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Have you had reconstruction?

Have you had reconstruction?

Posted by Lacey_Moderator on Oct 21, 2020 9:50 pm

Share your reconstruction experience or questions below. 

Re: Have you had reconstruction?

Posted by Survive2020 on Oct 21, 2020 10:06 pm

Reposting from another thread...

In July 2020, I had a left breast skin sparing mastectomy with immediate reconstruction (latissimus dorsi flap) to address a cancer recurrence (triple positive, DCIS and locally invasive tumour, no nodes). I went into my first appointment with the plastic surgeon with the intent of no reconstruction, but left thinking maybe I was too quick to dismiss the possibility. I think I just wanted the simplest solution and fewest surgeries. The surgeon was very good about explaining all options. What clicked for me was our discussion about the potential healing difficulties with skin that had undergone radiation. (I had a lumpectomy and radiation on my left breast a year previous). She explained that I could have reconstruction at any time, but that each new surgery would be another process of healing for the already damaged skin. I decided to have the LD flap because I wanted significantly smaller breasts (from a DD to a small B). I understood this procedure to be suited to my situation with a low risk of infection and I would be spared the abdominal incision of the DIEP flap. There would also be no muscle tissue removed from my back so I would have normal range of motion. The long-term plan would be to reduce the right side to match the new breast, with fat grafting done to fill out the reconstruction left breast. (no implant).

Waking up after surgery was shocking. It felt like a thick, flat, hard ring like a donut where my left breast used to be. That was the radiated skin. The surgeon assured me this was normal and to give it some time to heal. She was right. It took about eight weeks, but the skin has continued to soften and "drop". It is squishy soft in some areas, warm to the touch, although there is little feeling. The hope is that all hardness will soften, but there is no guarantee. The elliptical flap in the middle of the reconstructed breast is a different, thicker, hairier type of skin (back skin) so that's taken some getting used to. The radiated skin around the flap has the quality and appearance of raw poultry skin (large dimpled pores), but that is also improving over time and will be plumped up with fat grafting. It is somewhat like a patchwork quilt with the flap, a new scar high on the breast from the lumpectomy scar removal, and another scar extending under my arm from the sentinel node biopsy surgery. Quite a sight especially beside the large DD breast beside it! Despite all that, I see the potential of a nice, small plump breast in my future. Scars will fade and I do have faith in my surgeon. My horizontal back incision is long, about 20 cm, but it sits under a bra band. It, too, will fade. A bit of a "dog ear" on one end but I've been told that can be fixed if it doesn't resolve by itself.

I still have to do the fat grafting (belly fat) surgery and right side reduction/lift. Then there's the question of nipple reconstruction and tattooing. This is definitely not the definition of simple, fewest surgeries, but here I am. I realized after the initial surgery that, like it or not, I had opted in to a commitment of body reconstruction that would involve a lot of time, surgeries and recovery pain. Will it be worth it? Still not sure, but there's no turning back now. And there is something optimistic about planning for the future. 

Re: Have you had reconstruction?

