Immediate implant or flat? Quick decision needed - please help!

Going through breast cancer treatment Surgery
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Hello all,

I’m new here and this is my first post to the forum. I’m 46, with two teenage children and a very physical job. I was diagnosed a week and a half ago with multifocal IDC, two tumours in my right breast. Both are ER+, PR+, HER2-, grade 2. One right behind the nipple, the other in the upper outer quadrant.

The known plan so far is to have surgery (booked for 3 December, so three weeks away) and hormone therapy. Chances of needing radiotherapy or chemo are low, apparently, but not impossible, and I won’t know for sure until after surgery.

The surgeon has recommended a mastectomy rather than lumpectomy, due to the size and position of the tumours (one being behind the nipple and another in the upper outer quadrant) and my small breast size (B cup). She has also ruled out either DIEP or LICAP reconstruction as I’m quite slim, so not enough tissue. This leaves me with the option of either having an immediate implant reconstruction, or going flat on one side. She was great at talking through possible risks/complications of having an implant; things that could worry me are the circa 10% infection rate after implant surgery, which then leads to removal, Also, not yet knowing for sure if I will need radiotherapy, which could potentially damage the implant…

The surgeon told me she needs my decision by the end of the week, so that she can order the implant if needed. So I have less than two days to make the decision, which has really thrown me. I know it is an entirely personal choice, of course, but has anyone been in a similar situation, or made either decision and can tell me anything about their experience, good or bad? I am currently not leaning either way, just panicking about making such a big decision with such little time! Prior to this appointment, it seemed likely that mastectomy would be recommended, so I was getting my head around that, but I thought it might be possible to have a delayed reconstruction, and with that option out of the window I’m really not sure what to do.

With thanks and love to you all,
L x

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Dear lulup,

So sorry you are having to go through breast cancer, we are all here for you, with love and support.

Firstly take one day at a time, this is a big decision for you to take and also very personal. I think if this were me and my consultant was pushing me for an answer I would say yes to the reconstruction, which would give you time to consider if this is right for you, (allowing the implant to be ordered) if nearer the time you feel this is not for you, you will be able to speak to your breast cancer nurse letting her know you have decided go flat. Please don’t be afraid to speak up for yourself, this is so important to you.

Wishing you, health and lots of happiness going forward. Please come back to let us know how you’re getting on.

With the biggest hugs Tili :pray::rainbow::pray::rainbow:

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I agree with Tili. I had the same as you multifocal but 4 tiny tumours I was 34b and I had left mastectomy and hormone treatment and remained flat. I have had no issues apart from a seroma for a few weeks. Take your time and talk it through xxx

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Hi @lulup - sorry to her about your diagnosis. I also have a young child altho not necessarily a physical job. I chose to go flat & the recovery was extremely easy. Of course the decision was easier for me because I was definitely having chemo & radio. I am planning to have DIEP when treatment finished. You would be surprised how quickly you get used to it. Good luck with whatever you decide x

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As others have said, ultimately it is your choice and it is bewildering.

I was in the same position and spoke to a lot of friends. In the end, I went for immediate reconstruction and nipple removal. I’d already had a lumpectomy and second op for more clearance - mastectomy has given me peace of mind. I may need a fat transfer as I have a couple of ripples in my foob (false boob). It’s a couple of cup sizes smaller as there is a limit on the size they can put in, plus I’d had a fair amount of skin etc removed during my previous ops. They have offered a reduction in the other boob but I’ll be fine with a small fillet in a bra and am not fussed about a life interruption with more surgery once I’m through chemo. I will need the implant replacing 10-15 years down the line though. I felt happy waking up with some shape and feel like me when I look in the mirror and see a little cleavage. I was equally entertaining going flat, which gives a fast recovery and an option for later reconstruction.

There’s a very helpful downloadable booklet by macmillain about reconstruction- although I think they pick the most perfect boobs for their photos!

All the best with your decision.

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There are other options for delayed reconstruction I was told where they use an implant as well as body parts. Seems odd they can’t do an implant now or some other way of doing it now that can be rectified later after rads if you have it. I think I would be thinking about a second opinion to be honest which is what I did 6 years ago and ended up having a lift instead of a mastectomy but that may not be possible for you but you can still get a 2nd opinion.

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Ahh thank you so much for your reply Tili! My head was so scrambled I wasn’t even thinking of this as an option. I think the past few weeks have really taken their toll. We had sold our house, and after waiting 3 months for a completion date, we were told last Tuesday that we would be moving on Friday. A week after diagnosis. 3 days to prepare for the move, and on one of those I had an MRI scan and travel to and from the hospital! Last week was definitely one of my least favourite weeks!!

