Plastic Surgeon's "curve ball"...I'm upset!

You need another PS consult. Someone who is capable of listening to you. There is expertise and there is competency and there is prestige. There's also common decency, honesty, and care.

I can't speak to the concerns about healing. Some of that may be valid and should be considered. But there are also risks associated with multiple surgeries and radiation. Nothing is without some degree of risk and doing nothing at all is not an option.

I feel like it's really important to have providers that can "hear" you. Yes - you want people who know their business and will help you get through this and be as healthy as possible on the other side. But ... you also need understanding and compassion.

I think if you do not feel comfortable with that PS then you definitely need to seek another opinion. I don't know anything about him or your particular situation, but I will say that his point about the lack of sensation is a valid one. I tried to go the lumpectomy route (I also had 2 lumpectomies, and 1 had to be repeated for lack of clear margins). I ended up having to have mastectomy because my surgeon could never get a clear margin. I had bilateral mastectomies with implant reconstruction, and I am happy with my results. But the lack of sensation is a really big drawback in my opinion, and if I could have just had lumpectomies I would have preferred it that way. That did not work out for me.

All that being said, I think you have to do what is the right choice for YOU. That is different for different people. The whole breast cancer thing is so traumatizing to go through, I think all patients should be able to get the care that feels right to them. That may be different for different women. So find a PS that will help you with the choices you have made for yourself.

I just wanted to confirm that his opinion on the lack of sensation is a very valid one. My new reconstructed breasts look pretty good in clothes and even without clothes, but I can't feel a thing when my husband touches my breasts during sex. That is very disappointing and sad to me.

I wish you the best in making your choices.

Before my lumpectomy, I had all my requests to talk about reconstruction blocked by the first breast surgon and first plastic surgeon. They just kept saying we'll talk about reconstruction later. I didn't push it at that time.

Then the two plastic surgeon consults I had after that months later said they wouldn't do plastic surgery because since I refused radiation they ethically could not do surgery on someone who they felt still had cancer, that it would be detrimental to fighting cancer for me. So I was pretty aggravated and angry. It's so so hard. I'm crying thinking back to it. I liked each of the doctors themselves. It made me really feel I was going to die pretty soon and made me feel really stupid for pursuing it. It felt like such a waste of time and I just couldn't wrap my mind around all these wonderful plastic surgery stories I read on here and I didn't understand what was so different about me. I did refuse radiation but I've had all the other treatment recommended to me. Just so so frustrating to keep pursuing.

I made another appointment and had to wait two months for it. told him straight out I'm not doing radiation. I want a reduction and lift and my breasts to match again. This surgeon is actually wonderful. He doesn't lecture me about my cancer. He leaves that to the oncologists. He said he will do the reduction and all breast tissue he cuts out will be sent to pathology. The only think I don't like is he wouldn't do the surgery while I was on the Herceptin/Perjeta and I have to wait six months until after the last one. Also I am overweight. Every summary from every doctor, the entire first page includes an automatic paragraph reminding me I am considered obese and even losing just 5% of my body weight, blah blah blah. I am feeling extremely ugly right now. I am trying to get my weight under control after this very hard hard year. But that is not an issue for this PS either.

I have about five months to go. It's scheduled for October. It feels like I've waited so long for this it's never going to happen so I'm still trying not to get my hopes up.

I, can tell you Reconstruction is NOT a walk in the Park....Liz

Lack of sensation is a big drawback, but it might not be for you. I miss having normal sensation. At almost a year out - some sensation has returned, though.

Eagle - I had my BMX with recon after chemo and while still on Herceptin.

yep, you need to find a new PS. I am guessing he’s changing his tune because it’s difficult to get a good result with implants if you’re large breasted to start and need them to be proportional to your body when all is said and done. DIEP flap and/Or SGAP reconstruction often have far better results than implants for larger breasted women as there is no set limit on how big they can go. Odds are that PS does not do flap recons like DIEP/SGAP, feels he can’t do the appropriate size with favorable outcome with implants so has dropped to plan B. Perhaps check into DIEP flap.

