Bilateral or Unilateral Mastectomy? Implant risks?

Last week I was seriously considering bilateral but my surgeon talked me out of it. He said unless my MRI showed something he didn't support removing healthy tissue. My initial feeling is if they couldn't find this one till it was 6cm x 4cm (I'm an A cup) because of my dense tissue how the hell are they going to find anything in the other one if BC should occur there.

 Well my MRI did show 4 suspicous spots on the other breast. Chances are these are not cancer but they could be precancerous so biopsies would be needed. I also have very dense cystic breasts.

Now my surgeon feels I should do the bilateral because there is no way the other breast can be monitored with a mammogram. MRIs tend to show lots of false positives. This could be lots of biopsies in my future.  So I'm back to doing the bilateral.

 Actually I feel better about this. No more wondering if the other breast has BC hiding. No more mammograms. Matching breasts and maybe even no more bra! Yes I am going for a pair of A cups again.

I hope I find out about my surgery date next week when I meet with the surgeon again.

So far I plan for immediate reconstruction with implant expanders. After chemo (don't know about radiation) they will continue the reconstruction process with gummy silicon.

ailenroc, good information!  And a very important warning about getting a 2nd opinion about the pathology before heading into surgery, particularly for women diagnosed with DCIS.

lago, you mention some valid concerns and I agree that it's important that anyone heading into implant reconstruction understand these concerns, but as you say, for most women these are not reasons to not proceed with the reconstruction.  Since this is an educational thread, continuing the list that you've started, here are some other things to be aware of before starting implant reconstruction: 

IMPLANT RUPTURE (highly cohesive gel implants, i.e. silicone gummies; information is from Allergan):  For primary reconstruction patients in the MRI cohort, the rupture rate was 7.2% through 5 years. For revision-reconstruction patients in the MRI cohort, the rupture rate was 9.5% through 5 years. This means that through 5 years, approximately 7 of every 100 primary reconstruction women and 10 out of 100 revision-reconstruction had at least one ruptured breast implant...Across all patients in the Pivotal Study, all ruptures were intracapsular. There were no cases of migrated gel.

IMPLANT RUPTURE (cohesive gel implants, i.e. silicone but not gummies; information is from Allergan): For primary reconstruction patients in the MRI cohort, the rupture rate was 11.4% through 7 years. For revision-reconstruction patients in the MRI cohort, the rupture rate was 0% through 7 years. This means that through 7 years, approximately 11 of every 100 primary reconstruction women had at least one ruptured breast implant. There were no revision reconstruction patients with a ruptured breast implant... Across all patients in the Core Study, all ruptures were intracapsular with 1 case of extracapsular gel (one rupture progressed to extracapsular gel following exploratory surgery to confirm the rupture and then implant replacement was delayed). There were no cases of migrated gel.

UNSATISFACTORY RESULTS (either type of cohesive implant):  Unsatisfactory results such as wrinkling, asymmetry, implant displacement (shifting), incorrect size, unanticipated shape, implant palpability, scar deformity, and/or hypertrophic scarring, may occur. Some of these results may cause discomfort.

PAIN (either type of cohesive implant):  Pain of varying intensity and length of time may occur and persist following breast implant surgery. In addition, improper size, placement, surgical technique, or capsular contracture may result in pain.

ADDITIONAL SURGERIES (highly cohesive gel implants, i.e. silicone gummies; information is from Allergan):  In Allergan's Pivotal Study, the reoperation rate for Highly Cohesive Shaped Implants was 39% for primary reconstruction patients and 29% for revision reconstruction patients during the first 5 years after receiving the implants.... For women receiving primary reconstruction implants, the three most common reasons for reoperation were scarring, capsular contracture, and implant malposition.

ADDITIONAL SURGERIES (cohesive gel implants, i.e. silicone but not gummies; information is from Allergan): In Allergan's Core Study, the reoperation rate was 53% for primary reconstruction patients and 40% for revision-reconstruction patients, which means that 53 out of every 100 women who received Cohesive Round Implants for primary reconstruction and 40 out of every 100 women who received Cohesive Round Implants for revision-reconstruction had a reoperation during the first 7 years after receiving the implants....For women receiving primary reconstruction implants, the three most common reasons for reoperation were implant malposition, asymmetry, and capsular contracture.

