so many questions!

shanarose

Hi all. I am preparing for a double mastectomy with reconstruction. My plastic surgeon said that I do not have enough stomach fat for diep, so he recommend implants. He recommends implants over the muscle because I am active. Here are my questions:

1. If you have implants, are you happy with them?

2. Is this true that I may not be a candidate for diep? Isn't this the more "natural" option?

3. Which direction has less complications?

I would love any help/information you are willing to offer; I feel overwhelmed and lost.

Also, did you get a second opinion from another PS?

exbrnxgrl

1. Yup, very happy! My are almost 10 years old and I rarely think about them.

2. I was not interested in DIEP, however my ps wanted me to understand all of the options. I am petite and after examining me he thought I didn’t have enough abdominal tissue for two “breasts “ Some members have said that the surgeons at NOLA or PRMA can do wonders with us thin gals but they did not accept my insurance and again, I wasn’t really interested in DIEP. DIEP does use your own tissue, so is more natural in that respect .

3. Complications... I think each come with their own, I did not have tissue expanders as I had one step implants. I was truly one and done but often, regardless of which recon path you choose, subsequent surgeries may be needed. I think the DIEP recovery may be harder because you have more than one incision that is healing and it is a much longer, complex surgery than implants. I can’t emphasize enough that all forms of recon can have complications and multiple surgeries and there seems to be no way to predict them. I think my easy experience was not typical.

I loved my ps from the start. He insisted on educating me about every option, including pros and cons. I really appreciated the fact that he wanted me to be informed so that I could make my decision based on actual information. I did not seek a second opinion but encourage you to do so if you just want to hear another opinion. That can sometimes help to clarify things.

I have no advice one way or the other as there is no “right” solution for everyone. I would urge you to learn as much as possible as you go through the process. Yes, it’s a lot to digest, take small bites 😊.

MinusTwo

Shana: First - Whippetmom is the best resource for implants. If you'll read the header of this thread and provide the information requested, she will post back. Lots of food for thought in these pages.

https://community.breastcancer.org/forum/44/topics...

Second - I didn't have enough fat for anything except traditional implants. Mine are sub pec and I've never looked back. l'm happy with how they look & feel. The tissue expanders are a pain, but the result was worth it. But yes, I did get a second opinion before I committed. ALways worth learning more.

Pipandor

I did not have mastectomy or reconstruction but women facing those choices might find the following article useful.

https://www.medscape.org/viewarticle/945876?src=wn...

typhoon

Hi, shanarose! My bilateral mastectomy/reconstruction was just over 2 months ago.

1. Yes, very happy. My plastic surgeon did a wonderful job.

2. Like you, I am very lean and was told by two doctors that I was not a candidate for any of the flap procedures. The locations of my tumors meant that I was able to have a skin/nipple sparing mastectomy, with direct-to-implant reconstruction. My plastic surgeon went over all of the implant options, and we decided on the soft "gummi-bear" silicon implants. My objective was to look and feel as much like the "before" pictures as possible, and I think my surgeon succeeded. The implants feel very natural, and when I look it the mirror it's hard to tell that anything changed, other than the faint pink lines in the mammary folds and a bit more perkiness. My implants are placed pre-pectoral, and the surgeon created capsules/slings for them using Alloderm; in order to ensure quick healing and keep blood flowing to the nipples, she also used the Prevena wound vac system instead of traditional bandages, and as a result I was bandage-free (except for some gauze around the sites where the surgical drains came out) six days after surgery.

3. As others have said, with direct-to-implant you only have one surgical area (the chest) to heal. That said, any of these surgeries have complications. Although I didn't actually have a choice, I think that if other options were available I still would have chosen the route that I took. Because I wanted to stay the same cup size, I didn't have to do tissue expanders or a reduction, and I wanted to get everything done with in one fell swoop.

At the end of the day, you have to decide what your priorities are. My first priority was to look as much like me as possible; my second priority to was to be back on my feet and back at work as soon as possible, without the stress of additional procedures and surgeries. To be honest, whether my new breasts were composed of silicon or of my own tissue wasn't really something I was particularly worried about, but it is understandably a much more important priority to other people.

Wishing you the best of luck in your decision-making process, and all success with your surgery and treatment.

shanarose

Thank you all so much for taking the time to respond to my post. I will be looking into all of this valuabe informatlon.

DiveCat

1. If you have implants, are you happy with them?

Yes, I am. I have had implants (sub-pectoral) since 2014. I did direct to implant. I have swapped them a couple times (once due to rippling, another as I wanted to remove the Allergan 410s) and done fat grafting but I really don’t think about my implants much otherwise and don’t notice them. My current implants feel relatively soft, warm, and while they are fuller & rounder especially in upper pole, I am still the exact same size I was before surgery in 2014 as now (30E/32DD).

2. Is this true that I may not be a candidate for diep? Isn't this the more "natural" option?

I always wanted implants anyway, but I was also told I am not a good candidate. I am thin and don’t have much for a flap anyway. Honestly after seeing my mother go through DIEP I was not much interested anyway (she had some complications).

DIEP uses your own tissue so yes can feel “softer” but both are replacing breast tissue with something other than breast tissue. One comes from your own body, one does not

3. Which direction has less complications?

There is a risk with any, and you can’t predict if you will be one of the unlucky ones (though certain things raise risk, like being a smoker). My mother had DIEP and had some complications. I had implants and have had none. A friend of mine got implants and had to get one removed for infection and wait a few months. All you can do is learn about each and pick one best for you at time.

SkiviC

Hello everyone,

I am waiting to have my right tissue expander replaced after a nasty mycobacterial infection. I was told I needed to wait 3-6 months to make sure it's gone. That puts me at 10/21 for expander replacement. I still have my left expander. My physician would like me to consider the DIEP but I truly want least invasive and would rather just do implants and be done. He says I'm at risk for infection with alloderm and prefers not to use it but says it's still an option. Does anyone have any experience with alloderm or maybe have other suggestions? Thank you for any advice you can offer.

LillyIsHere

Since this is a question part of the forum, I do have a question:

Has anyone had any experience with their body rejecting alloderm sleeves from breast reconstruction? I had BMX and my right side of breast got infected 2 times and my right side of the body feels off. This tissue comes from cadavre and it is a slight chance of residues that my body is rejecting. Anyone with similar experience?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900825/