Making a decision on reconstruction

Hi Mckayla -

We're sure others will be weighing in shortly with their thoughts and experiences on making reconstruction decisions. In the meantime, we wanted to share with you this page from the main Breastcancer.org site called Is Breast Reconstruction Right for You?, which discusses some things you should consider when making this decision.

We hope this helps!

--The Mods

My BMX was two years ago this week, and I opted not to do reconstruction. I met with the plastic surgeon a couple of times, but lat flap was the only option for me, and I didn't want a surgery/surgeries of that magnitude. I was not sure that I would be happy with the result, based on photos of women of similar body size and build, and I didn't want to go through it to not be happy with the result. I can get the same effect from my bra (for me, this is enough, but it's very individual, so do what feels right for you).

I have been very happy with my decision. I developed lymphedema after the BMX (though I was very low-risk), and though I had made my decision about reconstruction by that point, it just kind of affirmed it for me. If I need breasts, I wear a bra with inserts, but I usually prefer to just wear camisoles and tops. Some things fit better with a bra, and it helps with compression for the lymphedema, but I'm comfortable either way. I also swim without inserts.

Good luck with surgery, and with figuring out what works best for you.

Edited to add that I was 44 at the time of my BMX.

I recommend getting a copy of the latest edition of Kathy Steligo's "Breast Reconstruction Guidebook" - the best I have seen on the topic. It will give you good information about reconstruction options as will as tips about finding a good plastic surgeon. I think the information in the book will make the decision easier.

http://breastrecon.com/the-breast-reconstruction-g...

http://www.amazon.com/The-Breast-Reconstruction-Gu...

Of course there is no one right answer to this question only the answer that is right for you personally. I have bilateral reconstruction with one side DIEP and the other side, done 4 years later, is an prophylactic nipple sparing sGAP. My personal reasons for the choices I made: I am active and didn't want any physical limitation on what I could do in terms of sports or general function. I didn't want to deal with a surgery (or repeated surgeries) years down the road to replace an implant. I did't want to be aware of, or feel the implant in place. (My tissue reconstruction just feels like "me.") I didn't care if there was a scar on another part of my body and I didn't care if the DIEP or sGAP surgery was longer than implant surgery.

I had problems with the cosmetic results of my initial DIEP recon and it required many revisions. Turns out my initial ps was well trained (Ivy league schools and a microvascular fellowship) but relatively inexperienced having done few DIEPs on her own when not in training. Things were finally fixed when I jumped ship and went to someone else who was much more experienced. I am happy with my reconstruction -- just wish I had initially gone to a ps with more experience. I have absolutely no pain or physical limitations and I think my cosmetic result is good. I do have some minor loss of feeling in the donor sites but it is not enough to be an issue for me.(In terms of O.R. time there are some facilities where two very experienced ps work together so the O.R. time is cut way down.)

Some general things to think about no matter what type of reconstruction you decide on:

Know that cosmetic enhancement is a very different skill set than breast reconstruction. You want a ps who does mainly reconstructions.

You want a ps who is very skilled, who does the type of reconstruction you want on a regular basis - hopefully once or twice a week, and has done multiple hundreds, even thousands (on his/her own when not in training.)

PS tend to recommend the type of reconstruction they are technically able to do and sometimes even disparage other options. It helps to decide on they type of reconstruction you want first and then go to the most skilled ps you can find that specializes in that reconstruction.

In addition to seeing photos of a PS work -you should be able to talk to former patients. and if possible see their results in person. (This is usual when it comes to breast reconstruction.) Any good ps will have a large group of happy customers who will be more than willing to talk to you. If you can't talk to former patients I would consider this a red flag.

If you want nipple sparing - you would want a breast surgeon who has done many of these.

Good luck with the surgery.

Kelly,

Have you considered a lumpectomy? Did your surgeon recommend a BMX or is that what you feel is the right thing for your situation?

I also had large breasts DDD++ and I felt there was plenty of room for the cancer to be removed completely, 2 surgeons told me a mx was my only option. I found a surgeon who removed it successfully via Lx and left me with a scar and a breast in tact. My tumor was 4.5cm, smaller than yours but IDC.

6 months after rads I had my other breast reduced to match. really cute lol. The PS offered to fix the scar but I had enough of surgery and its not so bad. The whole thing was really easy and I'm really happy with my 34D's or 36C.

Going through s BMX alone is tough and I have a lot of respect for all who chose that route. I'm pretty tough but I don't think I could have handled it. (??)

Its been over 4 years and so far so good. For me it was the right decision.

I hope you make the right decision for you. None of this is easy.

xoxMaureen

Hi Mckaylaleigh,

I was 32 when I was diagnosed, reconstruction was very important for me. I had a mastectomy of my left breast with delayed reconstruction ( I decided to keep my right breast) I had 6 rounds of chemotherapy followed by radiation. Due to rads a DIEP procedure was my only option. Having said that, I am really happy with the results and would probably have gone that route anyways even if I had other options. I didn't want to have to deal with future implant surgeries and I really like the natural feel of the reconstructed breast.

a couple of years later I decided to reconstruct the healthy right breast. It wasn't a decision I made lightly, I was undergoing yearly mammograms and follow up ultrasounds, MRIs....eventually I couldn't handle the stress each year brought whenever I had a mammogram. So I booked an appointment with my PS and he recommended a straight to implant (nipple sparing) procedure. Unfortunately they couldn't graft fat or skin from anywhere else in my body, I'm an athletic build.

So having said that, I have done both implant and DIEP and I like them both for different reasons. There are pros and cons for both. I guess I'm just sharing my experience here and they were both positive for me. I guess my only advice is, if you are a candidate for DIEP (or taking from another site) and that that's the way you want to go, make sure your PS is very experienced in performing this procedure.

Everyone's choice is personal and their own and I wish you the best of luck!

Mckaylaleigh,

There is a new type of silicon implant called "form stable" that has many benefits over silicone-filled or saline-filled implants. Form stable means that it is not a shell filled with a substance, but it is a cohesive gel that maintains its shape. These implants will not leak like shell implants. They have an anatomical shape. They are sometimes called "gummy bear" implants.

Some benefits include:

• More natural look & feel

• Variety of shapes and sizes

• Longer longevity than other implants

• Less future surgeries

• Fewer complications than traditional implants (no leakage)

I did not want additional surgeries or the scaring from transplanting tissue. I just received my implants last week and I am very pleased with the results.

Good luck with your decision.

Mominator