Reconstruction Options

Anonymous

Reconstruction Options

NTS

I had neoadjuvant TCHP from June-Oct 2017 with plans to have a nipple-sparing bilateral mastectomy afterwards. I met with a PS around Sept for a consultation. He advised he THOUGHT I had enough to perform a DIEP flap reconstruction. Prior to meeting with him, both my BS and Oncologist had warned me I may be too small for DIEP flap. After meeting with the PS, my husband and I were both weary about the vibe we got from the PS - he said he could do it, but didn't seem uber confident to my husband and I. He didn't discuss any other flap options, but did say if I needed radiation then I wouldn't be a good candidate for implants, as the skin continues to change and harden over time, usually presenting with uneven breasts.

So after the chemo, I had a repeat MRI. It showed I had a less than stellar response to chemo; tumor only shrunk by about 40%. My BS spoke to the Radiation Oncologist and they determined that regardless of what surgery I get, I should get radiation due to (1) tumor size (2) my age of 32 (3) poor response to chemo (4) small amout of tumor in one sentinel node. Because radiation can mess up a reconstructed breast, my BS suggested I get a lumpectomy first then move forward with radiation with plans to have the mastectomy in the future. I was fine with this because I just wanted to get the thing OUT of me asap.

I had the lumpectomy in November, followed by additional surgery two weeks later to clear the margins, then 6 weeks of radiation. I completed that last month. I'm meeting with the BS again in about a month to discuss the mastectomy, but I'm completely lost on what my options really are when it comes to reconstruction. I don't feel confident about the DIEP flap at all. I'm short, weight 97 pounds and wear about a size 0 these days. I'd love to fatten up for it, but I now essentially eat nothing but vegetables, fruits, non-dairy milk and whole grains because I'm scared to eat anything considered inflammatory and I'm exercising more than ever. However, my understanding is that implants won't look good after having had the radiation. I don't want large breasts anyway, I'd be comfortable with an A cup - just enough to have a feminine figure. Any input, suggestions or experience with reconstruction after radiation would be very helpful.