Reduction then later DMX vs DMX w/ DTI in 1 step

ShimmerGal

Context: PALB2+, currently DD wanting to go smaller to B, was told I was a candidate for pretty much everything

The plastics consult yesterday has left me more confused than ever. My PS prefers to do a breast reduction first (since I wanted to go smaller anyway, from about DD to , and then the mastectomy with direct to implant about 6 months later. I dont feel like I will be able to function as a human for those 6 months.

The pros of doing it in 2 steps are cosmetic, as far as I understand. The cons are things like leaving breast tissue in there for six more months, and then also a lot of anxiety, increased surgical risk from 2 procedures instead of 1, etc.

I think I would rather do a direct to implant, over the muscle and just be done with it, you know? Am I being hasty and ignoring the long term cosmetic benefits or is this a reasonable approach? What other considerations might I be missing and what further questions should I ask her?

Magari

Hi, Shimmergal - DMX = BMX, correct? (I.e., bilateral mastectomy?) Or are you leaving the uninvolved breast alone and merely reducing it in size to match the implant you will have on the cancer side?

I had bilateral mastectomy with direct to implant reconstruction as a single surgery. But mine involved implants on both sides that were about the same size as I was pre-surgery. I think it might be difficult to "match" sides in a single surgery if you are doing just reduction on one side and implant on the other. You are then dealing with different types of tissue that will have different amounts of swelling, settling, etc post-surgery.

Have you asked your breast surgeon how s/he feels about the 2 step approach, or are you working with an oncoplastic surgeon who will do both the cancer removal and the reconstruction?

ShimmerGal

Yes sorry, I was thinking double instead of bilateral and that should be BMX oops! prophylactic BMX for gene mutation + family history. I'm working with a BS and PS for these procedures. I'll see the BS next week and I'm having a heck of a time scheduling a follow up with this PS at the moment.