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Mastectomy
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Mastectomy

Hi, Please can someone tell me what sort of surgery I need for my mastectomy - I want to have reconstruction at a later date and I keep hearing about tram flaps and other things which I do not know anything about - I had DCIS and have been spending months reading up on that, now its developed to invasive which was found after my lumpectomy and I am having the mastectomy on Tuesday, so have very little time to read up on what I need to know.  Any advice will be appreciated.
Thanks
Hazel
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8 Comments
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326352_tn?1310997895
Tram flap is where they take some stomach muscle, fat from the abdomen, and the skin and recreate the breast using this material.  Looks fairly natural.  The nipple is created (for me at least) by taking the skin and making a mound.  Then the areola is created by a tattoo around the nipple.  This is a serious surgery, takes around 6-7 hours.  Hurts like the dickens, but looks pretty good.

Diep Flap is where they take tissue from the abdomen (minus the muscle but with all the vessels and connecting tissue), fat from the abdomen and skin and do the same thing.  It's supposed to be an easier to recover surgery since you don't take out the muscle.  Looks probably just like a tram.

There's also surgeries that borrow tissue from the buttocks (if you don't have enough fat or skin on the abdomen) or from the other side of your arm.  Don't remember their terms.

Then, of course, there's good ole implants.  An expander is inserted to "stretch" the remaining skin and then a saline or silicone implant is put in it's place.

This is my opinon.... having the mastectomy and then LATER having the reconstruction seemed to let my body heal so much better.  I waited almost 2 years to get my new boob.  Frankly, no one noticed I only had one.  Probably too busy looking at my bald head and pregnant belly!  :)

Sorry to hear you are having such difficulty.  Are you going to have to do chemo or radiation now?

Good luck, the mastectomy is fairly easy.  It takes about an hour to an hour and a half.  You'll have probably 2 drains in after the surgery that come out in about 10 days when the drainage stops.  Are they going to do a sentinal node biopsy?
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Hi, thanks for your post.  Sounds like you have been through it too - god how do all you brave women cope?  I think they are going to do a sentinal node biopsy, he mentioned it, but I wasnt in a state for it to sink in.  It should have been taking place in 2 weeks, and now its in three days.  I cannot believe that my so curable little DCIS has now turned into a major surgery, all because the secretary lost my notes for a month. I spent three months reading up on DCIS and now its all changed and I am going to have to try and catch up on mastectomys and all the after treatments.  Is ten days the usual amount of time to stay in? my doctor told me 4 days - I have 4 young children and a sick husband and am going to have to make some plans for help.  Sorry, I am starting to go on.  Thanks Hazel
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326352_tn?1310997895
I stayed overnight for my mastectomy.  The recovery was very easy, if that is all they are doing.  The sentinal node biopsy is where they will inject radioactive stuff into your nipple and follow it to the first nodes it encounters.  They will then remove those nodes and test them for cancer cells.  If they find even the smallest cancer, they will remove you lymph nodes.  It's like taking an ice cream scoop to the goo under your arm.  Not very particular or neat.  That is why you might have some numbness and funky feeling along the underside of the arm, pretty much for a goodly long time, if not forever.

Mom went through Stage 1 DCIS, I was stage 3 DC with 1 node involved.  She and I both had mastectomies.  She had a failed tram, and mine was textbook pretty.  So, I've been through quite a bit with breast cancer.  We both suffer from varying degrees of lymphedema.

So, surgery will occur.  You'll probably stay a night, maybe two.  I was good to go home earlier than they would let me b/c the doc took his sweet time doing rounds that next day.  Sheesh, never thought he'd show up.  The surgery is not very complicated unless they are going to try to do reconstruction at the same time.  I wouldn't just yet, because I just think things heal better, but that's me.  And I saw what happened with mom and some other ladies at work who did the whole nine yards and I was thankful I did mine the way it was.

Do you have some one to help out at home?  You will be under lift restrictions for 5-6 weeks depending on your doc.  I think my doc was being mean and told me to not life long after I could have from what I've read.  Not that I didn't have a toddler to deal with!!  :)  And I did cheat towards the end of the 4 week mark.  Gotta do what you gotta do sometimes.

Frankly, once you are able to get up and get your wits about you, go home.  As my mom, the nurse, always says "You can be sick at home".  And it's really not that bad.  Managing the drains is the worst.  Do you know someone who can help?  Get a long shoe string with some big pins to hold your drains near you upper chest.  Use the shoestring like a necklace.  It works very well.

You'll return to your doc in about 10 days to check the drains.  If they are not draining anymore, he'll pull them.  Not very fun, but oh it's so nice to be free of them!

Good luck, if you have more questions that I haven't answered, ask!
Lisa
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326352_tn?1310997895
PS... take a robe that zips or buttons up the front and a shirt that does the same thing for being in the hospital and going home.  The drains make things tender to do much more.  Plus it's much easier to access them that way.
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Avatar_m_tn
If you've got the stomach for it, you can watch a full surgery using the DIEP flap on the website OR LIVE.  It will give you a conceptual foundation.  Beware though, it's a real surgery -- and watching surgery can be very disturbing for those not used to seeing it.  There's also a video on the site for sentinal node biopsy.  Proceed with caution if at all.  The links are below.  The first one is the DIEP and the second is the sentinal node.

http://www.or-live.com/bethisrael/1896

http://www.or-live.com/EthiconEndo-Surgery/1881
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341137_tn?1287308643
Hi, thanks for the sites, but no, I havent got the stomach to watch any of it.  The only things I want and need to know after all of this horrible espisode in my life is to know I will be around to be with my kids as they grow up and that this mastectomy is the end of it for the next 10 -15 years.

Thanks everyone for your e mails, they are helping.
Best wishes,
Hazel
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Avatar_f_tn
HI Hazel, I am just came across this other posting of yours. I want to tell you that staying in the hospital isn't always the worst thing especially if you have little kids. My three were 2yrs, 4yrs and 6 yrs when I had my surgery, I was actually glad to be in the hospital for the three nights because I know if I was home I would have been doing things for the kids. Do you have help, you will really need it. Don't be afraid to ask people, my experience is that people want to do something but don't know what to do.....be sure to make suggestions to them. Have a friend contact the American Cancer Society, they can give you tons of information regarding the cancer, and services that help women in this situation who need help..HANG IN THERE!!!
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341137_tn?1287308643
Hi, just wanted to thank you for your last posts.  I hope you are all doing well. I had the mastectomy, it went well, the doctor was great.  I have recovered well from it, the lymph node experience is rather painful but I am getting better at moving my arm now.  I got a good prognosis which is what I needed, as does everyone.  I am now on Tamoxifen for five years.  I am just so grateful that we caught this early.  I am not going in for reconstruction - I feel I just want to leave well alone and the prothesis will be fine.  Apparently the first lumpectomy had actually removed everything and the breast and nodes were all clear, but for my peace of mind I am so glad I had the mastectomy.  Have a great Easter!
Hazel
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