Not enough tissue for reconstruction

[Pawsome]

Hope your surgery goes well. My surgeon did such a neat job and cleverly hid the stitches so I can wear backless dresses and I have a cleavage. It’s amazing what they can achieve. Also I’m now 8 years on from surgery and have had no issues with my implants and they haven’t needed replacing. My surgeon is a specialist in oncoplasty and they said they haven’t had to replace an implant because it’s ‘time expired’. He didn’t expect to have to see me again after he discharged me after the recon op. X 

[SadieH]

I've got another meeting with the team and they are going to refer me maybe to a specialist who focuses on women who are too scrawny. I will ask about this. Yes, they did mention that even if they could manage flap reconstruction it would probably require an implant too. 

[SadieH]

Good luck with your surgery - I really hope it goes well for you, and the reconstruction also. 

[SadieH]

Thanks! They did talk me through implants but were quite discouraging as they said they tend to fail/need replacing within 5 years if you have a mastectomy, due to the lack of tissue around them. But I'm just generally quite phobic about the idea of having loads more surgery. I've got two children and am worried about how I can explain to them that I'm going to be needing a long recovery, maybe several surgeries. So I think maybe I had already made my mind up when I went to the appointment with the plastics team and I need to be a bit more open-minded. It is good to hear these positive outcomes. It is a shame that options were so limited when I had my mastectomy in May as maybe I would have found some of these decisions easier if surgery could happen all in one go. 

[Pawsome]

I should have said I also had implants put in on both sides for my reconstruction. I didn’t have enough tissue to do the reconstruction without implants. Basically my surgeon pulled my back muscles forward through an incision in the armpit. The back muscles now in effect act like a pocket and he placed an implant on each side. As I’m quite petite and skinny it doesn’t really leave you with much options if you don’t use an implant x

[bookish]

Not quite the same boat, but I'm expecting bilateral mastectomy in January and I always felt I wanted the reconstruction at the same time. The general options I was told were using back muscle, abdominal fat, or implants. I've refused point blank on the back muscle - I'm happy to be keeping some kind of shape, but to me it's not worth the risks of cutting up muscle I'm still using! It's a nice thought to lose the tummy flab but almost certainly a no-go due to past surgery. So, we're going the implants route. My consultant seems quite happy with this, not least because it's a smaller op with no secondary wound site. Yes, there are downsides, but aren't there always?

I'll have another conversation about it all in December to make sure I'm still happy with this approach, but thought I'd give my story. Slightly wondered why no one had mentioned implants yet.

[Pawsome]

Yes they did warn me it would be a problem when I was talking about the surgery with my consultant but he also said that he found most ladies were ok with the back / shoulder option (using the Latissimus dorsi muscle). I had my primary in 2004 and had a single mastectomy. I was 26 at the time. I then had the reconstruction in 2012 (long story as to why the delay but basically my oncologist at the time wasn’t keen on me having further surgery). I also opted for a prophylactic mastectomy. I asked for that and my surgeon was quite happy to do that. So I had a delayed recon on the right and a mastectomy and immediate recon on the left. I was quite fit and active beforehand and I am still the same. I had quite a lot of physio after the operation and you do have to work hard to get your strength and range of movement back but that would be similar for whatever operation you went for. Yoga was quite good as it gently stretches our your muscles. 

[SadieH]

That is really good to know, thank you. Did they also warn you that it could be a problem for you when talking about the surgery? The list of potential issues seemed very long for all the reconstruction approaches, but esp for back/shoulder (assuming that is what you went for). When I came out of the consultation I felt pretty much decided that the only sensible course was bilateral mastectomy honestly, but the team obviously doesn't like to offer that and I assume they know what they are talking about. I'm in my 40s and don't care that much how I look in general, but I really, really hate having one breast. 

[Pawsome]

Hi - just wanted to say I had the same issue when faced with options for a reconstruction. My only option was the LD one or the back / shoulder muscle. I went ahead with a bilateral recon on both sides. I have experienced no loss of strength at all. I regularly walk and train 3 strong dogs, swim, ski and horse ride. I’ve also had no issues doing the housework - ie. pushing a vacuum around or carrying it upstairs. I was 34 at the time and I’m a size 10 and petite (5 foot 2). Xx

[SadieH]

Hello all 

I had a mastectomy during COVID which meant no reconstruction. I've since seen the plastic surgery team who say I don't have enough thigh or abdomen tissue for flap reconstruction, and I don't want to use shoulder muscle as I know that can compromise strength and I absolutely love swimming. 

Although it would be ideal to still have two breasts, it seems unlikely that I will ever have that again without compromises I'm not willing to accept. Therefore, what I want to happen is that I just have my other breast removed so at least I am the same on both sides. I absolutely hate piddling around with my fake breast on the beach and on river banks. The surgery team told me sometimes women have persuaded them to remove a healthy breast, but that they haven't always been happy.

I see that this question of healthy breast removal has come up a few times so sorry if I'm repeating, but I genuinely am nervous about making this decision. Has anyone else been in this position? Has anyone gone down this road and been left with regrets? As it seems like reconstruction will be completely off the table for me if I get my other breast removed, so I want to make sure I've really thought it through properly. 

Sadie