about recovery?

I'll find out in a few hours. But oh man, I don't know about the rest of you but I'm so sick of being poked and prodded.

Sheila · 10-30-2007, 06:35 AM

Louise
I for one had the implant, with tissue expander....Yes it is cold....like a popsicle when I go outside...and I have had some issues with scar tissue, and I did NOT have radiation. Reconstruction needs to be a personal choice, just make sure you go to someone who has done MANY! Ask to see photos of their work....some of us speng more time finding a good painter or autobody shop than we do a plastic surgeon, or any surgeon for that fact.
Whatever you choose, I hope it turns out perfect.

Verna · 10-30-2007, 09:41 AM

Louise,
I had the DIEP reconstruction in New Orleans with Dr. Dellecroce and I do not regret it one bit, he is the best. www.breastcenter.com My recommendation is to research and make sure the plastic surgeon you choose does not cut your abdominal muscle.
Good luck with what ever you choose.
Verna

Audrey · 10-30-2007, 09:45 AM

I had a unilateral mastectomy with a reduction on the remaining side and was happy with the results, but then a few years later I ended up with a finding of "lobular carcinoma in situ" in the remaining breast, so I decided to have that one removed, too. Now I wish I had just had a double mastectomy from the beginning. I have saline implants and the recovery was not bad--I've heard it's much harder when they take tummy tissue, too. I also sometimes wish I had silicone implants, which I think give a more realistic result. Good luck with your reconstruction--if only they could restore the sensation, too...

Louise O'Brien · 10-30-2007, 10:15 AM

Hmmm. It turns out this surgeon - who is considered the best in the area and who all the chemo nurses told me would be their surgeon of choice - specializes in the "pedicle" flap which does cut into one abdominal muscle.

Apparently in this procedure, the strip of muscle and flesh is left partially connected at the muscle. They then "tunnel" from that part of the body to the chest. Unlike the tram flap, this does not require blood vessel reconnection as the blood supply comes from the abdominal muscles.

He does not specialize in Diep flaps but has referred me to two doctors who do. I have no idea how long I'll have to wait to see them - but I'm guessing many months.

The problem is - they have less experience and the operation itself is eight hours compared the four hours he said it would take for the "pedicle" flap.
I'm not crazy about eight hours under antiseptic as it can bring its own set of problems.

So I guess I'm going to have to wait and see and weigh my options.

No matter where I go - I'm going to have to wait. This is Canada and while the procedure is free, there's still a waiting list. I waited seven months to see this surgeon and now that I'm "in the system" for him - he can operate on me as soon as I've finished Herceptin next March. No more waiting.

And that means I can get the whole thing over with and move on as opposed to possibly having to wait a lot longer for the Diep flap.

But God the whole thing, no matter what I chose, sounds like an ordeal.

He was honest about the implant and said it would be harder to get an even match. And he agreed that a reduction on the "good" side would be advisable.

One last question: Shouldn't I wait to see if I'm in the clear after my second mammogram next June or July before I have any procedure? He didn't seem to think this was an issue but then he's not an expert on HER2.

Soccermom · 10-30-2007, 10:38 AM

Dear Louise,
I know from experience that the Doctors at the Center for Restoration in New Orleans (Dr Frank Dellacroce and Dr Scott Sullivan) will do phone consults. If traveling initially for a consult is problematic you can email photos and they will be happy to discuss your options with you. Call their number and speak with any one of the Nurse educators, its worth the effort, I promise !. These are a special group of folks that are extremely sensitive to the needs of our community.
www.breastcenter.com

Post script...

I just realized you are in Canada and that traveling, insurance and $$$ might be too much of an issue to overcome...there is a Dr Joan Lipa that does the DIEP flap..I believe she is in Toronto. I have a Canadian friend that just had DIEP flap with her not too long ago and she is very happy so far. Hers was prophylactic as she has the BRCA mutation.

Let me know if youd like to talk!
Warmly,Marcia

theresaw · 10-30-2007, 02:56 PM

I had the reconstruction done at the time of my mastecomy, I had the transflap done, where they took my tummy pouch..I look at as having minor construction done, I got a tummy tuck, and a breast lift. Recovery was a uncomfortable, but I heard it's like when a woman has a cecerian..If I where you I would pray on what avenue to take...

weezie1053 · 10-30-2007, 05:46 PM

It's nice to meet another Louise...

I was my reconstructive surgery immediately following my mastectomy. I opted for the implant because I was told because I was so "small," it would an implant would work well for me. I was also told my recovery would be shorter and easier. I opted for the implant. In retrospect, I wish I had done more research and used my own tissue. It's too late for me, but other newbies may benefit by reading the above threads. I have been told my reconstruction looks good, but I wish I had been shown photos of results from the different type of surgeries. I feel like I am carrying a rock inside my chest.

I can tell you that my breast reduction of my 50+ year old left breast was a walk in the park compared to the other surgeries we have endured. Also, my stitches from my breast reduction are no longer visible; however, I still have some scarring from the implant reconstruction on the right breast. My sister also told me about a cream to fade scars, Mederma, and I am here to tell you that stuff is great!

I would highly recommend to anybody considering reconstruction to ask their plastic surgeon for photos of the results of the different types of surgeries. I know now my surgeon had to have had them because his nurse took plenty of my tah tah's.

Good luck!

Louise

caya · 10-30-2007, 08:14 PM

Louise,

Dr. Joan Lipa works out of Toronto General Hospital, and also at Princess Margaret Hospital (which is across the street), both hospitals are part of the University Health Network. She is a very good PS, and a lovely person as well. Last year when I was first diagnosed she spent over an hour with me going over all my options. At that time I decided not to do immediate reconstruction, but I have an appointment with her next week to go over it all again. My oncologist and GP both have said she does amazing work.