Types of mastecomy if I don't want to have reconstruction

Did your BS say you qualified for skin sparing and nipple sparing even though you planned NO reconstruction, as it really does not make a lot of sense in that those would still be options if you are sure you are not having recon.

I don't think they usually do nipple sparing if you are not having recon because your nipples could end up in a very odd place on your chest after the tissue is removed, or you could increase risk of nipple loss/complications by having to change placement of the nipple to make it more cosmetically appealing (which can also result in extra scarring/scar sites). Nipples are kept for aesthetics, rather than sensation, so I think the reason they aren't kept is that the risks to try and get proper placement is rather high. I have never actually seen anyone have nipple sparing without recon, be it immediate or immediate-delayed (with TEs). 

Similarly, skin sparing does not make sense if you are planning to go flat. You would just end up with excess skin flaps on your chest which tend not to look very attractive..not sure what size you are right now but it could vary from a small amount of extra skin to quite a lot. 

If you are planning no reconstruction, you usually want as flat, smooth, and clean of a look as you can get, and so your surgeon should remove whatever skin is necessary to accomplish that.

Hi Plover,

Yes, do be very specific with your surgeon, repeatedly, as Ariom did.

With my first mastectomy I was very specific but perhaps not emphatic enough. The surgeon decided that I'd probably change my mind and did skin sparing anyway. Three months later, when I had my second mastectomy, she'd got the message. As a result I have one nice flat side and one that, well, isn't. I do have dog ears on both sides.

I could have a revision on the right side but I do have mild lymphedema and I worry about exacerbating that.

If I did it again I'd take a photograph of a nice flat chest into the consultation with the surgeon, and tell him/her that's what you aspire to.

By the way, I've had absolutely no second thoughts about reconstructing. I'm content to be flat (just would like to have less belly). The truth is that nobody looks, especially when you carry yourself with confidence.

Hi plover, you are getting right advice here. However, please keep in mind that not all reconstructions turn out to be a disaster and many are quite successful. I for one is very happy that I opted for nipple sparing with immediate reconstruction even though I had to go through radiation after chemo.

Good luck with your surgery!

plover: best of luck with what you decide to do. Yes, I'm mad about what the surgeon left behind and I'd like to get it removed one day. I do have LE now (boooo) and so I'm concerned how surgery on that side would affect it. But my LE therapist is very assured that we could manage it. Extra MLD before and after surgery, keep the lymph moving and I'll be able to do it. Possibly next year. Gotta deal with the hysterectomy next!!

If I had found this forum preop,,, I would have known to be very specific about what I wanted. I just thought,,, no need to mention recon since I'm not having it,,,, that was wrong on my part. Speak up.

Thanks, Plover,,,, Keep hanging with us!! We are a bunch of fun chickies.

Hi again Plover, so glad you have found the photos and Breastfree.org, Erica is a member here and does a great job with her website.

I went there to look at pictures before my UMx, and have the photos of my Dog Ear revision posted there, for those who have the same extra skin problem, but aren't sure about the surgical options and results.

The scar project pictures are so powerful, I spent time looking at those too. There are a lot of resources, if you know what to look for. BCO, is a safe place to research everything, including all the surgical options which will help give you peace of mind.

Again, I wish you all the best!

plover,

I'm so glad your breast surgeon was willing to work with you to give you a result you'd be happy with. It sounds as if she succeeded! I hope your recovery continues to go well.

Same thing happened to me.  I thought my surgeon understood I was not interested in recon.  He left too much skin.  Make it clear to your surgeon what you want.

That's great plover! Yeah, my BS and PS both told me recon made recovery more painful; though I was fortunate and did not have really any pain past the first few hours...after that it was more tightness and discomfort but even that went away rather soon. It makes sense though, because as a no-recon you aren't forcing your pectorals to stretch and such!

It is great you are walking, I had recon but I too was walking 4-6 miles a day by Day 3, and give that ability to walk and move a lot of credit towards my good recovery/healing. 

