Scar revision surgery questions

akmom

Hi all, looking for some feedback from those of you who have had MX with no reconstruction.

My double mastectomy (August 2018) did not have a great cosmetic result and I have been approved for scar revision surgery. Was just assigned a surgery date of June 10th. It's been many months since my consultation with the plastic surgeon, at which time we discussed my wish for a “flat” chest. There are some folds and bulges toward the underarm area on one side, which the surgeon noted. I also pointed out the ridges of what is clearly breast tissue below my scars (both sides). However he didn’t seem to acknowledge these bulges as a problem requiring revision.

Is it reasonable to expect that the revision surgery should give me a true “flat” result? I hate the bulges - they are different sizes, for one thing, and the tissue feels swollen and uncomfortable whenever I get hot flashes (almost 15 years into menopause and they never really stopped, now on Letrozole, so...) Besides that, I am concerned at the large amount of breast tissue remaining, which it seems to me could make a recurrence more likely down the road.

Hoping this will be the last surgery and really want to get it right this time! Have any of you had additional breast tissue removed as part of a scar revision procedure? Or have you any recommendations regarding the surgery?

Thanks everyone - and in the words of our province's chief medical officer, “be kind, be calm, and be safe” xx

xxyzed

My initial mastectomy was skin sparing as I was undecided as to reconstruction. This left me with large side boobs under my arms. I went on to decide I did not want reconstruction and had a second surgery to remove the spare skin. The resulting scars extend around to my back. I have flat under my arms and am pretty flat on my non-cancer side with a bigger ridge on the cancer side. The cancer side is fibrotic tissue from radiation and previous cellulitis and is also puffier from truncal lymphedema. It is a lot softer now many years after treatment/surgery and many years of physio therapy.
While it is reasonable to expect a flat chest it may simply not be possible if you have underlying fibrotic tissue or lymphedema in the area but it can be improved.

akmom

Thanks xxyzed, this is veryhelpful.

KARW41

I wondered about this. I am 17 days out from a bilateral mastectomy, going flat. The surgeon really specializes in oncoplasty (I'm not getting that) and she made some remark that it may not be possible to get to "totally flat," noting the skin/fat under my armpits, I guess. I already had a lumpectomy and can see what she may mean. She was also displeased with the San Francisco surgeon's lumpectomy incision, acting as if that surgeon did not do a good job, leaving her with a difficult task or less pleasing result most likely. I have zero doubts about going flat at this point, after seeing the longer recovery time of reconstruction, and I have never been a big fan of having breasts, never had kids, always been on the athletic side, divorced, hope to never get married again etc. But this is one factor that would bother me, as I read above that surgeons can leave breast tissue in there, still?? I truly hoped they would be able to get all of that tissue out...... I had 9 cm of DCIS, small breasts, and they could not get it all with lumpectomy. Wondering: does the above post mean that it is difficult to get insurance to fix it if the first surgeon does not get things flat or without a lot of lumps remaining in there?? I have no idea yet what I'm speaking of, since my surgery is not until July 1, but I can see that this would be a concern for me also, if they leave a lot of tissue in there or don't get it flat.

buttonsmachine

I might be able to shed a bit of light on this. It is not really possible to get *all* the breast tissue out without doing something quite extreme, like I had (chest wall resection). Even on me there is still a bit of breast tissue left below my collarbones.

Also, if you remove a lot of the breast/fat tissue under the skin, you will be very concave with ribs jutting out, not smooth and flat. There can also be blood supply problems. I literally just have a thin piece of skin adhered over several ribs.

I guess what I'm saying is that it's a delicate balance. I also agree with what xxyzed said - the flat and smooth look is sometimes hard to achieve if there are lymphedema issues, scar tissue, and other troubles. Best wishes.

Aussie-Cat

Surgeons usually try to remove all the breast tissue but some fat tissue can be left - it can look and feel unpleasant but doesn't increase the risk of recurrence if it's only fat tissue. I would like to have revision surgery to smooth out the lumpy bits somewhat but the Australian public health system is so slow.

buttonsmachine

One option I have heard helps (although I have not tried it) is if you have your breast surgeon do the mastectomy, and have a plastic surgeon close up or do the revision surgery. Best wishes to you.

akmom

I had my surgery two days ago; haven’t had a proper look at the results yet but it feels like I have lost the worst of the lumps and bulges. (A general surgeon did the BMX and a plastic surgeon performed the revision surgery.)

I have also heard that the best option is to have a breast surgeon to do the mastectomy and a plastic surgeon present to “finish”. Haven’t heard from anyone who had that done. Would have certainly preferred not to have to go through this second surgery. Luckily for me, here in Canada, both surgeries were fully funded by our medical services plan so there was no cost to me.

KARW41, I too had zero doubts about going flat and have not regretted my decision for one second. Best of luck to you

akmom

Final follow up appointment with plastic surgeon today. He was happy with my healing progress. I am pretty happy with the results - not “perfect” but a big improvement. He feels the prosthetics will be more comfortable for me to wear without the ridges that were below my scar line before this surgery. Not that I ever wear them anyway

I took the opportunity to ask if if having the plastic surgeon present to “finish” at the time of MX would have been an option. He said no, in most cases it wouldn’t be approved (I am in Canada and don't pay out of pocket for any of the treatments or surgeries). Apparently it's a time management thing, where it wouldn’t be cost effective. He said in the US it might be different, depending on insurance- of course if you pay privately you can get whatever you want.

Miriandra

Breast surgeons in general are getting better about taking requests for flat presentation seriously and doing a good job with leaving a clean looking surgical site. (Several high-profile lawsuits for not following a patient's contracted care plan have started that trend.) My doc was very experienced with going flat, and a plastic surgeon wasn't necessary. If your initial surgeon isn't keen, perhaps they can recommend a colleague who has performed more flat procedures?

ELW412

I had a bilateral mastectomy 2 weeks ago, no reconstruction. My question is about the uneven appearance of my chest now. One side is fairly flat. The other (which had the ILC) is very swollen toward my mid-line and I am beginning to feel a long "lump" under the scar. It is sensitive but not painful. I have tried using ice packs to help get the swelling down, but it doesn't seem to do much. I don't go back to my surgeon for another 2 weeks. I don't have a fever or any redness so I don't think it is infected. Should I worry about this side not healing like the other? Is this just part of the healing process? Thanks!

LivinLife

I had an aesthetic flat closure and the surgeon did a very good job. They are unable to remove all breast tissue though try to... My GYN said it's not like breast tissue is blue and they can then remove all the blue tissue.... kind of an odd remark though I got his point. Anyways... after my surgery I had some hard lumps and bumps under the scar line and under my armpits - scar tissue, etc. Physical therapists would not touch me - even 6 weeks after surgery due to healing issues I have. A lymphedema therapist was willing to do very light myofascial release on these areas and they smoothed out beautifully!

ELW412

Thanks, LivinLife! This helps a lot. I will just wait until I see my surgeon again unless things change drastically before then!

(BTW, I can't wait to get a massage again! So many things have fallen by the wayside due to Covid and cancer.)