Immediate or delayed - how to decide?

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Hi all - my first posting.

I have DCIS, and I’ve been told I have to have a mastectomy. Only found out at the end of last week, so still getting my head round it.

I’m not sure whether I want reconstruction or not - but don’t want to do anything now that will mean my options are less further down the line. The BCC booklet on reconstruction (which was great) says that if you might want delayed reconstruction, you should discuss it with your surgeon as it might mean he does the mastectomy differently. Does anyone know what these differences might be? I’m worried that as my surgeon doesn’t do recon, and my hospital doesn’t seem to be that expert in it (no plastic surgeon, just general surgery), they might not know what not to do!

If anyone can shed light on this - I’d be really grateful.

Thanks

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Hi Abigail,

The recon decision is a difficult one and you certainly don’t want to be under pressure to decide. There are some treatment restrictions - immediate recons are not usually offered if you are likely to need radiotherapy afterwards as the rads can damage the recon. I think what you have read about the different way the op is done if you are interested in delayed recon relates to keeping the blood supply / skin available to use later. I have also heard that in some areas there can be a long wait for delayed recon as you are not a medical priority at that stage as the cancer has been removed.

I opted for immediate recon as I was having bilateral mastectomies and couldn’t face having nothing there at all. I have expander implants in now to be replaced with permanent implants in approx 6 months. The thought of further surgery is a downer but hopefully the result will be worth it.

There is another useful recon booklet on Cancer Bacup site.

Hope you get the info you need to make the right decision for you.

Regards
Misha

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Hi Misha

Thanks, that’s really useful. I guess it makes sense re the blood supply and the skin, though I thought that when they did delayed recons, they stretched the skin with expanding implants? Or does that depend which type of recon you opt for? It seems so complicated, it’s very hard to make sense of it all.

I’m due to see my consultant tomorrow, so I’ll ask about waiting times for delayed recon, though I think if I did go for it, I’d have it done elsewhere. I’ll also take a look at the other booklet you mentioned.

Best of luck with your surgery,

Abi

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I understand that immediate reconstruction produces better results with far less scarring which photographs will show. However, people who have delayed are often happier with the results because they have gone through the ordeal of having only one breast. I was absolutely delighted with mine, despite the scars but would have loved the chance for immediate.
Kelley

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Hi Abigail - I had dcis and had immediate recon and reduction on the other side and delighted with the results- Had to go in hosp before that for sentinel node biopsy to check nothing in lymph nodes -so that there would definitely be no need for radiotherapy which can damage implant- hey you do a great blue pee after that! Anway was all clear and had op 31st May and delighted with the results - that’s how it was for me - good luck with your decision and keep posting - this website is great - all in it together and so …We ARE Not ALONE! I dithered and changed my mind several times but glad I went for immediate!

Love and good vibes Chebsy

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Hi Abigal
I had immediate recon and feel it was the best decision i made I feel if i had just had a mastectomy i would never had gone back for the recon but then everyone is different i wish you luck with whatever you go for x

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If I were you I’d get referred to a hospital that specialises in breast cancer, there are a few breast cancer centres of excellence dotted about. You don’t want a generalist you need a specialist - specialism equals more skill, fewer complications.

Mole

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Thanks all for the comments and useful info to know. It does feel that, if you think you might want recon, then better to go for immediate. Chebsy: I think if I go for recon then it would be the implant option so glad to hear that worked out for you. I’ve also got to have SNB - didn’t realise I’d pee blue, worth being warned about that too!!

I saw my consultant on Tuesday and I’m feeling a bit calmer about it all as he was very reassuring. He is a specialist (the hospital just has a rubbish website so he’s not listed as such) and am seeing another surgeon who’s a specialist onco-plastic surgeon to discuss recon next week. So feel I’m in good hands, I just hope I’ll get answers to all my questions so I can make the right decision - still feels a minefield!

Thanks again,

Abi

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Hi Abi - you asked: would it make a difference to the way they do the m-op if doing immediate as opposed to delayed recon. I asked my surgeon this very question, and he replied, No.

So, I thought that was the answer. Now it seems not. Immediate recon can sometimes be done so the scars are in the fold under the breast and not seen, whereas without recon, the m-scar is right across the chest and when you do a delayed recon. that scar will be right across the remade breast. So I feel bitter because I feel my surgeon pre-empted my further investigation and discovery of this fact; if/when I have a recon now, I will have visible scars.

Also, I was told l could not have immediate recon because of the possibility of radiotherapy. But it seems now they could have done my sentinel node biopsy to discover my nodes were not affected, and then gone on to do an m-op with immediate recon. after that. I feel I was selectively informed, rushed through and I am very angry.

I just thought I should tell you this, because the information gathering is, as you say, a minefield, and I know that getting rid of the cancer is priority, and fairly urgent. But knowing that, they should make sure they give you all the information you need upfront. There are many women on here who have been upset by these breakdowns of communication in so many ways, and doctors know they are bad at communication, so push, push and push again to get what you need, and when they get annoyed, push harder. It is your body, and you are about to embark on a radical moment in your life.

Take your time, and all our best wishes and good luck - and loads of people on here have experiences you can benefit from so you can keep posting and asking, you’ll be amazed what you find!