Mastectomy with immediate reconstruction or delayed and surgery before or after chemotherapy.

Going through breast cancer treatment Surgery
1

Looking for a bit of advice.

Background to what I’ve had so far:-  Lumpectomy surgery in left breast to remove 2 cancerous tumours (which were later discovered to be attached when pathology done) and 2 further cavity shave surgeries, they still didn’t get clear margins which they have said indicates that the problem cells are more widespread in my breast than first thought and they are now recommending I have a mastectomy.

I now have to decide what order to have my further treatments, as there are a couple of options to think about:-

Option 1:

Mastectomy (without reconstruction) in a couple of weeks, followed by Chemotherapy (due to lymph node positive) and then Radiotherapy with hormone therapy drugs.

With an option to pursue a delayed reconstruction - but it could be 2-3yrs to wait for reconstruction and won’t know if reconstruction is even possible until I meet with that plastic surgeon & anaesthetist for that type of surgery (as I have a brain AVM)

Option 2:

Have Chemotherapy next and meet with the plastic surgeon to discuss having a mastectomy with immediate reconstruction after I’ve recovered from chemo - then radiotherapy with hormone therapy drugs.

The reconstruction options are complicated and varied and with it being a much longer surgery, my brain AVM throws in an extra complication for the surgeons/anaesthetists to consider.

Also, I don’t know how long chemo affects my immune system, so don’t know if it’s better to have the mastectomy whilst still being fighting fit, rather than after chemo when my immune system or blood platelets might be lower.

I don’t know if a DIEP reconstruction would even be possible, as I’ve had an emergency c-section in the past - my Consultant said they would have to scan my tummy to see if a DIEP was a viable option.

I wasn’t able to make a decision whilst with my Consultant - they are giving me a bit of time to really think through both options.

I’m trying to get my head around the news. 

Can anyone share their experience with having a mastectomy with either immediate or delayed reconstruction or anyone who decided that reconstruction wasn’t for them for whatever reason?

Also, anyone who has advice on whether having surgery after chemotherapy makes any difference re. recovery from surgery - was your immune system /blood platelets recovered enough from chemo to cope well with surgery?

I am also concerned about how I would mentally/emotionally cope with being flat on one side for possibly 2-3yrs (whilst waiting for reconstruction) or possibly for life - what are your experiences with this side of the cancer journey?

Struggling to decide what to do and all advice / peoples’ experiences much appreciated xx

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Hi Majestic Tiger - goodness, what a dilemma for you to get your head around. 

Afraid I have no wise advice, just thought, as you’d asked for experiences, I’d let you know how mine panned out.

I had a right side mastectomy 5 years ago.  I was advised not to have reconstruction at that time as there were concerns about the effect of radiation on the surgery site. However, I was assured that I’d be entitled to a reconstruction once other therapies were completed. 

Following surgery I was given a prothesis to wear - it can be worn directly on the chest or tucked into a pocket in a bra.  At every subsequent check up appointment I was asked whether or not I was considering reconstruction.  At the first of these appointments I was sure I was not up for more surgery and declined the offer.  At the next, I asked about reconstruction options as I was curious but, was still not convinced it was for me.  By the next appointment I knew I was completely happy with my lot and opted to stay as I am. 

I’m perfectly content, with my prothesis - when dressed, nobody would notice it.  It doesn’t impede my lifestyle at all - I go to yoga and pilates classes, play netball and swim (it tucks into my cossie) fairly regulary.  I’m very lucky to have a partner who accepts me ‘warts and all’, so have had no pressure from other ‘interested parties’ to make any decision.

Obviously, the choice to reconstruct or not is so very personal, so I’m not advocating non-reconstruction, just that it’s the option that suited me.  Hope this has been helpful. 

Good luck and very best wishes for whichever route you choose.

1 Like
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Hi there, sorry to hear that you have such complex options to consider, I too will let you know how my recent mastectomy and immediate reconstruction went and hopefully all the responses will help you choose the option that best suits you.

I had a mastectomy 3 weeks ago on my right side - the original plan was lumpectomy but MRI revealed more lumps and at that stage nodes appeared clear. However, given the overall size ,approx 4 cm, I was encouraged towards implant reconstruction as opposed to body tissue as apparently plastic surgeons would be cautious with me as possible would need radiotherapy afterwards. I took the advice, went with implant and, despite the rollercoaster of fear and worry and pain, it has been very successful for me. The first few days were the most painful but I adapted and slept a lot. Everything has settled really well and I feel stronger every day. 

