Implant v tissue reconstruction - advice needed

I recently turned 40, and in my first mammogram I was diagnosed with extensive, high grade DCIS in my left breast. Combined with high risk family history I’m going to have a double mastectomy with immediate reconstruction. They’ll also do a lymph node biopsy, and depending on those results possibly further surgery / chemo but fingers crossed it will be clear.

I saw the plastic surgery team yesterday to discuss my options and I feel really confused. I’ve been offered tissue reconstruction using my bum (there’s not enough tissue in my stomach or thighs), or implants. I can save the skin but not the nipple. I have pretty small breasts (B/C cup).

The surgeon and surgical nurse seem to take it as a given that I would want the tissue reconstruction option, but the surgery seems pretty brutal and the recovery tough compared to implants. Either way I’ll loose sensation and my nipples, so I feel like I’m missing something as to why the tissue reconstruction is so preferrable. I have two children under 10 and a busy, active lifestyle to keen to get back to life ASAP.

Would love any advice from people that have had similar surgery as to which option they chose and why?

Thanks so much

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Hi @miriam,

Firstly, I’m in a similar (although not identical) situation to you so sending much love to you because this isn’t how either of us would have imagined we’d start our 40s.

I can’t have tissue recon because I don’t have enough tissue (bum wasn’t offered as an option). I was happy with that because like you I had concerns about the surgery and, after some issues with my original lumpectomy wound healing, having an extra wound to worry about wasn’t very appealing. Plus I’m already going to need to give up a lot of my body and life to treat my cancer and reduce my risk as a BRCA2 positive gene carrier, so I personally don’t want to extend the harm and recovery time.

However I’ve heard people speak highly of tissue reconstruction because it’s your own tissue and thus:

  • it’s not a foreign body - your body forms a capsule around implants which means there’s a risk of some level of capsule constriction (however not necessarily problematic)
  • there’s no risk of anaplastic large cell lymphoma (which I’m told is rare with implants yet still a risk to be aware of)
  • there’s no need to replace them in future (although I’m told that implants are lasting a lot longer now so I’m hoping we can get to our 60s before that’s necessary - another driver to stay fit and active!)
  • it’s the same kind of weight and temperature as your original breast tissue (whereas I’m told to expect implants to be heavier and cooler).

Those are the ones that stick in my mind which could be reasons your team are assuming you’d want tissue reconstruction. It’s worth speaking to them again about why they’re making that assumption to see if there’s any clinical reason they’d favour this for you. However, ultimately it’s your choice taking into account the clinical options and all of your personal circumstances. I hope it goes well x

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@miriam I had a single mastectomy with immediate reconstruction and never looked back. Honestly, the thought of me being under the knife for 6 hours if not longer and the recovery put me off straight away. My surgeon has been on my case to have the symmetry surgery on the other one but I don’t really want another surgery. As I am very heavy chested I need to wear a partial prosthesis but I don’t mind as I can’t see myself being anything but heavy chested lady. I’ve been all my life and it looks weird to have the reduction surgery just for cosmetic reasons. I couldn’t have double mastectomy as I am not carrying the BRACA genes.

It’s been 3 years since my surgery and I can tell you that I am absolute fine with the implant even though I had radiotherapy after the mastectomy and chemo.

Just been on holidays and it’s was actually normal to go in the water with the prosthesis and Nicola Jane has got some wonderful bras and swimwear but you can also have pockets added to your own bra if you want to.

I just don’t see the point for such an invasive surgery when we are going through so many other things in our lives. But that’s me!!!

Wishing you all the best with whatever you decide.

Take care. Xx


Hi @rainbowcat,

Thank you so much for taking the time to reply. I’m sorry to hear about your diagnosis - I hope all your treatment goes smoothly.

Thank you so much for all this info - it’s incredibly helpful. I think I’m definitely leaning towards getting implants as it seems like a much easier recovery, and I’m not really bothered about how my new breasts feel.

Take care of yourself,

Miriam x

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Thank you so much for taking the time to reply @mun4o

I really appreciate all the info - it’s great to hear you’re happy with your implant.

Yes definitely feel the same way about avoiding such invasive surgery if I can - the recovery from implants sounds so much easier and I just want to get back to normal life ASAP.

Wishing you all the best,

Miriam x

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