Preparing for reconstruction

[sumanb]

I am scheduled for a mast on 4/10. I asked my surgeon if she needs to do something different so that I can have Tramp flap or whatever in few months. She said no. Do most people wait till they are done with Chemo and/ or Radiation? No one has told me specifically what line of treatment I will be having as they want to wait till the final pathology of the tumor is known after the mast. I 'd like hear from women in similar situation. I know I will be having lot of visitors, how people handle this (no left breast, drain tube etc.)  My DX: ER/PR +, HER2-, multiple tumors, 3cm, 1.5 CM and 2 MM no node biopsy yet but MRI, physical exam seem to show nodes to be OK. NO onco score yet. Thank you so much.

[urstandingonmytoes2007]

Hi there.  In response to your question, I wish I had went the route of mastectomy, then expander, then implant.  My initial surgery was the mastectomy with immediate insertion of the implant and it did not turn out as expected and it was incredibly painful.  Instead of a gradual stretching of my chest muscle, it was stretched all at once and I wasn't prepared for the pain or the complications that came with it.  I'm not undergoing the expansion process and I don't find it painful at all...the sensation is "tight", but not painful.  I hope that in the end I'll finally have something that I am comfortable with.  Good Luck to everyone and God bless.

[sumanb]

Dear urstandingonmytoes2007

Thanks for your response and sorry to hear about your pain. you mentioned, you wish you had gone the traditional route. DO you mean delayed reconstruction? or do you mean no reconstruction but use of prosthetic?

I have pretty much decided on delayed reconstuction as I have not gotten a plastic surgeon invloved to advise me on this issue. My surgeon seemed to think I should just get over the surgery and then see what treatment ( chemo vs rad or Hormone only) and then determine the timing of the reconstruction.

[Amy1973]

I had a double mast - 4 drains total.  The drains were easy but were more of a shock to look at.  My drains were in for 1 week, standard for my doctor.  My husband bought me a construction waiste belt to hold the drains in - great idea.  I found a soft pillow to hold while I sleep, it was soft againist my wounds and helped with sleeping.  I also had an extra one to prop my head on because it bothered me to lay all the way down to sleep.  My husband also bought me a little table to place by the couch to hold my drinks and meds and telephone.

I didn't have a lot of people come over, most I think just didn't know what to say so I rcvd a lot of cards and flowers.  I didn't like button ups so I wore a lot of zipper cotton jackets.

I had 2 small masses around 10mm.  Once I had the surgery they tested with snb and not cancer in lymph node.  No chemo needed.  Onc. told me that if I would have only had a lumpectomy I would have needed both hormone meds, radiation, and some chemo.  I had a little prog. but I not enough for drugs.  If I started them I would have to stay on for 5 years and I didn't have enough reason to go on them.  I said this is a no brainer for me - remove them both.

I had implants placed in on day of mast. My first week was tough, next week a lot easier.  I do home daycare and started watchng kids on the 3rd week.  I heard a lot of stories about how bad recovery was - mine was not that bad.  You will do great.  Every person is different.

[Amy1973]

You asked what it would be like to have one breast - I think you will worry more than others do!

I had to go almost 1/4 of the year last year with no breasts.  I have very small and to have no chest, almost a sunken in chest area looked bad.  I don't think anyone even cared.  I am 33 years old and have 2 small children and married - I could have carried less if anyone cared if I had breasts or not.  I wouldn't of said that before I knew I had cancer.  I thought breasts were all powerful and needed - but they are not.  I have delt with this and amost a year later that was the least of my worries.  I think it was harder when my 6 year old asked me about what sex was because some kids were talking about it on the bus.

Knowing you are removing the breast and the chance of it coming back should be enough to carry you through this time.  Plus, knowing that you are alive and going to win this fight.  I never wore a prostetic but you can get one now and have it for the day you need it.  You can also put socks or a small balloon blown up inside your bra?  Stuff if you must.  You need to do what feels best for you.  Wearing nothing made me confront what happened and helped me deal with it.  You need to find what helps you.  Good luck.

