Delayed reconstruction, anyone??

Ladies you would probably get more helpful responses, if you posted your questions on the Breast Reconstruction Forum, but  on this forum, check out the "Undecided about Reconstruction Thread".

I had delayed reconstruction.

I started my BC journey in Oct 2006 as a result of a decision to have breast reductions due to huge breasts and the resulting neck, shoulder and back problems.  Because a plastic surgeon would want a recent mammogram before doing anything, I went in a few months early.

Thank goodness I did.  My mammogram showed an area rated BIRADS 3 and suggested a six month follow up.  My female PCP told me no way and sent me off for a biopsy.  The surgeon asked permission to do an excisional biopsy with guide wires. Within the lump of tissue removed was a very aggressive small tumor.  I opted for a mastectomy (right breast).

Seven months later, when a mammogram on the left breast came back BIRADS 5, my oncologist told me that there was no way it was cancer (I had finished chemo and was on herceptin) but suggested I seized my opportunity and have the simple mastectomy I wanted to even me up (the gross body asymmetry after the first mastectomy was making my neck, back and shoulders problems worse).   I did (pathology results showed only benign changes of a aging breast) and was blissfully flatchested.

I was not interested in reconstruction and usually went commando, only wearing prostheses on a rare occasion.  I worked hard on getting my chest, back, neck and shoulder muscles back into shape with physical therapy, massages and daily exercises on my own after the PT ended.

 Fast forward to October 2008.  I was going on a cruise and had bought some dresses that were deep V necked for formal nights.  I purchased some foam prostheses that I could either stick to my skin or pinned into my clothing.  I was set to go, or so I thought.

I just wasn't happy with the way the prostheses looked and realized that although I was happy going flat 99% of the time, that other 1 % was also  important to me.  I was 58 and too young to be restricted to tee shirts for the rest of my life.

So after much research, I decided to go with silicone implants and also found a wonderful plastic surgeon 1 1/2 hours from me.

 I had the tissue expanders place on June 10, 2009.  Because of the length of time since my mastectomies (2 1/2 years right side, 2 years left side) and my hard work on regaining muscle flexibility, my plastic surgeon told me he was able to obtain better than average muscle coverage of the TEs.  He also used alloderm to reinforce the muscle coverage. 

I have a large ribcage so he used 800 cc TEs (my goal was B cup size breasts).  He was able to put in 300 ccs of saline in each side at the time of surgery (again due to the flexibility of the muscles).

 After the pain of the surgery disappeared (the PS warmed me it would be more painful that the mastectomies and he was right), I was never in any discomfort. I was real glad  that my exercising included working on my abs.  I can't imagine how painful it would have been to need my arms to push myself upright and was glad I could do it through lower body fitness.

 I had two more fills of 250 cc in each side to bring me up to 800 ccs.  The fills were 5 weeks apart.  Other that the needle stick which I was use to having in my port, I had no pain. The fills caused me no problems at all.  My skin would feel tight at the end of each 250 cc fill  but that feeling would be gone before I walked out of the PS's office.

 I could have had the exchange surgery at the end of October but again had a cruise planned and Thanksgiving travel planned.  By the way, the TE's looked fabulous in the strapless gown and spaghetti strap dresses I wore on formal nights.

I had the exchange surgery on Dec 10.  It was a piece of cake and pretty much pain free (I used some Tylenol over the two days following surgery).  I spent two weeks with a compression bra on, two weeks with a regular bra.  One month after surgery, my  PS tells me everything looks great, removed all restrictions on my exercises and activities, and will see me again in two months for followup. I have 800 cc implants which gives me the B cups I wanted (I am 5'6," 145 lbs).

Delaying the reconstruction was a good choice for me:

1.  I had time to get my head together after the BC diagnosis.  I also was past my two year date from the completion of chemo when the recurrence risks for my type of BC starts to drop.  That was a big relief.

2.  I knew that I could be happy be flatchested so if I was one of the women that reconstruction didn't work out for, I wouldn't be devastated by the flat look.

 3. It gave me time to get my neck, back, shoulders, and chest muscles into shape (also my abs).  The condition of my muscles played a big role in the ease of my expansion and lack of discomfort.  My skin (scars) were also well healed and healthy.

So my advice is to take your time.  The BC journey is as much mental as physical.  With time, one starts to relax, isn't as anxious and can take the time needed to decide on if reconstruction is right and also be in better physical condition to help the surgery be successful.

