I have a BRCA2 mutation and am planning to have prophylactic subcutaneous mastectomy (keeping the skin +/- nipples). I am petite, so my only options are implants alone or LD(latissimus dorsi) flap. I have been told that implants by them selves will only partly be under the muscle and that the part that is contact with the skin leaves a disappoint result due to scarring (only a thin layer of skin is left with no fat on it). I have also heard that the minimum size for implants only is a C because otherwise they can slip. Considering that my normal size is A, that would be quite a jump. Does anyone have experience of this? I know that LD flap can produce very natural looking results but I am concerned about the potential side effects. I already have problems with neck and back pain and have young children and a very manual job.
Hi Megdot
So sorry to hear of your impending op. You will get positive reports on this op and some not so positive. I am sorry to be one of the latter but I really wish that I had been told of all the cons for this op as I would not have gone for it knowing what I know now. Please remember that not everyone has the problems I have had as “very few people suffer from this so we don’t mention it before the op” as I have been told regarding:
1: Nerve damage which may or may not be permanent and is pretty damned painful.
2. Feeling crushed a lot of the time. They can apparently cut the nerve but that may affect the blood supply.
3. Needing further surgery when it goes wrong i.e. like mine with the muscle moving.
4. Recovery will be about 6 to 12 months I was told before the op, after the op it was suddenly 1 to 2 years!
Personally I had ld flap one side only and it has limited my strength in my arm and back. Initially it looked good, swollen but good, now almost 11 weeks post op and over the past few weeks the ld flap has pulled away leaving some ugly dents and giving pain also. See my consultant again in 3 months time and he will then get me booked in for about a 2 hour op where he will go in via the nipple area scar and remove the implant, replace with a slightly larger one and reattach the flap so I will be back in hossie for about 2 or 3 days and overall recovery time will be even longer now.
I am 5 feet height, size 10 to 12, 34C bust with a fairly high pain threshold but now on strong pain relief daily for nerve pain and by the looks of it pretty unlucky on 1, 2, 3 and 4.
Remember others have no problems with this op, do plenty of research and I wish you well with your choice of recon and a very speedy recovery.
luvnhugsxxx
Hi Megdot,
I am having the same surgery as you on Tues. Feb. 26. I am getting saline implants to start and once I am at my desired size I will have silicone implants put in approx. 4 months. I chose to do the silicone because they look and feel more natural. I am now a size D which causes me back pain because I have a small frame.
I will share my experience with this forum. I’m happy about my decision and I feel really lucky that my surgery will not be so invasive. I too have small children 6 & 4, my husband and I told them that my pom pom’s(breasts) have boo boo’s in them and that the doctor is going to fix them so I will be sore. They will be fine. I’m doing ok I’m just sad about the loss of sensation.
Hi Megdot
I had implant only reconstruction following skin sparing mastectomy. I was and still am a 36C bust.The implant was positioned under the pectoral muscle. The muscle that lies under your breast. The surgery is much quicker than other reconstuctions and recovery was quite quick. I was back at work in 8 weeks.
I did have some problem with a large haematoma and a fluid collection but this is very common and after having some fluid aspirated the haematoma was gradually absorbed. At no time was it painful although I did have a morphine drip for the first 2 days.I was driving 4 weeks after surgery.
At first I have to be honest and say I did not like it. It felt false and it looked so high compared to my other breast and I’m not that droopy. I used to say that it felt like somebody had stuck a pudding plus the bowl on my chest and I deeply regretted not having a diep.
But now I am 5 months on and I am pleased with the result. It has dropped a little bit. I must have got used to the falseness of it because I don’t notice it anymore. In fact I even forgot it. I was in the shower at the gym when I remembered that I had an implant because I noticed someone glance twice at me. (I have no nipple)
I haven’t used the shower since.
In April I have my next appointment with the plastic surgeon when we will discuss nipple reconstruction. He has also said he can “rearrange the furniture” in my good breast to lift it. He said he can take some breast tissue from under the nipple put it above the nipple and move the nipple up.
