To have reconstruction or not?

Hi, I have to go to the hospital tomorrow to discuss what type of reconstruction I want. I did say that I wanted reconstruction at the same time as the mastectomy but it sounds horiffic so changed my mind now (I think) to have delayed reconstruction. Does anybody know how they do delayed reconstruction? I think I remember the doctor saying they have to keep the skin stretched with something otherwise the skin will shrink. I am also not sure how long after the mastectomy you have to wait to have the restruction. I just want this thing gone out of my body but I don’t want to be flat, it will be very upsetting for me. Has anybody out there got any advice or been through this themselves. Any help would be great, thank you all. x

Hi Neetie,


Your situation sounds very similar to mine.  I originally wanted my MX and recon via a tummy flap done at the same time however another minor medical issue meant I wasn’t a good candidate for a long anaesthetic.  As a result I am having a phased recon following my MX on the 25th May.  I had a skin sparing MX and have a tissue expander (like a saline filled implant) placed over the muscle as a ‘space saver’.  At the time of op, this has an initial fill of saline with the facility to add more later once your wounds have healed a bit.  I therefore came around from the op with a boob of sorts.  Four weeks on, you wouldn’t notice any difference to the healthy one in a tight T-shirt!


I was disappointed not to get it done in one hit to begin with but then realised that a phased process allowed me to ensure that my reconstruction was the best possible.  Some immediate recons for example, are not totally compatible with radiotherapy so that may be something you should discuss with your team tomorrow if you need RT.


My BC nurse was very good at handing out leaflets on the various types of reconstruction possible and I read these before my recon appointment so I was up to speed and could ask my team the right questions.  I think you can download these from this website.


There is however a drawback to phased recon.  Where I am receiving treatment, there is a long waiting list for the second operation.  I look at it as the ‘emergency’ part has been dealt with within the official guidelines/timelines and the reconstruction then becomes less important.  I expect to wait about 10 months but as my tissue expander is so comfortable and looks so good, I am not letting that worry me too much at present.


I hope this is of some help, but if you have any further questions, please do ask.

Ezzie. X

Hi Ezzie and Neetie

I’ve had a similar experience - although it wasn’t planned that way!

Diagnosed sept 14, had mx with immediate implant recon. Unfortunately the wound did not heal during chemo and implant was removed. After chemo I had an expander put in May 15, then rads in July 2015. Had to have some saline removed as the skin tightened and the scar threatened to open during rads.
I had the expander swapped for final implant in April 2016.

When I initially discussed recon with my surgeon implant was my only option as I suffer with back problems so didn’t want LD flap and I didn’t have any belly fat for a DIEP. However, roll on nearly three years and post chemo/tamoxifen has seen my weight increase by 2 stone which has meant my good boob has increased in size and is now out of proportion with the implant, also I now have enough belly fat for a fab pair of boobs!

Back in march I discussed having another reduction to the normal boob. Still waiting on a decision- as it is over two years since diagnosis the surgeon has had to apply for funding and is going through an appeal process with the aid of medical photos to highlight the imbalance.

Now the dust has settled I really want a DIEP because I’ve realised the symmetry is going to constantly be challenged as my weight fluctuates in the future (I’m 50). Because the original plan was not for a delayed recon it is proving difficult to achieve.

I’d definitely recommend using temporary expander and then planning a later DIEP when the lifesaving treatment is finished. I couldn’t face further major surgery this time last year, but feel ready now.

Good luck with your treatment, psychologically it really helped me never to wake up flat. Even during chemo when the implant was removed the expanded skin and muscle formed a mini bump.

Am sort of in a similar position so your experiences are really heartening.  My margins, after second op, still aren’t clear so have got to have more surgery.  Either, more margin, or mx.  Surgeon is somewhat pushing immediate reconstruction but I don’t think I am ready for that.  I kind of want to get the cancer over and done with.  I actually like my ‘new’ operated boob as it is perky and a bit smaller albeit wi no nipple but the scar is kind of cool.  Original boob is a bit saggy…   If I go for the mx, I’m worried that what I will miss is the cleavage. I don’t wear particularly low cut stuff but its from my looking down angle, is what I’m used to seeing.   


How big did the saline thing get expanded too?  Could it go to a D cup?  Did you have any leakages or problems with it?  What do they feel like.  At the mo I don’t know if I want a foreign body in me when I stretch or do my archery - does it feel weird or is it ignorable?  How often do you need to go and have more saline put in?


sorry for the barrage of wuestions but hadn’t thought this would be a possibility.

I haven’t had my mastectomy yet, still waiting. My appointment today is to discuss when and what reconstruction I want, probably go for delayed but I wanted an expander so the skin doesn’t shrink. I only have small boobies anyway so I am hoping the op will be easier and there won’t be much difference in size with an expander. What we girlies’ have to go through eh! Thankyou for message x

Neetie, I hope your appointment goes well today and you get some answers/treatment plan.


Flyingarcher, I wear a 34D/34DD/36C bra dependent on make and I have been matched up brilliantly with my temporary expander.  If my consultant does a good a job as this on the final recon, I will be absolutely delighted.  To be fair, I am a bit saggy too so I am half hoping to get a bit of a better look out of it in the end! ?.  I have three sisters who are very honest with me and they are all impressed with my current cleavage and certainly would tell me if I looked lop-sided.  I don’t apparently having asked them for reassurance many times.


My implant is placed over the muscle subcutaneously.  It is mostly ignorable and causes me very little grief now 4 weeks post op.  I mostly forget I have it!  You can of course feel it and lying on your side in bed it tends to ‘flop’ in my larger boobs such that it can be a bit uncomfortable in the cleavage area but I just wear a comfy bra to bed which helps keep it in place.  I can’t quite sleep on my front with it but almost - think slight recovery position.  Top ups of saline happen approximately 4 weeks after your op and at around fortnightly intervals until the desired size is achieved.  I was advised little and often.


I am a fairly active person - I play tennis and into heavy duty gardening and DIY but it hasn’t stopped me too much.  I feel that my enforced delayed recon has probably done me a favour.  It has enabled me to make a more considered decision as to the type of flap used.  Like you, I didn’t want my back used because of the impact that this may have on playing sports.  Fortunately, I don’t have enough flesh here so it was quickly ruled out.  I am now looking at a DIEP but have borderline flab to make my double Ds.  I am fully resigned to needing a tweak on the healthy boob to achieve symmetry but I can live with that.


I feel very lucky that my treatment and the after effects have gone so well so far. I hoped you are blessed with equally good fortune in whatever decision you arrive at.  If I can help any more, please do ask.


Ezzie. X



Aww thankyou so much Ezzie, you have raised my hopes and given me more ideas. My appointment is later this afternoon so I will ask about the expander, sounds just what I need. Means a lot to get real answers from you lovely ladies xx

Hi Riversidedown, I have heard of the nipple tattoo before and sounds good, will give that a go after my treatment. I will ask lots of questions this afternoon to ensure I get the right treatment plan for me. Thankyou for help xx

Thank you so much ladies.  This info is so helpful.