Reconstruction
Hello Ladies
I was talking to a couple of friends about reconstruction with diep or tram flap. I was amazed that none had heard of them only implants as a option. I know lots of women aren't told about immediate reconstruction options at the time of surgery especially AA women. My question is where any of you told about all the different reconstruction options before surgery?
Comments
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I was given two videos to view when I was diagnosed. One was about choosing between mastectomy and lumpectomy, and the other was about reconstruction options. But I wouldn't say it covered all the different ones, because there was hardly anything about DIEP and other microsurgical flaps, just the TRAM and Latissimus dorsi. I would say it was a pretty good video, but somewhat outdated because of the lack of information about the more advanced surgeries.
I also did research on my own, here, at other websites, and at the public library. There is a book called The Breast Reconstuction Guidebook or something very similar to that. I got the first edition from the library and it also had less information about DIEP and other microsurgical flaps than about TRAM and LD. There is a new edition of the book coming out I think next month, which I imagine will provide more info on those types of reconstruction.
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Hi MGDSMC,
There are some interesting articles Breastcancer.org reviewed on this topic that you may be interested in reading:
- After Mastectomy, Few Women Referred to Plastic Surgeons to Discuss Reconstruction Options
- Reconstruction After Breast Cancer Surgery Usually Not Discussed
Hope this helps!
--The Mods
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curveball
Thanks for your response. Did you PS show you the video? I'm an RN and I know we don't always get informed about this before surgery.
I had to see 3 PS before I found the one who would do the one I wanted. The other 2 seemed to be more about what they wanted to do. The first thing i said to both were i dont want implants.One said you don't want a flap they can die and have lots of complications. He wanted to do implants with TE and have them filled over 6 months. The other PS give me a plant to hold and I information one it as if I didn't say no implants.
What I have found is lots of PS only recommend what they can do to get the most money.
Not sure if you had reconstruction but if you did was it implants with TE? To me immediate reconstruction doesn't mean 6 months later especially when the implant can be place at the time of masectomy but none mentioned that.
It was important to me to go in to surgery with 2 breast and out with 2 which is why I picked FreeTRAM. Double masectomy is emotional enough.
They are doing research on why AA women aren't informed about different types and many are never offered reconstruction. -
Hi,
I'm not African-American so hope you don't mind my post. The one step implant is not a general option. It can be used only under a specific set of circumstances. Generally only if the mx is skin sparing and you are going for an A- small C cup size. You also need to have a ps who is trained to do this and use of Alloderm seems important too. My ps was very honest and said that the ultimate decision would be made during surgery because medical necessity would trump cosmetic wants. Even though I was not interested in flap surgery my ps presented me with all the options because he said he felt I needed to be speaking directly to a doctor about this and not Dr. google. As for what makes the ps most money, I belong to an all inclusive HMO ( kind of like the club Med of HMO's) and the doctors are salaried. All this being said, I agree that many ps's do not present all reconstruction options to their patients.
Caryn -
exbrnxgrl
Of course we don't mind your input. Glad you brought up the point of skin/nipple sparing masectomy because neither of the 2 surgeons I didn't chose never offered it to me and that's what I'm having. I'm lucky to be in the medical field and knew where to get information on what I wanted without google but lots of woman don't. I did research for months and knew my options before I saw any PS. I never tell them I'm a RN because I want to know how they treat lay AA women.
As far as HMO you probably have a co pay and pay it each visit the PS. Plus exchange surgery and complication down the road. Lots of AA can't afford that plus meds and everything that goes with it.
Size is rearly an issue for AA women a C cup is ok with most. I think given the choice of having implant placed at the time of mesectomy would out weigh breast size.
My entire point isn't what a woman chooses but the options that are offered. Sadly it's already proven that AA aren't informed and we are trying to change that. -
Actually, what I originally got was a link to an online video on my health-care provider's website, but I had dial-up access at the time, so they loaned me a copy on disk to make it easier to view. I think they give the MX/LX link or video to all newly diagnosed early-stage BC patients, and IIRC that video refers to the other one, or there may be a link from that one to the reconstruction options video. I didn't talk to the PS until after I had seen the video.
