Coping with Surgery forum: Reconstruction: Options and choices

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Imagecritterologist
Nov 7, 2010 11:02 PM CST
Name: Critter (Jill)
MD
If you will have (or have had) a mastectomy, learning about the various reconstruction options will help you make informed choices. Your doctor may have a "favorite" option, but it may or may not be the best choice for you. Your insurance should cover reconstruction as part of your breast cancer treatment.

You should know that if you have had a single mastectomy, you can reconstruct one side and have the other breast lifted, reduced, etc. Surgery on the opposite breast "for symmetry" should also be covered by your insurance.

Implant reconstruction is readily available, but it's not your only option. From my reading, they seem to give the best results for people who have had a double mastectomy. With a single mastectomy, it can be hard to match up an implant on one side with the look of the natural breast on the other. Implants also have a limited lifetime; my plastic surgeon says they usually have to be replaced in about 10 years.

"Own tissue reconstruction" has been used for years to reconstruct the look and feel of a natural breast using fat and/or muscle tissue from another area of your body. Reconstruction using your own tissue results in a more natural look and feel. If only one breast is being reconstructed, you may have a more symmetrical result with this type of surgery.

An increasingly popular option for "own tissue reconstruction" doesn't use muscle tissue. Instead, a section of fat tissue is removed intact, and its blood vessels are reattached to vessels in the transplant area (which keeps the tissue alive) using microsurgical techniques. These procedures are becoming more common, but not every hospital has the facilities to offer them.

Although there are variations, the most common reconstruction using muscle tissue is called the "TRAM flap," and the most common procedure using only fat & skin is called the "DIEP flap." Good descriptions and comparisons of these reconstruction options are found on the breastcancer.org website ( http://www.breastcancer.org/treatment/surgery/reconstruction... ).

You may opt to have no reconstruction, or reconstruction may not be a possible option for you. You may then want to even things up (or round them out) by wearing a breast prosthesis, a breast form (often made of silicone) that tucks into your bra. Special mastectomy bras exist, with pockets to hold the prostheses, or you can have a pocket added to a favorite bra.

Although most people think about reconstruction only after a mastectomy, a lumpectomy or "quadectomy" (in which about 1/4 of the breast is removed, usually the upper outer quadrant that contains most of the "breast tissue") can leave you looking pretty uneven. It's worth talking to a plastic surgeon to see what can be done, especially if the plastic surgeon is able to work together with your oncology surgeon at the time of your cancer surgery.

***

It'll be another 6 months or so before I can schedule my reconstruction, and right now I'm planning to have a DIEP flap procedure (I had a single mastectomy). What information have you found, and what options are you considering?
Circles of Support for Breast Cancer
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Imagecritterologist
Apr 23, 2012 8:59 PM CST
Name: Critter (Jill)
MD
It's been quite a while since I wrote the above! I finished chemo, surgery, and radiation treatment by the end of 2010. I had been thinking of doing reconstruction in the fall of 2011, but the closer I got to my surgery date the more ambivalent I felt about it... and then I realized that I wasn't so much excited by the idea of regaining a breast shape on that side as I was excited about the idea that the surgery might relieve the continuing pain I had in a couple of radiation-burned areas of skin.

So, I talked to my surgeon about the pain issues, and we ended up taking out the tissue expander and also removing a lot of adhesions (scar tissue), which did indeed (eventually) improve the situation. I may still have reconstruction a few years down the line, but right now just being able to wear a bra again for support on the other side has me feeling much better about my appearance, and for me that may be enough. Most of the time, I don't even bother padding out the missing side -- I've gotten better at choosing tops that make it a little less obvious.

All of the above is really just to say... whether or not to have reconstruction, and when, and what kind of procedure.... those are highly individual decisions. Read and talk to people so you're informed about your options, but don't feel pressured. If possible, learn about reconstruction before your mastectomy, so your oncology surgeon can take your reconstruction plans into consideration.

Some of your options will be determined by the type of treatment you have (for example, if you're having radiation therapy, it's generally not advisable to have own-tissue reconstruction before, as radiation can be very damaging to newly reconstructed areas). But for the most part, it's up to you.



Circles of Support for Breast Cancer
I'm learning to dance in the rain! Thank you, Sally & Chris.
Imagehaighr
Jun 8, 2012 4:32 AM CST
Name: Candee Gaye
Western Maryland
Been there, Done that!
I am going to have some minor reconstruction on June 20. I am having as mastopexy to align my nipples and an injection to reduce the deep crevasse from the surgery. Should be a piece of cake?
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Imagecritterologist
Jun 8, 2012 1:13 PM CST
Name: Critter (Jill)
MD
Yay for being able to wear lightweight shirts in the heat of summer without feeling self conscious! Good for you.

