Reconstruction or no?

ARmom4

Hi everybody! I saw my breast surgeon today and I chose to go with a double mx. I'm having trouble deciding on reconstruction. I'm really leaning towards going flat because I'm worried about future complications from the implants. Also, the self esteem part of it. I feel like it won't bother me personally but I'd be worried how my husband would see me. He says he won't care, but I know that we won't know how we feel until it's real. I'm reaching out for your experiences to help give me different perspectives. Your knowledge is soo helpful! Thanks ladies!

Cpeachymom

AR- We’ll, you could always try going flat and if you decide it’s not for you, you could do delayed reconstruction. I’m not sure if there is a time limit, but I started my recon about 16 months after my mastectomy.

ARmom4

Cpeachymom:

How does that work? It seems a lot more difficult because I won't have the skin anymore. Does it involve grafting and what about the nipple?

MinusTwo

No - you tell your BS that you're considering recon later so they do skin sparing mastectomy. However if you have to have radiation, I believe it's easier to put the expanders in first.

I'm assuming since your HER2+ you'll be having chemo first? That will give you more time to research. There are lots of "flat & fabulous" threads.

I chose silicone implants so I could just pull on my clothes and go. But what works for you is the best options. I understand it's a hard choice.

blah333

My mother had reconstruction, I remember the first time I hugged her after her surgery and I felt like there was a wall between us. Breast cancer ruined hugging my mom I didn't want to have that wall on my chest OR mess up other parts of my body to make mounds. My mom does look nice in clothes, albeit a little unnatural. The reconstruction process was frustrating and required a few revisions but my dad has been impressed (visually) with the surgeons work, yet he also expressed disappointment to me that she doesn't feel anything when they are touched. A lot of men are understanding and take whatever comes or accept the new/altered you.. but some don't handle it as well. Hopefully your husband is a good guy. You have to do what will be best for you and make you feel the best in your own skin.

I got a bilateral mastectomy at age 35.. sucked to have to go through it but I am used to my body now (other than lymphatic issues). Though being flat is compatible with my body type, I just look more lean. I'm sure my profile seems a little odd at first glance for some people but nobody stares or has said anything or asked. I have always had trouble falling asleep at. night and sleep on my stomach and didn't want anything in my way (my mom told me to learn how to sleep on my back...nah). .also, reconstruted breasts just seemed like an insult to my real, natural ones. If I couldn't have mine I'd rather have a blank space there. For some reason I'd feel more self conscious in sexual situations with reconstructed breasts than a blank chest (scars are fading a lot). My current sexual partner doesn't seem to mind, though reconstruction or going flat, it is a loss either way for us, in that department. Sometimes I see myself in the mirror and am surprised I'm still able to be 'hot" without breasts. It's not as bad as expected and I"m starting to forget what it was like to even have them. Our culture's obsession with breasts seems increasingly ridiculous and stupid. Dealing with the loss of 2 lymph nodes and having to get biopsies for possible recurrences has been worse than becoming breastless.

Anyway - look at some pictures online, see what "resonates" with you. I gorged myself on flat pics (instagram hashtags like mastectomy or flat and fabulous, I forget) just to prepare my mind of what was in store for me. It also helped me realize I wanted horizontal scars, not diagonal lines. I talked to my surgeon about that and made sure they knew I wanted to be absolutely flat and to not leave any extra skin behind (skin sparing mastectomy, intended for later reconstruction). It IS possible to find a surgeon that can make it look good. Nowadays they can make the incision line quite neat. I was surprised and relieved when I undid my bandages. Choose whatever is right for you, and don't let doctors manipulate you in one direction or another. You're the one that has to live in your body, not anyone else.

HeartShapedBox

I struggled with the decision also, because i felt like the idea of reconstruction was pushed pretty heavily by all my doctors. But ultimately decided to stay flat (well, half flat for my unilateral mastectomy). Unless you like to wear a lot of low cut shirts, you can still always "look good under clothes" with removeable fakies if you choose. At the end of the day, I realized that only myself and my committed partner will be the ones looking at my naked boobs or lack thereof, and since both of us liked the look of flat (esp compared to the look of fake), and REALLY liked the idea of less risk, cost, time, and pain, that's what I chose.

