Don't know which reconstruction to have

Can’t make my mind on which to have an implant or have the flap from my back, would love to have people’s opinion. Many thanks as it’s so hard to get your head round it

Hi Khamsin

You should be guided by what you feel is right for you. Presumably your surgeon will have gone through all the options along with the pluses and negatives of each one. In my own case I was steered away from implants because there is a very high chance that I will need radiotherapy - Implants don’t do too well with radiotherapy so I was guided by my surgeon to consider - like you - implants from elsewhere. Again she went through the positives and negatives of each until it seemed quite naturally that I had made the decision to have a free DIEP flap. The surgeon even asked me why I had opted for the DIEP flap - in my eyes I’m donating to myself  so therefore less chance of rejection, not without its own problems but in the general scheme of things it feels right for me.

Whatever you decide - you need to feel happy and comfortable about your choice - the fact that you are struggling to make the choice tells me that you either need a second opinion or you need your surgeon or BCN to talk you through all the options again.

Life is now similar to a runaway train and you have to hang on just when It is hard to take everything in . I had both my husband and daughter with me when I saw both surgeons who will be operating on me. Make sure you have someone who can support you and ask questions for you when considering such an important choice. I hope you can come to a decision that you feel happy and comfortable with soon.

Hi, it took me a while to know what to do once I knew I needed a mx - looked into all the options, met with the plastic surgeon but essentially we ruled out a recon from my own body tissue as I am slim build and I had already had major abdominal surgery earlier this year. I swung back and forth between implant recon and just a mx, talked to lots of people, looked into all the pros and cons and still felt confused - I think I was trying to come up with an answer that covered all the what if’s and it took me a while to realise that wasn’t going to happen. I finally decided on an implant (I’m small breasted so difference in appearance wasn’t much of an issue). I’m nearly 6 weeks post surgery and have healed well, at times it feels odd (tight, pressing) and at others it now feels normal and I forget there is anything different there. Having said all that, there has been a potential issue that the area of DCIS was bigger than originally thought and there isn’t a clear margin between part of the removed breast and the skin - having radiotherapy ‘just in case’ there are any breast cells left there isn’t really an option because of the potential damage around the implant but my team seem to think its very low risk.

Don’t know if this has helped or not - I do know I found the decision-making process tortuous and felt better once I had made up my mind. Hope things go well for you x

Hi Khamsin.


like you, I was offered the LD flap, implant, or straightforward MX as I was not suitable for DIEP/TUG/PAP. I agonised for some time. Consultant/surgeon recommended the LD. BCN showed me pictures and discussed pros and cons but I struggled with the thought of removing a shoulder muscle. I could see that the finished result should be superb, but . . .losing a muscle seemed crazy as I am a very active person. However, agreed to the LD flap and was pencilled in for an op date. With2 weeks to go changed my mind and went for a straightforward implant. BCN understood my thinking but recommended that I talk it through with the surgeon/consultant again. 


Explained my concerns. The surgeon, who I have to say I had total confidence in (she performed my WLEs and SNB earlier in the year) firstly reminded me that there was little to choose in recovery times between LD and straightforward implants, because ladies like me would need a mesh implant as well as the silicon or saline implant itself if not having the LD muscle to give support and shape. LDs have a very low failure rate. LDs have a much lower likelihood of needing further trips back to hospital for lipofill or other tweaks. Other muscles in your body up their game to compensate for the moved muscle. The surgeon would cut the muscle nerves/tendons so that the new breast would not ‘twitch’. Yes, there were risks but there were risks with all forms of recon and even for a straightforward MX. What really swayed me was seeing a lady at a yoga class for people receiving radiotherapy - she’d had an LD more than 10 years earlier and everything was good.


So anyway. Here I am 5 weeks post op and everything is going very very well. I had a skin sparing mastectomy with LD flap and a small implant to gain the correct size. In hospital 3 days. Within a few days of the op I was independently washing and dressing. I walked the mile into town ( with two drains in still) for a coffee at my local Costa 1week post op. Once the drains were out I cracked on with getting back to normal and to be honest could have gone back to work ( so long as there was no physical stuff) about 15 days post op. 3 weeks post op I moved a ton of logs into the shed, admittedly slowly! 4weeks post op I was outside painting walls. I am now 5 weeks post op and feel pretty much back to normal and most of the time am not aware of the op. Scars are healing brilliantly thoughI think I have a small haematoma over the site of the last drain to come out. I’m not worried about this, but will talk to the BCN in a few weeks time if it’s not gone. Yesterday I did my first press up since the op just to prove that I still could, and it felt great. I now sleep on either side or on my back. Today I also spent 30 minutes on the sun lounger in the garden, face down. I’m out walking as normal and cycling (though too puffed out to make it up the hill by my house). I’m thinking of taking a short holiday and doing some swimming.


Downsides? I can only think of one. The loss of sensation in your breast is pretty much inevitable whichever operation you chose, but with the LD the sensation over your shoulder blade will change too. I’ve got a small spot which still feels numb but the rest just feels different. The scar on my back does not bother me, but perhaps that’s just me? Having to do the stretching exercises also does not bother me, but they do take a while each day.

Sorry, I’ve rambled on. None of us on this site would have chosen to be here and the decision over which surgery to have is horrible - I really struggled (as you’ll see from my other posts). As others have said, you have to try and work out what is best for you. My advice would be to ask questions about the things that are bothering you. If you have a surgeon/consultant/BCN you trust then clearly that’s a great help. For myself, I am happy with the decision I made. My new ‘breast’ is beautifully matched to my remaining breast - I am so, so happy to have such a near perfect new boob. The scars are tidy and with time will be hardly noticeable. I really wish you well with your decision making and if you want to ask anything about the op and recovery please feel welcome to message me. Otherwise, good luck. Caroline