There are lots of resources online that discuss the different kinds of reconstruction surgery, and not all of them are right for everyone (and a lot of women opt not to have reconstruction done). Reconstructing my breasts was important to me because having breasts is part of living in a woman's body, and I wanted to feel whole again.  Other women's mileage may vary, which of course is perfectly fine.  Reconstruction surgery is entirely optional, and very much an individual choice.

It's been several years now and I can't recall all the different types by name, but there are three basic options.  There's the procedure where a plastic surgeon takes abdominal fat and muscle and relocates it to your chest through microsurgery.  That involves quite a bit of recovery time since muscle is removed, and apparently you lose a lot of strength in your abs, some of which can be recovered with some diligent physio and exercise.  The bonus is you are using your own body tissue, the resulting breasts feel like real breasts, and you get a free tummy tuck. ;-)  Being fairly athletic, I was told this wasn't a good option for me since I didn't have enough excess fat to play with (I apparently had enough to make one small breast, but not two).  I had a colleague years ago who went this route, and she was very happy with the result.

Another procedure involves taking part of your latissimus muscle (upper back) and skin and moving it around to the front.  Again, the up side is that it's your own tissue.  The downside is lots of recovery time, and you will have back skin on your chest, which is a bit thicker and coarser than normal breast skin.

I opted for two stage reconstruction using saline and silicone gel implants.  During the mastectomy operation, a plastic surgeon implanted two saline-filled tissue expanders with ports. Once I'd healed from this surgery, he began seeing me every three weeks or so to inject the tissue expanders with saline through the ports.  My entire chest felt incredibly stretched and tight after this procedure, but in a day or two things started to relax.  An aesthetic point here:  the tissue expanders look ridiculous.  Imagine two small, circular sofa cushions in your chest, just as round at the top as at the bottom.  It looks okay under all but tight-fitting clothes, but I couldn't wait until I was ready for the gel implants.  I lived with the tissue expanders for five months until I was the size I wanted to be (about a half-cup size bigger than I was), then I went in for the second stage surgery.  So, two surgeries there under general anesthetic, but the second stage took about half an hour and they punted me home the same day.

There's been so much controversy about silicone implants, but a lot of the earlier problems seem to have been resolved with the current generation cohesive gel ones.  They're sometimes called gummy-bear implants, because you can slice into them and the insides stay inside the shell, unlike the earlier generation ones where the silicone gel flowed out.  Theoretically, then, they can rupture and not cause a horrible mess.  Apart from a capsule formation problem with the left implant that took a while to resolve, I have had absolutely no problem with them.  They're incredibly firm and on the plus side I could easily go without a bra (and have done with cocktail dresses).  I like how they look generally, although they're a bit on the voluptuous side for someone who's looking at 50 in a couple years' time.  I feel like I can wear almost anything.  I train for half marathons and I do wear a sports bra just because it's more comfortable when I go for one of my two hour training runs.  The main downside is that I always feel like I'm wearing a super supportive sports bra that I can never take off, and flexing one's pecs is an entirely different experience with the implants since they're placed between the pec major and pec minor muscles, both of which normally lie under the breast.  That was a very weird sensation that took a long time to get used to.

I had annual mammograms for a few years after the implants.  The technician has to flatten the implant against the chest wall and try to xray the skin and muscle on top of it.  After I found my first DCIS recurrence myself, they switched me to ultrasounds and that's what I've had since. 

The other thing is that implants have a life span of between 10 and 15 years, at which point the failure rate (i.e., rupture) starts to go up.  So I expect to have to have mine replaced at some point (and they may need to be replaced sometime during my upcoming adventure anyway).

A last point about reconstruction, although I think this has more to do with the mastectomy surgery.  Nerves are inevitably damaged in the process and so your skin sensation will be substantially reduced or absent from that point on.  My breasts are sometimes very cold and can feel a bit rubbery (like your mouth does after you've had novocaine for dental work).  Over the years some sensation has returned, but in patches and never 100%.  It doesn't really bother me, though, and has never interfered with, well, relations. ;-)

Please feel free to ask me about anything else on this topic.

