Advice on Reconstructive Surgery

rgilliam8867

Hi everyone!

I've been looking for you:) I just found this discussion board after looking for a few months (on and off) for a good group. I'm so glad I found you!

I was diagnosed w/ thyroid cancer while pregnant (3 yrs ago)--went through thyroidectomy, Radioactive iodine treatment, etc. All the docs said if I was to get cancer, thyroid cancer was the one to get. I said to myself, "Thank God is isn't breast cancer!". Well, 9 months after my RAI treatment for Thyroid CA, I was diagnosed w/ breast cancer. I had a modified radical Mastectomy (right side) w/ profilactic simple mastectomy on the left. Turns out I had a very fast growing, aggressive cancer, triple negative, 8cm diameter, 2 of 24 lymph nodes positive. It grew from a "bean-size" lump in June (when I first discovered it) to a plum-sized tumor by early Oct '06 when I had surgery. I was in denial for a couple months and didn't see a doc right away (until Aug), as I figured it was a swollen milk duct due to the RAI treatment I had, since I had breast fed my baby a few weeks before the treatment. Also, we were moving cross country that summer, and I was staying w/ my parents for a few weeks before moving into our house, didn't have a doctor, etc. All the stupid reasons I use not to seek treatment immediately (won't make that mistake twice).

Anyway, I had surgery, am 1 year past my last chemo treatment, and almost one year past my radiation treatments. I am now ready for reconstructive surgery.

I've seen a plastic surgeon about a DIEP procedure, as I really didn't want to use muscle, implants, etc., but even though I'm 30# overweight, I don't have enough belly fat to reconstruct both breasts (I'm short waisted and the majority of my fat is above the navel, and they only use the fat below the navel). So, he suggested the Lat-flap as my best option. I can't have just implants because of the radiation I had, and because the surgeon had to take most of the chest muscle on the right due to the size of my tumor.

I have talked to one lady (a friend of a friend) and read one account online about the Lat-flap, and both accounts were very negative! I'm looking for any and all experiences anyone may have had w/ this procedure, negative or positive (preferrably positive!), as I want to be realistic w/ my expectations and have all the info I need to make the right decision for me.

I really want reconstruction, as I hate the way I look, I MISS my cleavage and being able to wear pretty bras, lower-cut shirts w/out having to worry about leaning over too far and someone seeing my prosthetic-filled bra. I also miss being able to embrace my husband in bed w/out wearing a bra--he says it doesn't bother him that I don't have breasts, but it really bothers me!

So, anyone that has a few minutes, I'd LOVE to hear from you about your opinion/ experiences about reconstructive surgery, in particular the lat-flap.

Thank you so much, and I look forward to getting to know all of you!

Rita

susabella

Hi Rita!
Welcome, welcome! You have quite a story, and it sounds like your sense of humor came through intact. Good for you! I had a bilateral mastectomy followed by immediate reconstruction just 3 months ago. I wanted tram flap reconstuction, but was very disappointed to find that I could not have it. I was also not "fat" enough to have 2 breasts recreated. I was a little queasy at the thought of implants, particularly if they had to do tissue expanders with saline implants. I also have a bad back, and it would greatly compromise that issue. I ended up getting silicone implants under the chest muscle done immediately after the mastectomy. It was definitely plan "B", as I had my heart set on my own tissue. Our circumstances are quite different, but I learned to be flexible and always have a second and sometimes a third choice. I know what you mean about feeling unattractive for your husband and missing your pretty bras and tops! If I don't get out of these heavy duty sports bras, I'm going to scream! lol Could they have a little lace somewhere!? Please find a plastic surgeon who makes you very comfortable, and specializes in breast reconstruction, not all do. It's important that you really trust him/her, and believe in their advice.

My husband didn't care if I had reconstruction or not, but I did it for me, as I really cared. The gals here taught me that it wasn't vain to care about how we look, it's normal to want to look like we did before. I don't, but I'm pretty happy with the work my surgeon did, and as the scars fade, I'm sure it will get better. I'm learning to be proud of them. A nurse friend of mine kept urging me to massage shea butter into the scars, and it helped me get used the new "girls".

Well, those are all the "pearls" I have, sorry I could not address the specific type you were asking about. Again, welcome, I'm glad you found this site. It's been a godsend for me.

Let us know how you make out with your decision!

