Best reconstruction option for the highly athletic?

I'm not as young nor highly athletic as you are, but I do run (half-marathon training) practice/teach yoga, and am in the early days of becoming a TRX fan, so those activities informed my recon choices. I knew I didn't want implants under my muscles so my PS suggested autologous tissue recon. I had enough belly to create one breast (only had a UMX), and three months later I'm back to my old routines and feeling great (even with a few bumps in the road of recovery). Frankly, I sometimes forget I've had reconstruction - it feels so natural and allows me to do the activities I love. The only challenge has been re-stretching the muscles after the mastectomy, which with time are coming back to where they were before.

DIEP was a good choice for me, too, even having had previous radiation to the breast four years ago. I believe tissue recon can be completed after radiation, not prior to, but I could be mistaken. The other drawback is that tissue recon is a speciality, and not every PS is capable of doing it so you may have to cast your net a little wider to find a good PS.

I have been a competitive figure skater for 40 years, and have had all sorts of issues with my unilateral LD flap reconstruction. I have an implant in with my flap. Most LD flaps need an implant so the foob has enough volume.

My chest, side and back have spasms and tightness issues from the surgery. While I don't notice a loss of strength when I skate, I think I would notice if I rock climbed. I feel like I am in an iron corset, or that I have a rock duct taped to my chest, with the duct tape going around my side and across my midback. The tightness is sometimes so bad it's hard to breath. My ribs and spine don't move properly anymore on the surgery side, I have ribs that keep popping out of place, and although my shoulder has functional ROM, my PT says I do not have normal ROM.

I can function in daily living, and I can skate, but I am extremely uncomfortable 24/7.

That being said, my case is a very rare one, and it's unclear if my problems are due to the mastectomy or to the LD flap. But when it comes down to it, I think my problems stem from the fact that there wasn't a whole lot of meat on my back to move. I feel like there isn't enough room in my body anymore. For what it's worth, my PS's nurse told me that their younger, fitter patients have the most trouble with the LD flap. And the few women I've met online with problems similar to mine are all on the thinner, active side of things. I've also heard that moving the LD muscle can affect one's golf swing, b/c it affects one's ability to twist side to side. I've definitely notice that issue when I skate and have to check my shoulders against my hips to stop rotation on the ice.

I'm sorry you have to deal with this at such a young age. I was 38 at original diagnosis, 46 when I recurred and had the reconstruction.

Here it is.....

https://community.breastcancer.org/forum/44/topics/835911?page=10#idx_296

I am just going through the same decision - I rock climb and ski a lot too and just had a DCIS diagnosis in my healthy breast so I have to get the breast removed.

My other breast is already gone since my mastectomy about 4 years ago. I stayed flat on that side after having a tissue expanded implanted that I just totally hated. It is really not a good decision to have something implanted under a muscle if you climb...

Do not compromise any muscle for your reconstruction if it is not totally unavoidable - especially do not get a latissimus or TRAM flap.

I am now leaning towards a DIEP/SIEA flap, but my preference was a PAP flap, which my PS doesn't really want to do. He prefers TMG-gracillis flaps, but I do not want to sacrifice any muscles at all even if the gracillis is not very important. He did not want/could not promise me to not take the muscle during the surgery so I decided against it. Check out Dr. Allen for PAP flaps.

I do not have a lot of belly fat, but I can live with having small breasts as long as I am able to climb. This is why I am prpbaply getting DIEP/SIEA flaps with some additional fat grafting.

Send me a PM if you want to connect - would be great to climb together someday

Carini,

Sorry, I saw this just now. I am also a "uni" and a serious cross-country marathon racer. Did not want to mess with my muscles. My PS was going to do over the muscle implant with a matrix. But because my healthy Breast is small (34AA) and because I didn't care if the recon was a little smaller (lots of women naturally don't have matching breast sizes) we did fat graft of the entire breast. We both knew it was risky because my BMI a is an 18, there is not an ounce of extra fatty fat on me. We did stomach and flanks this summer which produc d a little 'bump', 90cc's. I was surprised how much that helped me psychologically. Last month we did my thighs and knees. Again, everyone was shaking their heads that there is so little fat. Surprise! He managed to get 155cc's (the nurse said "Who knew your thighs were so chubby?") Athletic women have beautiful golden fat that has more 'staying' power. So, right now my recon side is bigger than the natural, but you always lose some and he predicts I will lose right about to the natural one's size. I already LOVE it! It feels and looks completely real (cuz basically it is), it feels almost exactly like me before the mastectomy. This choice will only work for you if you are either naturally small on your healthy side or not concerned about total symmetry, and if you have a PS that really knows how to do this.

SkiQuee