Prepectoral implant with Mesh versus DIEP - 38 with 9 month old son

Going through breast cancer treatment Surgery
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Hi All,

I am new to this site and have read various threads but wanted to find out more about people’s personal experiences of the different breast reconstruction types.

I am 38 years old and have recently been diagnosed with high grade hormone receptive DCIS in the right breast. I have a 9 month old son which adds complexity in relation to recovery. I am a 38B/C in size but not particularly ‘full’ and a little droopy due to breast feeding my son until a few weeks ago.

Due to the extent of the DCIS the surgeon has said mastectomy is the only option. She believes this can be a skin sparing but is unsure if she can save the nipple. I am guessing that she probably won’t be able to.

I am going through what a lot of people on here are in terms for trying to decide what type of reconstruction to have (assuming all become available relatively soon in this COVID world)

I had convinced myself that implant was the way forward but I was very much focussing on the shorter term recovery because of my young son and not considering the longer term issues I.e. implant replacement in due course which due to my age means I am likely to need at least 1 or 2 further operations later in life due to how long implants last Irrespective of any complications. I have also not finished my family and therefore concerned about DIEP healing and pregnancy, which given my age I wouldn’t be able to wait that long to have another child.

So I am interested to hear about people’s experiences, good and bad, of prepectoral implant with biological mesh (on top of chest muscle rather than under) versus DIEP (using tummy tissue).

My main worries are:

COMPLICATIONS of each procedure and people’s experiences of these e.g. skin necrosis, fat necrosis generally. In the case of implants capsule contracture, loss of implant and rippling/kinking and infection. In the case of DIEP loss of flap, extent of numbness in tummy area. Ongoing long term pain generally for both procedures.

AESTHETICS of each procedure e.g. coolness, weight, sizing and shape of implant and in the case of DIEP how the tummy scar looks and feels and size/shape/feel of the breast. In both cases how does the symmetry compare and have you had to have further surgery to that or other breast for symmetry.

RECOVERY from each procedure. What in reality could you do after 1 week, 2 weeks, 3 weeks etc. How long is it before people returned to work?

Anyone who has experience of going though this with young children would also be of interest.

Sorry it’s rather a long post, I hope that some of you will be able to share your experiences.

Jenny

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Hi Jenny, I’m sorry you find yourself here. My experience does not exactly match yours but some bits might help a little and I’m sure others will be along soon. I had widespread high grade DCIS in 2014 which needed a mastectomy and I was offered skin sparing with immediate recon which I definitely wanted - but which type? I was not suitable for DIEP but had the choice of just implant or shoulder flap with small implant. I opted for just implant, for the reasons you say about easier quicker recovery. Mine was under the muscle (on top not offered) but with the mesh. I was back to usual activities, with care, after about 4 weeks. The first implant always felt a bit too big and after a year or so my surgeon replaced it with one which is smaller and a different shape, and I’m very happy with it. She says many last for years and it may never need replacing again (mind you I was already over 60!) The op to exchange it was very quick and simple. I sympathise with your difficulty choosing and I recommend speaking to the nurses on here, I found them really helpful with giving knowledgeable independent advice. Good luck with your treatment, love Mo x

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Hi Jenny - first of all a big hug to you, and a big welcome. This forum really is a wonderful place, lots of advice and support.

I had a mastectomy and pre-pectoral implant (on top of the muscle) with mesh sling (think called Braxon) about 3 years ago. I wasn’t suitable for any of the own tissue recons, but I wanted an implant because of the quicker recovery time. I don’t know if you are having radiotherapy but lots of surgeons won’t do an implant if you are having radio afterwards as there is a risk of hardening (capsular contracture), but my surgeon said that the risks are much lower with this type of implant. I had radio and touch wood all has been ok.

In terms of aesthetics, my implant doesn’t match my real one. It is a bit more round and unfortunately a bit larger. Actually I was really interested to read BluebellTime’s comment that she had had hers replaced with a smaller one, and that it was an easy operation. But for the moment I use a partial prosthesis over my real one and under clothes you would never know. I have got used to it now and am happy with it. I really don’t notice it day to day. I’m also a similar cup size to you.

In terms of recovery, I’m trying to think back. I think I was driving again after about 3 weeks then gradually built up activities after that. With any option you will have to do arm exercises to regain the full use of your arm - your team will give you full details and it’s so important to stick to it.

Going forward, I don’t know if or when I may need to have the implant replaced - again like Bluebelltime I was also told that I may never need it replaced.

I would recommend that you try to see some photos of ladies who have had both. Your surgeon may be able to show you photos or he/she may have a website with photos of previous operations. Of course it does seem very odd googling photos of other ladies’ chests, but it will give you an idea!

I’m very happy to answer any more questions you have, so please ask away. It’s really important to get as much info as you can and this is a safe place - do stay away from Dr Google.

My very best wishes to you

Evie xx

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Hi, I had to make same chouce too. I did attend a group ran by the hospital with women happy to share their experiences which helped. I also contacted people via this site who had undertook both procedures, again very helpful. The thing that I discovered is that although I did a massive amount of research, ultimately my body had its own unique and unpredictable response to the surgery. I did decide on implant mainly because of the fact that it is a smaller operation and the recovery is easier. However my body had a reaction to the dermal matrix and dissolvable stitches. Something I  couldn’t have predicted. So my advise  would be do as much research as possible and then go with your intuition. 

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Hi Jenny,

Suspect you may have made your decision by now and possibly had your op.

I was diagnosed four years ago and had a long gap before surgery - I had radiotherapy first on my right breast, and then had a left-side mastectomy and immediate reconstruction. I had two or three reconstruction options. The two I was most interested in were implant with mesh, and LD flap. I opted for the LD flap with an implant. The recovery time was swift. I was home three days post op and able to do all normal things for myself, even managed to walk into town (albeit slowly) for a coffee (with my drains in a shopping bag over my shoulder!). Some things were tricky for many months - getting out of the bath, pulling the car boot lid closed. Strangely, cutting a loaf of bread felt most peculiar because of the lateral movement. But within six weeks I was ready to go back to work and life was pretty much back to normal. A year later, I’d forgotten about my op as everything felt good.

The implant (using LD muscle for the ‘sling’) has presented absolutely no problems whatsoever. 

I guess I went for this op because I wanted a good outcome in terms of the shape of my new ‘breast’ but I did not want the lengthy op and recovery period of some other reconstruction types. 

We all have our own reasons for choosing the outcome we eventually go for. In my case, some forms of surgery were not an option anyway, as i did not have sufficient body fat to form the reconstruction. But I know that reading other people’s experiences really helped me feel confident about the final decision. 

I hope all goes well with whatever decision you make (or maybe have already made). 

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Hi Jen

I wondered how you are getting on now and what did you choose?

I am too trying to decide on options.

thanks,