BMX with FLAT reconstruction AND Nipples (Free Nipple Graft)

cyathea

Everyone deserves a choice about what happens to their bodies during surgery. Only two options were presented to me: BMX with reconstruction and BMX without reconstruction. That's it. I knew about the brave women who offered a third option of "flat reconstruction", but my first plastic surgeon didn't offer that. Even if he did, it would not be for me. When I looked online at the no reconstruction/flat reconstructions that others have, I realized that, for me, not having nipples would mean that I had a disfigured, mutilated chest. I do support and applaud those who go flat and don't feel the need for nipples. I think that all choices should be equally accepted.

Most women won't make my choice, but I feel that surgeons (both oncologist and plastics) should offer this third option so that it is at least something for a woman to consider. If I could have had a lumpectomy, I would have. A typical reconstruction is not a good choice for me. I don't want to have implants now and then have to swap them out in 10 years. I don't want multiple surgeries that would require additional time off of work. I love my work and want to get back to my "normal" life as quickly as possible. I don't want to risk additional complications to do a DIEP procedure even if the complication risk is low. If I were younger, if my cancer were different, I might well make different choices, but for me, now, I want a BMX with a reconstruction that includes nipples but not the complication of creating breast mounds.

The first plastic surgeon that I met was very nice, and I know that he is a good, well meaning doctor. He spent a very long time with me to review the reconstruction options of implants and DIEP surgery. I am grateful for that education, but when I told him that what I really wanted was to have a flat closure and to look as good as possible without breasts, he told me that he couldn't do that and that insurance would not pay for it. He said that any oncologist surgeon could do a "close" and that there would no need for the skills of a PS. (Actually, insurance WILL pay for this.) He also told me that most women who had a flat closure were not happy with the results even when they had initially said that they wanted a flat closure. Thus, he would not do the surgery.

I was disappointed after that meeting, but I wasn't born with a strong will for nothing! I did more research.

I saw pictures of female-to-male "top surgery" online and I thought: why is it that someone who "transitions" gets offered a fairly normal looking chest from their PS and yet women with breast cancer are not even offered this as an option? To me, being flat is not male, female or even non-binary. Many athletic women have very small breasts and I think they can still be seen as feminine. The difference to me is that these women have nipples. To me, nipples would make me feel more normal and "whole".

To be clear, I do not want an FTM male chest as a result of the BMX. I am a happily married heterosexual. I intend to wear prosthetic breast inserts when I am in public after surgery because that is what makes me feel pretty and feminine. To me, a prosthesis is the same thing as me wearing my wig, false eyelashes, makeup, or a push-up bra. Yes, I will miss my breasts, but I was happy with my body as a child and I can accept a flat chest again. For at least the first decade of my life when I looked down on my chest, I was "flat" but I had nipples. I think looking down on nipples is better than looking down and seeing nothing but scars. (Tattoos are not for me, but if my nipple grafts fail I might consider having a nipple reconstruction or a nipple tattoo.)

I am very grateful to those in the trans community for their willingness to share their experiences online. Without their contributions, I would not have had the information necessary to explain what I want for this third option for surgery. One great example is Britta/Bode Riis who posts videos under the name "SharpLeft": https://www.youtube.com/watch?v=V3QqVEcSs1c I think it is also helpful to realize that it might be 1 or 2 years before the scars fade and my chest looks more normal. It is also good to note that a BMX whose purpose is to remove cancer is not the same thing as FTM top surgery. Due to my current body, breast size, tumor size and other factors, I might not be able to achieve the great results that Bode had, but I would like my surgical team to at least try to achieve this. (I don't want dog ears, lumpy fat, or a concave chest. I want a chest that is as aesthetically pleasing as possible.)

Has anyone else requested a flat closure with nipples of their surgeon/PS team? Fortunately, my oncologist surgeon found a PS who can perform the surgery that I want. (My oncologist surgeon has been fantastic from the very beginning.) I would love to know if anyone else has gone this route. I have questions about how to choose the right size for the nipple/areola and the correct placement. (FTM surgery usually has a smaller areola (22 mm) and the nipples are placed further apart.) My surgery is planned for March. Please send me a private message if you would like more details.

Nana2-8

Having recently been pushed down the avenue of meeting with the Team = surgeon, MO, RO - and scheduling surgery, etc., I have digested the conversation that the surgeon presented to me. He was talking fast, drawing diagrams, etc and said the phrase "partial mastectomy" (when I think I blanked-out!) and also "nipple sparring"...and "move tissue around". I am not able to meet with him until maybe a week before my surgery (4/14) since I am out of town. I DO NOT want him to think I want reconstruction because of the same concerns you have.....repeated incisions, office visits, .....my age....and simply hoping to get this part behind me and do the work of 'getting on with life'. Are you getting the feeling that the latest approach from breast cancer surgeons is to assume everyone wants 'reconstruction'?

farmerlucy

Looks really good. The thing I like most about this whole ordeal are the 3D nipple tattoo I had done by Vinnie Myer in Baltimore. Since there is no feeling anyway, I wanted a smooth look. After seven years I rarely remember they are not the real thing. Also I don’t even own a bra. You might check out Hillary Clinton’s bio on Hulu. On it is a friend of hers from Wellesley. She has silver hair and wears a gray turtle neck. Totally flat. Totally gorgeous. Only a mx patient would notice her flatness. I’d take that in a heartbeat.

cyathea

Yes! Almost every doctor I have met presumes that reconstruction will be done. Even when I tell them that I want to be flat, they tell me that if I change my mind that I can have it done later. While I appreciate knowing that, it does seem to confirm that most people cannot understand why I am choosing not to do it.

Nana2-8, I hope you have a good team and I wish you the best with your surgery and recovery.

Farmerlucy, thank you for sharing your 3D tattoo experience. If my free nipple graft doesn’t work, I may be able to get a nipple tattoo. I’m not sure if there is anyone who does this in my area, but Baltimore is not too far to drive.

idkwhatsnext

I wish I had seen your message sooner. We both thought of a third option, AFT with nipple grafts, after only being given two options initially by our surgeons. Like you, I had to propose the idea and seek out doctors willing to do the surgery in a different way then they usually do. I also researched FTM surgeries to learn more about what I was proposing. Thankfully, I found a BS with oncoplasy training who had done many AFTs and a PS who had done many NSMs, They were both willing to do additional research of their own in order to provide me with the surgery I wanted. I had the surgery a little less than a year after you and I am currently still in recovery.

cyathea

idkwhatsnext I wish you well as you continue to recover. It is a long process for some of us. I’m one year from surgery and I still have issues with lymphedema and sensitivity when there is pressure on certain parts of my chest. (I don’t regret my BMX, but although I was able to return to work quickly, it does take some time to adjust to my life changes.)

I need to update my initial post from a year ago. From reading another post, it may not be necessary to replace implants every 10 years. That was the guidance when I talked to my surgeon, but science matches on and progress may give women different choices in the future