Allison

Allijay,
Thank you for starting this thread....and sharing your experience.....it is a big step and one that has a lot of variables....you have answered some of the questions going around in my head!
Take care.
Duchess

Allijay,
I'll add my thank you for starting this thread.
As Duchess says there are many questions and no single answer. As you continue to collect a variety of experiences here, I'll also direct you to the archived collection of stories about breast reconstruction on SharingStrength.ca.

Hope this helps.

Hi Allie,
Where did you have your reconstruction done and who did it?
I had mine done by Dr. XXXXXXX @ Civic Hospital in Ottawa. He hosts an information workshop about every three months. I had an abdominal flap breast reconstruction done using only the skin and fat from my abdomin. They did not cut into my muscle. I did have to gain weight so that he would have more to work with, which was not hard as I had Christmas time to do it, lol, Merry Christmas to me,
They gave me five months to heal before the nipples were tattooed on, then another month before they made the nipples by nip and tuck surgery. Now that they are settled and healed he is going to do a little more lipo to harvest more fat off my "love handle area" and fill in a little more where needed. I had a slice of muscle removed during mastectomy and it left me a little caved in there, so he's going to fill it. Having implants was not a good option for me given the amount of radiation treatments I had. Apparently the implants would likely migrate toward shoulder eventually. 

I am also here to share information should anyone wish too ask, thanks Allie for starting this thread. You are and inspiration to me, to get more active, I'm sporadic when it comes to exercise. I use to be at the gym alot before I was diagnosed, I guess I loss my momentum. Hearing stories like yours really helps to motivate me. Thanks again.

Hi Cheery,
My reconstruction was done here in Calgary; I guess I can't give the name of the doctor because it looks like your doctor's name got edited out.  I liked him a lot.  He was quite young and boyish looking with a great sense of humour.  Can I just call him Dr. Hottie? ;-)

I'm curious about your comment about implants migrating as a result of radiation therapy; I assume that could happen if radiation was given while the implants were in place.  Do you (or anyone) know about replacing damaged implants after radiation?  Is there anything about radiation therapy that makes implants a poor option once radiation therapy is finished?  I'd hate to have to consider another reconstruction method, since implant surgery is so easy to recover from relative to other types (I was out shopping for new clothes two days after I was discharged), and I don't relish the idea of having to use a prosthesis instead, since I'm so physically active.

Hi Allie,
When I had my radiation treatment I hadn't yet done reconstruction, didn't have existing implants. The doctor explained that the chest muscle, as a result of radiation, toughens, shrinks, tightens....if we didn't stretch daily our shoulders would pull forward. For some reason because of this condition of the muscle, it causes implants to migrate towards shoulder eventually. I was under the impression that it wasn't something that absolutely always happened but rather it could and does in some instances. I decided not to chance it.
I won't lie to you,the flap method is major surgery and down time includes 4 to 5 days in hospital, then bed rest and taking it easy for the first month. Surgery includes grafting artery/veins for blood flow to the new breasts. Use of arms is limited for a while. My doctor made me stay under a heated blanket my whole stay. Thank God I was over the worst of my hot flashes at that time. lol. I had my legs wrapped in massagers for a few days and was catheterized for a day and a half.
I hope this answers your questions.

Thanks Cheery for sharing your reconstruction experience.....looking forward to more stories on reconstruction.....both how it felt at the time and how the end results make you feel. 
 It  seems from what I have read or heard from other reconstruction experiences is that the mastectomy 'was a walk in the park' compared to reconstruction.....but most are thrilled with the results.....lastly the pros and cons on reconstruction obstructing the ability to detect cancer should a reoccurence happen....Hearing the positive stories... gives hope to those of us deciding what to do next in this health journey....
Duchess

Hi
I am waiting for my first appointment with a surgeon regarding reconstruction.  Now that you have gone through this what questions should I ask him that maybe you wished you should of asked.  I had a bilateral mastectomy, no radiation, and want to have reconstruction.
Thank you for the input.
Chestnuts

