Weight and reconstruction

Shevi, we just wanted to welcome you to Breastcancer.org, and let you know that we're so glad you've found our community. Sorry your circumstances brought you here, but we sincerely believe that it will be a great source of support to you.

We hope you get responses from other embers soon, but in the meantime we wanted to give you some articles from our main site that you may find interesting:

• Obese Women More Likely to Have Reconstruction Complications
• Going Flat: Choosing No Reconstruction
• Questions to Ask Your Surgeon About Breast Reconstruction

Please, let us know how it goes at your surgeon's appointment.

Best wishes,

The Mods

I'd guess the main issue some surgeons may have in your case is the fact that you're diabetic as opposed to just being overweight.

Diabetics, even when it's well controlled, are still prone to having poor circulation in many cases so a lot of the flap procedures would maybe not be considered as there would be a much higher risk of the flap dying due to poor circulation. Even in non-diabetic women flap necrosis can happen due to circulation problems to the transplanted tissue, but the risk goes up if you have diabetes.

As for weight, some of that will depend both on the surgeon in question and just how overweight you're talking; if you're just, say, 30-40lb overweight it's probably not going to be much of an issue (though the diabetes could be as I mentioned above), if it's more like 100lb+ overweight some surgeons may not be comfortable or willing to do anything but implants because of the higher risk of complications being significantly overweight can bring with healing.

It is worth noting that reconstruction doesn't have to be immediate so if you were set on wanting a certain procedure (and the surgeon was okay with the diabetic part) and/or you just wanted to try to lose some weight and get as physically healthy as possible before going through reconstruction, reconstruction can be started any time, even years after the mastectomy.

When you talk to your PS, just be honest about the goals you hope to achieve and be as specific as possible about what your end goal is.

For example: "To have breasts" is pretty vague.

Something like, "I'd like to have reconstruction that will give me as natural looking breast as possible that is as close to the size I have now if possible. I would like them to look good in clothing as well as topless, and like the results I've seen from DIEP reconstruction (or any other results you've seen from a different type of recon, I just grabbed DIEP as an example ). I'd like to have the reconstruction done at the same time as the mastectomy. Is that a realistic goal for me?" is a lot better.

If they tell you that your goal is NOT a realistic goal, ask them to give you details as to why.

A good PS will tell you if you're having unrealistic expectations or if they don't think your body will handle a certain procedure well due to the combination of weight and diabetes—and definitely be sure to mention that you're diabetic, it's obviously going to be in your chart, but sometimes things get overlooked if they're not brought up specifically.

It's also VERY worth asking if the PS has a portfolio of breast reconstruction photos (NOT just augmentations, an augmentation is very, very different from a reconstruction after a mastectomy) that they've done in the past so you can get an idea of what their work looks like.

I am also overweight, and my PS doesn't do immediate reconstruction, at least on someone with my BMI. I haven't asked if he ever does it. From what I have read, the failure rate of immediate reconstruction on obese women is pretty high, like approaching 40%, and that's without being diabetic thrown in.

He did, however, want to use the lat flap, to get me to a "size that fit my body." Well, my body SHOULD be an 8, instead of a 1X. If I ever lost as much weight as I should, I'd probably be unhappy with DD's. He said I'll probably end up being a C, and I'm fine with that. That said, for a lat flap I'd want a PS that had done a LOT of them successfully. I think sometimes women are constrained by price, location, and insurance reimbursement, but I don't think it's worth using a PS that isn't really experienced in microsurgery (which I predict you'd need if you have poor circulation,) just for those reasons. I know that's easy for me to say, but I'd rather just have implants if that's all that was available due to those restraints.

Right now I have TEs that I think are filled to 740 each. I'm not sure if he put 200 or 230 in when placing them. They are pretty taut now, and right up under my collarbone, but they aren't painful, and not really uncomfortable, for the most part. Good luck with your decision.

My sister had a DIEP flap in October. She had a BMI of 35. Not one doctor even mentioned it.

They liked her fat and told her so. She was not diabetic. DIEP was tough, but she is now

6 months out and doing well.