I had delayed reconstruction Dec. 2 2009.  My original mast. was April 08 and immediate was not a possibility cuz I needed chemo, radiation and herceptin.  Finished Herceptin in july 09. I'm glad that I waited because it would have been too much to deal with at the same time as chemo etc.  It also let me get my head together and be sure of what I wanted.  When I went for the PS consult I thought the tram flap was my only option because of the radiation. 

There were a number of reasons that I decided against it.  I wanted my other breast removed because my cancer is very agressive and that meant that the surgery would be 10 hours, a reg surgeon and 2 PS.  Scary!  Also I didn't have enough tummy fat to recreate my D's.  They thought I might be able to be a small B. There was also a 2 year waiting list.  So....after lots of thought I decided on a TE on the good side and a LD on the cancer side. 

 I thought long and hard about having the surgery, but for me I decided to go ahead since I was going to have the second mastectomy.  Hope this helps.

Hi Robin~

I'm in the same boat as you.  I'm 37 and currently boobless.  Right now, I'm in a holding pattern about recon.  I don't really mind being boobless (except that it has affected my body image WRT sex).  When dressed (at work, the gym, wherever), I don't even notice.  In the shower, I *do* notice but I don't find it upsetting anymore.

 Good luck with your decision.

Michele

Hi Robin,

I'm one who opted not to have reconstruction after a bilateral mastectomy. That was over three years ago. I haven't regretted my choice, but it's nice to know that if I ever change my mind, delayed reconstruction is always an option.

Meanwhile, I started a non-profit website, BreastFree.org, which provides information and support to women like ourselves, who have had mastectomies without reconstruction. The site has Personal Stories, Photographs, and sections on Breast Forms (prostheses) and Bras and Camisoles. I think you might find the Breast Forms section especially helpful.

It's important to find comfortable breast forms and bras, which can be challenging so soon after surgery. Also, remember that, like reconstruction, learning to live breast-free is a process. It takes a bit of trial and error to figure out what's most comfortable and attractive for you. I have several different breast forms (accumulated over the past three years) which are comfortable and look good. In clothes, I look as good as before and can wear all the clothes I wore before, including tops that are quite revealing--though no cleavage, of course.

Hope this helps.

Barbara

While I chose to reconstruct, in the end, I had assumed originally that I would not and pursued that path first. What changed my mind was finding out about the skill of those in New Orleans.  I was not persuaded prior to that at all.  I just completed a DIEP surgery, since I have extra abdominal tissue. When I was there, there were some very trim women doing procedures there which this team does frequently.  Just thought I'd toss that in.  It seems that we women have a knowing about what is best for us.  Fortunately, it is possible to have reconstruction later, if you decide it's the right time for that.  I am relieved that I had the freedom to make whatever choice seemed right to me.  I wish the same for you. - Christine

I chose implants for my reconstruction. It was done 20 months after my first mastectomy and 14 months after I finished rads.  My PS reccommends waiting 1 year post rad to let the skin recover as much as possible.

1:  The PS does use the original scar from the mast. the TE's are put under your pecs.

2.  The recovery from the TE wasn't bad for me.  I had my left breast removed and both TE's put in with the cancer side using my lat to augment the radiated skin.  Radiated skin doesn't stretch as well. My drains from my breasts were out within 5 days (PS's policy) and the one on my back stayed for 9 days.  I felt pretty good, just had the usual restrictions: no raising arms over shoulder height and no lifting over 5 lbs.

3. I didn't find the 2nd surgery as painful: I think because I am in better shape and because it wan't an unknown situation.  Stayed in the hospital for 2 nights. The fills were a different story.  I found them very uncomfortable/painful.  PS did not prepare me for the discomfort of the stretching of the skin and the pecs.  I wasn't given the same kinds of meds that many of the ladies in the US are.  Once I got the fills under my control, more time between fulls and less than 100cc in each breast at a time I was ok.  the problem for me was that both breasts were being done, and my back was also painful-----how do you sleep?  I couldn't get comfortable.

 4.  I haven't had my exhange, but my understanding is that it isn't a big deal.  The same scars are used and the hard work - stretching is done.

5.  No stretch marks yet and even with the TE's which aren't as pretty as the final version, I have perky breasts.  I have been doing yoga and playing racketsports.  I am going to physio to get my range of motion back.  I'ts good, but I want the full range that I had.

Hope this helps, PM me if you want.

Take care, Jan

Thanks to all who have posted.  I, too, am currently researching the re-con issue - after my chemo, I am due for surgery either April/May.  At 38C, I think it would probably be hard to match one side to the other, so am considering bi-lat.  All your experiences are helping me to get a handle on the issue.