Only in Canada eh? Reconstruction

Hello all,

I had a pedicle tram on June 16/08.  KiKi I am sorry to hear about your complications, and hope all is resolved now.

I love my tram.  I am still healing.  Wearing a full control girdle to support the reconstruction to my abdomin and will continue this until the end of July, after that I will switch to a medium support and then light support to gradually phase myself/tummy muscles out of support.  (Also, the girdle is not to go above my new belly button).  I was told  all I can do is walk pretty well (so I took that to mean no lifting, other than my coffee cup of course, no cleaning, no mowing, no vacuuming).  I am not able to go to work until July 28/08.  The ps gave me tape to put on the scars for support (I think nexcare makes it) and I replace it every 2 or 3 days.  I take long walks now.  Three weeks out and everything is healing nicely.   

Let us know how your consult goes.

So I had my consult with Dr. Khanna today so I'm reporting back as promised.  She's a great doctor and so honest and upfront.  Told me different options, could do this, could do that.  We were talking about a tram flap but she was concerned about the site of my appendectomy (from when I was 15...who'd a thought it would be an issue now) with regards to blood supply.  Then she said, no, she wouldn't do a tram on me because I had radiation on my entire abdominal area when I had ovarian cancer.

Her next suggestion was the one where they use the tissue in your back....dorsal something?  She said she would send me to PMH...used to be Dr. Lipa, but now would be her replacement.  Anyone familiar with this procedure or this doc?  She also mentioned the possibility of using expanders and implants (or is this part of the the dorsal?...I can't remember!).

Anyway, she is referring me to PMH, my home away from home, so I'm sure I'll be in good hands and will get all the info at that time.

BMac, what about an IGAP or SGAP.  They look great and scars can be hidden in your undies. Mary

Barbara, I didn't have a enough tummy fat for a DIEP or TRAM so I discussed the possibility of an IGAP with Dr. Lipa.  Basically, an IGAP uses the fat from under your butt (I definitely have enough of that!) and an SGAP uses the fat from the top of your butt.  I decided to go with implants instead so I can't tell you any more, but here is a website that explains both those surgeries.  

http://www.mdanderson.org/diseases/BreastCancer/reconstruction/     Click on "Tissue Based Reconstruction" down the left hand side.  The S-GAP and I-GAP are explained under "Breast Reconstruction with Alternate Flaps".  In the tissue-based reconstruction section, you'll also find information about "Breast Reconstruction with the LD Flap" - that's the latissimus dorsal flap reconstruction that's been recommended to you.

I did go to Dr. Lipa but unfortunately can't help you out with any information about her replacement.  Because my reconstruction is done and I only required minimal follow-up, I was referred to a different PS. 

BMac, with the IGAP or SGAP, they take fat from your hinny.  The IGAP is neat because the scar is hidden in the crease of the bottom of your tush.  You also get a sculpted tush in the end so it matches.  I think it's a great alternative, maybe even better than the lat flap.  I just don't know the medical end of it as far as tissue.  If you go to the breast center web site at NOLA you can see pictures.  They are great.  Take care, Mary

Thanks Gibby.  That's interesting because when I went to my family doctor to ask for the referral to Dr. Khanna she asked me had I considered Dr. Brown.  I hadn't heard of him before but said sure but I never got a call about the referral ever being done.  I need to see my family doc in the next little while so I will definitely ask for a referral.  I really respect my family doctor's opinion and now hearing from you this seems like the next step to take.

Let me know how you get on.  My surgeon wants me to wait two years due to the chance of recurrence but I want to have everything in place so I'm ready to go when the time comes.  I would be so thrilled to be able to have the surgery done in Oakville.  I think that the nurses at the hospital would know who the best surgeons are.

Thanks Sue, I'll keep that in mind once I know what kind of surgery I'm going to have.  It's always good to "speak" to someone who's gone through it.

Hi all

Gibby: I had my tissue expander put in with 60cc of fill immediately i.e. at the same time as my mastectomy.  It was uncomfortable for about two weeks - felt very tight and hard - and then gradually eased off.  I had my first fill at three weeks but it was only 25cc.  I had my second at five weeks, also 25 cc.  Neither of these fills was in any way painful.  The breast felt a little tight afterwards but nothing horrible.  We are doing this gradually because my breast was radiated with my first diagnosis 14 years ago and sometimes radiated skin does not stretch so well, hence the gradual fills.  I am not big breasted on the other side so it shouldn't take so long and to be honest I don't mind waiting.  In the US they do big fills - 150 cc etc and I can't imagine that kind of experience.  Where are you having yours done?

Sue

What kind of implants are you canadian gals going to get?

Hmm, thanks for the info Beesie.  I am thinking I may get the gummie implants too.  Are they inserted behind the muscle?  Mine are going to be inserted behind the muscle.

Yes, the outer shell of saline implants is made of silicone.  With the gummy, it's not the outer shell that is stronger, it's that the cohesiveness of the gel that's firmer.  It's called a gummy because the consistency resembles that of a gummy bear candy.  It's not solid and can be squeezed but if you cut it in half, both halves stay intact with no leaking.

Here are pictures, first of standard silicone implants (often called cohesive gels but they are less cohesive than gummies; these are what's available in the U.S.), then true gummies (available in Canada, Europe, Australia... pretty much everywhere except the U.S.) and last, a gummy that's been cut:

http://www.drteitelbaum.com/cohesivebreastimplants_6.html

http://www.drteitelbaum.com/cohesivebreastimplants_7.html

http://www.cohesiveimplants.com/

Edited to add:  Yes, mine is behind the muscle.  Most reconstruction implants are behind the muscle - I can only think of one person who said that hers was in front of the muscle and that was a re-do.

Just an update.   Gibby you recommended Dr. Stephen Brown and I assume you've had your surgery.  I finally got to my family doctor for a referral and she said I should phone his office to see if he does the lattisimus.  Well, apparently, he doesn't do recon at all anymore.  I hope that you were able to get your surgery.

I had a mastectomy a few years ago.   Sick of wearing a prothesis I decided to get reconstruction with Dr. Nicholas Guay of Ottawa.  I was obviously dealing with a lot at the time, but because of his kind words, I decided to trust him.   He gave me an implant on the breast removed and a mastoplexi on the other.  I am very upset with the results.   The implant is as hard as a rock and the mastoplexi was not what I thought.   That breast that was still beautiful (and perky) is now a war zone because of what he has done to me.  He messed up and kknows it.  I don;'t understand why he did surgery to a perfect breast.   He should have done the reconstruction first, and then a second surgery to make both look the same.   Now I have one hard perky implant and one droopy breast.  NO JOKE.    I am so embarassed at what he has done to me, that I have yet to show anyone.   I want to get it fixed, but don't trust him.  Anyone know what I can do??   My oncologist does not think that I should wast my time worrying about my breasts when I have more important issues.