Breast Cancer Now Forum

Hi this might be of use - https://www.nice.org.uk/guidance/ng179/resources/visual-summary-pdf-8782806637 It is the NICE rapid guideline on elective surgery that hospitals are advised to follow (updated 24 Aug) - relevant part is highlighted in purple (however I think each individual hospital makes its own decisions guided by this). The guideline says 14 days prior to op you need to social distance; then self-isolate from members of your own household (2m apart and practice strict hygiene within the home, sleep on own) from the time of your Covid test (usually given as part of the pre op tests such as blood collected for transfusion etc 72 hours before) until the op. I had my second op a week ago and this is what we did. I asked my family/kids to social distance with me for the two weeks prior as I couldn't see how it would work otherwise. I went out for a walk on my own or with one of them (at a distance!) prior to 3 day self isolation but beyond that didn't really go out. It is such a pain, I was lucky to be working at home. This is the second time we had to do this during Covid - the first time was worse as guidance was stricter and we had to self-isolate as a household for 2 weeks. I was told to be careful after surgery as I would be vulnerable in the case of any chest infection - so we've tried to be careful and I have social distanced again. Covid makes this situation just so much more drawn out. hope that helps x   ... View more

hi Lucky1 Interested to know more about this lipofilling solution, I have never heard of it to create a whole breast but it sounds much less invasive than diep which is great if it works. When you say the mastectomy scar is used - was your scar flat? where does the fat that creates the mound actually sit?  Thanks stefi   ... View more

hi Emma I have small breasts and was so conflicted for ages, it's not easy. I had multicentric cancer so didn't need chemo or radio but needed a mastx and was a candidate for immediate recon. While I was researching what to do, I came across a woman similar to you - she had a skin sparing mastectomy while radiotherapy was being done to preserve her skin envelope and then diep recon (own tissue afterwards). 10 years on she felt it was the right decision, she even got a flat stomach out of it - but it does depend on you having ample fat around your abdomen. If you want to increase your breast size though, I think that is also possible - you could ask your surgeon how best to achieve this. You might have to be upfront with the surgeon and have a conversation about making both bigger as you might be happier with going through the whole process if there is a chance of better boob shape at the end!  It's quite something to go through if you don't like your boob volume. I spoke to one woman who said that she might as well get something good out of a crap situation and asked for bigger boobs, & her surgeon offered that option using implants. I didn't want to modify my one healthy one, I quite like it, but was worried that if I didn't modify both - as I got older the healthy one would droop further and the new one would sit proud and high on chest so I didn't go for that. The option I chose was simple mastx as recovery shorter, less invasive op and actually with small boobs very feasible to look symmetrical with a pad or small prosthetic. There are some funky things you can wear nowadays, you can have your own bespoke underwear made. It's ok, I was devastated before the op just contemplating my changed body, I thought it was so unfair, but now am ok with it. You can't notice it when I have my clothes on. Good luck with deciding - I would be really clear with the surgeon about what you want out of it. take care,  x     ... View more

hi Emma, Have you been offered skin sparing mastectomy? that might work while you have radiation therapy. It preserves your own skin envelope - you just have a temp implant that gets swapped later - it gives you more time to think. While I was researching my options I came across a small breasted woman like me. Her surgeon offered her the option of going up a size - this is possible with implants; she had an immediate mastx filled with implant and then the other boob augmented with another implant slightly later. In the meantime she used a small silicone pad to even them up. She was really happy with her boobs afterwards, they were better than before in her view. You might ask the surgeon how to achieve this. I was happy with my breast size despite being a 'aa' and didn't want the healthy boob reshaped and lifted (which would have been needed for symmetry) plus didn't want the issues that come with implants (needing them changed & worries about contracture etc) so I opted for a simple mastx; really hard decision, took ages. I nearly went for the diep flap op (own tissue flap) but was put off by the long recovery and additional abdominal surgery - I have already had 2 c sections and have had other ops - I am not good at recovery and hospital stays. The thing is you might just need more time to think - in which you could have a simple mastx and recon afterwards. Sometimes it's presented as a black and white decision where there is no going back and it need not be. I guess the advantage of having the whole thing done at the same time is that you are a priority and don't have to go on a long waiting list for an op like diep which is relatively specialist and you might have more or less painful implant options. Equally being small breasted means that simple mastx is relatively easy to live with - I am very new to it but it does seem the case. Might be a bit of a pain swimming and strappy tops are a bit of a challenge. I realised that so much of my body image was tied up with these boobs, as if my femininity depended on it. But you can still look good - there are those lovely tatoos though you have to wait a few years for them. I did find a whole journal article on the problems small breasted women have in making these decisions - most of it is because they don't want the other healthy breast tampered with. However small boobs are rather fashionable these days so I wouldn't feel guilty to reconstruct them or worried that they are not sexy, they are uniquely you.  But it's a **bleep** situation you are going through so if you want bigger boobs, why not ask the surgeon if it is possible to go up a size or more and with your physique how?  I hope that helps! I am sorry you are having to go through all this during Covid -  I feel it has been so much more difficult to make informed decisions.  If you are interested in diep - make sure you talk to a plastic surgeon; and you might want to talk to a few women who have had a few of the options you are considering via the 'Someone like me' service that Breast cancer now provides - you can be matched by age etc. It's fairly swift. Some surgeons offer show and tell events where women talk about their experiences following recon surgery - which should be coming back in September. I hope that helps.x               ... View more

