Mastectomy now and DIEP later or Mastectomy and Tram flap now?

[Zanny]

I was diagnosis as mucinous carcinoma on May 18, 2005. The doctor said I only need the lumpectomy. The day before my surgery (6/23/05), they found out from my MRI that there is a second spot (about 9mm) inferiorly and centrally from my first spot (1.8x2.2x2.6 by MRI). The ultrasound biopsy is unsuccessful because they cannot see that spot from ultrasound or mammogram. I either wait to do the MRI guided biopsy(insurance don't want pay) to make sure it is benign or do the mastectomy and reconstruction. I rush to do the research for the Tram flap and DIEP. It seems that I still have to wait at least another monther if I am lucky to find a doctor in my insurance network who can do DIEP with my breast surgeon at same time. Or I can do mastectomy and tram flap reconstruction soon, still don't know when though. As I found a lot of negative opinion on Tram flap, I am really scared to do so. Is mastectory first with skin spare and then later do a DIEP a good option? Or wait another month to do them together, or matectomy+tram flap soon?

Which one is the best? I am confused and desperate. I am only 33 and have only one child. Please help. Thanks.

[CCF-RN,MSN-rf]

Dear zanny:  With respect to mastectomy and reconstruction, there is no magical right or wrong way to approach this.  Your best bet is to locate a good surgical team - breast surgeon and plastic surgeon - who are used to working well together (whether the reconstruction be immediate or delayed).  These experts would be best equipped to review your situation and help you determine the pros and cons of the different options so that you can make a decision that best applies to you. It may also be valuable to get another opinion as to whether breast conservation is still a reasonable option.  You can often find teams of doctors like this at large academic medical centers.  

[somermoone]

I was diagnosed with DCIS Oct 2003, due to Dr error did not find out until Oct 2004. We started with the lumpectomies and did not get clear margins. My choice was mastectomy, skin sparing with rebuild using the TRAM flap proceedure. This was done Jan. of this year. I'm very, very pleased with the outcome. Yes, it is hell for about 8 weeks but bearable. My breast look the same minus areola and nipple. I will choose to have areola tatooted on but nipple reconstruction. I am 44 years old, no risk factors or family history of breast cancer. I had a great team of Drs, do your research. This post may be too latte as you may have already had surgery,. Your insurance has to, by law, cover your surgical expenses and choices you choose. Check into this very carefully. Good luck and remember, no one can tell you what to do, you have to make the choice that is best for YOU, don't forget that. Good luck and take care, Karen

[somermoone]

Oops, I meant no nipple reconstruction...I don't really care but it might be important to the next person...

[rkmsim]

I had a bilateral mastectomy, skin sparing with immediate DIEP reconstruction.  I really wanted to avoid any compromising of the abdominal muscle.  I had to travel out of town to go to a doctor with experience doing the DIEP surgery but it was well worth it.

[Ruby360]

Hi... I had a mastectomy on the right side and the start of reconstruction in 1994 at the age of 38.  After months of expanders, I had the implant and although I wasn't totally happy with the visual results I was happy to be well and able to care for my family.  



10 yrs. later after some personal setbacks, I wanted a nipple and possibly a little balance", the right was higher up and mothers nature lowered the left more.  So I had the nipple reconstruction from tissue on the inside of upper thigh and a small implant on the left side to add some volume, it looked good but being a smoker I was told I was having a longer and harder time healing.  After 5 weeks and quitting smoking, there was  still crust around the new nipple I became a little worried that something was amiss.  Well I didn't wait long after that to get my answer.



The breast got red and hot so I went to the emergency room, they gave me antibotics through IV. and sent me home.  2 week later on a visit to my surgeon he sent me back to the ER. because the reddness was returning AND THE NIPPLE WAS STILL INFECTED.  This time they ran blood tests and found out I had MRSA Staff infection and needed IV THERAPY.  3 weeks worth, pickline insert, and after 2 weeks they sent me home to continue therpy on my own.. Early to rise, IV DRIP IN THE MORNING BEFORE WORK, AND AGAIN AT NIGHT AFTER SUPPER...

Bummer, but no reddness.. anyway this did not work for long and back into the hospital with mrsa again, seems the implant was harboring the germ so OUT with the implant, off with the new nipple " which was now all mishappened and a mess from the infection and another pickline reinserted and more vincomisem (SP)antibotic.



So a new decision needed to be made, no breast implant AT ALL or A tramsflap... I liked the idea of a flat stomach and softer breast so I went with the trams...  10 weeks later, still sore deep inside, possibly the muscle or another hernia (had 3 so far from this surgery).  Can't stop the draining, 2 or 300 cc's a day, and the drain keeps coming out and having to be reinserted. Doctor took me back to surgery 4 weeks ago andredid the flap because I had a huge cavit in the stomach holding all this fluid.



Stomach is all wavy and lumpy, but the doctor says all is good.. doesn't understand why I still need pain meds and how impossible it is to dress for work trying to hide that darn Jackson Pratt drain.  I am so miserable, in pain , swollen, hunched over, a mess.... will this end sometime this year!  Tell me your story, did it get better, do I need the mesh taken out because this might be the reason for the fluid build-up, will the pain meds do me longterm harm, will I ever be feeling ok again!!



Bless you all

Ruby