Two different opinions on reconstruction ! Who do you believe ?

Live4them

Everyone tells you to get a second or third opinion from doctors . The problem is what and who do you believe when they both say different things .. I'm having a bilateral mastectomy done . #1 PS says he can use my own skin and go directly to implant and even use fat graphing later to finish the job ...No TE needed he says .. #2 PS says I'm not a good candidate for that procedure because my breast are a little low , that his way will take a bit longer but I'll like the results . #1 measured and did a real good exam . #2 didn't measure or exam me the way the other one did . I want to be conservative and heal properly but don't know who to go with . Both were recommended by my breast surgeon

dlb823

Hi, and welcome to BCO, although I'm so sorry you have reason to be here.

If I was in your situation, I would want to know how many procedures like yours has each PS done? Experience is extremely important! What is their overall success and/or complication rate? How long ago did each one go to med school and do their residency? Newer docs may be more comfortable with newer procedures, such as direct implants and fat grafting. Older docs may be more comfortable with what they've always done. PSs tend to recommend what they do best. They may give you reasons or excuses not to do it another way, but the bottom line is their comfort level with the way they've always done it. What positive thoughts or concerns does your gut instinct say to you? If the responses to these questions don't help you decide, perhaps a third opinion would be helpful? In the end, there may be no right or wrong answer. Both docs might do a similarly excellent job for you, just approaching it differently.

Good luck! And let us know which one you go with! (((Hugs))), Deanna

muska

Hi Live4them, in the vast majority of cases they put an expander first, fill it in to "expand" your pectoral muscle and skin to desired size, and then do an exchange surgery. I suppose in some - rare - cases it might be possible to go to the implant directly. There are several factors that matter including individual anatomy, size and most importantly tissue status post mastectomy. The latter I think depends largely on the tumor size, location, skills of the surgeon who does mastectomy, etc.

In my case, I was told at my initial constult with PS that she might do direct to implant but will put an expander if direct-to-implant does not work out. I woke up with an expander. Looking back, I am glad I woke up with an expander because I cannot imagine how one could asses proper size, position and put a large enough implant under pectoral muscle immediately after mastectomy. She filled my expanders with 100ml at the time of surgery. My 'final' implants are 500 ml. I cannot imagine how one could put 500 ml implants at the same time as a mastectomy is done. Maybe in case of small implants and/or prophylactic mastectomy...

I would go back to the PS who claims s(he) will do everything in one shot and ask for detailed explanation of the process. Raise questions about every single step. What if...  I don't know your diagnosis or medical history but maybe one of 'what ifs' should be about possibility of radiation.

Edited to add that exchange surgery was a simple procedure in my case and I did not require any adjustments.

dtad

Hi just want to let you know I had BMX in May with direct to implant reconstruction. I was a 36 DDD before the surgery. I was interested in this type of reconstruction because I wanted to avoid the expander process and eliminate the second surgery. My PS said she couldn't promise she could do it once she got in there but she would try. It's a fairly new procedure so there are not a lot of docs that are comfortable with it. She told me I couldn't be bigger than a C cup with this kind of reconstruction. I'm now a full C. It's been an emotional and physical adjustment but it's getting better and better with time. I'm 62 and was much more concerned about how I would look in clothes rather than how they looked naked. Take your time and research both. Also if you decide to do the one stage make sure your surgeon has done a decent amount of them