What type of reconstruction would you do if .....

chicahunter-- as you've probably read on these boards, the reconstruction option is a very personal one.  Have you seen a plastic surgeon yet to see what the options are?  Some individuals lean towards implants (and there are so many types to go with) for their personal reasons, while others go for a "flap" reconstruction.  I personally went for a DIEP flap (using my tummy fat) as my reconstruction option.  I'm 34 and didn't envision wanting to go have to go in every 15 years or so to replace implants.  I also liked that it was my own tissue (and had more than enough to spare in the midsection) for the surgery.  However, it's a very long surgery not a short recovery period; most of the time, there's a second surgery to "tweak" things as the first surgery is to make sure the flaps are viable--then really focus on the other stuff later. 

There are positives and negatives for each type of option, and of course each individual's experience.  Whatever you choose, best of luck!

dont forget the third alternative ....fat grafting. the patients whose pictures i have seen have beautiful natural breasts. i think fg is ideal for prophy  patients especially if you can do skin sparing mx . you can start fg during the mx surgery if you line up the right docs.

eileenj...

Great recommendation about taking one's time, researching, talking to others, and interviewing more than one PS and BS if possible. Prophylactic surgery does give you that advantage many do not have, and it is well worth using it. 

It really is a very personal decision. I don't think any "one" method is better than any other from an objective standpoint, it is more like what is better for that one person based on their options and own subjective preferences, etc.

You say that your number one goal is to reduce your risk of breast cancer.  

Have you seen a genetic counsellor and/or an oncologist to discuss what your risk is? 

Extremely dense breasts (at the age of 44), fibroadenomas and past biopsies (if they are benign and didn't uncover any high risk conditions such as LCIS, ADH or ALH), don't likely put you into the high risk category.   Family history might, if you are BRCA positive.  Do you know if the family members who've had breast cancer are BRCA positive?

I have extremely dense breasts, a history of fibroadenomas and more cysts than I can count, I've had benign biopsies for calcifications and fatty necrosis, I have almost every fibrocystic condition under the sun, and I have family history of breast cancer (mother (post-menopausal), aunt (pre-menopausal), and on my dad's side, lots of prostate cancer, which is linked to breast cancer risk).  I've had breast cancer.  I am BRCA negative, although it's an uninformed negative (i.e. we don't know if the presence of a BRCA mutation caused all the other cancers in my family).  With all that, my oncologist assessed my risk to be diagnosed again to be about double that of the average woman my age.  That puts me at most at the very low end of the high risk category. Although I needed to have a MX on the cancer side, neither my oncologist, nor my surgeon nor my genetic counsellor ever suggested that I even consider a prophylactic MX for the other side.  My oncologist didn't even think that my risk level warranted taking Tamoxifen. 

I appreciate that everyone's risk tolerance is different; I have a pretty high risk tolerance and I realize that someone else in my position who is less risk tolerant might have chosen a different option.  But I also had an awareness that a MX is life-changing and particularly when coupled with reconstruction, is wrought with risks and possible long-term physical side effects.  I say this as someone who is now 8 years out from my single MX, and who, for the most part, had an easy time of it.  But the changes to my body are permanent and are there every day of my life.  Most women, thinking about this surgery, consider the risk reduction, worry about the surgery and recovery, and aim for good cosmetic results.  What they don't tend to consider are the implications of living the rest of their lives without breast or nipple sensation, with numbness, and with the possibility of a whole new set of aches and pains that might arise develop as a result of these major changes to your body.

For someone who is high risk - BRCA positive, or BRCA uninformed negative with a strong immediate family history, or who has a personal history of BC and has high risk conditions in the other breast - I certainly understand why a PBMX is worth those risks.  So I'm not trying to discourage you - or anyone - from having this surgery if it's the right thing for them to do.  However, before making such a life changing decision, I think it's important to understand your risk level, consider the other risk reduction options available, and to truly understand what's involved with a PBMX.

DiveCat, for me, I think mentally, it would be better for me to wake up with breasts already in place.  I have seen what other surgeries look like, i.e., extenders, diep, and I just dont want to see it.  I really want to see breasts when I wake...so I will consult my surgeons and see what their opinions for the best recon would be for me.  Then I'll have to make my decision.  But in my mind, my decision for PBM is made...Im moving towards it and towards an end.  Ive already talked to 4 other women who have had DTI, and with the same surgical team, and they had little to no complications.  Im hoping and praying the same for me.

Peace Love Light to all xoxoxo

eileenj, 

I absolutely understand feeling strongly about what will work for you. I was not worried about tissue expanders, if I needed them and they would provide a better outcome (indeed, I expected to have to use them because of my larger breast size and because of my location), but I knew I absolutely did not want to take tissue from anywhere else (muscle sparing or not) even if I had enough tissue to spare (I don't)! So I knew I wanted implants from all my research, reading, and observing/hearing personal experiences of others, but was not set on TEs or DTI. I ended up having the option of both but am going DTI, which is also strongly based on the fact I have such great trust in the surgical team that will provide that surgery. I am scheduled for a month from now (yikes).

The good news is, compared to even 4-5 years ago, many more surgeons are doing direct-to-implant....way easier to find surgeons these days who offer it!  Just know that when you wake up, they still might not quite look like breasts quite yet, in many women they can still appear quite flattened out/awkward and need time to settle...but you will at least not need to expand them!).

Good luck!