What are they injecting to reduce the surgical "dent?"
Circles of Support for Breast Cancer
I'm learning to dance in the rain! Thank you, Sally & Chris.
Imagehaighr
Jun 12, 2012 6:09 AM CST
Name: Candee Gaye
Western Maryland
Been there, Done that!
Some of my belly fat! Wish they would take it all while they are at it!
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Imagecritterologist
Jun 12, 2012 8:22 PM CST
Name: Critter (Jill)
MD
Hey, it doesn't hurt to ask! LOL When I was talking to the surgeon about doing an own-tissue reconstructino (which I've now postponed, maybe indefinitely), I asked laughingly if she could remove enough belly fat to reconstruct me to an EE size and then just use enough to make a B-cup breast. She said that she'd actually remove as much as was available, to give her the best chance of harvesting a really good piece for the reconstruction.
Circles of Support for Breast Cancer
I'm learning to dance in the rain! Thank you, Sally & Chris.
Imagehaighr
Jun 19, 2012 5:27 AM CST
Name: Candee Gaye
Western Maryland
Been there, Done that!
So, what made you change your mind if you don't mind my asking?
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Imagecritterologist
Jun 19, 2012 6:59 AM CST
Name: Critter (Jill)
MD
critterologist wrote:the closer I got to my surgery date the more ambivalent I felt about it... and then I realized that I wasn't so much excited by the idea of regaining a breast shape on that side as I was excited about the idea that the surgery might relieve the continuing pain I had in a couple of radiation-burned areas of skin.

So, I talked to my surgeon about the pain issues, and we ended up taking out the tissue expander and also removing a lot of adhesions (scar tissue), which did indeed (eventually) improve the situation. I may still have reconstruction a few years down the line, but right now just being able to wear a bra again for support on the other side has me feeling much better about my appearance, and for me that may be enough. Most of the time, I don't even bother padding out the missing side -- I've gotten better at choosing tops that make it a little less obvious.


Circles of Support for Breast Cancer
I'm learning to dance in the rain! Thank you, Sally & Chris.
Imagecritterologist
Jun 19, 2012 7:27 AM CST
Name: Critter (Jill)
MD
to expand on that...

Another major consideration for me was that the cancer treatment took nearly every ounce of energy I had. Reconstruction is "elective" surgery, no matter how necessary it may feel, and the reconstruction I was considering is a pretty major procedure. Recovery would definitely take some time and use up a lot of my "reserves." Thank God, all my tests have come back clean so far, but I would feel really dumb if I had the surgery and then had to re-start the fight against the cancer, with less physical strength than I might have had otherwise.

Waiting until I'm 5 years out from completing treatment and then looking at the options again just made more sense to me. I have a 2 year old. Not only does that increase my determination to stack the odds in my favor wherever I can, it also means that in 4 more years she'll be in grade school... and the logistics of having this kind of procedure will be much better.

But, as I said, I'm not sure it's much of an issue for me presently, appearance-wise. That may change, no way to know for sure. Right now, I think I'm just so damn glad to be alive that a lot of other things seem very minor.

It's a highly individual decision. I'm not trying to influence anybody else, just sharing my thoughts... for many, having reconstruction asap is the right choice. Just don't get pushed into major surgery because "it's time for reconstruction!" You've got options for the procedure, not only the type of reconstruction but also the option not to do it. I'm probably unusual in running around lopsided as a C/D cup, but there are good prostheses out there now also (and insurance covers them just as it does reconstruction).

Candee, you're doing a more minor type of own-tissue reconstruction, and I think you'll bounce right back from the procedure. The one thing I hope your doctor has mentioned... Moving a nipple nearly always results in losing sensation in the nipple. I talked to 2 surgeons about doing a lift & reduction on the right breast (after reconstructing the left, because I'd just as soon end up smaller and dare I hope perky)... both said that even though they wouldn't be cutting all the way around the nipple, it was still pretty likely that I'd lose some or all sensation there.

Since that's my only remaining nipple, and since DH & I have always had a lot of fun with my nipples, that's a consideration for me if/when I proceed with reconstruction and any "balancing" procedure on the other side. Doctors won't bring this up, and I couldn't find any numbers on it... The "how happy were you with the results of your reconstruction" surveys seem to be all about appearance... Just another reason people should take their time and make sure they have all the information.

Candee, that's not directed at you... you have taken time to heal, and these sound like just the right procedures for you, getting your shape & balance back. If you told me you were going in for DD implants on both sides, I'd check to see if you'd had a psych consult! LOL

I hope the procedure itself is a piece of cake with frosting! and that you'll heal quickly and be wearing cute little tank tops this summer without a bit of Blinking when you look in the mirror. Good for you, getting this done. I'll be thinking of you tomorrow... I'm assuming you'll be in & out pretty quickly ? or I'd be making plans to storm your room tomorrow afternoon...

