BMX without recon - Scar query

Judeshome

I am going to have a BMX (simple) either late Dec or early Jan, I am 65 and not planning on reconstruction. There seems to be a wide variety of cosmetic outcomes, is this due to the skill of the surgeon?? Does anyone request having a PS do the closure or is this something that can be adjusted by surgery at a later date. I have multifocal low grade DCIS and multiple papillomas diagnosed in a wide excision biopsy but my BS advises BMX because she foresees frequent checkups and probable biopsies otherwise. This has been going on for a long time and I am sick of the constant stress every time I have a mammo, ultrasound etc. I’d be grateful for any info.
Jude

mudd

I am also 65 and just had a simple BMX, no reconstruction ( IDC in left breast with 2 nodes removed) . I went that route for the same reason - multiple biopsies in the past and just not wanting to deal with that in the future. Plus I knew now I feel well enough to have gone through the surgery. Who knows how I'll feel 5 or 6 years from now if anything had recurred to undergo surgery like that when I'm in my 70s.

I had a PS do the closing and he was the one that put in the JP drains also. One week out and I feel pretty good, better than expected, but still a lot of limitations and intermittent pain on the left side. I didn't have them leave any extra skin because I was certain that I never want reconstruction. The only issue I have is that you are dealing with two separate doctors and each seems to just be responsible for their part of the procedure. I hope things go well for you. I'm still in shock when I look at my body and realize I am now built like an average 2 year old - flat chest and little poofy tummy!!

ravzari

I had a PS do mine as the general surgeon I consulted with straight up told me it wasn't within his skillset to make sure I didn't have too much redundant skin and nice scars (in his words he'd "do his best") and that would be something more for plastic surgery to deal with. Since he straight up recommended getting a plastic surgeon involved to 'clean things up' after he did the actual mastectomy part, that's what I did.

While that's not true for ALL general surgeons, it's definitely worth asking about.

Either way, you do want to be repetitively clear that you do NOT plan on reconstruction and do not want extra skin left, as some surgeons will leave it 'just in case' if you're not really loud about not wanting that done as many surgeons just assume all women will eventually want reconstruction even though that's not something they should be assuming.

Sometimes, even with a PS involved, you'll need a revision, usually for dog ears (extra bits of fatty tissue and skin at the ends of the incision line). If you're overweight, the chances of developing dog ears tends to be higher as it can be difficult to get it right in one shot. I had a dog ear on my right--and I am slightly overweight--that they excised about 9 months after my original surgery; insurance generally covers revisions to a surgery that was done out of medical necessity (as opposed to a cosmetic only surgery that you paid for out of pocket).

I have pretty even scars, with the one on the left being longer as I had more breast tissue on that side, though it's pretty moot now as the tattoo to cover them up is finished and, aside from the tiny bit of the longer scar poking out on the left (which is under my arm anyway) you can't tell I have scars at all.

Judeshome

Thanks so much for your helpful comments razvari and mudd, I have a Dec 15 pre op consult with my BS so this will be one of my questions. Do you have any other suggestions for things I should ask about? I am a bit overweight too, 5’6” 167lb and trying to lose a few pounds before the surgery as I am used to being active and can see myself gradually expanding as I recover with at least a week or two of inactivity! Jude

Luckynumber47

I had a PS surgeon involved in my BMX. I knew right off the bat that I hated her and should have gone for a second opinion but didn't want to delay my BMX any longer. She left lumpy mounds of tissue on each side near the cleavage and large dog ears under each arm. Gggrr! I thought if I had a plastic surgeon I'd have a better looking outcome. Wrong.

So, what I want to say to you is: get a PS you feel comfortable with. Go over your expectations, many times. Get it in writing. Make sure they know to take out that fat under the arms. Your BS and PS can coordinate their schedule so it's all done as one surgery. No need for you to have a second surgery.

Best of luck with your upcoming surgery. I had very little pain (except for those annoying drains) and recovered pretty quickly. It took a long time to get over the fatigue and I took lots of naps in the weeks after surgery. You can take walks to start building your strength back up as you recover.

ksusan

Yes, put it in writing that you do not plan to reconstruct and do not want excess skin left, and then request that that note be placed in your medical chart.

I didn't have a PS, and my BS did a nice job.

Judeshome

My BS did a wide excision and the closure was very neat,
I will make it clear I don’t want recon and find out who is doing the closure so I have some input. How long does a BMX take I wonder?? Thanks for all the advice, it is greatly appreciated. Jude

ksusan

Without recon it's a few hours. Mine was maybe 3? Then some time in the recover room. Apparently I offered to sign my own discharge papers, but I don't remember that.

ravzari

Without recon, it's generally under 5 hours. I think mine was a little over 4 hours.

I'm told that after the surgery and after my revision surgery, I tried to take a swing (as in punch!) the plastic surgeon!

I was mortified and apologized to her as soon as someone told me what happened, but she thought it was funny and not even close to the first time someone coming out from anesthesia had tried to punch her.

Leapfrog

I had a simple BMX last October without reconstruction and told my BS I didn't intend to have recon. He told me he could give me neat scars and he did. I have wide excision. I have a small frame but I had medium sized breasts which took up my entire chest. I was diagnosed de novo with mets so I knew there was a high possibility of lymph node removal. That contributed to the scar on the right extending past my arm pit and, as 29 nodes had to be removed, that was the only part of my recovery that was really painful (apart from the extensive bone mets). After a year my BMX scars have almost faded and are barely noticeable but I do have little dog's ears under my arms which are also improving now that I can do stretches again.

I would say it depends on the size of your breasts, the type and size of tumours (my right one was 10 cm and the left one was 2cm), and your body type. I think being small and slim helped with mine. The BS told me it would. So, I would sum all that up as only you can estimate.

Perhaps a consult with a plastic surgeon might be a good idea to get advice on how the size of your breasts and body will impact on surgery and compare that with what your breast surgeon says. Obviously the PS will be looking for work but you can size that up by listening.

My surgery only took 3 hours.

Leapfrog

Judeshome....one thing to be prepared for that no one else has mentioned. When you no longer have breasts you do notice your tummy. I'm not big, as I mentioned but I had to get used to being flat right down to my belly button and then having a noticeable tummy. Because I don't have any extra flesh on my I also notice my rib cage. It's strange at first but you do get used to it. Good luck. Keep in touch with us.

Judeshome

Thanks Leapfrog, I am exercising and dieting for belly reduction, I guess it takes something like this to make a person finally get around to it! Thank you for the info and support.