So all in all I am very pleased with the result and I am glad I had an implant. One other thing when my PS suggested a sub pectoral implant he said that If I didn’t like it there was always other options I could try later. It was that comment that made up my mind.
Hope that has been useful
Sandra
Hi Megadot - sorry you have had to join us but you will get great support here.
I had ld flap immediate recon last September and didn’t keep my nipple - am booked in for next mastectomy on 14th March and haven’t decided yet on what to go for - my only 2 options are the same as you - either just implants or another ld flap.
Am seeing my surgeon on Monday to decided.
I had ld recon first time as I had previoulsy had radiotherapy and this was the only option - it looks great now even though it is not finished yet. I still need the nipple to be done and a bit of liposuction to fill out some dents and gaps. It is a long op and first 3 weeks were hard as even though I was in no pain had very limited movement. My surgeon did stress to me though that even though I was in no pain for the first 5 weeks exercises shoudl be very limited to under the shoulder height to prevent the implant and muscle from moving. I too felt very crushed like I had a tight elastic band wrapped around my chest - very strange sensation. I was probably back driving within 6 weeks and had 3 months off work. Have only just started to lift light things now and am very cautious about using that arm too much. From my research I think that a ld flap gives a better result looks wise I am just really worried about losing 2 back muscles.
My surgeon is really pushing for another ld recon and does not want to do just an implant under the pec muscle - I can’t decide!! It is a really hard decision because we have years to live with the result.
Sorry been waffling a bit - I think ld flap will give a better cosmetic result but there are more long term side effects. I am in no pain and can do nearly everything that I used to do but am using my good side more than my other one at the moment for things like shopping and housework etc.
I will let you know how I get on Monday and what I decide.
Take care
Sarahx x x
Hello Megdot
I am probably not the best to give an opinion as I only had my op 4 weeks ago.
I have had a prophylactic left mastectomy, removing nipple, with immediate LD back flap and implants. I am due to go back for right side in a few weeks. I was not given any other choice of type of recon. My surgeon strongly urged me to have the LD flap due to the better, more natural result and the body is less likely to reject the implant. I plan nipple recon later also.
Since joining this site I have been amazed how the advice given by medics varies so drastically. Unlike Sarah, I was advised to get my arm moving as much as possible as soon as possible. My physio made me do some rather painful stretching on day 2, and once the drains were removed (day 7) I was encouraged to get my arm as high as possible above my head, pushing it a bit further each day. I was also told there was no restriction on lifting, as I can do no harm, and to lift within my limits. I was told not to drive for 6 weeks, which I think was more of an insurance issue.
I am pleased with my new breast and with clothes on you cannot tell which is the falsie. I will let my partner see me in the flesh when everyhing is complete. I have had to go back a few times to have fluid drainned from my back, but that is painless.
I have not heard about the minimum size implant issue. You are right that it would be rather a jump to go from an A to a C. I opted to stay the same size. I am about 5’9’', size 12 and approx 32 C.
I also heard one advantage of having LD flap is that you do not have to wear a bra as you have your own ‘natural’ support. Great for summer tops!!!
Any further questions, however sensitive, please do ask away.
Jackie x
Hi Mollyjoemax,
I’m happy that everything went well with you and actually everyone at this forum too:) So your plastic surgeon was able to put your implant 36C in during your first surgery? I asked my surgeon to please try to put a C implant in because I’m a large D and want smaller. She said she will try it depends on the muscle. If not I will have to have the saline pumps for a couple of months until the implant surgery. As for the implant, can you feel anything? Thank you, any advice or input will help.
