MX/Recon - implants v. tissue?

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Hi ladies,

I’m halfway through chemo and due to have my last one on 15th Dec. Then it’s going to be time for my surgery so I was looking for some pointers please.

My surgeon’s suggested a double mx and recon in same op which I am going to do. I’m 33 so want to have a matching pair at the end of this and also to make sure I don’t need to go through this again in the future. I’m hoping to get my new breasts as ‘normal’ looking as possible with minimum scaring or constant reminders. The big question for me just now is whether to get implants or to use tissue from back/tummy (if there’s even a choice). I think implants sound like they would give a better finished result but if there’s a possiblity of taking tissue from my tummy and making my tummy smaller at the same time then I’m thinking why not make the most of the situation… Help!

I’m meeting my surgeon again on Friday to discuss it all with eher but wondered about other peoples experiences while I’m waiting to see her.

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Hi Caroline. I had a mastectomy with immediate LD flap at the end of June. Couldn’t have tummy flap cos BS said there wasn’t enough tissue. He recommended doing it without an implant so that it would look more natural. Three months down the line it has shrunk so much that we’re now talking of a further op in Jan to increase the volume and using an implant is one of the options! As you’re having a double I think I’d be inclined to go for the implant and know there’s more chance of them matching. I know someone who had it done at the end of last year and she’s thrilled with her new pair. She had implants and tummy flap. Good luck!x

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Hi Caroline

It isn’t necessarily an either/or situation.

I had an mx with immediate LD flap + implant recon. The cosmetic result is great. Still got to wait and see what effect the rads will have on it though.

Dx

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Hi caroline.m

As well as the infromation you receive from the other users you may find it helpful to have a look at the BCC booklet on reconstruction.
The booklet covers a wide range of information on the procedure, from suitability for reconstruction to possible side affects and the recovery period after surgery. If you would like to order a copy or read on line just follow this link:-

www2.breastcancercare.org.uk/publications/treatment-side-effects/breast-reconstruction-bcc7

I hope this is helpful

Best wishes
Sam, BCC Facilitator

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Thanks so much for this. Chickengirl, sorry you’re having to get further surgery. Hopefully this operation will be your last. I read somewhere that with using your own tissues they can be absorbed back into your body and it sounds like it’s maybe what’s happened with you? What your friend had sounds like a good option.
DJ007 thanks as well for the information. I hadn’t realised they could do both so all this information is helping. Like you, I’ve to get rads after surgery.
When I was diagnosed it seemed like I had so much in front of me. Going through it now, the time seems to be flying past and hopefully soon it will all be done x

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hi there

i’ve recently had mx with expandable implant. i was told that the flap options, with our own tissue, can give better results but involve much more complicated surgery, with more chance of things going wrong. the implant option will look good in clothes but can be a bit asymmetrical - although if you’re having both done that shouldn’t be a problem.

i think, and maybe i’m wrong, that the difference is less in appearance than in the way it feels. the implants are quite hard when you touch them, don’t feel like your own body. but think you get used to it. others might know of other differences, i often wonder how the decisions are made on a case by case basis. often there’s a reason to go one way or another but i was also given all three options.

good luck judes xx

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Hello lovely,

Halfway through chemo! Whoop!! I remember feeling that the end felt like MILES away but the second half actually went pretty quickly. Are you swapping over to TAX?

As you know, I had my double mx last week (thanks for your message btw - much appreciated, I just haven’t got back to replying to everyone yet - been making the most of my recuperation!!). As I also had chemo first and as I have private health insurance I had the time and the means to do LOTS of research first (my insurance company covered as many consultations as I wanted, so I took advantage and saw quite a few breast surgeons and plastic surgeons until I was happy with my decision).

MOST surgeons I saw said the best result would be to be completely flatchested for a year until the healthy cells have recovered - and showed me pics to support this. However, there was no way I wanted to be flatchested for a year - the thought REALLY upset me - so I wanted to have the second best option for me!

First question is whether you’re having rads? If so, it isn’t recommended to use your own tissue as it is likely to be affected by the radiotherapy - and then you have to dig into ANOTHER section of your body if you want to build it up again. You only have one tummy and if they use it to make an amazing pair and then zap it - then you don’t have another tummy to fall back on. My surgeon showed me photos of the damage radiotherapy does and it can be quite substantial and the cells are damaged for years after rads. I saw piccies of ladies with a lovely matching pair after surgery to a completely wonky pair a year later where the radioed breast contracts and rises up. I have therefore had expander implants put in. They can be removed and replaced if they are damaged by rads and are a much more straightforward op than using your own tissue. It’s early days for me and there’s still some inflation to do - but so far I am really pleased and really worried about them being damaged by the rads as I’m really happy with them. I will then replace them either with a DIEP (tummy) recon or with implants.

