Is it ok to wait to have reconstruction?

amyi

I am uninsured until Jan 1 and am unable to find a plastic surgeon willing to work with me for my upcoming mastectomy. My surgeon had planned to do a skin/nipple sparing mastectomy with immediate reconstruction but will be unable to use the sparing technique if I wait for reconstruction. She also said she thinks it is too risky to wait till January when my insurance starts to have my surgery. My only options seems to be to have the bilateral mastectomy then wait a month or so to begin reconstruction. I have checked everywhere for financial assistance and I am right above the income cut off on everything. Reconstruction is the only thing I've encountered that will not allow me to set up a payment arrangement. Has anyone else had reconstruction separately and do you think I'm making a good decision? I only have a couple days to decide. Any advice would be greatly appreciated!!

curveball

I had a skin & areola (but not nipple) sparing unilateral MX last June, but (what with chemo, Easter and a niece graduating) won't be having reconstructive surgery until the end of next April. You might want to ask your breast surgeon why no skin-sparing with delayed surgery.

Two other options occur to me:

• since the end of the year is so close, and you are going to have two surgeries anyhow, could your breast surgeon do a lumpectomy only at this time, with completion of the MX combined with reconstruction after the beginning of the year? OR
• what about delaying any surgery until January? If you schedule your BMX + recon for the first couple of weeks of the year, that will be a gap of 8-10 weeks between dx and surgery. I had a delay of nearly 10 weeks between DX and first surgery due to additional testing that was ordered prior to my MX. I went nearly out of my mind with worry, but all the doctors I've asked about it say that much of a delay won't affect the eventual outcome of your treatment.

Just some thoughts. I hope you find them helpful. My best wishes for successful treatment and a great reconstruction.

amyi

Thank you, that's great advice! I'll call tomorrow and see if lumpectomy in the meantime would work for me.



I did ask if we could just wait till January and she said since I'm 37 I'm at high risk for it to spread etc and we need to do surgery as soon as possible. Terrible timing because I started a new job and after seeing the insurance prices, I decided to waive their insurance and wait and go on my husband's insurance which doesn't start till Jan and I got diagnosed a month later!! But on the bright side they don't consider pre-existing conditions so I am so grateful I will be getting coverage soon. It's really scary how hard it is to get treatment without insurance!! We've had a rough time working out payment arrangements every step of the way but the plastic surgeon is the first time I've been offered no other option than paying 100% up front and the cheapest price I've found so far is $8000.



I'll also ask why she can't do the sparing without immediate reconstruction. I was in such shock when she told me no plastic surgeon she partners with will work with my financial situation I didn't think to ask more questions. She is the only surgeon in my area that performs the sparing technique. Today has been the first day since I've been diagnosed that I've been an emotional wreck because I've been so anxious to have the surgery this week and everything I was expecting just fell apart. I know that getting the cancer out is the only thing that really matters but the thought of sparing and reconstruction has made it all easier to cope with!!



Thank you again for giving me some insight and advice!! I will keep you in my prayers as well for your continued health and upcoming reconstruction!! :-)

Traii

Hi Amy

Not sure how large your lump was however mine was 16mm....my surgeon wanted a mastectomy right away due to high grade 3 however they allowed me to have a lumpectomy to get rid of the 'c' in me and then chemotherapy. I'm having treatment now and then within 6 months of treatment they said I need to have the mastectomy which I too will be doing both .

Good luck with your appt with surgeon to see if lumpectomy is a possible option for you.

Moderators

amyi, you might also want to post your question in the Breast Reconstruction forum, where there are many women with widely varied experiences around reconstruction who may be able to offer you suggestions from how they went through reconstruction.

Best wishes,

• The Mods

Oropi524

Yeap just had it done 5 days ago!

Had a lumpdectomy in October due to invasive lobula carconoma stage 1, margins and lymph nodes were all clear but due to dense smallbreasts the MIR is not picking up on the cancer so I had my left boob off - mastecomy.  Now have the expander in. Its bigger than my normal right boob and it hasnt been pumped up yet!  A little bit of discomfort under the armpit but I still have a surgergical drain in which is worse than the expander.  I took this option as I dont often wear I bra and I knew it wouldnt take long to do.  I still have to go through radiation and the new softer implant will go in next year.

amyi

Thank you both so much for the wonderful advice!! I called my surgeon and she is going to do lumpectomy next Friday and we will wait till sometime in January to do the mast/reconstruct after I have insurance. I am beyond relieved!! I didn't think my surgeon would agree to it but she said she thought it was the best option considering my situation!! You ladies are amazing!! Thank you!!

