Advice on double mastectomy and breast reconstruction surgery

Bubblybubbles_1

Hi everyone. I need help deciding what to do with my surgery coming up in Feb 19th 2020.

A little background before I jump in to my question. I live in Toronto, CA and I am 37 years old and was diagnosed with breast cancer in 2018. Unfortunately, I was diagnosed within 10 days of giving birth to my daughter (c-section). Since I had a very aggressive cancer type, my oncologist started with 8 rounds of chemo therapy, lumpectomy to remove the tumor and 31 rounds of radiation that was done in January 2019. I am recovering very well. I wanted to get double mastectomy and immediate breast reconstruction initially but due to radiation, my doctor told me to hold on to my big surgery plans and do it later once I am recovered. Fast forward to August 2019, I met with my plastic surgeon and she put me on the waiting list for the surgery. I finally got my big surgery date and I can't wait to be over with. At the moment, I am on Tamoxifen, Metformin, Synthroid and goserelin injections (monthly)

As I mentioned earlier, I have an 18 month old daughter. I am having very hard time loosing weight. I came across Liposuction article and thought to ask my doctor is it is possible to get it done at the same time of the surgery. Is it safe to get it done along with the big surgery? Anyone has experience about this? I am kinda embarrassed to even ask my doctor. Since this is Christmas time, I will not be able to book an appointment with my PS anyways. I will call and make an appointment for next month but I really want to know if someone else has done this. Appreciate your help.

ScatteredEnergy

When it comes to cancer patients I don't know. But I belong to a tummy tuck group on FB and many women have everything done at once, kind of like a mommy makeover.

Bubblybubbles_1

ScatteredEnergy : Thank you for responding. I understand that it's difficult to answer this. I do like the idea of mommy makeover though. I will ask my doc that but I am not interested in tummy tuck. Just getting the idea of reducing my love handles. I am not overweight actually. 160lb at the moment but my body is totally out of shape. With boobs not same, I have lost confidence.

Brilee76

I had immediate reconstruction/straight to implant during my bilateral mastectomy surgery. I'm going to have fat grafting done to fill in and shape my "breasts". My PS is going to perform liposuction on my stomach for the needed fat.

Bubblybubbles_1

Brilee76 : Thanks for responding. So I am a bit confused. What is fat grafting? Is it similar to Lipo? If so, can it be done during the big surgery? I am thinking to get it done during my surgery and not after

Brilee76

During fat grafting they basically perform liposuction from an area where you have fat to take from and then inject it into another area. In this case, my chest. Kinda like skin grafting but with fat. lol

April0315

I’m so curious how this turns out. To be honest I would really like to have an eye lift and was too nervous to ask my PS if we could do it at the same time. Obviously that would be an out of pocket expense. I guess it just felt too vain for o ask about. I’m supposed to be worried about cancer, you know.

Good luck to you!

WC3

This would be something to talk to the plastic surgeon about. If you are having DIEP reconstruction, that is essentially a built in tummy tuck.

Beesie

What type of reconstruction are you having?

If it is implants, you need to consider the recovery and how you will manage having two different areas of your body affected. I've only had implant reconstruction, so I can't compare, but from reading here, my impression is that the recovery after autologous reconstruction - DIEP or GAP surgery in which fat, blood vessels and muscle are harvested from the stomach or thighs to create the new breasts - is much longer, more difficult and more painful than the recovery from implant reconstruction. I'd expect that liposuction would not be as severe a surgery as DIEP or GAP, in terms of how it would impact those body parts, but I know from friends who've had liposuction that it can be painful and they have to wear compression garments. How would you manage having both your upper body and lower body compromised and restricted in movement for several weeks?

If you are having a DIEP or GAP surgery, having liposuction at the same time might have less impact on your recovery. Still, if you are having a DIEP (stomach) and you want liposuction on your thighs, that is impacting a different part of your body.

Which hospital are you at in Toronto? I was at PMH. The plastic surgeons there specialize in breast reconstruction and are expert at both implant and autologous reconstruction, as would be the PSs at other cancer centres such as Sunnybrook. Therefore I would imagine that they would be very familiar with liposuction but I don't know if doing a straight liposuction is different from what they would be used to doing when they do a DIEP or GAP. One of the considerations is whether the same surgeon would do the procedure or whether another surgeon would have to be brought in for that part of the operation - you don't want someone doing either procedure who isn't totally familiar with it and doesn't do it regularly.

