Meeting with plastic surgeon in two hours. Have some questions.

I don't know if you will see this prior to your appointment but thought I would post anyway.  Breast and plastic surgeons usually perform the type of procedures they are comfortable with and have experience with.  Some docs will do nipple sparing and/or direct to implant, other won't.  If your initial BS/PS team does not recommend or do them, you can seek an opinion from a BS/PS team that you know does to see if it is something they would recommend for you.  Often when planning a direct to implant recon they will tell you they will bring both implants and expanders into the OR, plan for implants, but use expanders if they find something that prohibits them from going with implants off the bat.  I think, for the most part, whatever the original plan is does get followed - by the time you are in the OR they have done imaging and have a good idea of what your individual situation is, but it is prudent to be prepared.  The last thing you want is to wake up with neither because they did not bring options.  There are criteria beyond prophylactic breast removal that dictate whether nipple and skin sparing can be done, and whether direct to implant can take place. Generally for nipple sparing doctors prefer a smaller breast size, little to no ptosis (droop), and good skin elasticity and health.  Position of the cancer in relation to the nipple is also important.  For direct to implant you can only end being the size of what implant fits under your pectoral muscle.  You are limited to that so if you want to be larger expanders are usually suggested so that the pectoral muscle is stretched to the desired size to accommodate the larger implant.  That is not necessarily to say that you must remain small - only that you have a limit to what will fit behind that muscle without stretching it first - for some the size is perfect, and can be the same as their natural breasts, or even larger.  There are certainly cancer patients who have direct to implant, but in some cases if radiation is required doctors won't place them immediately because of the risk of capsular contracture, or issues with the reconstruction from rads, or if the implant will obscure the field of radiation. Good luck and hope you have a good meeting today!

mazy - you are welcome!  You will find that not all plastic surgeons have the same training, desire to learn new techniques, or comfort level with all procedures.  It can be a challenge to find one that you like who does the procedures you may want - but keep looking.  The good news is that you are in a geographic area with many choices - my son lives in Ashburn also!

again if you are thinking of only a lumpectomy I would get a MRI first so you know exactly what you are dealing with. Especially if you have dense breasts

SpecialK - Did you have your surgery at Moffitt? I have had both my surgeries there and may have my reconstruction there also. I was told about a place in New Orleans that specializes in reconstruction, that is all they do. I will definitely look into that too. I can't do anything until I lose weight but I hope to have that option. I was not aware of all the potential problems that can come up with the reconstruction. It really makes you think about it. Is it something you would do again? I guess they didn't go over everything with me because I can't do anything right now. I wonder if other health conditions would make a big difference on healing after reconstruction. I see that some people don't have anything done for quite a while. Do you think it is because of healing time or something else? I was told I can't even get a prosthesis yet, it is too early. I just want to go out and not be self-conscious. I guess I just have to be patient.