Question about reconstruction?

QQN4answers
QQN4answers Member Posts: 16
edited March 2014 in Breast Cancer #1
I have been reading some of the post about reconstruction and I'm wondering why more new cancer patients are not opting for the surgical method called "Skin Sparring" with immediate implant surgery. I had chemo first and then surgery and will not need radiation. I had my mastectomy 4 weeks ago which left me with my skin and nipple intact and only a small scar on the breast, they also took 6 nodes. The implant was done at the same time and the feeling is already starting to come back. Are recently diagnosed patients being offered this method? I was told that the chemo killed all the tumors and my pathology report came back clear. Is there something I'm missing here? Why are doctor's still using tram flaps and removing the breast skin? Does the tram flap make for a better look? Thanks Liz

Comments

  • wingingit
    wingingit Member Posts: 48
    #2
    There are those of us who opt for tram flaps over implants because we wish to avoid the placement of foreign objects in our bodies. Also, an implant may require replacement after several years. Yes, you probably have heard some horror stories about tram flap complications but I have also heard plenty of problems involved with implants on this site. (I suspect we hear more here from those who are having problems--and therefore, more questions--with either procedure than whenever things have gone well.) It is my understanding that when one has a skin-sparing mastectomy with immediate tram flap reconstruction the skin is saved but oftentimes the nipple is removed for precautionary reasons. The breast skin is typically removed when reconstruction is going to be delayed due to patient choice or followup radiation treatments. My plastic surgeon only told me a couple of days ago that I might eventually regain some feeling in my reconstructed breast (free tram flap 10 mos. ago) as nerves and blood vessels repair themselves. I also forgot to mention that an added bonus to all this was a tummy tuck. I have been known to joke about my extreme makeover--flatter stomach, perkier breasts, and with me curly hair. We have to make the most out of the positive with this disease! Anyway, it is just another personal decision as to the method which we choose . . .
  • Snookums
    Snookums Member Posts: 148
    #3
    wingingit said:

    There are those of us who opt for tram flaps over implants because we wish to avoid the placement of foreign objects in our bodies. Also, an implant may require replacement after several years. Yes, you probably have heard some horror stories about tram flap complications but I have also heard plenty of problems involved with implants on this site. (I suspect we hear more here from those who are having problems--and therefore, more questions--with either procedure than whenever things have gone well.) It is my understanding that when one has a skin-sparing mastectomy with immediate tram flap reconstruction the skin is saved but oftentimes the nipple is removed for precautionary reasons. The breast skin is typically removed when reconstruction is going to be delayed due to patient choice or followup radiation treatments. My plastic surgeon only told me a couple of days ago that I might eventually regain some feeling in my reconstructed breast (free tram flap 10 mos. ago) as nerves and blood vessels repair themselves. I also forgot to mention that an added bonus to all this was a tummy tuck. I have been known to joke about my extreme makeover--flatter stomach, perkier breasts, and with me curly hair. We have to make the most out of the positive with this disease! Anyway, it is just another personal decision as to the method which we choose . . .

