Is this a crazy idea?

[Louise O'Brien]

I've never heard of anyone else choosing this option, so I'd like to know if it makes any sense.

Next March I wrap up Herceptin treatments - and hopefully will get the portacath out soon after. I've always hated the damn thing and it hurts - I suspect because the remaining breast is rather large and weighs it down. I'm not overweight, but I'm a 38 D.

I'm now considering reconstruction and have already seen one plastic surgeon and he says I should have a reduction on the remaining breast. I totally agree - I don't want to be as big.

But I had reservations about the first plastic surgeon - mainly because he does the standard flap surgery cutting into the abdominal muscle and doesn't do the DIEP reconstruction. He came highly recommended though and I'm told he's an artist.

But it's been almost two years out of my life - and that of my husband's - and I don't feel ready for something that might require so much recovery time. I think I still need time to recover from the chemo and the Herceptin. I need more "normal life" time.

I also thought he was a little cavalier about HER2 because he was prepared to operate on me in March as soon as Herceptin is done. I said I'd rather wait until I had my second mammogram in July so I could feel more secure. He didn't seem to feel that was an issue.

So I asked for a referral to a surgeon who does the DIEP and I see the second surgeon on Jan. 4. However, I'm concerned about the length of the DIEP micro-surgery - eight hours under anaesthetic- and don't know if they do the reconstruction at the same time. One other slight problem - the first surgeon found that I had a small hernia in my stomach probably from a gall bladder operation ten years ago. So that has to be fixed as well.

So this is what I'm thinking. I think I might be happy with just reduction on my right side. Anything to make that sucker smaller. I could then wear a smaller prosthesis. I have one now - and don't mind it that much; a B-cup would suit me fine. I can only admit this here on this board but I feel freakish right now with that huge thing weighing me down.

I have considered implants - but I'm concerned about silicone and the first plastic surgeon I saw said it's not possible to get a natural look with saline.

So - has anyone ever done this? Just a reduction and nothing else? And if I go through with just the reduction, will the resulting scar tissue make subsequent mammogram harder to read?

[Audrey]

Hi Louise,
I don't think your idea is crazy at all. It's your body and your decision! I had a mastectomy in 2001 and decided to have a saline implant put in at the time of surgery, as well as a reduction on the remaining breast. I'm petite, but had a large chest and wanted to be more proportional. So I had a smaller implant and a reduction to a B cup. I was so happy with the reduction and even the smaller implant felt so much better, I could go braless if I wanted to. Several years later I had the remaining breast removed due to findings of lobular carcinoma in situ in that breast. I don't think a reduction affects the mammograms readings too much, ask your surgeon to be sure--Anyway, I decided to have a saline implant in that one as well, so now I match at least. Most days I'm fine with my implants, but sometimes I really wish I had chosed silicone, since they would look and feel more real, but then I suppose I would be worried about leakage, etc., so it's really hard to make a decision about reconstruction without some sort of compromise...Good luck with whatever you decide, thankfully we have so many options these days--

[Louise O'Brien]

Thanks Audrey. I'm leaning towards what you did. A B cup sounds wonderful. I don't think the Canadian health care system pays for silicone implants - only saline. Originally I was tempted to just leave things as they are, until we started talking vacation as soon as I finish Herceptin. Some place warm - and I thought - damn, I'm not going to be comfortable in a bathing suit.

So it will be interesting to see what the second surgeon has to say. I'm taking my husband with me because this decision is going to affect him as well as me. We've had a rough seven years personally and he deserves a break as much as me.