I have recently had a sub areolar excision to remove a 1.6cm tumour in my right breast. I got my results from this yesterday. I have been given the option of a total mastectomy with immediate reconstruction or a further wide local excision with removal of the nipple and areola complex as I have been diagnosed with Grade 3 IDC and more tissue needs to be taken to obtain a completely clear margin. I will also need sentinel node biopsy. If I take the lesser option I will also need radiotherapy for 6 weeks. I have less than 24 hours to make a decision and am trying to get as much info as I can. At the moment I am thinking that the best option would be a mastectomy because then the cancer is less likely to recur. I am considering whether to have the LD back flap procedure or the abdominal procedure. Would a small area of old stretch marks on my tummy exclude me from having a breast reconstruction using the TRAM or DIEP procedure and which would give the best cosmetic result? I am 56 years old. I have found out that the TRAM/DIEP procedure can be carried out at a hospital near me; although it isn’t the one where I had my previous surgery. The consultant at my hospital has only done one live tissue transfer previously although he would be supervised by a consultant surgeon from the other hospital. He could only offer me an immediate reconstruction using the LD flap and I’m not sure I want the scar on my back. I have also been informed that I could have later surgery to reconstruct a nipple on the reconstructed side and also surgery to reduce and match up my remaining breast. At the minute my mind is in a whirl! Any help out there please?
Hello Suzieb54
Welcome to the forums, this is a very worrying time for you but you have come to the right place for support from our experienced users who I’m sure will be along to support you soon.
In the meantime maybe you would like to talk things through with a member of our helpline staff who are there to offer emotional support as well as practical information. The free phone number is 0808 800 600 and the lines are open Monday to Friday 9.00 to 5.00 and Saturday 9.00 to 2.00.
Best wishes
June, moderator
Hi Suzie
Gosh poor you, 24 hours really isn’t long enough to make such a BIG decision - I had several weeks to mull over mine and did chop and change my mind a few times! Do you have the option of just having the mastectomy now and then have the reconstruction at a later date ? I had my mastectomy first and then had the reconstruction done 6 weeks later.
I was given the same options as you and chose to have the mastectomy as this is what my consultant recommended and I just wanted to get rid of it, but everyone is different and has their own ideas, only you know deep-down what is right for you.
I also decided to just have the implant reconstruction, which involves having an expander put in to stretch the skin slowly over several weeks/months using saline, then after a few months the expander is removed and replaced with a permanent silicone implant.
I chose this option as the operation is no where near as long as the other types of reconstruction, but then the end result will not look as natural as a TRAM or DIEP flap reconstruction - a friend of mine has had the TRAM flap reconstruction and it does look exactly like her ‘natural’ breast.
All in all, not a nice situation to be in and not an easy decision to make. I hope some others post on here before you have to decide, to give you some other points of view, but whatever you decide will be right for you.
Hope it goes well and Take Care
Samm xx
Thanks for your reply Samm,
It isn’t the immediate reconstruction I’m having problems with. I would prefer to do this rather than wait as I think the cosmetic result will be better. I have been talking it over with friends and relatives and I think I’ve decided I definitely don’t want the LD flap as the lady I saw at clinic yesterday had a really bad scar on her back and her back and shoulder looked slightly hunched. I do like to wear low backed swimwear on holiday and for swimming. I never wear a bikini so an abdominal scar isn’t a problem. I really need to know if I am a good candidate for the TRAM or DIEP procedure. I am overweight(2.5st)and do have type II diabetes but I seem to heal well. I don’t smoke and have no previous abdominal surgery scars. As I think I mentioned before I just have a couple of small patches of stretch marks on my tummy. I had my wide local excision only 2 weeks ago and the scar is almost healed now. I think if I don’t get answers to all my questions tomorrow when the breast care nurse calls me I will ask for more time to consider my options. I wonder though if this is putting my health at risk? If I go for the wide local excision and radiotherapy instead and the cancer comes back will having had the radiotherapy affect the type of re-constructive surgery I can have should I need a mastectomy eventually? I just have so many questions and not enough answers.