Thanks so much everyone for your thoughts and info. It is really helpful to hear all of your experiences even the not so good ones (thanks Curlycat). I agree that you get different opinions from different surgeons. Two I have spoken to seems to jump straight to the LD flap option (both sides at the same time) and minimised my concerns about my back and neck. A third has suggested a more limited flap (leaving a lot of the muscle to reduce the weakness and pain concerns). He says I am too thin to have a DIEP and that an SGAP could damage the sciatic nerve, has more risk of failing and can make it uncomfortable to sit. Am still thinking about forgetting about all this and having implants under the pecs but am worried that if it looks or feels really bad then later reconstruction will be more difficult with only a very thin layer of skin to work with. I also sometimes feel that maybe I am making too much of a fuss. I don’t have breast cancer and if I did I wouldn’t have all this time to make my decision. I am really fortunate to have the chance to dramatically reduce my breast cancer risk…but it doesn’t always feel that way.
love to all
Megdot
Hi Megdot
I know exactly how you feel about not having cancer and being given a ‘choice’. This sounds absolutely awful and very selfish, but I almost wished I had been diagnosed so that I had no choice!! How bad is that???!!
The way I dealt with such thoughts was to say to myself that I doubt I would regret having recon done now but I could very much regret not having it done if I was diagnosed later in life. It is better to recover from surgery while relatively younger, not undergoing treatment recently and not having the added anxiety of cancer.
I also know how you feel about making too much fuss. Just before my op I went through a phase of feeling really guilty about the whole thing and everyone who was going to be involved. I felt guilty that my surgeon was going to be spending time with me when she could be seeing diagnosed women. I even felt guilty for my dogs that wern’t getting as many walks. I worried about leaving everyone with extra work in my job… the list went on.
In the end I tried to stop thinking about it and just went with the flow. I thought I will see how I feel on the day of my admission. I treated this as a temporary phase of my life that will pass and I can forget and get on with the rest of my life with less risk.
I am suprised you have been given the option of LD both sides together. After 4 weeks I am still uncomfortable laying on the side that has been done. I am waiting for that to ease before I have the other side done.
Its probably not much help, but all I can say is I am so pleased I have taken the plunge, the LD method was my only choice, but I am pleased with the result so far.
Good luck and let us know what you decide.
Jackie x
Hi Megdot,
I had a skin and nipple sparing mastectomy with implant on Monday this week, and am only an A cup. I still have to have rads, and my surgeon said there was a small chance of problems with that, but if there were, I could then have LD flap or DIEP at some point down the line. I have to say, even the day after the op, I was thrilled with the look of everything - they cut underneath my breast, and even removed my lymph glands through there, so no other scar. I was out of hospital the day after the op, with 2 drains, and was just given co-codomol to take when needed, and although I felt some pain immediately after the op, (literally as I came out of anasthetic) I have only had mild discomfort since then, nothing too bad at all, in fact not taking anywhere near the maximum painkillers as I could. The drains will come out on Monday next week. I have to say that except for a little bit of bruising, my right breast doesn’t look any different to how it did before, you would have no idea it was an implant!
My surgeon recommended this for me, and as I had some excellent feedback from former patients about her, I was happy to take her advice, and so far (although only 4 days down the line) I am really happy with the results.
Good luck with whatever you decide!
Shannon
x
Thanks Jackie and Shannon! … for the empathy and the info.
Shannon, would you mind telling me where you had your surgery? If you don’t want to put the details on the main site maybe you wouldn’t mind sending them as private message. Really happy for you that your choice seems to be working out well and that you are feeling so well so soon. Would love to know how you feel after a while.
Meg xx
Hi jbaby
Yes I had the implant at the same time as my mastectomy and sentinel node biopsy. I don’t have much sensation at all. Just after xmas I was ill with a fever and thought I had got flu. It was only when undressing that I discovered a very hot(so my husband said) swollen, bright red boobie. I had an infection around the implant and didn’t know…Intravenous antibiotics have sorted that out.
It was probably that episode which made me accept the implant because up to that point I had moaned about it feeling so fake but that made me think that I didn’t want to lose the implant and go through more surgery. Now as I said in my previous post I don’t notice it and I think it looks good. Can’t wait for a nipple.