The benefit of a DIEP flap is that it looks very natural and lasts. I’ve seen 3 different DIEP flat recons in the flesh and they looked amazing - just like normal breasts (although better as they were all perky and symmetrical!). These girls were obviously really pleased with the result as they were happy to show everyone - but I stopped at having a feel! But they said they felt really warm and natural and part of their body. For me, the biggest downside is the surgery itself. My plastic surgeon said for 2 boobs it will take about 20 hours and that I will be catheterised and bedbound for quite a few days afterwards as I recover. That scares me… And I was told a minimum of 2 months off work for recovery.

Implants are a much quicker and straightforward op, but have to be replaced over the years, they wont feel like part of your body and don’t give a very natural look. It’s not the same as the WAGS who have natural breast tissue in there as well as the implant pushing this up - it would literally be a mound of implant. That said, I don’t mind the shape I’ve got from my expandables so far. It’s not natural at all - quite like 2 tennis balls stuck on my chest - but I don’t really mind it. However, the feeling is so weird as it’s completely numb. I do feel as though I could do a Mrs Doubtfire and set fire to my chest and I wouldn’t feel anything. It’s a very strange feeling. And they’re quite solid, rather than the soft and bosomy result you get from a DIEP.

If you’re not having rads, then I think the decision is slightly easier as you’ll have the one big op (followed by smaller ops no matter which option you take to tidy, do nipple recon etc). I’ve decided to wait and see how I feel. I want the DIEP flap, but the thought of having massive surgery in a year’s time is already freaking me out - so if I get on with the implants I might have them replaced by implants and just put it off for a while. Although, in the long term I know I want it done, so maybe I should just bite the bullet!

Oh - and the bonus of a tummy tuck at the same time is also great! One of the girls I met was quite large but had a perfectly flat tummy as they obviously take all of the fat out of the lower part of the tummy and then pull it all down from the upper tummy. You then also get liposuction from the sides to tidy it all up! :slight_smile:

Good luck with your decision - let us know what you decide. Ask lots and lots of questions and ask to see lots and lots of photos. She might have patients who would be happy to show you their results in person too.

xx

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Anikka thanks SO much for all this information, you’re a gem and I’m glad you’re getting on ok after your surgery! I hope hubby’s been at your beck and call :slight_smile: I’d asked the BCN to arrange for some before/after photos for my appointment but real life would be so much better. This is the first I’ve seen my surgeon since she gave me my diagnosis at the start of August and she’d said then I would need rads but I guess now I’m further down the line we can see if this is still the case. The information you’ve given me (and everyone else reading this thread now) is invaluable so again thanks a million. I feel like I’ve got a better idea in my head now of some of the questions I need to address and I’m not going into my appointment blind. I would love to go down the DIEP flap route simply for vanity and getting a tummy tuck so it’s also handy to know this is something that can be done after rads. I’ll come back on Friday and let you know how I got on.
Take care and I’ll speak to you soon xx

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Not a problem.

Forgot to say (but you probably know) that you do get a big scar across your tummy from the DIEP flap and they might have to redo your belly button depending on how much skin they have to remove from the upper tummy - so there could be a scar there too… Just that you were saying that you wanted minimal scarring. I think the scars on the boobs will be the same either way. Mine are very neat - a kind of intervetd T with a cut under my boobs and then a vertical one coming up to where my nipples were. So once I have proper boobs and new nipples I’m hoping you’ll hardly see any scarring.

I met a couple of surgeons who said that if you’re planning children it’s best to wait until after childbirth to do the DIEP - and others who said it doesn’t matter and that some of their patients have gone on to have children…

Also you can’t wear push up bras with the implants. They sit where they’re put behind the muscle (I’m wondering if that means you don’t need to wear a bra…? Anyone know?) so you can’t push them together to form a cleavage. Not a biggie in the grand scheme of things - but thought I would mention it!!

x

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Hey!

Well my meeting went quite well this morning although by surgeon wasn’t there after all so I met with my BCN and have to see my surgeon in a few weeks.

The BCN was great, we had the discussion about how we’re going to deal with the recon. and the information you gave me was a real help. I’ve to get rads so have said to them that I would like to go down the expander route to start with and wait for my final op after rads. It made a huge difference going in with a bit of knowledge so my BCN is going to speak to my surgeon before my next appointment and they’ll see what they get in place. They said it may be a case of me getting a plastic surgeon instead of the surgeon I have now as there’s more work involved than in the single mastectomy they thought I might want.

So it’s just a case of waiting again now for another few weeks until the final decisions are made and everything put in place. They also said as procedure they need to get a second opinion on my decision for a double mastectomy - not that they think I’m doing the wrong thing but to make sure I’m 100% about my decision.

