Reconstruction options?

Hello people, I am looking for some advice. I was diagnosed with inflammatory breast cancer in March, at age 30. I have met with the surgeon and we are going forward with a double mastectomy (I have a CHEK2 gene mutation so that even the "good" breast needs to go). I will be done chemo in mid-July and will be seeing a plastic surgeon soon afterwards. With everything happening so fast I need to make a decision about reconstruction. I am by not mentally/emotionally ready to be flat-chested, and I am not interested in implants (I believe they have to get redone every 10 years or something?) So basically I'm trying to figure out what I want. The flap procedure sounds interesting - I think it’s called DIEP? What kinds of complications did anyone have? Is there anybody that had a full mastectomy and were able to have a similar size again? I guess that is where tissue expanders come into play? I don’t yet know if I will be getting radiation, but did that affect anyone’s reconstruction results? Sorry for all the noob questions! Thank you!

Thank you so much for the reply! It is very helpful to hear of other people’s experiences. I am still not decided but it is interesting that implants don’t necessarily have to be redone every 10 years. You gave me some valuable info and I thank you for taking the time to reply

I had bilateral mastectomies with silicone implant reconstruction over the muscles. The expander stage is more painful this way because the expander gets sewn to the skin (it takes a few weeks for the pain to disappear), but my new breasts look big. I actually went a size up, although I wish that I had stayed the same size. By going bigger, I stretched my skin, which led to three years of complications that are still ongoing: recurrent infection and intermittent inflammation in my blood vessels due to changes in circulation. I think that I am finally learning how to control the inflammation through my diet and that the infection (which originally hospitalized me and had me on intravenous antibiotics for a few days) was resolved through the additional surgery that I had (explanation followed by ten months without an implant, followed by new reconstruction with another implant). I still have recurrent redness, but it no longer appears to be an infection. We’re actively trying to figure it out.

I've learned that being a thin person made the result look worse in a way because the edges of the implants are ripply under the skin, like when you pick up a slightly deflated beach ball with one hand, and depressions or indentations appear in the ball. I could have filled in these areas with a little thigh fat, but because I battled a recurrent infection, I opted not to have more surgeries that could expose me to more bacteria.

My breasts look fantastic in bras and clothing, or when I am naked and pull my shoulders back, which makes the ripples disappear. With a little thigh fat, I think they would look awesome. By going above the muscle, I needed a cellular dermal matrix to pad the skin. ADM is donor tissue from cadavers. This could be another reason for my recurrent redness—if my body is rejecting it. My problems, though, are rare from what I understand.

My friend just had flap surgery and a bunch of complications, including infection, but this was after receiving radiation, which could be why. I’ll ask her whether she is happy with her new breasts’ appearance. Meanwhile, my mom had reconstruction with implants placed under her pectoral muscles. I believe that she thinks they look “okay.” I’ll ask her if she’s happy with them and repost.

Yes, you can probably have skin sparing With expander. I would also strongly suggest you get at least one more opinion. Measure twice, cut once!

My plan has changed many times, and so has the Drs. opinions, so I do think another opinion would be good. First I was told I was not a candidate for DIEP, not enough fat. I had TEs put in during Bmx. I had an infection and they came out. Due to chemo and radiation, I decided to do DIEP, which I suddenly became a candidate for, hmmm. PS was mislead by BS into thinking I would not be doing chemo and radiation. I did gain about 10 pounds. Than my radiation oncologist tells me implants are not out of the question after radiation. hmmm. Lots of different opinions. I have a lot of flappy thick skin due to TE removal, and it looks fine to me, I could probably get implants. I'm afraid the radiation wasn't strong enough. It was very easy. But currently am still thinking DIEP so I don't have to worry about implants for the rest of my life. 6 months after radiation would be November, but I'll put it off til January to save ruining the holidays. I'm also scared implants could mask a reoccurance, especially over the muscle which is what my PS does, even though everyone says no. But also thinking silicone implants is the only way I can get periodic mris, which is sad that would be a consideration. Both of my PS consults also mentioned Lat Flap, which I find really wierd. You need implants with that. Why in the world would I take a muscle off my back instead of the fat off my stomach. I don't trust any of them, I've had bad experiences. I'm so confused.

Ivy - it's such a personal decision. Some want no reconstruction. Some want implants. Some want more complicated surgery like Lat or Diep flaps. Some are constricted in their plans by other medical issues. There's really no way to recommend the path to take. If you've researched, you know the average time to heal for each type of surgery, which is a personal consideration.

I agree about getting second opinion. That gives you more thoughts to consider. I also recommend that you go with a PS who has LOTS of experience and does whatever surgery you choose on a daily basis with good results. Some are better at one type or the other.

Hi Ivy - glad you are almost done with chemo. Making the decision is very difficult. I went back and forth in the beginning originally thinking I was only going to do lumpectomy. But then completely changed course and decided on bilateral MX.

I came to this decision based on my age, not wanting to do rads or hormone therapy among many other factors. I was a mess in the beginning but was at peace with my decision when I finally made it. And surgery just confirmed that for me, with stuff going on in my “good boob".

My surgery went well overall. I had bilateral nipple sparing MX with prepec expanders (worst things ever!) and then finally implants. It is a big surgery and no easy task. I had a lot of pain post surgery (3 weeks of drains) and some delayed healing in the beginning but no major problems otherwise which I'm very thankful for. My BS did a great job with nipple sparing and I have inframammary incisions so you can barely see my scars.

Even though we are all dealing with different diagnosis's and situations we all are unfortunately forced in to making decisions we had never thought or hoped we would have to make. So I hope you can come to peace with your decision and make the choice that's best for you. We're here if you have any questions and I wish you the best going forward!

You’re welcome. Yes, it’s such a tough situation to be in. But like you said, you’ve gone through so much already and finally can get on with your surgery and put the worst behind you. Best of luck to you!

Thank you beeline! Delayed reconstruction never crossed my mind, but that probably has a lot to do with self-image and vanity. I never realized how important my looks were until I lost my my hair. Unavoidable emotions is an understatement!