One shot reconstruction

Jade645

I am just wondering if anyone knows the history of breast reconstruction.. when they are started doing the two step procedure with the expander then the exchange vs. one shot kind of one and done?

My mom really wanted reconstruction, but is super leary of hospitals/ surgery etc.. I would say beyond what an average person is. So when she originally went to first PS they told her the basic two step procedure expander then exchange. She got a second opinion and just asked can you do it in one shot.. I want reconstruction, but doesn't want to go under twice.. he said he could probably make it happen for her.. so she is signed up for reconstruction with this just one shot procedure.

Everything I have read here and mostly elsewhere is on the two step and I can't imagine many people would want to go through this twice unless there was an actual advantage of two vs. one step.

dlb823

I would urge your Mom to get a third or even a fourth opinion. Plastic surgeons are notorious for selling procedures they're comfortable doing, which doesn't mean there aren't much better options out there. Plus, I would be extremely leery of a any surgeon who said he could "probably make it happen." What the heck does that mean?

I don't know where your Mom is located, but if she's within a reasonable drive to any of these NCI-designated cancer centers, I would trust them to give her the most thorough evaluation of her situation and options, as well as have the finest docs with the most experience. http://www.cancer.gov/researchandfunding/extramura. And if she's not within say a 2 hr. drive of one of them, they can sometimes recommend highly qualified docs in your area who may have interned or been residents in the past, so have top-notch training and skills.

My bio page details what I went through after starting my tx locally, then finally, at my sister's urging (she's in radiation onoclogy research) moving to an NCI-designated facility.

Good luck to your Mom, and so glad you've found BCO for support & help! Please keep us posted on her situation, but don't let her compromise on experience or bedside manner! Encourage her to keep looking until she finds docs she totally likes and trusts! (((Hugs))) Deanna

besa

I second dlb823's warning about some ps recommending the procedures they are technically able to do and downplaying or even disparaging other options. Get multiple opinions for different plastic surgeons before deciding on a path. Also know that breast reconstruction is a different skill set from cosmetic enhancements. You want someone who does breast reconstructions mainly or almost exclusively.

If you are looking up "one shot reconstruction" you should put the terms "one-step breast reconstruction" or "alloderm assisted implant reconstruction" or "direct to implant reconstruction" into the search engine.

Consider getting a copy of the latest edition of Kathy Steligo's "Breast Reconstruction Guidebook." The best I have seen on breast reconstruction. The book which will explain options and a section on how to choose a skilled ps. You can get a copy from Amazon. com or from the web site below.

http://www.breastrecon.com/the-breast-reconstructi...

http://www.amazon.com/The-Breast-Reconstruction-Gu...

This is a link to Kathy Steligo's web site with a brief explanation of direct to implant reconstruction.

http://www.breastrecon.com/expandersimplants.html

(There are lists of plastic surgeons on the above web site. Know that it is an unvetted list.)

exbrnxgrl

I agree with the previous posts. One step is less common for a few reason; Not as many ps are trained to do it and don't do it often enough. It can be done successfully, only under a specific set of circumstances. The mx/bmx must be skin sparing, the patient, generally can't go much bigger than her natural size. Skin condition must be good and rads should probably not be in the picture. The patient must accept that the pectoral muscles are going to be stretched out very suddenly and some find the idea of this painful

I have had one step and am quite happy with it, but I met the narrower criteria for it and had a ps who was very experienced in the procedure. However, he was clear in telling me that when he went into the OR, if he felt that the result would not be good, cosmetically or any medical considerations precluded it, he would go with expanders. He was quite a perfectionist and I am happy for that.

It is clearly not for everyone, but can be great if it works out. I have needed no revisions. Good luck to your mom and yes, it is called one step reconstruction.

Jade645

So after that .. about a day or two later my mom decided to not do the reconstruction.

She was worried about the "probably" and the liklihood of having to go back in later for a revision... she really wants to avoid hospitals, surgery, needles etc. at all cost.

Because she changed her mind they changed her location at the hospital for the surgery and that made her anxious.. but pretty much everything is making her anxious right now for good cause.

Thank you for all the information.

Erica3681

Hi Jade645,

Given how anxious and uncertain your mom has been about reconstruction, it makes sense for her to go ahead with a simple mastectomy without reconstruction. This will give her time to recover from both the surgery and the stress of diagnosis. She can see how she feels about living without reconstruction. There are many lightweight breast forms (prostheses) these days and women are often surprised that they're both very comfortable and entirely natural looking. Or, she could choose to go flat.

The good news is that if, after living breast-free for a while, she decides she really does want reconstruction, she can have a delayed procedure. The biggest issue I see is that if she thinks she might want reconstruction down the road, her surgeon will probably leave extra skin. This is not necessary for future reconstruction, but is standard if later recon is planned. The downside of leaving extra skin is that your mom's chest will not appear smooth and flat, since the extra skin will lie in folds against the chest. So, you might want to have a discussion with her and her surgeon to decide which way she wants to go.

Best of luck.