Watch this space, once I know more I’ll come back on here but I feel happy that I know what I want and also that it should be possible to do it this way. Oh and it looks like my operation could be mid January :slight_smile:

xx

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It’s good to have the time to research these things before making your decision isn’t it?

None of the surgeons I saw were keen on the bilateral. I think it goes against their training to take more than is needed.! My geneticist spoke to my surgeon and explained how strongly I felt about it despite not being a BRCA carrier and she was then ok. It was funny as for me it felt like a no brainer. I think if I’d only had to have a lumpectomy it would have been a much harder decision - but as I had to lose one breast anyway, I actually preferred the thought of the symmetry of having the other one done too - and anything I could do to reduce my risks if having to go through this, I will! And after the op I feel even more pleased that I made this decision. However, it’s a big decision and you obviously need to make sure that you make the right decision!! Good luck with that.

And you’ll def need to meet a placcy surgeon to assess your tummy tissue to make sure you have enough for recon - esp if you want to keep the same size.

There was a really, really good link on the forum for breast recon info. I’ll see if I can find it…

Z

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share.breastcancercare.org.uk/forum/viewtopic.php?f=27&t=33034&p=571609#p571609

Edited to say that I just read through this PDF again and it really is excellent - so deffo recommended to anyone contemplating recon. Thanks SCACO!

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Hi there ! 7 years ago aged 36 I was a skinny size 10 with two kids and had an immediate masectomy and LD ( muscle from back) reconstruction. At the time ( I am a GP) friends begged me to have an implant finish the chemo, have radio and reassess. My advice to you is don’t rush the decision …absolutely only have a bilateral masectomy if your oncologist AND your surgeon feel you need it ie you are gene positive or you have a lobular carcinoma. Don’t do it because you think it will give you a better cometic result OR lower your risk of developing cancer in the second breast without an elevated risk factor.
Next is if you are having chemo/taxol and or tamoxifen or other you will get slowly fatter…! If you are thin now in a year you might have a nice fat belly.
LD reconstructions do look good in the hands of a fab surgeon BUT you lose a major muscle in your back …back pain, arm stiffnes, wasting neck muscles and postural issues this is hugely worse if you have two done. My neck is slowly bending over . Implants dont last for ever …they go hard and shrink the skin tightens over them and they can look a bit bionic…Implants are ice cold and in my case I feel that I have something foreign stuck on my chest.Bras are not very comfy. The boobs are empty at the top and very bulbous and quite firm at the bottom.Apparently `i have a good one and it was done by an absolute expert so I would hate to see a bad one !You get a big scar on you back mine is in the bra line but it still looks like someone tried to murder me.Sunbathing on the tummy is a pian cos the breasts are in the way. What else…my kids thump it and laugh at my rubber boob and if I gain weight one boob stays small the other balloons …nice…my husband doesnt care how plastic fantastic they look… I have had enough of my LD and am now thinking of a diep because I would like soft warm natural looking breasts that dont feel like rubber balls and i would rather have the op now at 43 than later at 53…what do you do when you are 65 and your LD recon goes all wrong. I now have a bmi of 25 and just enough gut so may well psyche myself up for it.My surgeon says that an LD lasts about 10-15 years. You are so young you should have one op and go for gold…I would get yourself referred to the Royal Marsden for a second opinion if in doubt. I would have skin sparing implants (ie keep yourself nice pouches cos you will have much better result later ) do all the treatment and radio stuff and six months after all is done …and it does take a year or two before you will be running marathons in a pink bra… go back feeling strong and shop around surgeons >get somone who does 2-3 DIEP a week usually in a big teaching hospital in your county …look at his pics and go for that. you will need a CT scan to check you have the vessels in your tum .I am sure you can get fat enough for a DIEP …pizza and curry should do it !
sometimes surgeons offer ops they are familiar with…fair enough …most surgeons have not done a DIEP…do not let a breast surgeon do a recon on you no matter how nice they are you must get a breast (onco ) plastic surgeon that is what they are there for ! Sometimes when you feel awful it is easier to go with the people you know and not rock the boat…BIG mistake…this is your body and you are going through time with it …make a very informed choice. the NHS allows for second opinions no good surgeon or GP should refuse you that with the serious decision you have to make. GOOD LUCK . i would listen to sandytoes too . Maybe I am down on the LD my oncologist and breast surgeon who are top people( as i am in the trade) sing the praises of the DIEP. Please don’t do double unless you absolutely have to it just doubles all your problems. (You will get to a stage years later when you are not obsessed with the risk of developing cancer in the other breast if that is the reason. My surgeon advised me against a double LD. I have met people with v bad back and neck problems post double LD) GOOD LUCK young lady I hope you get soft warm life lasting breasts that the fab little body that carries you through this journey and way beyond deserves !