This week we are in our new house and my mind is fully on surgery, but you are totally right, I can request the reconstruction to get the implant ordered and then continue to think and talk it through. I could really do with taking the pressure off for a minute!!
Lots of love
Lulu xx

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Thank you @joyousjen, it’s really good to hear your experience. I’m also 34B and (although I wished my boobs were bigger when I was young!) I have enjoyed the freedom being smaller chested brings, sometimes going braless in summer and being able to wear strappy tops etc. I wonder how being flat on one side would change or limit my clothing choices, ie wearing a bra with a prosthesis. These sound such superficial questions, but I guess this sudden decision (and diagnosis) does bring up so many questions I never thought I’d be asking…
Lulu xx

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Thanks so much @brambles1. Having a multifocal diagnosis, I am looking forward to the peace of mind that mastectomy will bring. The two tumours have the same histology so it is quite possible there is some cancerous tissue between them, and I am very happy to ensure they get rid of it all! It certainly is a bewildering choice though xx

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Thank you sunshine x I’m really glad that recovery has been easy for you, and I hope that treatment isn’t being too harsh on you? Thinking of you moving forward xx

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Thanks @Linda_Corinne. Yes, I am a bit confused about whether there are really no other options down the line. I think I’ll give my breast care nurse a call today to discuss, and see if she can answer any of these questions for me xx

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I had a mastectomy in the summer last year. My oncologist didn’t think I would need chemo or radiotherapy and I opted for a silicon implant. I could have opted for an expender but I wasn’t sure yet if I wanted DIEP. I never considered going flat. The recovery went well with no infection. When the histopath results came back, they found out the cancer has spread in the lymph nodes and I needed both chemo and radiotherapy. A few months after the end of radiotherapy I started to see some change in my breast. The implant retracted and my breast is smaller and firmer. It’s not too bad aesthetically but I was so happy with my new breast after the surgery. It was difficult to see my body changed again and I just hope it will not change any further. I’m becoming more open going flat and if I need an implant replacement I will definitely consider it this time… but I still hope I can keep my implant for many more years

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Dear @marie911
Thanks so much for sharing your experience; it’s really helpful to consider the different possible scenarios. I’m sorry that you had to see your body changed again after radiotherapy, and my fingers are firmly crossed that you don’t see any more changes and you do get to keep your implant for many more years xx

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I was in a somewhat similar position early last year needing to make quick decisions at each stage of my treatment journey. My journey changed along the way; I was diagnosed with IDC ER+ PR+, HER2- and had an original treatment plan to have the lump removed, followed by radiotherapy and endocrine treatment. However after a further MRI & biopsy, this became a multifocal BC tumour diagnosis and the treatment plan changed, with just a couple days given for me to make a decision on the type of mastectomy +/- reconstruction I wanted.

I felt really overwhelmed and didn’t feel I had sufficient information to make the decision (i.e. wasn’t able to see a plastic surgeon for another 4 weeks to review viable non-implant based reconstruction options and I knew I didn’t want to risk having a silicon implant due to skin allergies/sensitivity, and I also hadn’t spoken to oncology to understand if I’d need radiotherapy to my chest wall due to how close/deep the second 2mm tumour detected via MRI was to it.

As I was slim my breast surgeon wasn’t able to clearly tell me if any of the body fat based reconstruction options would be viable for me, without being seen by the plastic surgeon. So I decided to get a second opinion privately, I saw another breast surgeon who referred me to see a plastic surgeon who spent an hour and a half explaining what options were viable after examining me & showing me photo’s of reconstructions she had done previously to help visualise. She explained that even though I was slim, body fat based reconstruction was possible with a combination of fat from my abdomen (DIEP) & thigh/buttock area (PAP), but would most likely involve one or two smaller surgeries for fat grafting after the first main surgery; I was a C/D cup. She also said that if I didn’t want to choose the immediate body fat reconstruction option (longer surgery & recovery time), she could do a nipple sparing expander surgery with a silicon implant (shorter surgery & quicker recovery time) which could be replaced with body fat/changed later if I didn’t get on with it due to allergic reaction (she mentioned this would be rare, but explained that there was such a thing called implant sickness symptoms) or needed radiotherapy.

That appointment with the plastic surgeon is what gave me the clarity I needed to make the decision that was right for me at the time (she went through various risk factors, DIEP failure rates and a lot of other information). The reconstruction options were just too involved for me, and I couldn’t see myself having multiple surgeries in the future in order to match the reconstructed breast to the other; At that particular time in my treatment journey I wanted to get on with surgery and understand what my oncology treatment plan was going to be. So I decided to go with a mastectomy without reconstruction (flat on one side) and leave delayed reconstruction as an option for the future seeing how I felt after.

I am now 20 months on from that decision and can say I have no regrets. I’m still working through finding the best fit bras and the most suitable prosthetic for various clothes I wear, which are practical lifestyle changes I’ve had to adjust to so it is a process. But other than that I can say I am happy with the choice I made and haven’t really thought of delayed reconstruction since then (but it’s still there as an option if I should want it, even though it wouldn’t be aesthetically the same as if I had had it done as an immediate reconstruction). Hoping some of the above information helps you make the decision that’s right for you.

Sending you love and hugs xx

P.s. I did have chest wall radiotherapy in the end, so had I chosen a silicon implant based reconstruction it would have been affected by radiation (capsular contracture).

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