Looking back at the past year - it goes by quick and you'll be back to feeling better in no time.  

[urstandingonmytoes2007]

When it comes to reconstruction...ASK QUESTIONS...and don't leave your doctor's office until you are fully satisfied with the answers.  This is your body and you have a right to make a fully informed decision...about saline v. silicone, TRAM v. Implants, Immediate reconstruct. v. delayed reconstruct.  Educate yourself about seromas and JP drains and what to expect if there are complications.  I had a bilateral mastectomy on 3/2 with the immediate placement of silicone implants...besides severe pain, I had necrosis of the suture lines and nipple grafts and malpositioning of the implants...I looked like a 12 yr old Linebacker--NOT pretty.  On 3/14 I had to have a second operation to remove the implants and necrosis and this time they inserted expanders.  I wish I had done the more traditional route the first surgery...I think my recovery would have been faster and I doubt there would have been as much pain.  Hindsight is always 20/20.  I start expansion tomorrow and I'm hoping for something in the end that looks reasonably "normal" or at least a boob where a boob is SUPPOSE to be ( and not under my armpit like the first surgery!).  Good luck to everyone..God bless.

[peekawho]

The size was about 2.5 cm, er/pr+, and I don't think they were even doing HER2 back then..this was in 92 or 93.

Non-palpable mass, found on my first mammo.  Doc wanted to watch and wait, but I elected a biopsy.  

Though I initially had tissue expanders placed, I "woke up" completely flat as they don't start expanding you for some time.  I would have had the tram, but time was of the utmost importance to me to get back to work, as a single mother, as quickly as I could.

I'm toying with the idea now of either having the tram now, or getting new implants.  I have saline, and I think that silicone would look more natural.  Or a tram, so I get that "tummy tuck" I need.  I also had bilateral nipple reconstruction.

I truly hardly give it all a thought now.  I am what I am.  The only reason I'm thinking of redoing it at all is midlife crisis!  I want to look better.

[sumanb]

Thank you so muh for taking time and going over the details. Every little bit helps. I will go and I gather my shirts with front opening. It is encouraging to hear that you went back to work after 10 days. In my case I am retired so I don't have to worry about work. You said you did not need chemo. How nice. Do you mind telling me what was your path report?
( er/pr, her2 status and sz of the tumor etc.)

Thanks again.

[peekawho]

I have had 2 mastectomies, but don't have much info on Trams, b/c I had implant reconstruction.

I can tell you I was in for 3 days with the first, 2 with the second.  I had 3 drains each time, removed oh...about 3 or 4 days post op.  They are simple to care for, you just empty them once a day or as instructed by your doc.

You will of course have discomfort, which should be easily managed by the pain meds your doctor prescribes.  Have plenty of button down shirts available.  It's hard to pull a shirt on over your head for several days.  Have plenty of soups/easily digested foods, crackers, etc ready prior to coming home. Its common to have some nausea as a reaction to anesthesia or the pain pills, so keep your foods light.  If anyone can pre-cook or assemble meals for your family, it will be a great help as you won't feel much like doing anything for several days.  My co-workers chipped in and had restaurant meals delivered to me every evening for a week!  What a blessing!  If people are asking what they can do, that's a great idea.  Don't be afraid to ask people for help.  They want to help.  

I remember washing my hair at the kitchen sink, b/c it was more painful to raise my arms to do it in the shower.  I didn't really blow dry it, and just pulled it back into a pony tail.

With my first, I was riding a horse on my 7th post op day, and went back to work (nurse) in 10 days, although I was admittedly pushing it.  I stayed out about 2 weeks with the second one.  I had a lot of trouble both times with seroma formations (liquid forming near the incisions) that required drains to be put in again later with my second mastectomy.

You will probably have a tight ace bandage around your chest for several days.  Oh, have ice packs on hand, they feel great!  

I didn't have to have chemo or anything, my nodes were all negative.  Good luck to you, and if you have any other questions, ask away!