Therapeutic mammoplasty

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Yes, I know, those two words are a right mouthful! I did a search for TM on this site, but nothing came up. Even Google didn’t come up with much that’s useful, but there’s a little info on the CRUK site (I hope I can say that!) for those who are interested.

Yet therapeutic mammoplasty could be an alternative to mastectomy and immediate recon for women who are suitable for the procedure and are in the fortunate position of being able to make treatment choices. From what I can gather it’s a relatively new form of surgery.

I was mentally geared up for facing mast with recon. The treatment plan was changed when the surgeon talked me through therapeutic mammoplasty. Was happy to go ahead and the procedure was carried out last Wednesday. I was out for 3 hours and allowed home the following morning…wow.

No drains, no dressings, no stitches (I’ve been glued together). No pain or painkillers either, full use of arm and able to shower since the day after. Was cycling to work by Monday morning, much to my own surprise and that of workmates. Really, no problems although I’ve been stretching in case the wound tightens as it heals.

Obviously the breast area is tender and there was a bit of bruising and swelling, but the surgeon was delighted and I’m ecstatic. A week later and the whole thing is settling down nicely.

The surgery involves a reduction, with the breast tissue itself filling the gap where the tumour was. The nipple is removed and re-attached, but mine is none the worse for that. Like I said, I don’t think its suited to everyone (I read somewhere its an option if you’re larger-breasted, but that’s definitely not me!), but maybe worth a conversation with your surgeon. Much less intrusive than mastectomy and recon, less anaesthetic, less recovery time. The left breast will be “lifted” at some point in the future to match.

So that’s my experience (so far) of therapeutic mammoplasty. Now for my next issue: peripheral neuropathy. Closely followed by speech therapy.

Hope some of you find this useful. I’m still amazed.

L. x

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Hi Lanterna,

I’m a few days post op & I thought I would post here as my procedure does seem similar to yours.

Well they haven’t used any fancy terms with me!; just lumpectomy / segmental mastectomy. I’m a B / C cup on a small frame and was warned that I could lose noticeable volume. Also a lift on the ‘good’ side was less of an option for me.

Anyway, it is still early days yet, and I have a two week wait for path results. But, I have to say that so far it looks good! I’m trying not to get my hopes up in case I need re-excision, or things ‘settle’ differently post swelling, but it looks as though my surgeon has managed to retain the general shape of my breast. I gather that a good deal of ‘manipulation’ went on inside, but there is not much to see outside, roughly 2 inch scar above nipple, v. neat, with glue. No bandages or drains! Minor bruising & little pain!

I was only in overnight. Also had a guide wire inserted beforehand, which in my case had to be done aided by mammogram (not US) as I had previously had a metal clip inserted to mark tumour shrinkage from my neoadjuvant chemo.

Anyway, this is all a bit longwinded, but it’s the kind of info that I would have liked to have had in the lead up to my surgery and I hope that it might be helpful to someone in the future. I will also be posting on my Neoadjuvant thread when I get my final path results……

So how are you doing, Lanterna? Are you still have probs with peripheral neuropathy?
I have had some success with acupuncture in that dept.
Will you be moving on to rads soon? let me know…

Thanks again for starting this thread!

Lomalinda

XXX

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Wow, sounds good! I had a full skin sparing mx with immediate recon because I had a 18mm tumour just under my nipple. I felt it was a shame to loose my whole breast when the tumour was so near the front so to speak. I am no doc and it may be that because it was under the nipple that I would have had to loose the nipple anyway to ensure sufficient margins but to think he could have just shaved off the front part of my breast tissue and kinda sewed the skin back together with perhaps a nipple at a later stage would have saved me a lot of recovery time (not to mention 1 less rather large scar).

Can’t change the past but it does make you wonder.

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Hi girls,

Great to hear you’re doing well, Lomalinda! Sounded like you had a bit of a rough time after getting home. And even greater to hear you’re happy with the result! Mine’s settling nicely, still feels a little firm but that’s not something I’m worried about. Have been on antibiotics in case of infection, and that’s been a bit rubbish, but all manageable.

Thanks for the tip re acupuncture - I’ll definitely give it a go! Bit fed up with Bird’s Eye Frozen Toes!

Lined up ('scuse the pun) for rads simulator on the 4th, followed by 15 nuclear zaps. How about you?