I have to say, now that I'm recovering 3 weeks after surgery, I cant imagine being in even MORE pain than I have been already with expanders pushing on all that traumatized tissue (as many in my surgery group are!) Women doing reconstruction face many more painful fills and other procedures after their mastectomies, and often seem to deal with lopsided foobs and other issues needing even more corrective surgeries trying to get a good result, whereas i'm glad to just be be DONE and hopefully able to sleep comfortably again soon!

ARmom4

MinusTwo: Right, I forgot about the skin sparing part! My mind is all over the place. We're doing surgery first, then chemo after.

Blah333: My husband is a good guy. Even if he does have problems when it happens I don't think he'll let it show. I just feel like I want my chances of another surgery or problem to be as low as possible and with implants you never know!

HeartShapedBox: I would feel totally fine (i think) with just prosthetics. Like you said, only my husband and I would see them. I also like the sound of shorter recovery. I have 4 kids. The youngest is 4. I need a quicker and less painful recovery.

Thanks for your thoughts ladies!

simv1

Hello, just diagnosed and meeting with breast and plastic surgeon in a week. Trying to gather info and understand ins and outs of going flat vs implants so I can decide what is best for me. Any tips on what to consider are much appreciated.

JRNJ

Are you too skinny for DIEP? I was told initially I was. Than after failed tissue expanders due to infection, and decision that I need radiation, I am suddenly not too skinny for DIEP. I went for second opinions at Rutgers and Sloan for chemo and both drs looked at me and said you need to get DIEP, forget implants (and who cares if you are an A cup). Which I found a little insulting as it is my choice how big I want to be. It seems to be the preferred method of reconstruction. If you go on NOLA website they list it first. I am making this decision this week also. I was going to try implants one more time, but have decided DIEP is the best option with possible implants also. I don't want to delay my radiation. And I have 6 months to gain more weight and possibly avoid implants. If your dr. doesn't do DIEP, you should get second opinion. If you think flat is for you, my foam stuffed sports bras are really comfortable and lightweight and cheap and look good, lol.

RatherBeSailing

I would second JRNJ about considering DIEP. A bigger surgery and longer process, but looks and feels natural and once it's done, it's done - no worries about implants leaking.

I was also told by first plastic surgeon I didn't have enough abdominal fat for DIEP, but a second PS said he could do it by using both sides of my abdomen - called a stacked DIEP. I'm a bit smaller now (and why do they always presume we want to be bigger?) but he lifted and reduced the other breast to make them match. He also did a nerve graft in the new breast - no nipple sensation, but it does feel like part of my body. All in all, it looks great and feels quite natural - even have a nipple and tattoo on the new breast.

Not certain about doing skin sparing without having temporary tissue expanders to fill them out - seems you'd have a lot of slack skin? Might ask your surgeon.

There are many options. Go with what you feel in your heart is best...

SimoneRC

Dumb question. Just curious.... Can DIEP be done with skin sparing or do they always take the skin from the donor site and move it?

RatherBeSailing

Not dumb! Yes, DIEP can be done with skin sparing. If there is not enough skin, or skin is damaged by radiation, they can use donor site skin.

SimoneRC

Thank you, RatherBeSailing!

ARmom4

Hey ladies! I decided to go flat for now. I want the shortest recovery time so I can start my other treatments (chemo and targeted). After I'm done with that, I'll go back for DIEP. I do have some fat on my stomach I would like to put somewhere else! I am just not comfortable at all with the risks that come with implants. I want the option with the least amount of cons. Staying flat for now allows me to just move on to chemo after surgery. And later, maybe a year or so, I have a chance to sort of get a makeover when I feel better. So that's where I'm at. I get my appointment date for surgery tomorrow. I think I'm ready.