SSM and TE, do they work well together or not?!

Dafne

Hello to all the wonderful ladies here, and please share some knowledge as I'm more confused than ever.

I'm going to have a bilateral mastectomy soon. My plastic surgeon, during the first meeting we had (a short one, I admit), told me he was gonna use the tissue expanders method, as he doesn't think I'm a good candidate for autologus reconstruction -not enough belly fat for 2 breast mounds. Since I was diagnosed I changed hospitals, but I know from the breast surgeon that performed my first lumpectomies that I'm candidate for skin sparing mastectomy, maybe nipple sparing too.

But as I was browsing, I found this site, of University of California, where it states, among others, that:

"...Therefore, a tissue expander or an implant alone cannot be used after a skin-sparing mastectomy because:

• These implants must be covered by a muscle and there is no muscle in the chest which can do this. The pectoral muscle can cover an implant, but only after about 6 months of stretching.
• The implant not covered by muscle looks and feels unnatural.
• The implant not covered by muscle very often (30 percent to 50 percent) gets infected and has to be removed.
• To close the skin with an implant or expander reconstruction, you need to make a long scar across the breast, removing extra skin and defeating the purpose of the skin-sparing mastectomy...."

So, in other words, according to their claim one cannot have either tissue expanders or direct implants after SSM!

But I thought this is happening all the time. At least the direct implants thing.

As for the tissue expanders, sorry but that wasn't exactly what Angelina Jolie had? Bilateral prophylactic mastectomy, skin and nipple sparring with tissue expanders?

In Susan Komen's site, they say:

"With a skin-sparing mastectomy, the tumor and clean margins are removed, along with the nipple, areola, fat and other tissue that make up the breast. What remains is much of the skin that surrounded the breast. This skin can then be used to cover a tissue flap or an implant."

They don't mention the tissue expanders, but they talk about an implant.

On realself on the other hand, where a lady asks "Is the Use of an Expander Recommended for Nipple/skin Sparing Mastectomy?"

many surgeons reply that it can certainly happen, and actually one of them says: " Whether one uses expanders or just inserts the final implant after a skin sparing (subcutaneous) mastectomy depends on many factors including your skin, the tumor nearness to the skin, your medical history, and who is doing the mastectomy among others. Although this procedure can be done inserting the final implants primarily, using expanders is certainly the most cautious and safest way to proceed."

So, what is going on? Who is right and who is wrong? And if the UCSF is wrong, how can a University post such unaccurate and misleading info?

I will see my ps sometime next week and talk with him some more, but I'm really curious to know and understand so I can ask him all the right questions.

Falconer

I don't know what you're referring to about Angelina's experience, but in mine, I had a unilateral mastectomy and a tissue expander placed under the pectoral muscle. My PS even considered placing it in front of the pec but there wasn't enough skin to do so unfortunately. It might have spared some of the discomfort I currently feel. Eventually, he will take the fat he can- mainly belly- and make it into a smallish breast- the other side is a 34B. Hope that answers your questions

SpecialK

I would question the date of the UCSF article, particularly since they reference TRAM, a surgery that is less frequently done now. You can certainly have both a SSM, or NSSM, with expander or direct to implant - if you are a good physical candidate, as the realself info states.I had NSSM with expander placement at that surgery in 2010, with incisions in the IMF. If you google "UCSF" and "skin sparing mastectomy" together, you will find additional articles that reference these surgeries with the successful use of immediate reconstruction.

Dafne

Falconer, sorry you feel discomfort with the TE, but I realize it's a common thing. Hope you feel better soon. So your doctor is going to use fat transfer to make your reconstructed breast? If you don't mind me asking, was that your preference over implants? I understand it's a different procedure than flaps.

When I mentioned Jolie, maybe I was not completely right. She had nipple sparing, but don't know if it was skin sparing too, with TE for a few months.

SpecialK, thank you so much for clearing things out. I guess I should have googled UCSF and SSM together, but I guess my mind is not really high functioning these days, lol.

Thank God there is breastcancer.org!