I had reconstructive surgery in 2002 at the same time as my bi lateral mastectomy. At the time I had tissue expanders implanted and during the course of my chemo I went monthly to have saline injections, that slowly increased the size. The implants are much higher because they are placed under the chest muscle. Later I had nipples (nip and tuck as Cheery says, lol) then tattooing. Over all I was very happy with this type of reconstruction. I have had some issues over the years. In 2007, I developed capsular contracture. This is a painful condition caused by scar tissue encapsulating the implant and my breasts began to feel like they were in a vice grip. My surgeon (a wonderful doctor) removed them , cleaned the area and replaced them with a smaller implant.(now 2 sizes smaller than my true size). With this condition it is very important to massage the area and exercise to maintain good mobility. I did not undergo radiation, but my implants have migrated toward my shoulder. I have just finished chemo for the second time, and during this time I was not able to keep up my daily exercis routine, and I have noticed a tightening in my breast are again, so I am determined to get the mobility back in my underarm. My grandmother and mother-in-law (both had mastectomy) were never told to work at keeping arm strength, and as a result in their later years had little use of there mastectomy side arms. Hurray for the Dragon Boats!!! Now ,that I have rambled on I have to say that over all I m happy with my choice to have implants. My sister is also a BC survivor and has not yet decided what she wants to do in this area, she doesn't love the look of implants, yet is not happy about the limitations in her wardrobe. (she is only 46). I have seen the tram flap a couple of times, and I am very impressed, in 2002 this was not an option for me. Sorry about being so wordy. I hope maybe I have helped with some info you may not have known.

Hi Lori, it's interesting to compare and contrast our experiences with implants.  My breasts are very firm and do feel like I've got a bra on that I can never take off, but they've never been painful.  I guess capsular contracture was never (yet?) an issue for me, but it's good to know that it can be resolved (I'd go down a size anyway if I had to have them replaced; a larger bust sounded like a good idea at the time, but since they don't really compress much sometimes they're just in the way!)  I didn't find that the implants sit higher on the chest; they seem to "hang" at just the right height.  Did you get the round implants or the teardrop shaped ones?  I went for the teardrop shaped ones (more natural looking), but the round, Pamela Anderson style ones were an option I had.  I've never massaged my breasts (I was never told to), but I am pretty active anyway so perhaps they just sort of get massaged as I move about.

For anyone else reading and considering implants, I'd suggest going on the smaller side and definitely consider the teardrop shaped ones.  They don't make different types of implants for reconstruction use, so all implants are the same ones that are used for women who want boob jobs, and they tend to be designed to give a pushup bra look.  A smaller teardrop implant will help minimize that if you don't want porn star breasts. 

As for detecting recurrences, with implants it shouldn't be an issue, at least it wasn't for me.  The implants are under the pec major muscle, which breast tissue sits on top of.  Whatever breast tissue remains after a mastectomy, then, will lie in a thin layer right under the skin and on top of the muscle.  Any new lumps will be obvious when they're still very small (my recent recurrence was smaller than a pea when I found it).

Hi Chestnuts (love your handle, by the way!)

I imagine you've already done quite a bit of reading on the various options, and your surgeon will help you narrow those down based on what he/she thinks you're a good candidate for.  Do you have one method or another you're leaning toward?  I think each method has its pros and cons, both from an esthetic standpoint and surgery/recovery standpoint.  If you can, try to meet other reconstruction patients who have had the same procedure you're considering.  I met two through my surgeon, who had volunteered to talk to other patients.  These generous women allowed me to see and touch their reconstructed breasts and answered any questions I had, so I had a really good idea of what I was in for. 

I am in France and having a reconstruction next tuesday and must admit to being very scared. especially for the pain. I had DCIS one breast removed a year and a half ago. I would have been reconstructed sooner but I had a HORRIBLE surgeon who was so unpleasant I didnt even consider it.

I have now though met a great doctor, references from two friends he did and other doctors I know.

