I had a successful lumpectomy last month that removed my tumour (1.3cm shrunk to .7cm with neo-adj chemo) with good clear margins. Sadly, the satsuma-sized bit of tissue removed contained a large area of surprise DCIS extending margin to margin, so they have now recommended I have a completion mastectomy.
My oncoplastic surgeon has offered me an immediate LD recon, just cutting out the circle of aereola/nipple, but I do not want implants. My natural boobs are a 34D, and I’m wondering how he is going to get enough fat and muscle to fill the skin that will remain. Has anyone had an LD recon with no implant?
Also, I am due to have three weeks of rads afterwards. I’m worried about how the recon will hold up.
Finally, I am worried about future loss of strength and discomfort. Anyone have a positive experience with this?
Thanks in advance…I am so confused about what to do!!!
Hi Carrie,
So sorry you are now faced with a mastectomy, but please let me reassure you as I had exactly the procedure you are describing and 18 months on am thrilled with the results. I had an 8cm tumour shrunk to 2 by neoadjuvant chemo and nodes involved, so I always knew I’d have an mx. My lovely Breast Surgeon said he’d cut a ‘wee hole’ - nipple/areola - and take it all out. My Plastic Surgeon dislikes implants so would only do immediate recon without them, and depsite being slightly overweight I was too thin for a DIEP (tummy tock)!!
OK, so before surgery I was 36DD, which I was told would be tricky to match. My recon is a ‘generous C’ and I am waiting for an uplift on my ‘good’ side. I have a 20cm scar on my back, a roughly 5 cm scar under my arm (from lymph clearance) and a little circular patch where the areola was. The scars have faded well and the skin is soft. I have a lot of numb skin on my breast, upper arm and back - something they didn’t mention - but otherwsie all is well.
I was driving after six weeks and worked all through my 25 rads (which my recon survived brilliantly)
I still feel some ‘tightness’ across the scar espeically when it’s cold/damp and I think my arm is slightly less strong than before - but I am cautious due to risk of lymphoedema. I have excellent movement in my arm, totally natural cleavage and feel generally very positive - I hope you will too.
Feel free to check my profile info or to private message me if you think I can help any further.
HI Carrie
I had delayed LD recon without implant October 2011.
My previous size was 32 D, the recon is nowhere near that size but I have just had a fat transfer op 2 weeks ago and I would say I’m a B. My PS will give me at least another one fat transfer op maybe 2 and then a reduction on the good side.
I’m happy to go down to a B or C if need be - very pleased with results.
Jude
Hi Carrie
I had immediate LD recon with no implant in June 2011. I was a 34C and despite being slim was very pleased with the amount of volume my oncoplastic surgeon achieved, giving me a good match. Unfortunately within a couple of months the recon began to shrink and went down two cup sizes. In Jan this year I had a further operation and now am the proud owner of a particularly pert boob courtesy of an implant!
I really hadn’t wanted to go down the implant route but was told I couldn’t have fat transfer as they wouldn’t be able to harvest enough. I have to admit it does feel a bit strange just because it is so solid and unfortunately it’s not very comfy when I try to lie on my front at night!
As far as the original LD goes I still have quite a dramatic scar on my back which does feel tight at times but that goes after I’ve done some stretches. There is numbness in my boob, my back around the scar site and also under my arm from where I had a SNB and then an op to divide the nerve going into the boob to stop it from twitching. That’s one thing they don’t warn you about - the twitching. It’s most bizarre when it does it involuntarily but quite a good party piece!
I’ve found that I have minimal loss of strength. I run a lot and this hasn’t been hampered infact I’ve found it’s a really good way to stretch my back. I also do pilates and have noticed that I can’t always hold the poses for as long as I used to but feel this is a small price to pay.
All in all just over a year down the line I feel very fortunate to be in the position I am. I feel healthy and positive about the future. Just got my first mammogram to wait for at the beginning of Sept.
Good luck for your op. I can assure you it’s not as bad as you probably think it’s going to be. You’ll cope because we do. It’s how we’re made!
Anne x
Thank you so much for your replies. I definitely wouldn’t mind being a B/C cup (what I was before breastfeeding), as long as my ‘good’ boob had an uplift to match (sadly, it tends to be the bigger one anyway). It’s great to hear that you aren’t suffering any major pain or loss of strength issues. Anne, I’m sorry to hear you had problems with shrinkage, but fab that it’s been sorted and you’re feeling positive now.
