Plastic surgeon only operating on one breasts at a time?

1982M

I was very surprised when I met with the plastic surgeon today that he won't operate on the other breast during my cancer surgery on my left breast. I'm younger and other then breast cancer I am healthy. I am a healthy weight, none smoker, good blood work through chemo…. no other noticeable issue. Just breast cancer. The surgeon told me If I have a oncoplastic reduction with radiation he won't operate to make my right breast match for at-least a year incase it shrinks. If I choose mastectomy and implant based reconstruction I was told I won't need radiation from the breast surgeon but he also won't do the other breast until everything heals incase I do need radiation. No matter I choose it's at-least two surgeries. I'm so sick of it all.

I also found out that no fat grafting or anything considered cosmetic will be covered. I do not get a say in any size implant- it's 100% up to the surgeon. We didn't discuss any cosmetics. Nothing about how either of my breast look do I have any say in. If I go with mastectomy they don't do prepectoral at all. I am a candidate for skin sparing but no nipple sparing once you have cancer. They also rarely if ever do a nipple sparing.

The plastic surgeon was honest and said they had barely done oncoplastic reductions here. I gathered that bc my radiation oncologist also said she hasn't done many. If I choose it, I know I am going in without my team having experience with it as they just got it approved here.

Anyone else have to delay surgery on the other breast? How did you cope? How long did you have to wait?

Aram

1982M, my surgeon wanted to do it one at a time as well. I insisted on having them both at the same time and he accepted but he still wanted me to know I can change my mind and have one at a time. Apparently there is less risk of complications with one at a time

I am surprised about sizing. I told them I don't want anything bigger than a C and there were no issues. They actually asked me what size I wanted. Do you know why it is left to the surgeon? What if for health concerns one wanted a smaller one? That is very concerning they are forcing women...

wrenn

I didn't have reconstruction so can't comment on that and hope that you get more responses here but for the benefit of those who think Canada has a shitty health care system (recent comments in a thread) I just want to correct your statement "To start I'm in Canada so I don't get a second opinion" We can have as many opinions as we want. I have done it many times. But if there is a specific protocol for one clinic that isn't a Canada matter.

I am so sorry you are going through this struggle with your providers and I hope it can be worked out. I am also relieved on your behalf that you like the surgeon. That makes such a difference. All the best for speedy answers.

1982M

Thanks for replying Aram. I’m do feel a bit relieved that this is some other people’s practice. The surgeon said size will be based on my muscle room and skin. I honestly was a bit shocked at the lack of options and I didn’t think to question much. I’m also exhausted and foggy. I’m guessing if they put an expander in (which he said he rarely does) he would prob let me have more say? I honestly didn’t expect to only have one breast done at a time and no real say in size. It shocked me.

I was also surprised how much they emphasized that the only goal was symmetrical in cloths. That naked I get what I get. He wasn’t crude about it, but he definitely said the number one thing was none of this was cosmetic and nothing cosmetic would be covered and the whole goal is to match in cloths.

Waves2Stars

Do you mean you are getting surgery on your left breast for cancer, and the right for symmetry? If so, I think it’s common to wait for reduction and lift on the unaffected side for a few months. First of all, if you don’t have cancer in that breast, there isn’t an emergency to do that cosmetic portion. Second, they like to see where your non radiated breast will sit after healing before altering the position of the unaffected breast. But maybe I’m misunderstanding your situation. I was initially disappointed I wouldn’t get the lift on my “good” breast after my surgery, but the lack of symmetry hasn’t really bothered me much

1982M

Thanks WaveStar.

Yes. I have cancer in the left and not in the right. I am glad to hear the asymmetry doesn’t bother you. I don’t even think I would be that upset if it was a few months. I won’t be able to get symmetry surgery on my right for at-least a year. I didn’t realize that going in bc I hadn’t read that as many people’s experience. I, like everyone, am just exhausted from this process. I wanted to be able to move on with my career and grad school and family and not interrupt it all again. Not only that, I don’t even know if I’ll have enough sick times to cover what I’ll need for surgery the second time. I mean, we will be fine…. I’ll make it work with unpaid leave, butI am definitely disappointed to learn it’s two surgeries no matter what.

Aram

1982M, may I ask which province you are in? I am in Québec and my PS told me we might have other surgeries later if the result is not satisfying. I am very surprised at your doctor's comments. I had an appointment with another PS at the beginning and to him the cosmetic result was very important as well. Is it possible for you to find other women in your province to see whether this is common practice?

Waves2Stars

Look, I think wanting a good cosmetic outcome is very important for some people (me included), and especially at your age. It’s very disappointing to have this stuff drag out for so long when you’ve got a chance to go back to normal life! I don’t regret my mx at all, and have embraced my Corpse Bride breast as kind of an awesome door prize for this bc experience. I, too, thought having the sad sag bag of a normal breast for months would be awful, but I’m glad to have full feeling in at least one nipple for now. I will get a revision at some point, but like you, am tired of thinking about cancer, and would like to be normal for a while. I hope you get the outcome you really want

1982M

Hi Aram, I sent you my location via private msg. I do feel like my experience isn’t uncommon. I know right now they are only doing implant based reconstruction bc they can’t access the operating room where their microsurgery stuff is due to Covid.

My friend saw the other plastic surgeon here and ended up just going flat bc of the bedside manner etc of the surgeon she was referred to. Reading reviews (which I always take with a grain of salt) I don’t think I’m a one off. I think this is how they function. I did try to find anyone who had surgery with my surgeon and couldn’t find anyone. I asked home care nurses, my friends, online….. the other surgeon is more experienced but I couldn’t find anyone in real life who was happy with their outcome with her. Several bad reviews, plus my friends experience I decided it’s better to chance it with the other guy.

Thank you both for your replies. I do feel better knowing the one breast at a time isn’t just here or isn’t just me. I did know they did it occasionally, but when reading online it seemed the normal was to do both. A year apart really threw me. I’m still not sure what I’m going to do but I’ll have to decide soon. I feel like it’s a lose/lose so I might just flip a coin.

Beesie

1982M,

The situation you find yourself in might not be uncommon for the particular Canadian/provincial location where you live, but from my experience and from what I've read on this board from other Canadians over all these years, I'd say that your situation is quite unusual

As I was reading through your post, I was shaking my head at everything, relative to my own experience. I was able to get a second opinion (and did so). I was able to choose my breast surgeon and plastic surgeon. I was able to decide on the type of surgery I would have (lumpectomy or mastectomy, type of reconstruction with the MX, surgery on the contralateral breast) and I was certainly able to choose the size of the implant. As far as I know, any further surgical requirements that came about afterwards would have been covered by OHIP. With my first MX, I did opt for a single MX, which was my breast surgeon's recommendation, but during that surgery I had a small implant added into my contralateral breast. With my second BC diagnosis, my surgeon recommended a lumpectomy but I opted for a MX, and we changed out the previous MX side implant at that time. Since I wanted to stick with implant reconstruction, my PS suggested over-the-muscle, but since I had a good experience with under-the-muscle implants and since I feel that option allows for better monitoring of recurrence, my PS had no issue at all doing the surgery that way.

I'm sorry that you find yourself in such a restrictive situation. Without knowing where you are, I can't offer any suggestions.

1982M

Thanks Beesie,

I do believe it's my province. Perhaps other small provinces too might have issues. I couldn't imagine rural residence and how much more difficult it would be. At least I'm in a city.

Previously I have heard about people who just up and went to different provinces. I can't afford to pay out of pocket to do that, but prob can for revisions. Covid back logs for surgery and covid 19 may have made it worse.

I am not sure how to reframe for a more positive perspective but I’m trying.