My pathology has revealed some positive nodes so I will have more treatment ahead, yet to be discussed, and I now understand that radiotherapy can possibly also have an impact on the implant - so I’d try and get advice from those who have had further treatment post surgery/ reconstruction. From what I have read on here, every woman’s journey is unique and it can be overwhelming to make these decisions but getting feedback from anyone who has been through it I found really helpful. 

Best of luck and take care x

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Hi! I had a bilateral mastectomy in April. I decided I wanted reconstruction (although if you’d asked me right after the mastectomy I would’ve said no way lol). I only had cancer in my left breast but I don’t want to go through this again. I’m 45 and if taking them both reduces any risk of recurrence, then I was all for it.

At the first hospital I went we started with a nurse telling me I could have a lumpectomy if I wanted it. A week later, the surgeon said the left had to go but he could cure me surgically. To me, that was a big sign to move on.

Luckily, I’m close to Seattle and there is phenomenal care here. I had two different tumors, with two different kinds of cancer, but both were invasive. At University of Washington they do the most complicated mastectomies and reconstructions all day every day (at least that’s what the surgeons told me). I got to have nipple-sparing surgery and I’m so grateful for that. I was not given a choice on the order of events. During the mastectomy a plastic surgeon would place deflated tissue expanders in. Then, once I’m on the mend they would fill the expanders every week with saline until we are pleased with the size. If I needed chemo or radiation it would be at that time. Here’s the reason, if radiation damages your skin that’s all fixable during reconstruction. They don’t want patients on chemo trying to heal from massive reconstruction surgery. It makes logical sense, but it meant that I felt like quasi modo right after surgery. I’ll be honest, it sucked. I thought I would be flat but there’s extra skin and ripples and weird extra armpit skin. Plus you have lovely drains hanging out of you Pinocchio style. But most of that disappears as they fill the expanders (I mean for weeks I described my parts as lumpy pancake batter with googly eyes…batter part is gone but the googly eyes are still here). That’s done so your skin doesn’t shrink up or create adhesions. Here, they choose not immediately fill the expanders because they want to give your body time and reduce infection risk.

I am aiming to have DIEP flap surgery in December if everything works out. They want to do my belly scan like right before. They told me it’s rarely an issue to not have the right vascular situation for the surgery. I’ve had twins and a C-section, so it was a relief. Gosh I hope I don’t jinx myself! LOL

Hope this helps!

In my left I had 2 tumors. Both are classified as invasive; one lobular BC and one ductal BC.

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I don’t think anyone can predict how you will feel after any of these options. Even if they appear to have gone through something similar no one is you. I found it extremely difficult to hand over my body to complete strangers who seemed to know so much more than me. That was 19 years ago at my first diagnosis. I now face my second phase of cancer treatment as the first didn’t work as I have a recurrence of the first cancer I had in 2003. At that time I had three surgeries - the benign lump removed which proved not to be benign, then a quadrantectomy to make sure all the cancer was gone, then another operation when that got infected and antibiotics didn’t work to clear that. This was under local anaesthetic and the only surgery I actually enjoyed as it was painless and I could see what they were doing outside the operating theatre. Shame despite radiotherapy afterwards there was something left behind so I now have two tumours.

That means this time mastectomy appears to be my only option and since it is now very difficult to get an appointment let alone surgery it seems there are delays everywhere. I have not made life easy for myself by asking to go to a breast cancer centre of excellence in London not my local general hospital. They do offer reconstruction there but not as many options.

I think I will be guided by my consultants but one advantage of delayed reconstruction is that they might have more staff available at some future time to do more operations. On the other hand, there might be an even bigger back log then. So much seems to depend on where you live, your age, your viability for surgery. So I don’t have answers. There is a website where you can view videos of people who have had different kinds of reconstructions. I forget the name of it but I did speak to someone involved in their website who was helpful a while back. 

Seagulls

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In 2006 I had a Mastectomy with Immediate LD recon. Currently, I am going through it again with my remaining breast and given the wait of years, I’d go for immediate recon now. 1 surgery, 1 recovery.