SSM with tumor close to skin?

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kittymama
kittymama Member Posts: 139
edited June 2014 in DCIS (Ductal Carcinoma In Situ)

Originally, I was scheduled for a skin sparing unilateral mastectomy with one-step Alloderm reconstruction.  The surgery was scheduled for next Wednesday, March 30.  The surgery plan has been in place since December 2010. 

The other week, my BS told me that he has to remove some skin because part of the DCIS tumor is close to the skin.   He said that because I have no fat in my breast, the remaining skin would not have sufficient blood supply and would become necrotic.  This makes sense. 

However, there are implications for reconstruction.  With a one step Alloderm procedure, I need all my skin because the implant is placed at the time of the mastectomy (my surgeon has known for three months what type of reconstruction I was having and hasn't spoken up about the skin removal until now, but that subject is a whole other post).  My PS said that if the BS removes as much skin as he is planning, that she will have to insert a tissue expander, which I was hoping to avoid.

Anyway, my question is, has anyone had a skin sparing mastectomy with DCIS close to the skin?  Did the surgeon remove the skin or were you able to keep it?  Has your surgeon ever mentioned skin necrosis?  Thank you in advance!  

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  • dlb823
    dlb823 Member Posts: 9,430
    edited March 2011

    Bumping for kittymama

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  • JAT
    JAT Member Posts: 81
    edited March 2011

    Hi Kittymama:

      My situation wasn't quite like yours.  I had the skin sparing mx with tissue expanders--which I'll admit were very uncomfortable for 2 months, then got better- and by the 4th month I  had my implants (that part is a breeze).  My path report after the mx showed a narrow margin close to the skin but 2 tumor boards said radiation was not necessary-- but the BS  removed extra skin at the time of the exchange (I think Beesie had a similar problem and she did this as well).  This did give me a much longer scar line and for 2 years the area felt tight, even with PT, but now it's ok. I know you don't want to do the TEs but you need to take that skin out. I worried day and night until my exchange surgery when the skin was finally removed-- the pathology came back negative.  My BS and PS work as a team so they consulted beforehand and kept me in the loop-- can you get the 2 drs to do this--maybe it is still possible to do one-step even with the extra skin removal.-- Julie

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  • kittymama
    kittymama Member Posts: 139
    edited March 2011

    Hi! dlb, thank you for bumping and JAT, thank you for your response.

    JAT, if you don't mind me asking, did you go bigger or stay the same size? I had wanted to go slightly bigger, from a full A to a small B, but with the skin removal, I don't know if this will be possible.

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  • JAT
    JAT Member Posts: 81
    edited March 2011

    I don't mind the question. I was about half an A cup and went to a large B (though I think it's really a C on my small frame). I kind of regret this-- in most clothes it looks fine and real but sometimes I feel like it's too much-- the funny thing is that no one even noticed how much bigger I was--I guess no one ever  paid attention to my boobs!-- Julie

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