Hi, All,
I've checked into this discussion a couple times over the past two months. Heeding everyone's advice to be very clear about what I want, I certainly didn't expect to find myself here with a nagging feeling about yesterday's BS appointment....
I met with the BS about a month ago to discuss having a PBMX (high risk made even higher by recent ALH finding). She is all for it, would make the same choice herself. The problem is that she doesn't understand why I would want to go flat. I told her I never had any doubt about it, but had also spoken to a few people and had done lots of reading. She asked if I would please at least have a PS consult, which I agreed to. I even went with an open mind, and had begun to toy with the idea of DIEP flap; I realized that I really was only entertaining reconstruction to please others and not for my own happiness, so did not have any additional PS consults. Yesterday, I returned to the BS to give my final decision and schedule surgery. I still got a lot of resistance from her--she wondered if I hadn't liked the PS (not so, he was actually incredibly informative, not at all egotistical, seemed very genuine) and said I could see someone else. I assured her that recon was just not for me and that I wasn't changing my mind.
Next step: how the surgery would be done. She normally does skin-sparing mx, at which point I made it clear that's not what I wanted because I was not going to change my mind. She said she would modify it, but still start from near the armpit because of having to do SNB (big surprise to me, which I am investigating!), come straight in toward the nipple/areola and back out. I apparently looked confused and showed her a set of pictures from breastfree.org--said I thought the cut would be right across , horizontal, and evenly matched up. She said her way would give me a smaller scar, but that toward the center of the chest I might have a little ridge of skin. I asked if that happened, could a PS fix it up at a later point. She said it wouldn't be necessary, and that when wearing breast forms this would give me better shape. I didn't even dare tell her at that point that I have no plans of wearing breast forms! I really felt that she simply was not listening. I reiterated that I did not want *any* extra skin, that I wanted flat, smooth, and evenly placed incisions. She couldn't promise it... So, when I got back to work, I promptly made an appointment for another surgeon I used to attend many years ago. I see my current BS again in about 2 weeks to receive surgical orders, though I don't know what exactly that is about. It will give me a chance to decide whether I will allow the SNB, at least. I really don't like making waves; she's been an excellent doctor and has kept a close eye on me for years, so I'd really hate for our relationship to end this way, but I can't see any way of making her see my side of things. The very least I'm asking for is that she accept my decision as valid, and do whatever she can to provide smooth and flat--even if it means a longer scar.

aunt paula, I'm 46 for a little while longer. I think that's part of the problem people seem to have....But I'd rather be proven wrong this way than go through recon and prove others wrong. I do believe I will get the breast forms, just in case, or for special occasions--and maybe I'll have totally misjudged the situation and decide to wear them all the time. But I don't want a ridge left behind just to make breast forms fit better. I want my chest to look "clean" on its own and not have to be hidden. Maybe that's part of what the surgeons aren't understanding? Just because I have the option of external prostheses, I shouldn't have to accept whatever comes.

Glennie, we are definitely sisters! I had 3 nodes removed on the opposite side, and damned if I didn't develop LE on the no-nodes side! Ha!  Not to be outdone, the node side had to catch up, but I still don't have nearly the swelling or difficulty on that side as I do on the left--truncal, breast, in my NECK (how does that even happen?! LOL). 

You are entitled to be crabby! That sounds miserable, and I hope you get relief soon!

Lilith, I find it disturbing, that your BS isn't able to reassure you, that she is able to carry out your wishes. She is working "For" you, after all. That would be a red flag to me. My surgeon didn't try to influence me either way, but I had told him on day 1, I didn't want reconstruction.  

I was very clear about what I wanted, a straight scar, because I wasn't interested in reconstruction. I did in fact end up with a Dog Ear at the end of my scar, but I didn't blame my surgeon for that and I had it removed, about 15 months later.   

I had a Uni, so I do wear a breast form, most of the time, but I sure don't have, or need, a ridge to hold it. I have a Contact form that sticks directly to my chest, no ridge required for that either, and I have a whole wardrobe of other forms, which I wear in bra, or camisole pockets, just like Glennie said. 

When it comes to the SNB, my surgeon said that if I had a lumpectomy, I would avoid the SNB, but if I chose to have the UMX he couldn't, in good conscience, not do a SNB. He didn't expect there to be any invasive component to be in my final pathology, but if there was, it would be too late for a SNB, after the breast tissue was gone and I would have to have more nodes removed. I could totally appreciate his point and although I really would have preferred to forgo a SNB, I had to agree with his logic. So I went ahead with the SNB.

It is all a series of really tough decisions, but for me, having a Surgeon that is "On the Same Page" would be of paramount importance. I wish you all the very best, with it all.