Remember that if you have a Mastectomy, you will not feel the mounds on your chest.  I embrace my sexuality too, and it sucked to lose my nipples. However, having implants does NOT make one have breasts again - so I wouldn't go in thinking you'll have a perky chest like someone who just gets implants within their breasts does.  I started recon and realized all the issues I didn't know about before I jumped in and got them the hell out of my body and went Flat and Fabulous.  I think I look sexy just the same... Hell, most models on the runway are flat as well.  Sexuality is about confidence and your brain, not if you have silicon in your chest.  My husband thinks my flatness is hot too.. I could lose my entire body and be a brain in a jar and I'd still be hot.     Just a reminder that you sex appeal shouldnt' be based on your chest. 

Marymorris, I have been on prednisone over ten years and was on methotrexate before too. I gained 50 lb. and was so sick I used a wheelchair.

When I got BC I refused radiation even though docs said I was a candidate because of my autoimmune problems, at age 63 (over 70 they would not have recommended it) , so sometimes they offer it even with auotimmune issues. How much prednisone are you on from rheumatology? Tapering it even a little could help control appetite and obesity. I also have RSD in two extremities which could flare, and big-time fibromyalgia ( probably not an autoimmune problem, just a consequence of everything, still hurts) and osteoporosis with prior fractures. I had PMR , less active now, and three years of lupus, autoimmune overlap syndrome.

Even I can force walking since BC diagnosis, limit calories strictly, limit prednisone even though I get more pain. I take metformin for appetite control. I have lost 28 lb., plan on 10-15 more. I was a AA bra size before lumpectomy, still would be, but cannot tolerate a bra due to chest wall muscle inflammation and pain. My husband does not care about boob size, and worried about my being overweight, he just wants me healthy as possible and with less pain and not dying. You do not need FOOBS to be healthy and beautiful, and weight loss is about health, and keeping BC away.

Marymorris, those were horribly high, but necessary, steroid doses for your TA. Fortunately that was not a complication of my PMR.

Make sure, if you have not already done so, to protect your bone health: get a bone density scan baseline and annually thereafter, check 25-OH D in blood to make sure it is well over 30, and maintain calcium intake from diet or supplements of 1.2-1.5 grams elemental in divided doses each day (3-4 dairy portions or equivalent, or supplements, or combinations).

If you are on daily steroids at least equivalent of 5mg a day of prednisone yu should ( if no contraindications) be on an anti-resorptive.

mary,

If you click on my name you can see my profile and the various posts I’ve made. Some where, probably in the 2018 DIEP thread in feb or march I think I posted about my experience. In a nutshell, the expander held the breast position for the year+ that i had treatment and healing. I was planning DIEP from the beginning but knew I needed to recover from radiation first.

DIEP surgery and recovery for me was easier than the mastectomy. I am in my mid 50s and active. While I'm up 15 pounds since diagnosis i am routinely referred to as “fit and thin”. I think the fitter and more active you are the easier recovery will be.

I am happy i had a single mastectomy and DIEP. I’m a D pre and post surgery if that information helps you. My tumors were in two quadrants and my surgeons advised that lumpectomy would be too icky (my words) due to how much tissue would be taken. I had nipple and skin sparing mastectomy

Here’s the link to the pics of one of the DIEP flap groups Mary is looking into. Just for the record, these pics are their standard results. I had my BMX and DIEP done with this group and I look better now than I did when I started (and I looked pretty darn good when I started). And my new breasts are very natural looking and feeling. Can’t feel my nipples but they do react to touch and cold. If you saw me naked you’d say, “maybe she had augmentation as I can see a slight shadow on the underside of the breast...but I don’t see any tell tale bulges or artificial shape/position so maybe it is just a shadow.”

https://www.breastcenter.com/result-photos/diep-photos/

I think I read a research article on this site just a few days ago that said radiation may not be necessary for women over 65. If you don't want radiation, please read the information on this site about its application for your age group.