It’s so helpful to hear from people who have actually been through it. My BCN made me feel a little silly and overdemanding when I spoke to her regarding my concerns, and I felt like saying, ‘Well, have you actually had a breast cut off and replaced with another part of your body?!’
After nearly driving myself round the bend this week trying to make a decision, I think I have decided to go with what the surgeon initially suggested - a skin-sparing mastectomy with a tissue expander to ‘hold’ the skin until after radiotherapy. That way, if the skin doesn’t hold up, I still have the option of an LD or Tram/Diep recon. If the skin does survive, I can decide at that point whether a simple implant will be satisfactory or to go ahead with an autologous recon. Right now I feel that I’m under more pressure than I can cope with to make a decision I will have to live with for the rest of my life, and the TE route feels like it leaves me the most options open. I am also considering a prophylactic mastectomy on the other side - my large area of DCIS wasn’t picked up on multiple ultrasounds and mammos, so I am now a little worried about what might be lurking in the ‘good’ one. I don’t fancy giving up another year of my life to this sh*t, so another bonus of doing the TE/delayed immediate recon is that it gives me a little more time to consider the prophylactic mast, and then I could have them reconned at the same time.
Argh!!! So many decisions and unkowns!
Thanks again, ladies. I really appreciate your thoughtful and comprehensive responses, and I wish you the best with your futures.
Carrie xx
I have the skin sparing implant. The surgeon done a great job with it, and it’s actually changed my view on having an implant. I was getting LD with implant after rads…
I’ve not had rads yet.
Good luck with it all X
Hi,
It’s so hard to decide isn’t it?
I am trying to make a decision and keep changing my mind about whether or not to have reconstruction at all! I have to have a risk reducing mx on the healthy side due to high risk of recurrance (BRACA 2 gene) and have had chemo, mx and rads on the other side. The options seem limited because I haven’t got enough body mass to have the DIEP flap (yeah!) and not much around my back either. The surgeon is therefore suggesting I have two LD flaps with expander implants on both sides to bring me up to a B/C cup which would be find with me. It’s just such a big op and I don’t want it delayed either as I’m totally paranoid about the ‘healthy’ breast which is itching like mad and just seems to be screaming ‘get rid of me’. I think that the simple mx would be able to be done very quickly but the big reconstruction may take longer to get booked. Half of my friends/family are saying ‘why bother’ while others say go for it. One daughter says that I absolutely must have the reconstruction as I would then have come through all the s…t with style and get a new paid of boobs in the process! This is just such a positive idea and makes me want to do it. Aaaagggghh! I’m usually so decisive. I think I definitely need a mammogram on the health side in any case just to put my mind at rest a little.
Good luck to everyone in making the right decision for them.
Jan
x
Jan, it is totally confusing, isn’t it?! I keep going back and forth, too. If I didn’t need to have rads it would be a much easier decision, but I don’t want to compromise my back muscles and then have rads ruin the recon. But the idea of having several more surgeries doesn’t appeal either. Sometimes I think I’d be fine to be flat on one side, then I get angry and think why should I let crappy cancer steal my breast.
I’m considering bi-lat mast because my DCIS didn’t show up on any imaging, so I don’t know how I’d ever have peace of mind otherwise. But then I wonder if I’m being crazy to cut off what seems to be a healthy breast.
It’s all so hard.
Big hugs to you, and all the best with the choices you are facing. Thanks for replying.
Carrie x
Thanks Carrie. At least the decision to have another mastectomy is a no-brainer for me as they told me at the genetic consultation that I have an 85% chance of a recurrence in my healthy breast. At least they will have a good chance in getting a match if I go for the reconstruction which I think will have to be LD Implant with expanders. My family are all making fun of me saying that I will end up like something from Eurotrash!
Good luck and hugs to you too.
Jan
x
Hi
I had immediate LD recon with no implant 7 years ago over time it shank so last year I had an implant put in underneath the muscle . It’s great . The LD recon does leave alot of numb areas but you get use to it.
Rehana
Eeek - got a call from the MacMillan nurse yesterday to say that he had ‘pencilled me in’ for 21st September to get the mx and double reconstruction and that I would be having a mammogram next Monday at my next appointment to check on the itch! I’m quite pleased but also rather nervous now. But, as Julia Roberts mantra is, “The only way out is through”!
Jan
x
Rehana, thanks for sharing your experience. Did you have rads on the recon side? I know that can cause shrinkage. Glad you’re happy with the final result!
Jan, eeek indeed! But sounds like good news. Keep us posted with how you get on.
xxx