Just wondered if there are any other slim forum users out there who have experience of reconstruction following mastectomy for a new primary cancer, and radiotherapy for a previous one? (Same breast)
I had a meeting with our hospital’s plastic surgeon (caught me on the hop because the letter was from the surgeon and I didn’t know I would be discussing reconstruction). Anyway, he told me I did not have enough stomach fat for a TRAM and, because of damage from previous radiotherapy and reduction, my reconstruction would be LD flap without implant. He also said that I don’t have enough fat on my back to match my “good” breast, so I will need a second reduction. (I have already had that side reduced by half to gain symmetry following a previous lumpectomy.) I was given no idea how much breast tissue will be there following these operations but it won’t be much. I’m a 34D at present.
I am reluctant to have the LD Flap done because I don’t want to lose any strength or movement in my back, because I would like to have a fall-back in case my reconstruction fails, but also because the surgeon wants to do a complete node clearance as he says it won’t be possible to access my armpit area again if I get a recurrence. Is there really no other option for someone in my position? Has anyone experience of an autologous reconstruction using flesh from an area other than the back or stomach? Or has someone had a stacked DIEP resulting in a small breast? (I feel I would prefer a too-small reconstruction using stomach fat to a too-small one using my back muscle.) And is there really no chance of an implant? My radiotherapy was over twenty years ago, and I was offered an implant on the “bad” side four years ago, but chose to have a reduction and mastopecty instead. If it was a possibility then, why not now?
Hello Margaret
Can’t answer your query re: radiotherapy as I didn’t have it, just mx and chemo.
I had an LD recon without implant a year last October.
Like you couldn’t have DIEP as not enough flesh, the other recon I was considering was SGAP? There are a few where you can take skin and fat from inner thighs and bum - worth looking into.
I haven’t noticed a great difference in loss of strength/movement from moving the back muscle and still do the amount of exercise I did pre recon.
I Had the recon a year last October and this July had a fat transfer op (from thighs) to fill out the reoncstucted breast. I’m awaiting another one of these op early next year and also will require a reduction on good side. Although I’m slim, my orginal size was a 32D. I will probably wtih the recon and fat fillers get to a B cup and the reduction will be taken to that also.
I could have had an implant with the LD but chose not too.
hOpe this helps.
Jude
I had a delayed LD flap with implant following radiotherapy. It was the only option open to me due to being slim and no fat to take from anywhere. Why can you not have an implant with an LD flap? My recon is a C cup. I am not aware of having lost any strength in my arm following the recon.
This is my fourth attempt at a post. not really sure whqt im doing wrong…
Please excuse delay in getting back to you to say thank you for replying to my post. I really am grateful that you took the time to do so, and it is reassuring to hear that the LD flap has worked for you. I think it may be easier to use an implant with a delayed reconstruction, as they would remove some of your irradiated skin and replace it with a healthy skin graft from the back, but I don’t really know. I was just told that my flap would have to be without implant, and that I have a small back muscle with little fat, so not much hope of matching the 34D on my “good” side.
I have had a bit of a knock back, having received copy of the letter following my meeting with PS. It states tht LD Flap is my only option, but he thinks I have had IBC (which I don’t really understand, as I may have it now but surely can’t have had it in the past without being aware of it?) so would be advised not to have an immediate reconstruction because he thinks it very likely I will get a recurrence. The letter also said I had ADH in the tissue removed from my “good” breast when I had it reduced to match it’s partner in 2008. I was not informed about this, and am now considering a bilateral mastectomy. Not sure what to do, because I would prefer either to have two breasts or none, and the PS said a bilateral reconstruction wouldn’t be easy. I don’t understand this either, as I know others have had this done. Oh well. Anyway, this together with the Taxotere SEs and the cold I caught in my “good” week really dragged me down, so I didn’t get back to you as soon as I should have done.
Hi Margaret
I had radiotherapy in 2010 and had an implant only reconstruction last year. I have Beckers implants and they inflated them gradually over 6 months and am now a c cup. For me it was the only option offered as I did not have enough fat elsewhere.
Good luck
Thanks Tracy,
that sounds interesting. Not sure whether or not it would be a possibility for me, but well worth investigating and might avoid the need for a second reduction.
I’m in a similar position, wondering about similar things. I had a bilateral mx in Dec 2010 (found out I was BRCA1 positive hence bilateral), using expander implants. Then found a new primary so ended up with an implant on one side and flat on the other, where I then had radiation. I am slim (size 10-12, 30E). After 2 years, my implant side looks ok rather than fantastic (though it wd prob be less odd if I had two!). The implant is comfortable but shifting around a bit so there is some looser skin at the bottom. In other words, it is far from perfect but I cd definitely live with it, if it was not for the fact that I would like to have 2 breast shapes again in the nearish future. I now understand better why it is said that implant based recon may require further revisions and corrections.
Saw my oncoplastic surgeon this week. Her view: option 1) expander implant with strattice, and a 50/50 chance of success given the rads. She said she would be prepared to try it if I wanted to . If it failed, I would be back to square one in the sense that I would not have had surgery on any other sites on my body. Option 2) LD flap with implant. 98% chance of success, but then I am wedded to an implant on both sides. Given the flaws with the implant So I am not sure that I am prepared to “use up” my back muscle if it commits me to implants only. 3) Stomach: she thinks I cd maybe get away with 2 much smaller breasts - need to see the specialist 4) Thigh or bottom…
In other words, all the options are available and none are straightforward. I’m going to give it time.
On your point about 2 breasts or none, I was adamant when the second primary came that I wd just have both implants removed and be done with it and go flat or use prostheses. My surgeon discouraged me from doing this and she was right, if only because the prostheses do feel heavy and awkward and having 2 wd be a real nuisance in my view.
C2010
And thanks for your post. Your surgeon certainly seems to be very thorough. Mine just gave me the one option. In some ways, it would be good to have someone else make the decision, but I’m really not sure the LD Flap is the way to go. As you say, it does commit you to using up your back muscle. Beginning to panic now, as I have a scan on 28th December to see if my chemo is actually doing something. If so, I will have the last of my seven chemo sessions on 7th January. If not, they want to go straight to surgery - and it’s all getting horribly close. Although I would prefer to wake up with some sort of a breast mound after my Mx, I am beginning to wonder whether a delayed reconstruction might not be more sensible. Have you any idea which of your options you will try for? I see you said you were going to give it time. Guess that’s possible if you go for the delayed recon…
Thanks also for your input on the two or none question. Agree with you about the heaviness of the prosthesis. I wore one for a few months prior to my reconstruction, and hated it. And it was only a 34C, because I had half a breast for it to go on top of. A full one, or even two, must be much more awkward.
I could really do without all this uncertainty! Oh well, will start rereading all these comments yet again.