Suzie
hi, not sure if they will allow this link but this helped me decide on what reconstrucction i wanted theres loads of photos
prma-enhance.com/index.cfm/Action/Gallery/GalleryID/29077/PageID/1946/ProcedureNameID/19
Hi Suzie,
I thought I would just let you know that I had a mx and immediate DIEP recon. I was (still am) overweight and had a good roll for the recon! Upside was a nice flat tummy which has also been improved with liposuction. My PS also was very clever in that I only had a small “paddle” of skin to close the mx/recon and he managed to find skin without too many stretch marks - I certainly had plenty post babies!!! I have had a nipple recon and am waiting a tattoo which will completely cover and get rid of the remaining odd stretch mark that if I am honest, aren’t even visible. Don’t be put off by that thought and also the flat tummy is a real bonus and in my view the length of scar is now just “part of me” that I don’t even think about - well not too much now. It does take time and yes it is a constant reminder but at least I know that I don’t have BC there any more.
Hope this helps,
Maggie
Just to let you all know I have decided to go to another hospital for the TRAM or DIEP flap reconstruction - if I am a suitable candidate. I was referred yesterday so hopefully I should hear something soon. I watched an excellent video on You Tube last night which showed an actual TRAM operation. A bit gory and made me go all shivery but the end result did look good and at least now I know exactly what is involved. It was an Italian video if anyone wants to go and have a look. I don’t think I would be allowed to put a link on here.
On Thursday I go back to my original hospital for Sentinel Node biopsy and should hopefully have my results for when the referral comes through. I still don’t really know whether I am doing the right thing; this is a big operation and I have a fear of anaesthetics and hospitals in general. I guess really I wish I didn’t have to have anything at all done but clearly this isn’t an option.
Thanks Maggie for sharing your experience with me. Was it a long recovery period and how old are you if you don’t mind me asking?
Suzie
Good for you for gooing to another hospital; some people don;t seem to be offered the chance and others don’t know that they are entitled to do this. I too have seen some pretty awful ld results, disabling and just plain ugly so go for your TRAM or DIEP as I’m sure you;ll get a much better result.
Hi Suzie,
I don’t mind you asking - I am 51 now but was 50 when I had my mx and recon.
From start to finish I returned to work - phased return - after 10 weeks. I am a hospital Matron so pretty active job which I found ok except couldn’t carry heavy loads or stretch particularly well to start with but after a further few weeks was back to doing everything.
If you have any other questions , ask away.
Hope your consultation goes well, keep us informed,
Regards,
Maggie
Can’t remember if I mentioned that I am hoping to be able to have a double mastectomy with immediate reconstruction by TRAM flap. I need to await my Sentinel node biopsy results first to see if I need any further treatment before the mastectomy. I have a feeling that I may encounter opposition to my plan as I don’t have (to my knowledge) any cancer in my other breast or the BRCA gene (not that I have been tested as I am the first sufferer in my family. I know that I will worry every day that it is going to come back even though I know the incidence isn’t that high. However, I am certain that if I do just have one side done and then it comes back I will be left with no possibility of using the same site for reconstruction. I do not want implants at all and also I don’t want to have more scars than necessary. Another factor is that I will more than likely have asymmetrical breasts which I would find very hard to live with. The way I see it is that I have to look at myself every day of the rest of my life and I won’t be able to do that if I am lop-sided. I know they will offer surgery to balance my breasts but I don’t want to keep my breast and worry every day. I would much rather have the double mastectomy with an immediate reconstruction and look more or less symmetrical from day one. Obviously I will still worry as I am a worrier but I don’t think I will be as bad. After all that going round the houses has anyone had experience of convincing the surgeons that this really is the best option for you? If so what did you say to get them to allow you to have it done? I believe I will have to see a psychologist too. What kind of things do they ask you?
Suzie