    I agree with wingingit and was also informed the nipple could harbor cancer cells as well. I went for the implants and have some feeling post surgery 2 months on the right. Left isn't finished yet. C
  • DeeNY711
    DeeNY711 Member Posts: 476 Member
    #4
    All of my options were based upon what would afford me the least statistical probability of recurrence anywhere, including skin. In addition, your situation and mine were very different based upon what you have described.
  • blossomtime
    blossomtime Member Posts: 98
    #5
    I had immediate reconstruction with expanders. My dr recommended modified radical mastectomy and also did not recommend skin sparing do to chance of harboring cancer cells. At the time I was of the attitude "lets get this show on the road" and get it over with. I ended up having radiation but so far it has not affected my reconstruction negatively. But every case is different so be content with the decision you have made. Dont try to second guess yourself, it will only cause you many sleepless nights. I am sure your doctors felt this would be a good option for you or they would not have recommended it. Take care. Sharon
  • DJC
    DJC Member Posts: 52
    #6
    Hi Liz-I had a skin sparing radical mastectomy performed in June followed by an immediate Latissimus flap reconstruction utilizing an all-in-one implant/expanding device. My plastic surgeon was able to partially infuse the expander with saline while I was under for this comprehensive set of surgical procedures - I woke up to find a nicely shaped mound where my right breast had been. I, too, was advised that my nipple and areola should be removed as a precautionary measure - they will be recreated this coming Spring using my donor skin and tattooing. But, because my breast and plastic surgeons used a skin sparing technique, my scaring looks as if I've had a breast reduction - with an inverted T-shaped scar situated in the lower quadrant of that breast. I have had some feeling return and hope to recover more. I will also have lifting surgery performed to the bilateral breast when the nipple reconstruction procedure is done. Anyway you slice it, though, (I know - bad choice of words) - I think having the option of having our breasts reconstructed after requiring such disfiguring surgery is truly a miraculous thing. Donna :)
  • obliva
    obliva Member Posts: 18
    #7
    I hadn't heard about the "skin sparing" surgery, but then the docs weren't going to save my nipples either because 1) chance of cancer cells, and 2) after my first round of cancer with radiation they didn't look too viable anyway. I'm just starting the reconstruction. I had expanders put in at the time of my double mast. but just finished all the other stuff. Projected date of implant surgery will be the end of January. I know this sounds weird, but I've sorta enjoyed being breastless this summer. It almost brought back that feeling of being a little girl (yeah, I know, I haven't been little in a long time)...but that time before we were labeled women, and just were.
  • jake10
    jake10 Member Posts: 202
    #8
    I was told that the skin saving procedure including the nipple was not recommended for ductal carcinoma. But I bet the recomendations are different all over the country and change due to advancements in procedures every day.
    To look at it from the dark side: Doctors don't know everything. I had a very small tumor found on a screening mamogram. I opted for a mastectomy and my surgeon and oncologist could not understand why and recommended a lumpectomy. but they did encourage me to make my own decision. Come to find out the pathology showed difuse, invasive DCIS throughout the tissue. Just a time bomb waiting to explode. God was with me on that one. Warm thoughts: Beth
  • Kathy713
    Kathy713 Member Posts: 6
    #9
    wingingit said:

    There are those of us who opt for tram flaps over implants because we wish to avoid the placement of foreign objects in our bodies. Also, an implant may require replacement after several years. Yes, you probably have heard some horror stories about tram flap complications but I have also heard plenty of problems involved with implants on this site. (I suspect we hear more here from those who are having problems--and therefore, more questions--with either procedure than whenever things have gone well.) It is my understanding that when one has a skin-sparing mastectomy with immediate tram flap reconstruction the skin is saved but oftentimes the nipple is removed for precautionary reasons. The breast skin is typically removed when reconstruction is going to be delayed due to patient choice or followup radiation treatments. My plastic surgeon only told me a couple of days ago that I might eventually regain some feeling in my reconstructed breast (free tram flap 10 mos. ago) as nerves and blood vessels repair themselves. I also forgot to mention that an added bonus to all this was a tummy tuck. I have been known to joke about my extreme makeover--flatter stomach, perkier breasts, and with me curly hair. We have to make the most out of the positive with this disease! Anyway, it is just another personal decision as to the method which we choose . . .

    I am 2 yrs and 10 months post masectomy and tram flap reconstruction. I chose this type of reconstruction to give myself some closure. I went into surgery with 2 breasts and came out with 2. I was not thrilled with the thought of having to go through months with the stretching process and then the implant surgery. I needed to get to the other side of the cancer mess. I wasn't particularly enamoured with the look of implants and the prospect of having to replace the implant after a period of time. I liked the idea of a breast that was "all me". With having infiltrating ductal carcinoma, saving the nipple was not an option. I have regained about 1/2 of my feeling in my breast and abdomen since the surgery and I still have the benefit of the tummy tuck. Hell of a way to lose weight and get a flatter belly, isn't it? If I had to go through this again on the other breast, I'd opt for an implant.

Discussion Boards