OVERALL COMPLICATION RATE (highly cohesive gel implants, i.e. silicone gummies; information is from Allergan):  The results indicate that the risk of at least one occurrence of any complication (including reoperation) at some point through 5 years after implant surgery is 47% for primary reconstruction patients and 51% for revision-reconstruction patients... The most common complication primary reconstruction patients experienced within the first 5 years of implantation was reoperation (39% or approximately 39 patients out of 100). The most common complication revision reconstruction patients experienced was also reoperation (29%).

OVERALL COMPLICATION RATE (cohesive gel implants, i.e. silicone but not gummies; information is from Allergan):  Allergan's results indicate that the risk of at least one occurrence of any complication (including reoperation) at some point through 7 years after implant surgery is 70% for primary reconstruction patients and 73% for revision-reconstruction patients.... The most common complications experienced within the first 7 years of implantation for primary reconstruction patients were reoperation (53% or approximately 53 patients out of 100) and implant removal with replacement (24% or approximately 24 patients out of 100). The most common complications experienced within the first 7 years of implantation for revision-reconstruction patients were reoperation (40%), asymmetry (13.3%), and implant malposition (13.3%).

Here's the information source for this data: http://www.allergan.com/assets/pdf/11174_Recon_Labeling_7308.pdf  

All this information is not to scare anyone away from having implant reconstruction!  However I think that anyone going into this procedure should be aware of these risks, and of the fact that about half of the women who have implant reconstruction do require revision surgery.  Additionally, there are other threads on this board that talk about post reconstruction pain.  Many women who have reconstruction have some level of discomfort at one time or another although usually this isn't severe or problematic, just annoying. Personally, I'm 4 years out since my replacement surgery and when I do something strenuous (I did some heavy lifting this morning), my chest muscle over my implant aches. It's uncomfortable but something I can live with.  However unfortunately for a few women, the pain can be on-going and severe. 

None of these are reasons to not go ahead with implant reconstruction - in the end, most women are satisfied with the results and most women are comfortable (most of the time) with their implants.  But it's important that anyone starting off on this road be prepared for what lies ahead.  I hope that this helps in that regard. 

you chose a good topic for discation.thanks for this post.it's helpful for lot of peoples.

 Alina's List

Moderators? Spam, I assume.

Thank you for sharing your story and I admire your courage. My gene pool is very poor things from breast cancer to canavan disease. My mother had dual implants over 30 years ago and has had no problems. I would say choose a doctor and talk to some of their patients. In my mind, all of those risks and troubles are up to the doctor who does them. Goodluck!

ailenroc, I'm just beginning to make my way through this post, but already I have found it incredibly helpful in navigating these overwhelming choices. Thank you so much for sharing your honest experiences and the entire journey; it's a huge help to hear someone else's thoughts as she walks through this. These are exactly the debates I'm having in my head and needed to hear from someone farther into the journey than I am. Thank you so much.

*****

I've now read through the entire thing and can't tell you how grateful I am for the information you provided in here. As you said, it's really hard to find quick, comprehensive info ANYWHERE on these issues! You raised several points, even five years ago, that I've wondered about myself, such as the older surgeons supporting prophylactic mx not so much due to 'old school' mentality but from experience of seeing young women coming back again later for a mastectomy after a recurrence or additional primary cancer.

I'm terribly sorry to hear that you're having autoimmune issues now, though. It seems like you should get a pass from all other health issues after walking through BC, doesn't it? Please keep us posted on that, as I also wonder what you'll find out regarding any possible role the implants may have played. I do wish you all the very, very best.

Thank you so much, allenroc.

And I am praying right now that there is resolution to your autoimmune issues as well as answers for whether they're related. The uncertainty is often worse than bad news.