Hey Ostrich, I know what you mean. I think tumours behind the nipple (mine was, too) are difficult in all sorts of ways. I was ragingly furious at diagnosis 'cause I hadn’t found anything to worry about, and always thought I was “breast aware”… so it was a bit of a shock. I guess diagnostic tools and surgical techniques are improving all the time, so the more we can pool our knowledge and work out the right questions to ask, the better.

Having said that, I gather “therapeutic mammoplasty” just means “breast surgery for medical reasons” so I’m now on a mission to find out the proper term for the procedure.

Stay well, all.

L xxx

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Hi all,
I’m new here, have just (today) been diagnosed with benign phyllodes tumor (soooo thankful it’s not more serious!), but it’s about 4,5 cm !!! (from 1.7 cm in Feb - they thought it was fibroadenoma), which the doctors want to remove ASAP as it’s growing really fast. MAybe this sounds totally superficial, but: the problem is, i am not sure about the surgeon - he says he has not heard about the possibility of mammoplasty (I have fairly large breasts, so this seems to be a possibility from other topics and papers i have come across). He also says that because the tumor is close to the surface (not further in), this means that the dent will be LESS visible - but this seems a little strange to me: surely it would be the other way around, wouldn’t it?

Also, does anyone know if would moving tissue arround would interfere with, or increase, chances of recurrence? Just thinking in case of not achieving clear margins etc…

I have a surgery date for 20th of jan, but I worry that if i go to another hospital i might have to wait longer - which would probably mean the tumor would get even bigger… What should I do??

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Hi,

I have just joined this forum and thought I would share my experience of Therapeutic Mammoplasty.

As Lanterna says, TM basically means breast surgery for medical reasons. What was actually done with me, under the banner of TM was a Wide Local Excision (WLE) along with a Reduction Mastopexy, or ‘breast reduction and lift’.

I was diagnosed with high grade DCIS at the end of October '08. On November 20th I had a wire guided WLE as a day case and the surgeon removed 42mm of tissue. This was apparently at the outer end of the 40mm recommendation for WLE. Unfortunately, when we got the pathology results, there was not enough of a clear margin on one side, so I was told I would have to undergo further surgery. Given the amount of tissue removed under the WLE, my surgeon said the next step was mastectomy. However, before jumping to this, he recommended I meet with one of his colleagues who is also a plastic surgeon and is looking into using TM as an approach in BC.

I met with the new surgeon in December and he said he would try it. Effectively reopen the existing scar (positioned at about 4 o’clock on the inside of my right breast), open along the lower arc of the breast, remove more tissue, reduce, reconstruct and lift the breast by moving tissue around and removing the repositioning the nipple. Apparently a challenging operation compared to a ‘normal’ breast reduction and lift, given the position and size of the ‘defect’ area. Also no guarantee they would get enough of a clear margin. I was happy to give it a go though. The thought of a lifted and perter boob compared to my 50 year old saggy one, and the alternative of a mastectomy, was quite appealing! :slight_smile:

I had the operation on January 15th., 10 days ago. I was kept in hospital overnight and expected to stay at least a couple of nights, but was let home the next day. I got the pathology results last week and they have got it all this time … wey hey. As for the breast, it is doing great! A bit sore and bruised, but settling down nicely, a great shape, not too much smaller (I was fairly well endowed to start) and lifted by a couple of inches. Like Lanterna, my surgeon was delighted and I am more than ecstatic!

I will start a course of radiotherapy in a few weeks and then, 6 months or so later (assuming no complications down the line of course), the surgeon will operate on the other breast to even me up. This comes under the banner of TM also as they want to ensure ‘symmetry’ in the end result. So, despite all the traumas of the diagnosis, there is hopefully a good outcome to look forward to!

I wanted to let people know about this as it is apparently a pretty new approach. It is seen as a possible alternative to mastectomy with immediate reconstruction in suitable cases. However, not all surgeons can do it as is does require a plastic surgeon. I was really lucky to be under a great team who all work together to get the best outcome for the individual patient. But be sure to ask about it as an option if you think it might be right for you.

Hope you are still doing well Lanterna!

Regards to all.

B x

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Hello all,

Glad to hear you’re all out there and doing well!

Apparently the correct medical term for the procedure i had was a “segmental mastectomy” which sounds exactly to what BijouB and Lomalinda have gone through. Yes, it needs a plastic surgeon on board.