hi Sandra,  I didn't go for it in the end, I wasn't ready for such a long recovery and didn't want to put it off any longer . They started breast recon in Oxfordshire which was my nearest centre at the end of July. So as long as Covid is controlled in your area, diep recon should be back as an option. Good luck x ... View more

hi Sheila what a lovely quote. Thank you. Hope you are having an up part of the day today too 🙂 ... View more

hi Sheila,  Thanks for you reply 🙂 You sound very sorted for 1 week post op - I really hope the scar settles down ok; I wish I had been as decisive as you as the prospect of drawing this out even further is horrible. Where I live they are advising ER+ women to go on tamoxifen if they want recon and to go for immediate rather than delayed - I'm not clear why - I think it's just a better aesthetic they say and less ops but I am not sure why it has to be so black and white. Thanks for sharing your experience and showing that it's not always so easy and you can have doubts but that it gets better and some surgeons are on board with the idea that the decision can change. I have a counsellor now and we discussed using the experience to reflect on what makes me me, what makes me a woman if you like - it is so wrapped up in this breast business at the moment, it's difficult to disentangle what is what! Like another woman on here I have researched my way through this just to cope, which has made it worse in some ways but through a friend I have found a seamstress in Shoreditch who also can potentially make custom designs http://www.buttressandsnatch.co.uk/bespoke-1 so I'm interested to hear that you have also explored that route. It's all very difficult with social distancing though isn't it. But I found knowing there were other options to standard Nicola Jane etc really comforting - like I could get someone to sew me out of this situation with fabric that fitted my unique contours rather than my own body tissue!  I think I had a lot of grief up front and the surgeon took it to mean that I didn't in my heart of hearts want simple mastx, he said most women don't look as upset. I was trying to perhaps anticipate the grief to deal with it, I don't know why I wobbled and was so upset by the prospect.  I like the idea about writing to your former self and I will definitely do this, I have found writing things down useful.  At the moment each day I wake up wondering what to do as immediate recon has suddenly reappeared on the horizon. It's tempting to go for recon but it sounds arduous and I don't really want to take so much time out if I can help it.  I guess simple mastx is a reversible decision; recon isn't so much - diep is quite a commitment - I wonder if getting through it means you really need to be sure. The thought of multiple visits to get it right afterwards, perhaps having a new nipple, tatooing etc also feels like surgery is ongoing for ages. I am wondering if my age has something to do with why am feeling torn and tired of multiple interactions with hospitals! Anyway thanks so much again, and hope things continue to go well for you,  Stef x ... View more

hi ladies,  I am also stuck with the reconstruction or no reconstruction dilemma. I am 50 and am lucky in that I have stage 1 ER+ but unlucky that it is multi-centric so mastectomy is my only option - this was a terrible shock as it was an incidental finding. I was diagnosed in May and have been dithering about having the mastectomy or waiting for recon. I finally decided on mastectomy in July wanting to get it over with but then wobbled badly a few days before the op so was advised to just have the sentinel node and see if my options were narrowed - nodes are clear thankfully as of last week so am back to square one. I know I am lucky as some of you ladies are have difficult diagnoses and part of me feels guilty for even posing the question; whereas I am stuck at the very beginning with a low grade and can't decide. The team keep telling me it's a life changing decision and I need to be 100% behind it but I am ambivalent. I am very small breasted and I think that is part of the problem - as I don't actually have cleavage as such but actually I rather have gotten used to my small breasts over time. It seems like recon isn't reconstructing very much and it's a major op to do it! I know that sounds odd 🙂 Anyway, how to make this decision and not regret it? I think Covid has made this much more difficult as there is a lack of certainty on dates for recon and couldn't see the plastic surgeon until a week ago - so it's all been horribly drawn out. She is very nice and says that recon now starting up again and diep is an option for me and that there should be no long term complications, that you might feel a feeling of tightness in the abdomen. I am always a bit doubtful about these things though. I have had 4 ops in my life, sometimes things don't quite deliver as you expect! I forgot to say due to having small slightly droopy breasts (blame the breastfeeding!) and being a keen swimmer, my two options are: mastectomy or Diep unless I want the other breast altered (implants would give me a lopsided look). I have realised that Diep scares me, particularly during Covid and maybe during any second wave. For me it would be a six hour op and the surgeon would put in a mesh to maintain abdominal strength (she does this with all her patients apparently) followed by 2-3 months off work which seems like ages. But equally mastectomy worries me as I am concerned about how I would feel about how I look with the scar and whether I would find prosthetics difficult to size or uncomfortable/annoying; I don't find choosing a bra that easy - with my shape nothing fits well.  I don't wear revealing clothes but I do like to have freedom to choose I guess. Mastectomy to me still seems a dramatic decision for my stage of cancer - though I can see it is possibly the most practical and sensible option. I have sought some counselling and have some issues about body image but I am not sure they will disappear overnight!  So anyway, any thoughts on how to decide most gratefully received. I am increasingly worried about waiting. thank you xx   ... View more

thanks so much for that, that's so useful very grateful x ... View more