He is going to place an implant under the muscle and adjust the other breast. I will be in the hospital 3 nights and he has ordered a nurse to come daily for 15 days to change the bandage.

I CANNOT IMAGINE that this willl not be very painful. I am strong with pain. I am almost ready to change my mind. My mother was supposed to come over from NY for this but cannot right now and I have to have this done before I change my mind.

I would really love feedback from anyone who has been through this.

Thanks for replying to me

Hi Allijay,
Thank-you for starting this valuable info trend. I had lobular breast Ca in Aug. 2010. I had a modified radial mastectomy with an axillary node dissection in the fall of 2010. Followed by chemo and radiation. I had decided to have a propylactic mastectomy for the right breast in fall of 2011. However, I have not decided on reconstruction yet. I am an OR nurse, plastic surgery also and it is way to invasive for me. I am still undecided. I noticed that you have dediced to have prophlactic oophrectomy done--can I ask your reasoning for your decision? My MD's are all telling me not to worry but I am very concerned as my breast cancer was estrogen positive. There is so much correlation and literature to support breast cancer and later on developing ovarian cancer--do you agree? Thanks for your reply if you can help..Franca

Hi Franca,
I see your post is directed to Allijay, however, while you are waiting for her to respond, here’s a link to our Canadian Cancer Encyclopedia on breast cancer and Prophylactic oophrectomy http://info.cancer.ca/cce-ecc/default.aspx?cceid=192&toc=10&Lang=E . I’m glad to see you are seeking information and feedback from the community to help you make your decision. 

There may be others in the community that have faced this decision about whether to have a prophylactic oophrectomy, and it would be great to hear from them.

Janet_Admin

Hello Franca,
In your post you mention being an OR and plastic surgery nurse so perhaps you have some insights to share regarding the length of the DIEP procedure. I am having a difficult time making a decision regarding immediate DIEP flap reconstruction. I have IDC  in the Rt breast but because I am also a BRCA1 carrier I've decided on double mastectomy and I need sentinel node excision. I am apparently a good candidate for DIEP. I've decided against implants so my choices are go breast-free or DIEP. My concerns with DIEP are the duration of the procedure (longer for something to go wrong), possibility of DVTs and the immediate recovery sounds intense. I am 58, have hypertension (well-controlled with meds). The duration of the procedure, 10 hours on the OR table is giving me pause. Thoughts? Anyone else out there have bilateral DIEP procedure?
Thanks!

Hi Songbird,
I understand that it may be difficult to make such a decision. The DIEP procedure is safe and results are good. If you are having difficulty deciding---go for another consult with another plastic surgeon.  Ask for pre and post photos of previous patients. The surgery procedure is lengthy but the OR nurses usually place SCD's  (sequential compression devices) on your legs  to prevent the blood clots.  They also give you Heparin intra-op and post-op usually.  ASK Lots of questions on your consults!
I have decided to wait as I don't have enough pannus tissue to construct.  My surgeon wants to use my back muscle and tissue to reconstruct my breasts.  I am also quite numb from my axillary dissection that I am afraid of further numbness.
I hope this info helps.
Warm regards,
Franca

Thank-you Janet.

thank you Franca for taking the time to reply. The information is helpful.
Songbird

Hello everyone!

Thank you Allijay for starting this thread. Six months ago I was diagnosed with a malignant phyllodes tumor, DCIS and LCIS in my right breast, and IDC in my left breast. Three weeks ago I had a bilateral mastectomy and began the reconstruction process at the same time with insertion of tissue expanders that will eventually be exchanged for implants. I welcome the opportunity to add my voice to others with regard to what I have learned on this journey. I would also welcome the opportunity to interact with other women who are going through - or have gone through - the reconstruction experience. I know there is a support group called Keeping ABreast in the UK where breast cancer survivors who have undergone (or who will be undergoing) reconstruction get together every so often to share their experiences, arrange fund raising events, etc. Does anyone happen to know if such a group exists somewhere in or around Toronto, Ontario?