what kind of reconstruction

[Callygraphcs]

After these next 3 courses of chemo I need to have a mastectomy. Because I also need radiation, I'll have 2 wait for reconstruction about a year. That seems like it'll be distressing to live w/o a breast for that long. I'm weighing reconstruction against implant. Of course, none of it sounds good, but I know they'll never match my other 52 yr old breast w/implants. Silicone makes me nervous, saline seems heavy & unstable. Reconstruction is 8 hr surgery.
What's a girl to do? Any ideas?

[Callygraphcs]

You have been so helpful - thank you. Your info was really great - and yes, if you are so generous & willing to share pix with me, I would really appreciate it. If you change your mind that's okay too. my email: ***@****

I'm just starting my second  chemo courses - (last year I had incorrect chemo after pathology report changed) - 1st of 3 rounds chemo tomorrow am, then 2 mos, then surgery, then radx, so I have some time to decide. You have confirmed my thoughts on implants - thanks. Again, my reserve is that time I'll have with a chest like a winking eye!

I had a C-section with the 1st of my 2 kids. I was up & about really quickly, but that was almost 15 yrs ago. I'm not sure I have enough stomach to make my now almost B cup size- but that can easily be adjusted I suppose. (cupcakes anyone?) I also considered back & front healing necessary w/the I-GAP - something to consider.

I thought the skin would have to stretch for reconstruction surgery because the tissue was moved up to the breast area (under the skin??) I think the thought of the whole experience seems worse than the decision for me. I'm still mourning the fact that my darling twin sister of a breast will be cut off@#!

Did you get depressed? or did it take you a while to get over it? Do you still feel forever reminded about it? I imagine it's just something to live with?

And do you mind if I ask (altho' you've been so wonderfully forthcoming) did you have a nipple tattoo? My mother said we can't have any tattoos (only kidding). I understand there's something called nipple sparing surgery but can't imagine I'm a candidate for that.

I also think about my two girls 12 & 14 just getting their breasts & hope they can have clear thoughts & emotions about it all. We talk about it as much as we can comfortably.

I'm sorry your mom had such a rough time and I wish you, those darling little kids in your pix & your family LONG happy lives. Thank you for reaching out with such warmth & honesty.

[lhughes]

My surgeon didn't do DIEP, he still does TRAM b/c he has done so many and thinks it's best for "him".  I've heard of DIEP, but didn't really look into it.  I was so glad to just get to the point of reconstruction!!!  My mom had a failed TRAM and then had a saline implant put in (she was 58 at the time).  It looks bad, in my opinion (sorry mom!).  Her surgery incisions necrosed in the breast and in her tummy area.

When I had my mastectomy, it was just a simple one.  You only need expanders if they are doing implants, I think.  I had a flat almost concave area on the left side and a big ole breast on the right.  I was pregnant too, so big ole breast got bigger!  Really, I was glad to not have to wear a bra at all, but when I needed something (especially in some of my shirts...oh having seen the pictures after I would have just totally gone boobless and NOT gotten the prosthetic.)  If you want a pic of me with the prosthetic, which you can PLAINLY see from the camera angle... not good... I'll send you one.  Sorry got off track there..

Basically, after seeing THAT picture, I went to finding shirts that weren't V-necked and used one of the cheepie exercise bras from walmart, 3 for 10 bucks that had simple straps, no support at all and was straight across in the front and back.  It held in the one boob while giving the second area a grandual decline to the armpit.

Most people didn't realize (although they KNEW) that I did not have my second boob.  That really startled me because I thought it was much more prevalent than apparently it was.  You get used to not having the boob there, now I've got it back and I'm having to get used to having it there again.  ha ha

I didn't really like looking at it to start with, it's a bit disconcerting, to be honest.  It took me maybe 3 months to actually LOOK at the scar.  My mom (a nurse) and my husband tended to the drains and he helped put the scar stuff on there to keep it moist.  After I looked at it, I decided it wasn't the end of the world and it was going to be temporary.  I was just 37 at the time.

My radiation onc suggested the tram flap also and not the implant with the radiation.  Sometimes the skin won't stretch like it should and the implant procedure fails b/c of that.

I had PLENTY of skin on my abdomen (thank you pregnancies) to put back the breast.  It was nice to have all that extra skin removed.  Whether it's from your backend or your frontend....where ever you have more plentiful skin and fat, might as well get a lift while you get a new boob!  :)

One thing with going for a tram over the I-GAP....all the incisions are on the front part of your body.  Makes figuring out how to lay a lot easier.  I equated TRAM with a serious c-section.  It was about the same, maybe a bit harder to get out of bed as when I had my 2 c-sections.  The drains make it worse.

The better thing for diep is probably that you won't have a ridge along your pelvic line like I have where the muscle was obviously taken from.  It's not bad until you run your fingers over the scarline.  My scars are finally starting to fade and it really does look fairly decent.  I just wish they were a tad bit smaller.  But hubby wanted them back as they were.  I would have loved to have had B cups!

PS Mom's implants did spring a leak.  ho ho.  She had such awful luck with that.  I'm VERY THANKFUL mine went as well as it did.  Pretty much textbook.  Doc and I kissed each other bye-bye not too long ago.

[Callygraphcs]

Thanks for  this info. You are very helpful. Reconstruction does seem the best besides the surgery. I've heard some nasty other tram flap stories so it is especially good to hear from you.
They now do DIEP flaps which leaves the stomach muscle & just takes the vascular (from the muscle) & fat ( a bit longer surgery). Also, in NY, Ca, N Carolina they're doing the same with the area where bum meets thigh. (I-GAP) Now we're talkin",even tho' I don't live there.
Did you have expanders right after surgery? Was it hard to be w/o a breast?
I'm ready to get rid of this cancer. They think it's gone with the previous chemo & lumpectomy - just that tis cancer is hard to track the way it presents itself.
Thanks so much again.

[lhughes]

I waited almost 2 years to get my breast reconstructed.  I had a tram-flap done.  I also had to go through radiation.

Honestly, and I asked, people didn't know I was without a breast for almost 2 years.  I used a fake one when the dress I was wearing required it, but mostly just went without because the prosthetics are HOT.  I am a size D cup, still.

When they did my reconstruction, it was about 7 hours, they lifted the other breast and I got a great tummy tuck out of the deal.  it was pretty painful on the first 2 days, but after that, I adjusted.  

Talk with your surgeon, but I would HIGHLY recommend getting a tram reconstruction done instead of the implant.

Good luck to ya!

[Cleveland Clinic]

Dear Callygraphcs,   You may want to discuss this with a plastic surgeon who is experienced with breast cancer reconstructive surgery.  Many plastic surgeons can show you photographs of women who have under gone the various techniques.  They may also have suggestions as to what is best for you.