Unilateral MX & Prior Augmentation: Recon Options

MommaGin

Hello, I'm a new BC Patient. Just had non nipple sparing UMX with TE put in, awaiting pathology on DCIS and lymph nodes, and then hopefully on to recon. My prior implants (20 years old) still in right breast. I am at MD Anderson, but have seen a total of 4 PS (3 outside the institution and in private practice). Two have recommended stacked DIEP for the UMX side, with a new implant and collagen or fat grafting added to the non-diseased side. The other two said I should just replace both sides with implants and add fat grafting as I will never be symmetrical using an implant on 1 side and DIEP on the other. Is that true? Has anyone had experience with using their own tissue for 1 side following UMX, and keeping an implant on the other side where they had had prior augmentation?

Moderators

Hi MommmaGin,

We're "bumping" your post to get it back into Active Topics and hopefully get you some responses. Are there any members out there who can weigh in on MommaGin's situation?

Thanks!

--The Mods

MommaGin

Thank you, moderators. I know my situation may be a little unusual, but I am hoping that someone in this amazing community has been there and has some insights to share. The hardest part of my BC diagnosis has been sifting through the many alternatives and options to find the right solution for me. It's kind of overwhelming at times. Every bit of shared experiences helps.

Lula73

I’m guessing you’re thin and that’s why they’re saying stacked DIEP? Any way you look at it your left breast will never feel the same as the right unless you do the exact same procedure to both. I understand you have an implant in the one side but the implant that would go on the UMX side won’t have any natural tissue in it like the other died so it will still feel different and may look different too. You mention multiple opinions inside and outside MDAnserson. Have you gotten a consult at NOLA by chance? They are the ones who often find a way to make things work when others say there’s not enough. They have pioneered a new procedure called the APEX flap that they use when a woman is on the thin side to enable her to have enough tissue. APEX and SGAP can be used together to do a stacked flap as well if additional volume is needed. I had APEX done bilaterally and am very happy. Here’s a link to their site:

www.breastcenter.com

MommaGin

Thank you for sharing, Lula73. I have not been to NOLA. I have visited with my MD Anderson PS, plus three other Houston plastic surgeons who were recommended to me by others in Houston who have had recon work done by them. Two of those doctors came with the highest recommendations from multiple local sources. One of these two has also been frequently mentioned in these forums (Dr. Aldona Spigel), and I also read about her in a recent New York Times article from Jan 2017 which discussed new efforts to restore sensation/feeling after recon. The MDA PS told me I was too thin to do the DIEP without reducing my other breast a size or two. This was a shock to me as I do NOT have a flat tummy by any stretch of the imagination. The other doctors concurred and said I could still do a DIEP but it would have to be a stacked DIEP. Nearly all have promised symmetry can be achieved, even with an implant on my right breast, but this would be achieved over time and with other phases of surgery.

Going to NOLA would be very difficult for me as I have three children ages 3 to 11. They have been troopers over the past week, but it would be a big sacrifice for them to be without both Mom and Dad for a week or more and for repeat trips for follow up, etc.

The APEX sounds interesting. I wonder how different it is from the stacked DIEP that some of the Houston experts are using. My understanding is that DIEP (as compared to the Tram Flap procedure) does not involve weaskening or cutting of abdominal muscles, which the NOLA website said is one of the benefits of APEX. I'm glad you've had a good result and are happy with your decision. I really hope I can join you someday and say the same to encourage others.

Lula73

MommaGin- I don’t know your family & support situation, but here’s what I can tell you about traveling for the procedure. You need about 9-10 days in NOLA for stage 1:

Day 1 is travel day in Day 2 is pre-op Day 3 is Surgery Day 4 & 5 are in Hospital Day 6 is discharge Day 9 is post-op visit Day 10 is travel day home

You need about 8 days for stage 2:

Day 1 is travel day in Day 2 is pre-op Day 3 is Surgery Day 4 is discharge Day 7 is post-op visit Day 8 is travel day home

You can always fly in the night before pre-op vs the day before and fly out evening of post-op visit to reduce the number of days. Unless you have major complications you will not need to travel back to NOLA until the next procedure is scheduled. Minor issues are handled via phone & email if pics are needed.

You can leave the kids with a trusted friend or family member or bring them with. The center has a Murphy bed in your room if your DH wants to stay with you if it’s just you two. If you bring the kids, DH and the kids can visit you during the day as they would do if you were at a local hospital and head back to the hotel or Airbnb afterward for the night. The patient to nurse ratio at the hospital there is 1:1, in a pinch 2:1, so its nothing like MD Anderson or other hospitals where 1 nurse has 10+ patients. You will be well taken care of and promptly when DH isn’t there. Once discharged, you’ll stay at the hotel or Airbnb until post-op visit. Stage 2 is far less complicated and much easier and faster to recover from. A trusted friend or family member can definitely travel with you for that one if needed. My dad watched my kids for stage 1 and DH went with me. DH stayed home with kids for stage 2 while my mom accompanied me. We had intended to take the kids both times but they had things going on at school that they were very excited about and did not want to miss during stage 1 and our 12 year old had started a new school (traditional school where he had been in a more montessori style School) and was still transitioning when stage 2 happened and we felt he’d be better off staying the course at school.

I guess what I’m trying to say is that it can be done without much disruption. We’re talking about an average of 14-18 days out of 365 days in the year to have both breasts done exactly the same with likely only natural tissue keeping in mind that DIEP, SGAP, APEX can only be done once. Only you can say if it’s worth it to you to make it work out. I hope you’re in my place too this time next year! We all are worth it!

MommaGin

Thank you Lula. I was so impressed by your post that I did contact NOLA and had a wonderful phone consult with them. Ultimately, I decided on a local Houston surgeon, Dr. Sean Boutros. After learning of everything that set NOLA apart (I drilled them on very specific technical questions ranging from the size of their facial incisions to the type of anesthesia they used, plus I insisted if I were going to travel there, I only would do so for Dr. Dellacose), I realized Dr. Boutros was just as good, easier on my family since he was local, and had already been holding my hand and investing in me like no other PS. Very, very pleased so far.