Hope that helps
Sandra
Hi Megadot - saw my surgeon today and I have opted for another ld flap rather than implant only so I will look symetrical. He also said that there is less chance of capsular contraction(? not sure if right term there!) - basically implant hardening if I have the ld flap again. Booked in for 14th March - so bit scary now. I am worried about the impact on my back of two muscles being moved but at the moment I am coping fine with one so hopefully it will be ok.
Take care
Sarah x x x
Hi Mollyjoemax,
That does help, thank you. And I’m so happy you are doing well with them. I am going in tomorrow, so I’m a bit anxious and scared. Thanks again for sharing your story.
Best,
Jen
Dear Sarah
I really hope everything goes well with your upcoming op! It sounds like a good decision considering you have already had an LD on one side. I have been told the thing about capsular contraction as well Keen to hear how you do.
Megxxx
Hey Shannon,
I’m happy to hear your feeling so well! I’m having surgery in the morning and I’m a bit nervous. But reading your comment has eased my worries a bit.
Best,
jbaby
Hi -
Megadot - will let you know how i get on - just want to get thorugh nect 2 weeks without feeling too stressed.
Jbaby - good luck for today - hope it all goes ok.
Sarah x x x
Hi Megadot
Hope all is well with you and all the ladies on this thread, good luck to all approaching surgery, I just wanted to update a tad more. I am the one here that has had problems with the ld flap, I sincerely hope that none of you goes thru the same.
I was very interested to read that Jackie was advised to stretch from day 2 and to get the arm up high from day 7, driving from 6 weeks and I see that Sarah was told to keep the arm down for 5 weeks.
I was told do the exercises on the bcc leaflet from day 1 post op, i.e. arm up high, arm round my back to bra line, etc, etc, no driving for 2 to 3 months and I did all of the above and ended up with the muscle breaking away from the sternum area. I am of course wondering if this was wrong advice and want to be sure before they do the next op that I dont do anything that will make the ld break away again.
I had been telling them from about 6 weeks post op that I was very tender in the sternum area and that I felt that the recon was pulling further and further under my arm. Finally saw my consultant 1 week ago and now I need a second op to reattach the ld flap to whatever they attach it to. Has anyone else had other advice on exercises post op, I have been told to continue with all the exercises and have just started driving at 11 weeks post op (drive automatic car) and am worried that by doing the exercises that this ld will pull away even more. I have severe denting at cleavage area and also the ld has dropped down leaving a tender dented area at the top of the recon. Any advice welcomed oh wise ones.
Have a great day, luvnhugsCarolexxx
Hi Carole - sorry you are having such problems and more surgery. I was def told by my surgeon for first 5-6 weeks not to lift arm any higher than shoulder otherwise flap could move. Only to do exercises 1-5 on bcc sheet. Then I saw physio and only did other exercises when she said. Apparantly I was told that muscle and implant are only held in with stiches at first and until are bodies have started to grow tissue around then to keep them inplace we should take it really easy. Everyone seems to get different advice but this has worked for me. I started driving about 6 weeks post op and that is an automatic too.
Also told not to lift anything heavy at first at all and then take it really easy - even kettles full of water are heavy. Also no house work for 4-6 weeks - we have to have some bonuses with this horrible disease!1
Take care and hope they sort you out - sounds like you are having a rough time of it.
Sarah x x x
It’s a bit worrying isn’t it!!!
I have been doing my exercises and I have pushed myself each day, despite pain, thinking it is the right thing to do.
Am I doing the right thing, by doing as I am told, or am I doing more harm and risking having to go through the same as Carole?
How are we to know?
I think I am going to slow down a bit. My GP has signed me off work for another month, which I did not expect, so I am going to stick to doing things that do not hurt. Maybe we should listen to our bodies, and the warning signs. How many physiotherapists have been through major surgery, and when we say to them ‘that hurts when I do that’ take it seriously?
If we can be given conflicting advice depending on where we live, then we have to make up our own minds and do whatever we feel is ‘right’. It certainly helps to hear the experiences, good and bad, of others. I like the sound of no housework for 4-6 weeks.
Take it easy everyone, but not too easy!!!
Jackie xx