Questions about breast reconstruction

stokerfan - under the breast reconstruction section where you've posted, you will find literally thousands of descriptions from members who have done several different kinds of reconstruction. You can try the 'exchange' thread, or a number of others. Once you do some reading, if you narrow it down a bit - for example are you considering implants or DIEP or ???? - we will be better able to relate relevant stories.

Stokerfan:

Apologies, I forgot to answer your initial question.

My bilateral mastectomy with immediate expander placement was actually kind of a breeze from my perspective. I woke up from surgery feeling like nothing happened but anesthesia. I felt and looked like I still had breasts, and for a few minutes I was worried that I had had a bad reaction to the anesthesia and they aborted the surgery before even starting it. I was very relieved to find that that wasn't the case.

I did not have much severe pain. I took an oxy at the behest of the nurse the first night but I found that Tylenol adaquetly kept my pain at tolerable levels provided I did not move or use my arms and hands in ways I was not supposed to. However a few days after the surgery the skin on my chest surrounding the expanders felt sunburned to the touch.

I had two drains, one of which caused me some pain if I was not careful, but only had them for a week. I required a bed wedge for a few weeks as it was impossible for me to sit up from lying flat on my back, and I required assistance getting dressed for the first two weeks though I managed to improvise with some ingenuity on occasion.

I had to wear a surgical bra 24/7 for a few weeks but at the time it was usually more comfortable to wear it than not.

I didn't have much discomfort during the expander fills. The expanders had a hard base, which could be uncomfortable...I had a nerve one of them kept hitting, and sometimes after a fill I would feel tightness, but nothing horrible. I should mention that I had pre pec expanders, meaning they were under my skin, over my pecs, as opposed to being under my pec muscle.

My exchange surgery, where my expanders were replaced with the silicone implants was a different story. I thought it would be an easier recover than the mastectomy and I think it normally is, but I think they had to do a little more work than usual and I woke up in a lot more pain than with the mastectomy. I felt like my arm was sewn to my side at the armpit and I did have sutures in there but the exact cause of the issue remains a mystery two me. It resolved a few weeks later when I had my port removed and I'm not sure if the port was hitting a nerve or pulling on something or if being numbed up from the removal surgery allowed me to break a problem suture. I just know that the port removal resolved the issue.

Also, I had not realized I would need the bed wedge again or assistance after the exchange surgery and this resulted in me getting stuck on my back for half an hour the morning after my first night home.

But I'm happy with the results...I'm pretty impressed actually; I think my surgeons did an excellent job, and I do not regret my choices.

Stokerfan:

Do you have the pathology report? It should say the type of breast cancer, the grade of the tumor and receptor type, for example my breast cancer was grade 3 invasive ductile carcinoma and it was estrogen receptor positive (ER+), progesterone receptor positive (PR+) and human epidermal growth factor receptor two positive (HER2-positive). Another way of saying that is that I had high grade, triple positive IDC. Does your doctor suspect lymph node or chest wall metastasis?

Because my cancer was HER2 positive, I had chemotherapy before surgery. That is called neoadjuvant chemotherapy. They also like to do neoadjuvant chemotherapy for triple negative breast cancer, which is breast cancer with none of the three receptors mentioned above.

The more common type receptor type of IDC is hormone receptor positive (ER+ and/or PR+) HER2 negative. For this type of breast cancer, they often do oncotyping to determine if chemotherapy is necessary or will be effective.

My initial ultrasound when I was diagnosed showed suspected lymph node involvment but another ultrasound and a PET/CT did not. I also had a breast MRI before starting treatment, which did not substantiate lymph node involvement. In any case, during my mastectomy they did a sentinel lymph node biopsy which came back negative, so radiation and axillary node removal were not necessary in my case.

If it was determined that I did need radiation, I'm not sure if they would have left the expander in or removed it.

I had Diep Flap from tummy unilateral. Left side. I had complications but it was me, not the surgery. I had Blood Pressure drops in surgery for an allergy to Gabapinton. So ended up with necrosis and more surgery. No regret, I have cleavage and had my right side lifted and reduced and will have an additional lift done again in summer of this year to get it up a little higher. Most days I do not wear a bra, I wear a tighter tank top under shirts. I recently had cellulitis in it and I am not sure how I got it. It was a Strep A and hit my bloodstream too. So I picked up a bacteria somehow and it landed on my reconstructed breast. My tummy is flat and I did get contouring with Liposuction on hips and for side boob. Insurance covered it all. The flap has a football shape skin pad from my tummy as I did delayed reconstruction. I can hardly see it myself looking down. Scarring is not so bad. I did loose my belly button to necrosis but oh well, don't need one. I chose this over implants as I knew I did not want implants. First few days were rough in hospital but no worse than my knee replacement surgery.

Stokerfan:

As your cancer is HER2 positive, you will likely be getting the targeted therapies herceptin and perjeta along with the chemotherapy. There is a forum here specifically for people with HER2 positive breast cancer in case you are interested.

Just out of curiosity, have you met with an oncologist yet?

Stokerfan:

Good luck on your surgery! I hope they get clean margins and wish you an easy recovery.

calicoclara, I took my own drains out. I snipped the sutures and gently pulled them out and put a dressing over the holes. There was nothing to it. My fluid outputs had dropped on my breast and my abdominal drain just lost suction for some reason so I did one, the the other a week later. Due to corona, it was an option. Maybe you could ask for your situation?