Circles of Support for Breast Cancer
I'm learning to dance in the rain! Thank you, Sally & Chris.
Imagehaighr
Jun 26, 2012 6:13 AM CST
Name: Candee Gaye
Western Maryland
Been there, Done that!
Thanks for the info, you do your research!
Surgery was moved to yesterday 6/25 and took about 2 1/2 hrs. I go in today to have the binding removed. The biggest issue was where to put the IV since I have had lymph nodes removed on both sides with the cancer and melanoma.
Had a fair amt of pain during the eve hours and last night, but took the pain meds and feel quite good this morn, just woozy.
Recovery will be about 6 weeks but should go smoothly. I'll keep you posted.
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Imagecritterologist
Jun 26, 2012 2:41 PM CST
Name: Critter (Jill)
MD
I was wondering how everything had gone... thought I'd read somewhere that you'd rescheduled but then couldn't find it... glad everything went well!!

gentle gentle hugs...
Circles of Support for Breast Cancer
I'm learning to dance in the rain! Thank you, Sally & Chris.
Imagejoeswife
Nov 7, 2012 11:11 AM CST
Name: Debra joeswife
Derby,Kansas
Zone6a
My 72 yr old friend had a breast reconsturction after a single mascetomy. The expansion and all the things she endured gave her a lot of discomfort and grief, and now she is wishing she had not made that choice. My sister opted out for reconstruction, since her scars and insicions are everywhere, and already she feels adhesions. I had breast augmentation over 20 yrs ago, so that my flat "nipple only chest "ld look normal, and now I wish I had my flat nipples only chest back. I am only posting this to let you know my firend said she tells everyone not to do it, if u r just doing it for vanitys sake. Now she fears the cancer will be in her other breast, and after going thru a hematoma? .. she is all over the board about this stuff. Yes, at 72, she felt the stab of vanity.
I used to reccommend flat chested women to my plastic surgeon all the time, one of my duaghters included, now we both regret our choices, as the scar tissue that binds the implants are horrible to live with. Good luck to you both with your choices, and I wish you the best! Sorry for my spelling, I am tired today. Sticking tongue out
Remember: You get what you give in Life,so be careful of what you are giving!
Imagecritterologist
Nov 7, 2012 11:45 AM CST
Name: Critter (Jill)
MD
I wish I'd taken a little more time to consider before having them put in the tissue expander, as I did have a lot of pain & adhesions (scar tissue that makes the skin "stuck" to the muscle underneath, which can restrict movement) with that dang thing. It was presented as such standard procedure that I didn't really even consider not doing reconstruction until well after my mastectomy.

Something I didn't anticipate about not doing the reconstruction... it's easy to talk to my daughter (3) about ways in which some people are different,whether it's needing a wheelchair or missing a hand... she knows most women have 2 breasts, and Mommy has just one now, but that doesn't make me "less" in any way that matters.

As far as your friend's fears for her remaining breast, I hope I can provide some reassurance... My oncology surgeon at Johns Hopkins told me that there was NO statistical difference in outcome between having a single mastectomy and removing both breasts (when cancer had only been detected in one). Basically, I think that means the biggest risk is posed by the cancer you know is/was there, rather than by a different breast cancer that might someday develop.

The risk is there, just as the risk is present for somebody who has never had breast cancer... but unless you know it's going to keep you awake at night for years to come, or unless you're at a really elevated risk of developing breast cancer, there's no "medical" reason to remove the other breast as a preventive measure.

BTW, the more gentle stretching and moving you can do, both with arm motions and with very gentle manipulation of the skin, the more you can prevent and even help break down those painful adhesions. My physical therapist was a whiz at massage techniques that helped a lot, too.
Circles of Support for Breast Cancer
I'm learning to dance in the rain! Thank you, Sally & Chris.
Imagejoeswife
Nov 8, 2012 10:19 AM CST
Name: Debra joeswife
Derby,Kansas
Zone6a
Thanks, Jill..... you are so lucky to have a darling daughter.. I must have missed you even being pregnant! Gee, I didn't know there were physical therapists for that massage thing. I will let my friend know. She is still going thru the checking in with Dr thing, and now she is going to have her other breast "lifted" >?
My youngest daughter is a mini me like my oldest daughter who had the augmentation done, she, however, is very proud of her whole being and doesn't care whether she has "large" breasts or not.. the other two daughters are very well endowed, one needs a re-duction. I told her it would be cool if we could reduce hers into mine and get rid of these horrible implants. LOL ( I have 4 adult daughters and one adult son) Enjoy your darling daughter.. they grow up so fast!
I am going to tell my siter about the gentle stretching thing, her chest is hard as a rock, ( which is normal if no "Pillows" are there, right? ) the adhesions are forming so quick it is amazing how the human body sends out armys of cells to isolate something and cover it ..
Remember: You get what you give in Life,so be careful of what you are giving!
Imagecritterologist
Nov 8, 2012 12:15 PM CST
Name: Critter (Jill)
MD
I started a PT thread on this forum http://cubits.org/metoo/thread/view/41318/ and checked there just now to see if I had more info... I can't quite remember the "fancy" name for the massage that's meant to break down or prevent adhesions between skin and muscle. But any PT who handles post-surgical patients should know about it.

Our daughter is the light of our lives, for sure. God performed miracles in bringing our family together... we brought her home from the hospital when she was 2 days old and finalized her adoption exactly 6 months later. There are a couple dozen threads about her in DG's prayer forum... she has an extensive online "family," with all the people who helped pray her into our arms!
Circles of Support for Breast Cancer
I'm learning to dance in the rain! Thank you, Sally & Chris.

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