hysterectomy, tummy tuck, implants need advice.

exercise_guru

I could really use some advice. I am finishing up Chemotherapy and because of the Gene I have my doctors want me to have a hysterectomy 6 weeks after Chemo. I have a lot of risk factors, young, bad Gene, family history of ovarian cancer, HR+ and bilateral breast cancer with two different kinds of cancer. I have talked to my OB and she thinks its the right decision too. I am not sure why still trying to find out but they want me to have the open abdominal kind. I have been to hystersisters but that just scared me there.

so I am trying to decide on this surgery and the side effects and whether my body can handle it. I am also thinking I will get a second opinion. Maybe I can do the hysterectomy and implants in separate surgeries and have an easier recovery time because then the hysterectomy would be orthoscopic. In this case they would schedule the surgeries three months apart. For those of you going through treatment you probably understand how tired I am of treatment and how much I really would like a normal feeling of life again.

Anyway in the middle of this plan one surgeon said I could have a tummy tuck I am about 25 pounds overweight and I have this "apron" of fat that they would remove. It wouldn't be under my insurance and be a lot of our money like between 5000-8000 dollars. I looked at pictures and I thought . At this point I have so many scars from the double mastectomy being a thin saggy middle aged woman vs a rubeenesque middle aged woman wouldn't be worth it. Also who knows what our future expenses will be and I have job instability right now so while my husbands job is stable probably not a good time to burn through money that could be used for more important things as my job ended when I was diagnosed and I need to find a new one when I finish treatment. Also I have a partner for 20 years and he is not going to leave me over a little tummy bulge. Ofcourse having a flat stomach is kind of a nice perk coming out of this.

I should post that for my reconstruction I chose to have the aerolas built out of my skin rather than just tatooed on so they need a donor site for the nipple and the aerola. It thought the nipples looked more natural and I sought out a surgeon who had done hundreds of these. If it comes out of my abdominan then the skin would be lighter but I could just have it tatooed later. Between my legs has a natural darker pigment but then I have two scars between my legs.

OK so then the doctors say I can have two out of three or have the implants separate from the hysterectomy. Right now I am leaning towards no tummy tuck because I just don't want to face the drains again and the recovery is much more involved. Any advice?

• Hysterectomy & tummy Tuck ( would have drains again and a much longer recovery time)
• Hysterectomy & implant exchange with nipple reconstruction ( If I do this they would build my aerolas out of the abdominal tissue so one less scar between my legs)
• Hysterectomy orthoscopic separate
• three months later Implant exchange. ( they would have to take the tissue between my legs so I would have a scar inbetween my legs, on my abdomin and accross my breasts.

I am starting to feel like Frankenstein.

I am strugggling with this decision because it is the first one I have had a lot of choice in. Before It was just "get the cancer out"..."Get Chemo" survive survive survive.

marijen

Hi, If you live until say 90, you still have more than half your life left. I would choose the option that would make me feel the best about myself even if it means more recuperation time now. If you're out of a job anyways now might be the best time. Money is forever a problem. Somehow we find a way to make up for it. How come the implant exchange causes so many scars? Did you get a second opinion? If I had the choice I'd do the hysterectomy & tummy tuck (after a second opinion). And the Implant exchange in three months. You asked for advice, this is more the pros and cons. Advice: do what makes you happiest in the long term. Let us know what you decide....

MelissaDallas

I would think an abdominal hysterectomy and implant exchange would be really hard. I had an abdominal hysterectomy plus partial omentectomy and could hardly get in and out of bed or a chair. It would have been impossible if my upper body had hurt too.

BrooksideVT

I'd really grill your doc (and probably a second opinion) on the advisability of an abdominal approach for your hysterectomy. There may be a clear medical reason why this would be preferred, but I would want to be very clear on exactly what that reason was. As for me, I had a vaginal hysterectomy a few years ago, and the recovery was a breeze--practically painless, and, as I was staying in my son's basement guestroom, I was continually, and comfortably, charging up and down stairs to use the bathroom. As for what recovery might feel like if you decided on the tummy tuck, do check out the DIEP reconstruction threads here.

DLcygnet

Definitely get the second opinion.

I'm BRCA1+ and the route I'm going is to get an oopherectomy (ovaries only) after I have my 2nd child [or give up]. When breastfeeding is done, I'll get a bilateral mastectomy with DIEP flap reconstruction (tummy tuck -> fat becomes breasts). My breasts will be a little smaller, but that's fine! My insurance will probably cover all of it because the tummy tissue is required for the reconstruction & isn't just an add-on item. When I asked about having everything done all at once, even my oncologist said they'd be separate surgeries anyway. But mastectomy/tummy tuck can be done all at once and oopherectomies are supposed to be relatively easy now (similar to prostate surgery). I'm turning 34 in 1 week, so the idea of swapping implants every 10 years or so until I'm 90+ does not appeal. If the ovaries are the biggest concern - then get them out (assuming you're done with kids). There is no time limit on the other stuff. Really. As sick as you are of being "the cancer patient," you have time. And wow... I know plastic surgeons take tissue from legs & butt all the time, but wow that's a lot of cutting.

I hope that helps.

inSF

I have the BRCA2 mutation, so I will be making the decision between hysterectomy vs. removing just ovaries and tubes. I do know there are plenty of individual cases where arthroscopic surgery is not really possible (e.g. excessive scarring from previous surgery), so presumably it's a good sign that your surgeon is even presenting it as an option. Having had both laproscopic (through belly button) surgery and a laparotomy (bikini line incision), the recovery was significantly more difficult with the laparotomy, as it is a major surgery. That said, my surgeons at the time believed that the laparotomy is a superior procedure in terms of being able to clearly visualize any pathology and ensuring adequate removal of everything. It may just come down to your own intuition on whether your body can handle the additional recovery required.

I'm a bit curious about the "tummy tuck" not being covered by insurance. If tummy tissue is being removed as part of the breast reconstruction (areola), that should be covered - can't they just remove a bit more tissue than they technically need for the reconstruction? I know in some cases plastic surgeons will even remove a portion of a healthy breast to match a smaller reconstructed side, and that is covered as part of the reconstruction. The point is that leaving you with a positive cosmetic result is part of the procedure. You may want to talk to the breast plastic surgeon a bit more about the surgical plan and what can be covered.

In any event, best of luck - all of these treatment decisions (chemo, rads, multiple surgeries) are incredibly difficult. The risks and side effects are real, and all our bodies handle the struggle differently.