Four months later, I’m happy. The scars are healing really well, the nipple is doing fine and completely healed. Skin texture was a bit altered (peau d’orange for a while) due to rads but still using the ol’ Aqueous and everything’s good.

It IS a new approach, but really worth asking about.

Top surgeon (really rate him) winked on the morning of surgery and said “I’ll give you the boobs of a 14-year old”. I laughed at the time.

Well, now one side’s a pert 14, and the other side’s an unpert 55 so I reckon if you add them both together and divide by two, they’re a median 34 and a half each…

Going in in a couple of weeks’ time to start the process on the left hand side, which will be lifted to match. Have mixed feelings about more surgery but think it’s the right thing to do.

Hope it’s all going well Lomalinda, Bijou, Ostrich. And Norgegirl, check with your surgeon about recurrence possibilities, but I haven’t heard anything to worry about. Let us know how you get on!

Soon to be less lopsided L … x

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Hi Lanterna & Everyone,

I’m feeling quite happy so far too. Some minor skin reaction from the rads, but my scar has recently started to flatten out and I’m really quite symmetrical at this point….when viewed straight on anyway! ….looks better in the cold weather if you know what I mean…LOL!

I do feel that I have a small amount of swelling though, which must be contributing to the balanced look, so I’m keeping a close watch on that.

I’m scheduled for a 6 month post surgery mammogram in April. I’m told that this will be a kind of road map for all future scans. What do you all think about the internal stitches? Mine feel just like a lump/mass…. I’m hoping that they will be able to let me see one of the images so I know what I’m doing for self exams…

So, just to say Good Luck with your op, Lanterna. I’m sure they’ll do a splendid job for you….34 sounds pretty good to me, but you even may get sweet 16’s!Please post & let us know how you get on.

This is one of the most uplifting threads on this site. Don’t you think?

LXXX

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Cheers, Lomalinda,

I think it’s great that some of us have been able to benefit from this procedure, and only hope that it’s offered to more women up and down the country as it becomes more standard.

Re internal stitches: I can still feel a sort of thickening/lumpiness along the scar line from the nipple, although it’s improving all the time.

But I couldn’t help cracking a smile, Loma, when you described the thread as “uplifting”… it sure is, I’ve certainly been uplifted, and look forward to being uplifted on the other side sometime soon…

;o)

L. xxx

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Well, had reduction mastopexy last Sunday (I know, SUNDAY???), drain removed and home by Monday p.m.

Quite different from first op (didn’t have a drain first time round) but hadn’t taken into account all the work that goes into matching results of first op.

Looking good so far, and both surgeons and nursing care fantastic.

Uplifting!

L .

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Great news Lanterna!

Finishing r’therapy this week and will hopfully have my ‘matching’ and uplifting surgery later in the year …

BijouB

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Cheers, BijouB!

Hope all well with the rads and you can look forward to a bit of a break before mammoplasty round 2.

Keep us posted on how you get on.

L. x

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The surgeon needs to be oncoplastic (if that is the correct term). It is not an uncommon procedure at my hospital. I will post when I have had procedure.

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Hi Ladies,

Glad I found this thread as someone had recently mentioned mammoplasty to me and it’s proving difficult to find out more about it.
Lomalinda,it sounds like I’m having similar treatment to you,neo-adjuvant chemo (I’ve had 6 of 8 so far)then breast conserving surgery followed by rads. I’m a size 8/10,B/C cup,am I too small for this sort of surgery? There’s not alot to play around with!
I’m worried that I won’t get the chance to discuss this properly with my surgeon (haven’t seen him since I was diagnosed) before the op.I’m assuming you don’t just turn up on op day and he gets on with it.I don’t want to be rushed into something before I know all the options.
How are you all feeling now,post treatment? still pleased with the results?
Smelltheroses,good luck with your surgery,hope it all goes well.

Love Helen xx

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Hi Helen,

It’s a long time to be thinking about what happens next, those eight rounds of chemo! What type are you having?

Well, I had to press my BCN to get me an appointment with my surgeon. They really just didn’t seem to get it that after six whole months of doing chemo, you have a lot of thoughts & expectations building up! They gave me an appt. with one of the junior surgeons & then I guess I would have just met the surgeon on the ward. I gather that this isn’t unusual, but if you want to know more about what will happen like I did, then I would definitely ask your BCN about it. I felt more prepared, but I have to say, my surgeon wouldn’t make any clear statements about how I would look afterwards. I think that even with the post chemo scans (I had an MRI after & a few ultrasounds during chemo) they still don’t know exactly what they are dealing with until the op.