Traii

Glad to hear amy...cancer comes out on Friday for you...best amazing feeling and glad surgeon agreed

Take care....its not all that bad...my axillary removal was more sore than lumpectomy!

curveball

@amyi, will your surgeon also do a sentinel node biopsy with the LX? That way, if any additional node removals are indicated, they can be done along with your MX/recon next year. Glad your surgeon agreed to adapt procedures to your circumstances.

Linda-Ranching-in-the-mTns

Amyi... just a thought... you are now only 4 weeks from end of year.... and your new insurance. By the time your surgery actually takes place, perhaps only 2-3 weeks.



I had lumpectomy (and 2 lymph nodes removed) in august. On the plus side... it was much easier and less painful than I expected. On the bummer side, they found more cancer so we had to move forward with a dbl mastectomy ... which I had nov 6 along with phase one of a DIEP reconstruction.



My advice is to not limit your surgery options what is local.



We live I'm the middle of nowhere... I am 3.5 hours from my oncologist, 5 hrs from my lumpectomy surgeon, 12 hrs from San Antonio where I finally had my mastectomy and recon.



We tried denver first (5 hrs) but those DIEP surgeons couldn't get me in until January.... which meant a mastectomy and tissue expander (with weekly adjustments) to stretch my skin to the size needed for the recon... followed by another major surgery (phase 1 DIEP recon) in Jan... meaning all new copays and deductibles.



I just kept calling until I found a good facility who could do the all-in-one surgery.... ended up in San Antonio and they did a great job.



My best to you... just keep all your options open



Linda

amyi

Hi, yes she said she is going to remove nodes during lumpectomy to send to pathology. She said she usually just takes 1 or 2 to start with. She's also doing some sort of procedure with a needle before surgery I can't remember what they called it.



I got a call from the surgery center and even tho it is going to be very expensive, they worked out a payment plan for me. Then we'll schedule a double mastectomy/reconstruct with the s/n sparing sometime in January after my insurance starts.



And wow Linda...that is quite a journey you've had to make for your procedures!! Did you run into any issues with the Drs being out of network? I would love to have a Dr I know of a couple hours away do my reconstruct but they said my insurance prob wouldn't approve it since I have in network options.



Thank you ladies so much for your advice! I can't explain how comforting it is hearing experiences and success you've had getting thru this!! Sometimes I feel like I hit another wall everywhere I turn trying to get thru treatment but I guess it's just part of the journey and challenges most of us have had to deal with!!



Wishing you all good health and continued success in your treatment!!

Traii

Hi Amy

They put a dye in you to see where the first couple of nodes are so that when you are getting the lumpectomy done the nodes closest to the breast are removed also (Sentinel Lymph Node Dissection) ......thats what happened when I had my lumpectomy.

Glad to hear that they have come up with a payment plan for you also.

Looks like you'll be having your Mastectomy before me as I will still be having chemotherapy in January...they are looking at around May for me , I've decided on the double also.

Wishing you all the best for your lumpectomy next Friday and a speedy recovery

Dawn1008

Hi Amyi, not sure why your doc is saying that she can't do skin sparing without recon.  I had a mastectomy on the right side in October, skin sparing and I will get reconstruction after 5 months of chemo.  My surgeon highly recommended waiting for the reconstruction because if you require radiation it can impact the implant negatively.  So, it's good that your surgeon is being accommodating, but you might want to check around or get another surgical Doc's opinion.

PS - it's so close to January!!!!

Best of luck!

Traii

Amy, how did you go with your lumpectomy and results, hope you are recovering well and good pathology report

amyi

Hi Traii, the surgery went great! She took out 5 lymph nodes and the area under my arm has been really sore but other than that recovery has been good! I got the pathology results today and she said its stage 2, 4cm and 1 lymph node had cancer, and estrogen positive, prog neg, and we don't have the hers2 results yet. I go see the genetics counselor in the morning for my results there. I'm not sure what treatment they will suggest yet. They had originally told me they thought the tumor was less than 2cm and I might not need chemo so I guess the larger size will prob change things a bit. I go next week for follow ups with GS and oncologist so they will prob give me my options then. Thank you so much for checking on me!! :-)



How are things going with you? Is your last chemo still in Jan?

Traii

Good to hear from you Amy

Mine was 1.6cms and 2lymph nodes involved and needed chemo. Im sure you will have a action plan real soon thats when you'll be all set and go



Im sitting in the waiting room now...they are running behind

Last one correct until 2nd Jan

Happy I'll be fine for xmas and NYE

Keep me updated hun...fingers crossed good news hers 2 result and genetics testing.



Traii