Brca1 and can't decide on what type of surgery. Please help.

Willow420

I'm 40 and just tested positive for brca1. My mom died from ovarian cancer at 45, her mom in her 60's and her sister battled breast cancer twice. So I'm definitely having surgery but can't decide on implants or diep flap. I have size triple e breasts (yep,they're huge and saggy) and what I call a "skin apron" (hangy belly)from having a son and weight gain and loss. I would prefer the diep flap because I don't want to deal with expanders and implants with possible complications, but I'm terrified of the pain in my stomach area afterwards. I had a hysterectomy 3yrs ago due to a large fibroid and the pain was 1000 times worse than I expected. Plus my incision wouldn't close and I had two infections that took forever to go away. Has anyone had the diep flap with tummy tuck? If so, how bad was the pain and healing process? And will they be able to make my breasts a size c? I hate having huge boobs. I have an appointment with my GP today so he can refer me to an oncologist so it's gonna be awhile before I get to see a surgeon to ask these type of questions. Sorry for the long post!

inks

I am sorry that your family has been affected by BRCA cancers.

You definitely want to meet with a plastic surgeon before you can decide on the type of surgery. Your prior abdominal surgery may affect your chances of having a DIEP flap surgery but if you have a lot of extra skin it should not be a problem. Either way you should be able to be at least a C cup. Since you are having a prophylactic surgery you should look into skin and nipple sparing mastectomy and look for a surgeon that does this kind of surgery. I hope you have a good outcome from the surgeries.

besa

If you are thinking about DIEP you should go to a ps that specializes in DIEP (doing them multiple times/week) and having done many hundreds, even thousands on their own when not in training. PS often recommend the type of surgery they are able to do and sometimes even disparage other options. Also know that cosmetic enhancement is a very different skill set from breast reconstruction. You want a ps that does mainly reconstructions. If you do decide on implants - the same thing goes. Find someone who does mainly implant reconstructions and is very experience (not simply implant cosmetic enhancements.)

I had a DIEP flap which automatically comes with tummy tuck in 2007 following a bc diagnosis. There are many other women on the boards who have had DIEP reconstructions. I also had a prophylactic nipple sparing sGAP on the other side over 4 years later. I went smaller (from a D to about a B or small C- I didn't have that much tummy to work with.) My original DIEP ps was well trained but had done few DIEPs on her own (when not in training). I ended up having other ps do revisions. I wish I had know to go to someone more experienced from the start. Any good ps will have a large group of happy customers willing to talk to you and if possible show you their results in person. Talking to former patients is usual when it comes to breast reconstruction. If the ps doesn't allow this it is a red flag.

I agree with Inks - having both a skin and nipple sparing mastectomy would be a nice option. Also know that the success of nipple sparing depends a lot on the skill of the bs who does the mastectomy. Again if you want n.s. you need to find a bs who has done many, many n.s. mastectomies. (The breast surgeon does the mastectomy and then ps steps in and does the reconstruction. ) At a few facilities there are two senior ps working together on a reconstruction (not a fellow or resident working with a senior ps) and this cuts down the O.R. time greatly.)

If you don't already have one, consider getting a copy of the latest edition of Kathy Steligo's "Breast Reconstruction" guidebook. Among other things it talks about the different breast reconstruction options and the pros and cons of each. Also how to find a good ps. The best I have seen on the topic

.http://www.breastcancer.org/community/gift-shop/bo...

Also have you visited the FORCE web site www.facingourrisk.org (A good resource for anyone dealing with BRCA mutations)

exercise_guru

There is another website called FORCE where there is some very good forums for DIEP and prophylactic reconstruction