It sounds like you are of similar shape & size to me! I should think it all partly depends on how big the site is and where it’s located. Mine for example was a vertical 12 o’clock, so the contour of my breast looks really very good. I was told that even though I had good “shrinkage”, they still would have to take the whole area where the tumour had been, plus enough for margins. Hope that helps to put you in the picture. My margins were good, so I had less rads that we first had planned…. Right now I am struggling a bit with swelling in that breast. (I’m hoping that it isn’t lymphoedema, but anyway, that is something for another thread!!) But it does look very good; still wearing all the same bras I had before the op. The scar is flattening out a lot, but I really don’t expect things to finally settle for a while yet.

I hope that your last two rounds of chemo go quickly for you. Let us know how you get on & if there’s anything I can help you with just ask!

LXXX

P.S. Hi Lanterna,
I had lost sight of this thread, so I didn’t know you had your other op! How are you doing now?

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Hi Lomalinda,

Thanks for your post.I’m having 4xEC, 4xPaclitaxel.Tumour is below the left nipple centrally(6 o’clock). At my last ultrasound,Apr 14th it had shrunk from 2.7cms to 1.6,I had a marker inserted and have another ultrasound this Friday.Oh,and I’m triple negative,with clear lymph nodes.
I know everyone’s different but how long after chemo did you have your surgery? And have I understood correctly that you don’t usually see your surgeon until the day of the op? What good is that? I want to see him beforehand to discuss my options,I want to know what my breast is going to look like!
One last question (sorry),did the surgeon mention mammoplasty to you or was it the other way round.

Love Helen xx

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Hi Helen,

Sounds like you have a really good response already! I hope that the last two chemos will do even more. Also sounds like they are doing a good job of monitoring your progress.

I had my surgery about 5 weeks after finishing chemo. I think that any time between 4 to 6 weeks is what the guidelines say, but I’m not 100% sure about that.

My hospital is super busy, so I just think that is the way they arrange the pre -surgery appts. there. Yours could be different; you should check with your BCN so you know what will happen at your surgery planning appt.

I was really wanting more info when I was where you are at now, and I just couldn’t find it! Also, I knew that I might have to have more than one surgery if they couldn’t get clear margins… I decided to console myself by doing some research into a recon procedure called lipofil. Still don’t know whether I will need or want it though. There are several threads about it on this site. Just have a search in the recon section. It might help to reassure you that there are future options if you want to pursue them…

My surgeon never actually used the term mammoplasty with me. (the first time I heard it was on this thread!) But I was aware that my surgeon was performing other types of surgery (like breast reductions) at the hospital, so I just assumed that aesthetics would be part of the package!! I’d never met him because another surgeon had performed my SNB (nodes clear).

Well, I hope all my ramblings are of some help! Good luck with your ultrasound on Friday!

LXXX

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Hello ladies, I am home now after surgery. I had my wle, snb and bilateral reduction. I am trussed up with waterproof plasters, very wide, and definitely have one blue nipple and breast! Apart from that, I can’t see much more. However I am in no discomfort or pain. I go for a wound/ dressings review on Monday and then for my results on 3rd July. I feel really optimistic and would recommend this procedure! The cancer has been removed (I hope!) and I have my reduction. I will post again when I have further news! x

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Hi Lomalinda,

Had ultrasound last Friday and it’s now shrunk to 1cm,saw the oncologist today and she said this Thursday’s chemo will be my last,don’t have to have no.8,Yippee!!
Also,I’m seeing the consultant tomorrow afternoon to discuss the surgery.I’ll probably spend the rest of the evening trying to think of all the questions I need to ask him.
Will let you know how I get on.

Smelltheroses,how are you feeling? Hope you’re doing ok,where did you have your surgery done?

Love Helen xx

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Hi Helen,

That’s great news! Good work! (I was wondering if they might give you time off for good behaviour). That should mean that you are all the more fit for surgery too!

I hope that your meeting with the surgeon goes well today & that you manage to get all your questions addressed. Let me know what happens.

All the best to you and Smelltheroses; hope your results are good ones.

Lxxx