hi all. Just stopping by to add my stiry. It's a hard choice to make and none of them give you your breasts back. You just get good sims! You do only have skin sensations. I am getting my exchange to saline implants next Wed. I have had the right TE in since 12-11. My left side is on my 3rd TE due to infections and cellulitis. So keeping my fingers crossed that 3rd times the charm x 3! Since 3 seems to be an important number. LOL

Making that decision is hard and every person has reasons for some of the choices. I could not do silicon because I have a pacemaker and can't do the MRI. I can't do any of the flaps or DIEP because of past surgeries and they are very long sx and I am diabetic so those were out. I choose BMX because of family history which turned out to be the right choice because they found the IDC in my prophylacticly removed breast. I also had a scare this past summer with a large egg Size lump under my arm right up against the TE. It had to be ultrasound and they said they'd do a mammo if the radiologist needed it. So yes, mammo can be done after BMX. Thank goodness it was just a fat infiltrated lymph node. The SNB was done at the time of BMX because my P'S said that it is not possible to know which node is the sentinel node after the breast tissue is removed. So the new marking is genious! .

I had assumed that the reconstruction would be the easy part. But it can be. And it might be. Hope I didn't scare you but so much depends on individual circumstances. In my case my P'S removed the implants right away. Many other P'S will try to save the implant and try antibiotics first. It just depends. Sorry for all that info. LOL

Jmb - I get yearly MRI's to check the breast area. Also, if I was doing it again I would think a little harder about doing the DIEP or no-recon. Diep isn't done in my area (much) and I would have had to go out of town for several weeks. But maybe it would have been worth it. My implants are fine, good even, they look great and I have no pain. I had no issues with surgery or healing. However sometimes I wonder what it would be like not to always feel my pecs flex. I am glad though that the implant is behind the muscle, so hopefully if I were to get a local recurrence I would find it early. Norecon is still attractive to me, but only if I could have a PS close the surgery.

The screening does seem to vary widely from what I can tell from these boards. Perhaps it is a regional thing. I'm in Oklahoma. At my center, you will never pay more than the cash price for an MRI. The last time I asked it was around $1200. My onc wants them yearly at least through year five, then she said we'd talk about every other after that. Works for me, because they can check the integrity of the implant then also. My PS said the recommendation on a PBM is every other year to check the implants.

I was 48 for the second DCIS in situ. I was 50 pounds overweight and did a simultaneous TUG flap and BMX. What was I thinking? The docs whom I trusted talked about it like it was no big deal and the better choice to implants. They said I'd be back at work in 2 weeks--try 6 months!

I would rather that I had the BMX and delayed reconstruction, or the BMX and TEs, nipple sparing. I think that was the safer and more effective option rather than two failed flaps, permanently damaged legs and lymphedema, impaired cognition from all the anesthesia, 11 pints of blood, acute renal failure, and quite frankly, a crashed career. There was a less invasive reconstruction option, and my PS steered me away from it. I know now that I should have gotten 2-3 more opinions from other PSs before going into surgery. My husband and I refer to my simultaneous reconstruction surgery as the unmitigated disaster that launched a thousand other health problems. Probably the most prudent action for me given my BMI would have been to have the BMX and TEs, and then go super slow toward implants while I lost the weight. AHHHHH HINDSIGHT!!!

In addition to the BMX and reconstruction, I also had sentinel node biopsies on both sides, and both breasts and the SNBs were sent to pathology during my surgery, which takes time.

My surgeon explained that my surgery took so long because of the procedures in the OR. They treat it like 4 separate surgeries - each mastectomy and each reconstruction gets a full sterile procedure and OR protocols. First they do the MX on one side. Then they count the sponges, get a full new sterile set of instruments and whatnot, and do some other quality control/infection preventing procedures in the OR before starting on the second mastectomy. They only have one side exposed at a time - while they were operating on my right side, the left side was draped, and vice versa, which lessens the chance of infection. So then after both mastectomies and SNBs were completed and the path results were back, they were ready to proceed with the reconstruction. That is a different surgical team and my breast surgeon then left and my PS and his assistants started their job. They did LD on one side of the back, then placed that LD flap and tissue expander on the one side. Then a full count again of sponges and various OR protocols to prevent infection and to to make sure they can close the wounds. Then the second LD flap and tissue expander. So the doctors are not working the whole time, there are other things going on, but when you think about all of it, it makes sense that it takes 14 hours. If you read recent articles about the rising rate of hospital based infections, there is good reason to take the time and take extra steps to try to prevent infection. But 14 hours under anesthesia is too much and if I had known then what I know now, I wouldn't have done it all at the same time.

My staged bilat DIEP ended up being 14 hours, but that was because the blood supply on one side was really entwined with the muscle, and it took my PS that long to tease it out without having to cut the muscle. I was fortunate in that I was in good health otherwise and tolerated the long anesthesia well. I actually appreciate her taking the time to tease out the blood supply - I think a less talented/experienced surgeon might have decided it wasn't worth the effort and just cut the muscle to get the blood supply, essentially turning my DIEP into a TRAM. Because of her patience and willingness to take the time, my ab muscles remained intact. I have no issues at all with ab muscles, and can do crunches, planks, and any other core or abdominal exercise with no issues. But my case is extremely unusual - most bilat DIEPs run 8 hours at the most.

If I were to do my one step PBMX nipple sparing mastectomy, I would have still had the same procedure but I would have had a slightly smaller implant the first time so the skin could acclimate heal and get used to the implants(not tissue expanders) then I would go back six months later and have larger implants put in and then have any revisions done at that time.

jmb5, there is a law that insurance had to cover a MX on the other side or surgery for symmetry. My insurance Co hassled me about some of my reconstruction being experimental (my hospital's attorneys are dealing with this and I will not have to pay any of this), but they did cover the prophylactic MX without any issue.

I have had complications with my flap reconstruction (scar tissue necrosis) that will require probably two more surgeries to complete. Reconstruction is a commitment! My results look great and I think having a BMX was easier for me to deal with when I could wake up with breasts. I have big hips and have always appreciated my bust for balancing me out. Surgery is no picnic, and I wonder sometimes if i have would have been just fine not reconstructing. I am invested in the process now and look forward to getting to the finish line, but if someone had told me then that I would have 4 reconstructive surgeries, I might have opted for one MX instead.

Hooray for second opinions!!