Posted by TT53 on Oct 22, 2020 12:00 pm

I was diagnosed with BC in June of 2019.  Originally I was told that lumpectomy was the best option to deal with this.  So I underwent my first lumpectomy in July of 2019 and no tumor was found, only DCIS.  Unfortunately the surgeon did not get clear margins, so I needed to have a second lumpectomy in August of 2019, and that is when the second tumor was found.  This news was so stressful for me, because I have serious problems with anesthetic.  But I agreed to the procedure.  Before I walked into the operating room, the surgical nurse points to a cart and tells me this is my crash cart just in case.  At least they were prepared. LOL
At my follow up surgeon's appointment, before he even gave me the results, I knew the news was not good.  They did not get clear margins again.  He told me that he had consulted with other medical professionals and also my oncologist about my situation, and the conclusion was to have  another lumpectomy. That would be a third one.  A mastectomy would be an overkill.  But at this time, I had great doubt.  I had read somewhere,  if you have two separate tumor locations, it is called a multi focal cancer and a mastectomy should be preformed.  The reasoning for a third lumpectomy was that the tumors were only 3.5mm and 3.0mm in size.  
I went home and struggled with a decision for a week.  It was the hardest week of my life.  I did not follow the recommended route, but in order for me to have a piece of mind, I had to follow my guts.  Unfortunately this meant that I would need to be changing my surgeon as well as getting a plastic surgeon.  The hospital where I had my lumpectomies did not perform reconstruction.  So in October I celebrated my birthday with attending a new medical appointment.  Since everything was such a whirlwind, I just went along with all the recommendations of the two new surgeons.  By this time, I just wanted the cancer gone.  So in November I had my mastectomy on my left side with an immediate reconstruction.  At the time of the appointment with the plastic surgeon, I was told if she can do an implant right away she will do that, but if not, I will end up with an expander.  All depending on what the surgeon will leave behind for the plastic surgeon to work with.  Partly because of the two previous lumpectomy surgeries, I ended up with an expander.  My expander was placed just under the skin, not under the pectoral muscle.  I had an amazing anesthesiologist, who did a block on me, so I did not have to have a general anesthetic, and I woke up normally with minimal pain.  Don't get me wrong, I had about 3 tough days afterwards when I got home.  I also had drains which I had to monitor as to the amount of fluid draining for about two weeks, due to my drain plugging up.  I did not realize this, and I thought I was out of the woods with the drains only to find out I had to have them another week once the surgeon removed the little clot.  Once the drains were removed, the incisions needed to heal.  I had a bit of necrosis, so I would say it was roughly two months before the filling of the expander started.  I had no pain with this procedure at all.  I went every three weeks for a filling and by March of 2020 I was supposed to have the expander replace with the implant.  Covid hit and my surgery was cancelled.  Since you can have the expander in for a long time, there were no issues with waiting.  The issue was me.  I just wanted to be done with it all.  Impatient ha ha.  My wait wasn't so bad.  I had the final surgery in June 2020.  Again the implant was placed just under the skin, so I did not have any pain.  It was amazing.  Besides the problem with the anesthetic, and having to stay in the hospital recovery until 9 p.m,   it was all a smooth sailing. 
Now the only issue is that I have rippling on the upper edge of the breast.  My surgeon told me that this was because the surgeon left her a thin layer of skin to work with, therefore you can see the edges of the implant.  She also told me that this can be fixed by injecting fat in the area.  I still have not decided if this is a big enough issue for me to have another surgery, so for now I am happy to be done with this darn BC.
Yesterday watching the virtual BRA event confirmed for me everything that I went thru is normal, I only wish I knew more at the beginning.

M....
 

Re: Have you had reconstruction?

Posted by Buffythevampire on Oct 24, 2020 10:44 pm

It all started with a bleeding nipple. I was referred to a Surgeon who performed a lumpectomy (October 30, 2018) to remove a 1 cm tumor and was diagnosed with DCIS. Then rather then cut into me again he wanted a better image and was sent for a MRI. A second larger tumor (2.5 cm) was found and was told anything larger then 2 cm meant mastectomy. I was then referred to a Plastic Surgeon. My mastectomy/expander surgery was March 12, 2019 and I was then diagnosed with triple positive IDC. My expander was filled every 2 weeks and was at capacity just before my treatment started. The mastectomy/expander surgery required me to be off of work 4-6 weeks. Because my journey started with a bleeding nipple that was removed as well.

I was then referred to a Medical Oncologist for my chemo treatment (May 14, 2019) which included Herceptin. My chemo ended early September 2019 but Herceptin ended April 2019. I was prescribed an oral pill Letrozole which is a hormone blocker which I have to take for 5 years. I did not need radiation. I had to wait for enough time to pass to get the chemo out of my system before I could continue my reconstruction (minimum 6 months).

On July 2, 2020 I had my next reconstruction surgery. I have an implant which was placed under the muscle and the other side was reduced and lifted. This surgery I was asked to take off 2 weeks from work. Way easier surgery then the mastectomy/expander one. On October 16, 2020 I had my nipple reconstructed using an origami technique. I am waiting for the tattooing which is the final phase, I believe. 

It is a very long process when you combine reconstruction with treatment. I have smaller breasts then I did in the beginning (which I am ok with) but I am crossing fingers that the cancer is out of my body and will stay out. From the BRA (breast reconstruction awareness) event I read that only 16% of women get reconstruction.