I’m 37 and was recently diagnosed with DCIS. Because the area is so large I need a single mastectomy and will lose the nipple and will probably need radiation afterwards.
One of the (many) things I’m struggling with is my limited reconstruction options.
My surgeon essentially talked me out of implant reconstruction. He said that capsular contraction is very likely with radiation, particularly in my case because he doesn’t think I have enough fat to do any fat grafting. Even if I don’t need radiation, he doesn’t think I’ll get a reasonable cosmetic result from implants. He will try it if I want but it doesn’t sound like a good option for me.
He also thinks I am very borderline for DIEP reconstruction because I have little spare skin around my stomach. He recommended against an LD flap (from my back) because I am quite sporty and it can impair functionality and I may not have enough skin there anyway.
He is going to refer me to a plastic surgeon to consider the options in more detail.
So I wondered if anyone in a similar situation with a similar body type (low bmi and small breasts) has any advice.
I’m aware that some surgeons work with alternative flaps, which may be an option for me. I’m in the fortunate position of having private health insurance so could look around for a surgeon who has experience of these.
I think I will find it very hard mentally going into surgery without any viable reconstruction option so even though the reconstruction is going to be delayed I’d like to explore this in advance.
I was in a similar position. Implant wasn’t recommended due to radiotherapy but this wasn’t needed in the end. I had a DIEP flap immediate reconstruction. Not sure of the details why some have to wait. They were unsure if I had enough tummy for my 34DD but I went on a chocolate binge (not sure that’s recommended but it was fun!) and they created the same size new breast in the end. I did have to lose my nipple too due to position of one of the tumours. This was 13 weeks ago. Still recovering but happy with it all on the whole. BMI was about 20/21 I think so more than you probably. Best of luck.
@tiamaria sorry to hear about your diagnosis. I was diagnosed with high grade DCIS and Paget’s disease in January at 33.
Just wanted to share my reconstruction path if it is helpful at all
My treatment plan was a mastectomy & radio therapy (this did change since my mastectomy & I’ve since done chemo). For health reasons at the time I wasn’t going to be able to do the DIEP or flap options. My surgeon also raised the issues with the implant & radiation. I was against going flat so was offered an expander implant, which takes the pressure off the skin & can have the saline taken out for radio therapy. It still has its risks of contraction. It is then slowly inflated again with saline to stretch the skin after radio therapy. I’ll then have this replaced with a permanent implant when the time comes but there is also an option to go down the DIEP route if I want to.
Although it’s a temporary solution for now I’m actually incredibly happy with my reconstruction. I did lose my nipple which is hard to get my head around. Based on how everything has went with my reconstruction & how the implant is sitting, my surgeon doesn’t think I’ll have any issues with the implant during radio therapy.
Thanks for your reply. It’s really interesting that you managed to get a 34DD with that bmi. Suggests it might be possible for me as I’m only a B and have had two children so there should be some stretch in there. I maybe just need to speak to another surgeon.
It seems like some surgeons are willing to do immediate reconstruction even with radiation but mine was totally against it.
This is really helpful. Sorry you ended up with chemo too - I’m still hoping to avoid that.
The expanders sound like they may be a reasonable temporary solution for me. I think it would feel better than waking up flat and might keep my options open. Can I ask have you been told if you’ll need fat grafting to make the implant work? And have you found the expander uncomfortable?
My surgeon has mentioned doing some lipofill when we switch to the permanent implant. I do have a slight dip near the underarm with the expander so can’t imagine there will be a lot needed - I’m a 34B.
I’ve not found it uncomfortable at all. The implant port for the saline sits just above the ribs, it can sometimes feel a bit irritating (I’m also a front sleeper so don’t think I help this!) but it doesn’t impact on anything.
Although my surgeon gave me the option to go flat he advised against it based on my age & the potential mental health impact. The expander was really the only option I had but I’ve had a really positive experience with it.
Sorry to hear you’re in this club. 3 years ago I had a single mastectomy with loss of nipple and had immediate PAP flap reconstruction where it was taken from the back of the thigh. I was too skinny for anything else (other than implant) and have very small breasts but didn’t want to be flat. Was a long operation but went well. Good luck with whatever you decide to do.
Hi i had LD flap with implant in 2004. Like you i was very slim and fit/sporty. I didnt have enough fat from elsewhere so had an implant under the flap. Apart from long term nerve pain, which is a risk of any surgery i believe, it has been very successful. I had horses and it didnt stop me doing any of yhe work or riding. Ive just had a recurrence and have kept my Ld flap but had a new implant.
I think it has become a less used reconstruction these days but i had a brilliant plastic surgeon back then! Good luck with your decision x
