Is mastectomy with immediate reconstruction typically an option?

CarolAnnieLumpLump

I am seeing my breast surgeon on Monday for the first time. I would like to have mastectomy with reconstruction at the same time if it is possible. There on some on here who have had this done. Did you have a gen surgeon and a plastic surgeon working together or are there surgeons that do it all alone? Are there certain conditions that allow this type of surgery? Is this crazy to even consider? All these decisions are so confusing.

dtad

Hi there. Reconstruction at the same time of surgery is common. Not sure if you are speaking of direct to implant reconstruction or TEs. Usually a beast surgeon and plastic surgeon work together. Good luck and keep us posted.

Lula73

yes it definitely can be done! Not crazy at all. Options include direct to implant or natural tissue reconstruction. Note that not all PSs do immediate recon, so if the one your getting ready to see says it can't be done or they don't do it, just move on to another. I did the immediate natural tissue recon. Breasts are soft & warm and natural looking. Would do it again in a heartbeat.

SpecialK

chikita - initiating reconstruction with expander to implant at the time of mastectomy is very common, and some are candidates for skin and nipple sparing mastectomy. Direct to implant is also an option, but the candidacy for that procedure is more stringent. Direct to implant is usually done for those who are smaller busted, wish to remain original size or go smaller, and is subject to skin and pectoral muscle integrity. Assessment for candidacy can be done by a plastic surgeon, and not all are willing to do direct to implant - some because they don't routinely do it, others because they feel they get a better result from expanders to implant. Both of these types of procedures are done by a surgeon - preferably a breast surgeon - and a plastic surgeon. The breast surgeon is responsible for removing the breast tissue and checking the sentinel nodes (SNB) and the plastic surgeon accomplishes the expander placement or implant placement, and closes the incisions. For patients who prefer autologous reconstruction using a flap or tissue from another part of their own body, this too can be done at the time of mastectomy, but the combination of docs is a breast surgeon and a micro-vascular plastic surgeon. This type of procedure is done by fewer plastic surgeons so you may have to travel to find the right type of physicians. Something many of us encounter is plastic surgeons sometimes only offer the type of surgery they do - you may have to actively search for one that specializes in the type of surgery you want to do. Good luck!

mountainmama406

I happened to luck out and had a plastic surgeon who does this. Both surgeons work together, it was about an hour for mastectomy and 2 for reconstruction. In my case I didn’t have to do radiation, which can mess with your skin quality and maybe be a factor in your options for reconstruction? Very happy with my resilts

CarolAnnieLumpLump

Thank you ladies for your responses to my question. I am looking forward to getting some answers on Monday and will post what I find out.

Lula73 & SpecialK- your tip about maybe needing to look for a surgeon that will do what I want is a good one. I am anxious to get the tumor out of my body so I appreciated your comment about finding someone that fits what I want and not just going with what the first one is capable of.

Mountainmama406-Thanks for letting me know the timeframe yours took, I was wondering about that. That doesn't seem like too long at all. I was thinking it was going to take all day or something!

Dtad- I am thinking implant...I don't know what TE means. lol total newbie. I like what Lula73 said about the natural tissue feeling natural.

So many things to consider and I feel this sense of urgency to get the thing gone and find out about my lymph nodes!!

Thanks again ladies. Hearing your comments made my day easier.

xo

Lula73

almost all BC is slow growing. We all know that feeling of urgency to get it out, but the reality is that waiting a little longer does not have a significant impact. Most women have 4-8 weeks between diagnosis and surgery. Here’s a link to the center I traveled to for Natural tissue recon. Be sure to check out their before & after photos...before & after tell the story of each PS. Before selecting one be sure that you’ve seen their work and you’d be genuinely happy to have the results in the photos for yourself (and not just considering you’ve had BC). If not, keep looking for a PS. There’s a great video on their site titled ‘I wish I’d known’. It’s an excellent resource for anyone considering recon of any type. Feel free to ask any questions you think of!

www.breastcenter.com

beach2beach

I had direct to implant at time of surgery. My BS and PS worked together. Surgery between both was 4hours. I was unable to do fat grafting,,not enough fat but I was happy to not have endure expanders and a swap surgery down the line.

NotVeryBrave

I think more and more women are able to have this surgery although it's sometimes not presented as an option initially. When I discussed it with my second opinion BS - she referred me to a PS that could do it. It was a bit of a hurdle to find a time that they were both available and the OR was open and staffed for four hours.

I had my surgery after finishing chemo. The initial tumor was far enough away from my skin and nipple that I was able to keep all of that. My incisions were under the breast and really don't show now. And I was able to avoid radiation.

Meow13

My DIEP with lift on other side was a little over 10 hours. My mastectomy done 4 months earlier was between 2 and 3 hours.

LisaK12

I had a double mastectomy and sentinel node biopsy with immediate, direct-to-implant reconstruction. The whole thing took about five hours, and I was in the hospital for two nights. My breast surgeon and plastic surgeon worked closely together. I was a large C cup before and am the same now. I was THRILLED to avoid tissue expanders (TEs). Recovery was not bad at all. Definitely recommended if you are a candidate.

CarolAnnieLumpLump

lisak12, thank you so much! I am so sorry you had to go through all of that. Iwill be asking the surgeon today about doing this for me. Others had mentioned only smaller sizes. Mine are DD now but i would like a nice C for sure.