With all that, I think it's definitely worth asking the plastic surgeon about. It's nothing to be embarrassed about; once you are in having major plastic surgery, it makes sense to ask about other things you would like to have done.

Bubblybubbles_1

Beesie : Thank you for your reply. I am having silicone implants and hoping to stay the same size (34C currently). I will be having the surgery at Cambridge Memorial hospital. My PS is Dr. Stephanie Ma. I am not having DIEP FLAP surgery. I don't have enough stomach fat to create C cup. My PS is really good actually. She has lots of good reviews and very experienced. I totally trust her. I need liposuction on my love handles. My waist is so big compare to my chest and legs/hands. It's totally out of proportion. I am dealing with this issue forever actually and I am just ready to get rid of them for good. I will obviously continue my exercise routine 4X a week as I know it's not a weight loss surgery. I just wanted to know if it can be possible to do with the big reconstruction surgery.

WC3 : Thanks. I am not having DIEP flap surgery. I am going for silicone implants.

April0315 : Thanks. I will definitely let you know if I go through with this. I need to talk to my doc about it though first

Brilee76 : I see. Isn't that the same as DIEP flap surgery?? Sorry, consider me new to medical terms here.

Lucyred

When I had my final implant surgery after the expanders I had lipo on my arm pits. I had to pay for it but it was cheaper then going in separate for it.

I also just had an abdominoplasty (tummy tuck) and lipo done with my nipple reconstruction just 10 days ago. I paid a half of what it would have cost to go in separate to get this done.

Don't be afraid to bring up any additional work your PS can do for you. It's what they do. Good luck to you.

Brilee76

It's my understanding that both skin and fat are taken for DIEP. I already have silicone implants. The fat grafting is fat only to make them look less implanty for lack of a better term. Without breast tissue, the implants are unappealing in my opinion. There are a lot of sunken in areas on my chest and a huge, flat area between my implants. Right now, it looks like implants with skin just stretched over it. When I lean over you can see the implant rippling beneath my skin. The idea is to inject fat between the skin and the implant to hide the rippling and make the breast area look more sloped and natural as opposed to the current round object under my skin.

Bubblybubbles_1

Lucyred : Thank you so much. You reply made my day. I was actually worried about the cost and recovery time. I will be applying for short term disability benefit and I will be getting 3 weeks off from work and to rest. Hopefully I am eligible. I made an appointment with my doctor in January.

Beesie

DIEP is an extremely complex micro-surgery that creates a new breast using blood vessels, skin and fat from the lower abdomen. Fat grafting simply takes the fat from another part of the body and injects it into the breast area to create more fullness. Very different procedures.

lkc

i did bilateral silicone implants 6mos after i finished rads without any problems...

off topic a bit , but was wondering as you are HER2 pos, did you do Herceptin?

Bubblybubbles_1

ikc: yes . I had herceptin rounds for 1 year after I was done radiation. It’s not that bad compare to chemo

Bubblybubbles_1

Hi everyone. I thought to answer and update my own post here so we all get to be updated. More information the better in our cases. Anyways, I had my double mastectomy with skin sparing nipple sparing surgery in February 2020 (before covid hit). I had silicone implants inserted as both my breast sizes were different, my surgeon added bigger on right and a bit small on left. My results are okay. Radiation made it worse. The entire implant contracts sometime and because of that the skin on the right side has become very very tight. Both of my breasts are not aligned due to radiation side effects.

I did not had the mommy makeover surgery. My surgeon mentioned that the surgery was 7 hours long and they can not risk putting me under anaesthesia for a very long time. Please ask me any questions you might have.

Thanks.

Trishyla

Just to clarify, Bubblybubbles _1, it is not a "Mommy Makeover" surgery. I believe you are referring to Diep flap surgery, which is a highly specialized microsurgery to replace breasts that have been removed, mostly due to cancer.

It's highly insulting for you to equate it with an elective surgery done strictly for vanity. Do you think I chose to have my breasts amputated so I could get a Mommy Makeover?

Please call it what it is. Reconstructive surgery. Not cosmetic surgery.