I was also told by the first PS I consulted that I was not a candidate for any flap surgery, and I started a thread about that. I later went to a different PS and was told that DIEP is an option for me after all. I was really glad about that--I didn't realize until talking with the first PS how little I wanted to have implants. The video said flap surgeries are generally "stable and trouble free" once they heal, whereas implants can act up at any time and would almost certainly have to be replaced at least once, and maybe two or three times, during the rest of my life (I'm 56). And now after hearing about the prolonged discomfort some of the other women in the June MX thread have had with their TE, I don't want anything to do with them! I have't had my reconstruction yet. I'll be halfway through chemo next week; then the PS likes to wait at least two months afterwards to let you recover from that, before doing the reconstruction.
Right after my diagnosis, I did want to have immediate reconstruction, but due to the location of my tumor there was a possibility I would have to have radiation treatment even with MX, so it has ended up being delayed. I also didn't know at the time whether I would be having chemo, but I suppose if not for the possible need for RT, I could have had an immediate reconstruction and done chemo after that. I did have a skin sparing MX with my areola but not nipple remaining, for the original breast skin to be available for use in the reconstruction.
I don't remember any more whether the video I saw mentioned immediate reconstruction vs delayed. It may have. I also don't recall whether it differentiated between immediate implant and TE with later exchange. I may have gotten info about immediate reconstruction from one of the books I read rather than the video. One other thing about the videos, at least some of the women interviewed for them were black. I believe they were all actual breast cancer patients. One chose no reconstruction, one used a prosthesis and one had an implant.
Don't answer if you don't want to, but I'm curious, are you asking this question for a research project? Because I notice your signature says you had lumpectomy, not MX, and I would not have expected you need reconstruction yourself with a 1 cm lump.
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@exbrnxgrl, I am a member of a health cooperative, which I guess is sort of like an HMO, and I think the doctors in my system are also salaried. But I think it's always a temptation for doctors to advocate, perhaps unconsciously, the treatments they are able to provide over some other tx which will be done by a different doctor, even if it makes no difference to their income.
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curveball
Thanks for your input. I'm not asking for personal reasons just so many AA women aren't educated about reconstruction options especially in Los Angeles, Compton and watts in California. Sad but lots don't have and can't afford computer access to look up information which is why it's so important that we do what we can to educated them and doctors to sit talk and explain options.
Yes I did have a lumpectomy back in March but the margins weren't clear and they found another one. This is why education is so important. They wanted to take me back in to clear the margins but I wanted double MX without implants, never ever want them. Anyway was informed if I had BMX would have to wait about 6 months to start reconstruction. I knew that chemo could be done first from research than immediate reconstruction before radiation. No doctor addressed that until I said something. That's an issue with all women not just AA. There is no need to walk around dealing with the emotions of missing breast even when radiation is needed. Every woman who wants MX can have chemo first than surgery with immediate construction by flap. Plus after chemo they can see if it actually work when they remove the breast and not wonder, hope or rely on scans. They look at the actual breast under the microscope and if something is still there treat it. I know there is no difference in survival but helps with anxiety. -
I was diagnosed in 1993 and was given either Lumpectomy or mastectomy and suggested to have mastectomy will reconstruction, but after expander was put in a few weeks later, my body rejected it and I was taken to E R and it was removed, I just started to use prothesis and have every since. I would have like to have the reconstruction be a success for I was in the process of making wedding plans when diagnosed,But I am 19 yrs Survivor(Praise the Lord GOD). msphil(idc,stage2, 0/3 nodes, L mast, chemo:adriamycin, cytoxin and 5 FU, and rads and 5 yrs on Tamoxifen0 God BlessUs ALL.
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