To recon or not to recon? Overwhelmed!

Hello there, so sorry for your diagnosis. I am not sure I can answer some of your questions but I can share my experience, for what it is worth. I am 46 and recently had a UMX with direct to implant. I had a skin sparing mastectomy but was unable to keep my nipple. I am pleased with my implant so far, I am slightly uneven but look fine in clothes. At some point I will probably get a small form to make up the difference. I did get unexpected news that I will need radiation due to positive nodes so I do worry about implant failure. My PS never mentioned that the recon could change my risk for lymphedema and I had 3 sentinel nodes taken at time of UMX. Recovery has not been that bad and this was the first surgery I had ever had. I will say that my plastic surgeon has said that fat grafting to fill in any places could be an option after I finish healing and that insurance would cover anything needed for symmetry in my other breast. She said I could get a lift or a small implant to match the roundness of the implant. I wish you the best as you make this decision, and you will make the right decision for you. The early stages of diagnosis were the most scary for me but things do get better. There is no doubt this is a crappy situation to be in but it sounds likes you have a caring team. Just be cautious where you get your information and that it is a reputable source. This site has a lot of great information and always ask as many questions as you need. This forum has been a lifesaver for me.

I think that one of the best options for "lazy" is a direct to implant reconstruction. That's what I had and one of the reasons was that I could just get everything done at once. I was able to save my skin and nipples and the implant is under the skin instead of under the muscle. That's an important consideration for someone who is very active.

Answers to a few of your questions or comments:

Implants don't have to be replaced every 10 years. Most are warranted for that amount of time but expected to last much longer these days.

People who are younger and healthy generally recover much more quickly from surgeries and with less complications. It's helpful to be at a good weight and not smoke.

I would think that any possible further surgery could mess up a tattoo. However - many tattoo artists are very good at camouflaging problem areas and could perhaps fix something like that.

If you have a recurrence after recon, it probably depends on where the recurrence is as to what they do for the surgery and how an implant is impacted.

I'm not aware of an increase in lymphedema risk with recon vs without. It seems to mostly be related to disruption of the lymph drainage system and can actually be independent of how many nodes are removed.

I'm sorry that you have to make this hard decision. I would definitely recommend seeing at least two BS's and two PS's for their input. And keeping reading! But in the end - you know yourself the best.

hellosara,

I was about to write a long response to answer your questions, but NotVeryBrave already did!  I agree with her answers. Also, please note that past statistics about implant replacements may not apply to newer implants, which are designed to last longer. 

There are members here who have had their implants replaced, including myself. My implant was replaced because of capsular contraction, which is when scar tissue forms in the capsule, or pocket, and moves the implant out of place. No one knows why the scar tissue forms. In my case, it formed around the left implant, and pushed the implant up. The correction for that is removal of the implant, removal of the scar tissue, and replacement of the implant. The surgeon usually uses the same scar to make the incision. My implants were placed Jan 2016, the left was replaced June 2017. My breasts look as similar now as before replacement. . 

Best wishes on your decision,

Madelyn 

I'm sorry that you are going through this. So many questions and emotions, aren't there? I can only comment on my experience which was 11 years ago. I used by lats and silicone implants. I was also quite thin and actually didn't realize that they take out the lats completely and put them in the front. I wouldn't recommend that at all and if I could do it over again, I would have chosen the tissue expanders. My back is forever changed. Anyway, I enjoy having breasts, even though they have no feeling. I look good in clothes and most people I'm sure have no idea that they aren't real. I think I made my decision too quickly and it's good that you are really investigating and researching. Good for you. I hope all goes well. The important thing is to be here and continue enjoying our family and friends. By the way, I haven't changed the implants and don't plan on, unless I absolutely have to.

Wow! Thank you to NotVeryBrave! Excellent answers. Just to add my 2 cents....I had a bilateral mastectomy in July 2018. I had read a lot about straight to implant surgery and thought that was what I wanted. I learned that basically because your breast skin isn't expanded as it is when tissue expanders are inserted - the max size implant would be an approximate B cup. That may be perfect for you, it wasn't for me to look my normal. I would ask if a skin sparing mastectomy is an option...then straight to implants if that is your choice. Alternatively, I have seen some absolutely beautiful tattoos. Don't stress too much. Though we are all different I can tell you I took a couple Tylenol after my mastectomy....nothing needed after my exchange. My ONLY issue was the tissue expanders. The very best to you.