ReadyAbout

One thing to consider: prepectoral reconstruction. This is a newer kind of reconstruction and can be done direct-to-implant or with tissue expanders. In this reconstruction, implants are placed above the chest muscle instead of under it, so your recovery time is quicker and there are fewer issues with regaining range of motion in your arms. Not everyone is a candidate for it, but a friend had prepectoral with direct to implant in January and is very happy with the result; I had it done last month but with tissue expanders and I was back to some form of daily exercise within a few weeks post-op. (Having said that, I cannot emphasize enough what a brutal surgery and recovery this is - I exercise because it lifts my spirits - not because I feel great.) My PS does not like to do direct to implant because he wants to see how the tissue responds to surgery and also, I had too much droop (thanks kids) to do direct to implant. In my case, it was good that I didn't have direct to implant. The tissue on my left side had issues with healing and was in danger of becoming necrotic, so I did 10 sessions of hyperbaric oxygen therapy and the tissue healed beautifully. Look for a PS who doesn't seem rushed, listens well, and takes time to explain things - you'll end up spending way more time with the PS than the BS after surgery.

msphil

yes sweetie I had it done also quite common. Stay Positive. God Bless.msphil idc stage2 0\3nodes 3mo before and after surgery Lmast got married our 2nd then 7wks rads 5yrs Tamoxifen

SLL101984

It absolutely can be done and that was my plan going into the operating room. However I left the final decision up to my plastic surgeon once she was in there. BS did her job and the PS was waiting to step in as soon as it was done. I was a small B cup prior to surgery and I was out for almost 9 hours (they said about 4-5 hours going in so my family was very on edge by the time I came out). I did end up with expanders which I’m happy about because my skin was showing signs of stress. They were left empty at time off surgery and allowed everything (including my nipples) to heal well. They have not been as bad as I thought they we’re going to be either. A little soreness here and there in certain spots but I was worried I would constantly feel like these foreign things were in my chest and I’ve actually forgotten they were in there sometimes.My PS also said by going this way she will be able to play around a little bit during my exchange surgery.

Macushla

I had this done in April and I have to say it is amazing. My sister had a DIEP flap 17 years go and could not get over the dfference in our surgeries. My surgery was 4 hours. Breast surgeon did the mastectomy and SNB and plastic surgeon worked his magic with a silicone implant (I am a 40C, well endowed, and they did a outstanding job. Prepectoral implant wrapped in biomesh. Nipple sparing and skin sparing. All those years of taking care of my skin paid off.) Because of where my tumors were I have a fairly large scar from my left nipple directly to the side of my torso. But, he put a PICO dressing on the wound and when it was removed two weeks later looked like a scar that was a couple of months old - I could not get over how good it looked. There has been some tightness, uncomfortableness, but I worked through it and almost 3 months later I would say i have 90+ range of motion the swelling is mostly gone, just some tenderness on my side where the drains were, and mild lymphedema. Can we post pics here? I would be willing to do that as an example for what it would look like. I would have appreciated a concrete example of a post surgery pic from soneone who had exactly the same procdure. If you want to see, I can email you I suppose - help relieve any anxiety you may have about it! :-)

I refused infusion chemo completely and just yesterday had my initial consult with the RO - who does not have experience with this type of surgery (I live in a fairly rural state, just over 1million people overall) and we talked a lot about capsular contracture should I choose to do radiation. Interestingly AND NOT OFTEN MENTIONED IN DISCUSSIONS ABOUT THIS PROCEDURE the implant with the biomesh protection is less suceptible to capsular contracture as unlike with pectoral muscle, there is no vascular system runnig through the mesh - no blood vessels to contract and thus much less likely to constrict and rupture. This is a huge plus. I didn't know this until yesterday, but it is making my decision about radiation a lot easier.

So def there are surgeons who do this, and let your surgical oncologist know you are interested - they may be able to specifically look for a plastic surgery practice that does this. GOOD LUCK!!!

Meow13

DIEP is intense microsurgery usually requires 2 plastic surgeons. Mine was 10 hours long also had lift on other side I didn't have an implant it is all my own tissue.

Lula73

I chose DIEP because it looks and feels the most natural. The DIEP breasts are warm and soft. They will age naturally with me. I was 44 and plan to be around a long time so implants would need replacing. I've seen too many situations where the implant shifted into the collar bone area, into the abdominal area, over to the side under the arm. How long do you have to live like that before they can get you in to fix it? And you know those surgeons assured those patients it wouldn't happen. I would do DIEP again in a heartbeat.

With all that being said, selecting a good DIEP surgeon is important. Just because a dr is trained to do the procedure in no way means he does it well. The individual surgeon's before and after photos tell a great story. When you look at the before and afters ask yourself if you'd be happy to have the results you see in those photos (not just happy considering you've had BC). If the answer is no, keep looking for the right PS. You should be happy with the results, you should feel comfortable changing in the open at the gym and spa, comfortable being intimate with your husband topless, comfortable looking at yourself in the mirror. I am amazed everyday when i look in the mirror. I even wear a low cut bikini to the beach/pool.

Here's a link to the group referred to as NOLA on these boards. Their before and afters are the real deal (I'm living proof-yes I traveled from NC for them to do the mx and DIEP). If the PS you're meeting with doesn't have pics that rivals theirs, keep looking. And be sure to focus on the abdominal scar (is it located nice and low, how prominent or not is it, etc) as well as what the breasts look like when viewing any before & afters. There is also a great video on their site called 'I wish I'd known' that's great for any woman undergoing surgery for BC regardless of where she's going for her surgery.

www.breastcenter.com

Come check us out in the 2017 & 2018 DIEP threads! There's a list of questions to ask any potential PSs on those 2 threads as well that you'll likely find helpful.