Mastectomy decisions

BTeich
BTeich Member Posts: 6
edited August 2021 in Surgery - Before, During, and After

I am 39 and was diagnosed with breast cancer this past May. Shortly after I found out I have the BRCA 1 gene mutation. I am currently in chemo and will be having a double mastectomy this fall. I have F cup breasts currently and have always wanted smaller breasts. I have decided against implants. Flap reconstruction is not an option because of a lack of available fat. A fat graft was proposed but I have decided to decline as I don't feel the additional costs (second surgical site, increased healing time, necrosis etc.) outweigh the benefits (a very small addition to the size of my "breasts"). One thing that my PS has suggested is to use the excess skin from my breasts to make a very small mound, less than an A cup, where my breasts once were. I spoke with my general surgeon and she was in agreement about this as a feasible option as well. She said that doing this would result in less scarring and that the healing time would be the same as if I had opted for no reconstruction. I am wondering if anyone has done this and what the experience has been? I see people mentioning excess skin and making sure to let their surgeon know they don't want excess skin and I am wondering if this is possibly what they are referring to? I am guessing not but just want to make sure there is no downside that I am missing. My goal is to move forward from this with as little intervention/repeat surgeries as possible.


Thanks in advice for the advice and opinions.

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Comments

  • moth
    moth Member Posts: 4,800
    edited August 2021

    BTeich, sorry you're dealing with this & having to make this decision.

    when people want a flat closure, now known as an aesthetic flat closure, they do not want skin left over so I think that's what you've been hearing about. Skin, without supportive tissue will sag, either now or eventually.

    Has your surgeon shown you photos of what they envision the final result to be?

    Have you looked at the Not Putting on a Shirt site? https://notputtingonashirt.org/ They have several examples in their revision gallery of people who had skin left over which they decided to revise to a flat closure later.

    I think whatever you decide, you have to have a good understanding of what the best case scenario is, and also an acceptance that cosmetic outcomes are sometimes not quite what the surgeon or pt anticipated.

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  • Moderators
    Moderators Member Posts: 25,912
    edited August 2021

    BTeich, sorry you find yourself here, but glad you found these great people. Moth gave great advice.

    It sounds like you are thinking this well through.

    Here is a link to our section on Reconstruction in case this could be helpful.

    Also, you may want to take a look at the threads in our reconstruction forum as well.

    We're all here for you!

    The Mods

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  • Aram
    Aram Member Posts: 417
    edited August 2021

    Hi Beteich, I am in the same situation as you. I am currently leaning toward aesthetic flat closure as it leaves less breast Tissue. It seems to me with BRCA1 mutation, the less amount of breast tissue left, the better. I have not completely made up my mind yet.

    As moth said definitely asked them for pictures of what they mean for skin mountain and aesthetic flat closure so there are no surprises.

    Good luck with your decision.

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited August 2021

    I am wondering if what your PS is suggesting is a Goldilocks mastectomy. This is different from leftover skin left on the chest with the thought of doing recon later, and also different from Aesthetic Flat Closure. The surgeon uses the mastectomy flap, after clearing the breast tissue away, to fashion a breast mound - so a form of autologous reconstruction without removing a flap from elsewhere on the body. I don’t know whether this could be augmented with lipo-fille fat at the time of surgery, which is a small amount of fat taken by liposuction and centrifuged to spin off fluids, then injected under the skin of the breast to soften and add volume. Here is a link to the Goldilocks explanation:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759440/

    There are a few members here who have used this technique. I believe you can find their posts using the search bar - just type in Goldilocks and those should show up.

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  • BTeich
    BTeich Member Posts: 6
    edited August 2021

    Thank you for the comments! I have learned so much after following the links and exploring the websites. Even knowing the term goldilocks mastectomy has opened up a whole new area of information and it does sound as if this is what the PS suggested. I feel so much better prepared and have armed myself with photos of what I am envisioning so both surgeons know what I am looking for.

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  • K-Gobby
    K-Gobby Member Posts: 140
    edited August 2021

    To all, I consented to Genetic testing at the City of Hope and surprise! I carry the BRAC2 gene. So instead of 4 infusions every 3 weeks, I get one infusion per week for 13 weeks.

    Sept 14th, I have a video appt with the geneticist. Both of my sisters are being tested.

    My MO said a double mastectomy is really the option for me. Also this gene loves getting into the ovaries too. I need to keep reading from all of you. I likely have 3 months before it happens, but honestly, I do not know. The ovaries could come out before. To be healthy all my life, I am grateful that the City of Hope is where i landed. What if i had not had a genetic test? I may have just had the four infusions. I feel like a week at a time for each chemo. By then I will read from all of you, talk out loud to the people i can and make the decision to do it. One may have had small breasts, and wished for bigger, but almost never is the wish for nothing. Much to think about.


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