Any advice welcome - mastectomy/recon options.

Hi,

I hope I can get some advice on this please? I am still only on Chemo No 2 of 6 but already starting to think about my mastectomy after. I have been looking at the different options and it seems the DIEP offers really good results (even if it is a longer op) and if I were suitable I think I would seriously consider this option.

The main concern I have at the moment though is the fact that I would be due to have 3 weeks of rads after my op and I wondered how this would impact on any surgery I had done beforehand.

Psychologically I think I would fair better were able to have an immediate recon but if the rads would compromise the results that is a bit of a dilema I guess. Can anyone tell me about there experiences please. Can an immediate DIEP recon with follow up Rads be done?

I would really appreciate your help with this one.

Many thanks

Tam

Hi Tam

I had a Mast + immediate recon (DIEP) in May. At the time there was some ‘umming’ and ‘arring’ over whether or not I’d need rads afterwards (in the end it was decided I didn’t as mast had successfully cleared the area and no lymphs were invovled). You really need to ask your consultant/aurgeon about this. I was told by a surgeon and also read that DIEP reconstruction ‘may’ be able to withstand rads but I don’t know if there’s a definate answer, hence the need to check.

I agree (from what I’ve leaned) that DIEP does arguably give the best results and, for me, ‘waking up’ and still having most of my breast was essential (my mast was ‘subcutaneous’) for psychological recovery as well as physical.

I haven’t been of much help to you with this answer. Feel free to ask anyting you want re DIEP op but please push the issue about rads/recon until you’re happy with the answer.

Good luck. Cathy x

Hi - I think you should ask the surgeon/oncologist because as I understand it radiated skin is normally allowed to settle for a time before reconstruction. You need to ask about this because it sounds as if for you the emotional aspects would be very tough and I know that a friend who was told she would not be getting immediate recon due to pre mx rads actually managed to negotiate a WLE rather than the M-op as her lump had shrunk a lot. They sort of re-organised her boob and she needs the other side reduced but for her this is preferrable to m-op and delayed recon.

Be pushy and explore your options. I think it is important not to be so persuaded by the “you must have mx and there is no other way” argument that you go along with decisions which will make you unhappy.

Love and luck

Jane x

Hi,

Thanks Cathy and Jane. That does help actually. I think the key is to make sure I feel I am being given all the options possible isn’t it?

My understanding is that because my lump is so close to my nipple that rules out a lumpectomy. I have an appt with my surgeon on the 4th so I will ask him. Are there any other questions you would have asked in my shoes - you know with hindsight and all that?

Thanks again to you both.

I hope you are well on the road to recovery now?

Tam x

Hi Tam

I’d say ask to see pictures of work the surgeon who’s operating on you has done (this should be available). I think when you’re getting immediate recon, you really need to have an idea of what the breast will look like (ie, will they remove nipple etc). I did a heck of a lot of scouring for info before my op and so when I woke up and saw myself, I didn’t have any surprises or see anything I didn’t expect. Also, as I’d never had an op before in my life, I had to know everything that I was to expect. For me that meant far less psychological difficulty in coming to terms wth the whole treatment.

I think when it comes to this issue, being fully informed is essential (or having as much information as you want - not everyone wants to know all the ‘nitty gritty’ - but for me it was a great help and made me feel I had some input during the process).

There’s loads of ladies to help here at all diffeent times day or night - lifesavers!! Lots of love. Cathy x

The NHS Choices website will give immediate reconstruction rates for different hospitals if you put in breast cancer as the condition you have. I found they differ widely in London and the SE. Whilst this could be due to poor statistical collection, it makes you wonder, and it seems evident you need to find a hospital which specialises in reconstruction and immediate reconstructions

I had a mastectomy in april followed by radiotherapy,I am having hopefully a delayed reconstruction next year my surgeon prefers to let the skin settle after radio to get a good result.My scarring is not as bad as I feared in fact it is very neat and smooth,I did worry about having a prothesis for 12 months. how would it feel, would it look real from other peoples views. No one notices in fact my neighbour could not tell which is the real one.
Emotionally it is difficult even when you know you have been given all the options as I had and made an informed decision that you are comfortable with,I don’t know what options I will be given next year but I know my surgeon is excellent and will offer me the best he can.

Just thought I would post an update and say thanks to you all for helping me get to a decision.

I had my mastectomy and immediate reconstruction (diep using tummy as donor site) on the 10th December. Three weeks along I am making a good recovery. The surgeons have acheived quite amazing results and psychologically it has far less trumatic than it could have been.

Thanks again everyone xxx

delighted to hear your operation went well and your feeling good. I am waiting on an appointment with my plastic surgeon to discuss diep/tram flap surgery. I had my mastectomy 3 years ago and had chemotherapy but didnt need radiotherapy. I said at first a prosthesis wousd be ok but it isnt I hate it its not comfortable and I have tried for 3 years to get used to it. Hope I dont have to wait too long for my appt. Any advice would be welcome.
Take care Carolyn159