Love, Sue

LesleyH

Rita,

I had a lumpectomy so don't have advice on reconstruction. I just wanted to send my love and support. You have been through such a lot. I know there are wonderful women on the board that will give you their insights into this process. I do understand how you feel. I opted for a lumpectomy and constantly second guess myself - was my vanity a dangerous choice?

Hugs.

Lesley

suzcarl

Hi. I don't have advice about reconstructive surgery because I had a lumpectomy, but I'm interested in knowing if you had chemotherapy and, if so, what kind. I also was diagnosed with triple negative breast cancer and had surgery last month.
Take care.
Suzanne

Future

I had a lat-flap with very good results - my problem was with the expander and nosocomial (hospital) infection. Through all the infections the flap stayed viable and the nipple and tatooing looks great. My problem - the infection; my surgeon sent me for a second opinion and neither one of the surgeons wants to try and put in another implant. I had a simple mastectomy on the other side and the surgeon's trying to now manipulate things to make them more symetical. For most, a lat flap can only create a small mound. Suggestion when you talk to the surgeon is not only ask him about his infection rate but has the hospital had any increases or problems with infections over the past year. Sidebar: My boss happens to be a general surgeon (not in practice) but he tells me that after the type of infection I have the body creates a "biolfilm" or a protective cover and surgeons are hesistant to disrupt this because there may be bacteria still hiding in there.
Bottom line: very happy with the actual flap -- the infection around the expander is what created the problems. Second surgeon said we could scrap everything and go with free flap bilaterally but I'm not willing to go that drastic right now.

rgilliam8867

suzcarl said:

Hi. I don't have advice about reconstructive surgery because I had a lumpectomy, but I'm interested in knowing if you had chemotherapy and, if so, what kind. I also was diagnosed with triple negative breast cancer and had surgery last month.
Take care.
Suzanne

I can't remember the name of all of them. I had 4 sessions of dose-dense Epirubicin (looks like red koolaid, and you'd never look at red koolaid or fruit punch the same again) and something else--every 2 weeks. Then 4 dose-dense treatments of Taxotere. I had to take the Neulasta shot after each treatment to boost my White blood cell count, since having it every 2 weeks doesn't give your body a chance to recover on it's own. If you just had a lumpectomy and no lymph nodes were involved, you probably won't have to have chemo--they might recommend just radiation, which is a lot easier to handle! Let me know how it all goes!

Rita

RNHF1986

Hi, Rita! Sounds like we have some things in common. My diagnosis was T2, N0, ER neg, PR neg, HER-2 neg, high Ki67 (moderately to poorly differentiated infiltrating ductal carcinoma). My tumor size was about 2.9. I chose to have a bi-lateral mastectomy -a modified radical on the left which had the tumor, and a simple on the right. I had had previous massive doses of radiation for Hodgkin's when I was 19. I was diagnosed with bc at age 41. I had 4 treatments of FEC-100 (Fluorouracil, epirubicin and cytoxan) followed by 2 Taxotere which caused severe burning, so I was switched to Taxol for my last two treatments. I started reconstruction about a year after my mastectomy. I couldn't have any previously radiated tissue used, so it was advised that I get tissue expanders and then saline implants after all my chemo treatments were over. I was glad I went to see the plastic surgeon the day before the mastectomy. They took pictures of what my breasts looked like (something I would not have done myself) and helped me to start getting used to the fact that I wouldn't have breasts anymore. I don't know about lat-flaps, but do know that you really need to have a good trusting communicative relationship with your plastic surgeon. And, even though you do, it doesn't always turn out the way you thought. I expected to be about the same size that I was before, but I don't know if I can accomplish that. I still have my tissue expanders in, (which I do have to admit, the expansion was painful to me) and am trying to figure out what to do next. I had the expansion done last March, but had some thyroid issues myself (thyroid taken out, but no cancer). Now, here I sit with expanders that aren't the size I wished they were and trying to make a decision if I could get any more size before I can do the implants and nipple reconstruction. I feel kind of on a timeline again with the summer coming up and wanting to wear a swimsuit (the tissue expanders don't fill out exactly like a breast shape). I understand your ambivalence and hope that you can wade through all the information, as well as figure out what's in your heart. I too, have a supportive husband who says it doesn't matter to him what I want to do. I just needed to do all this for myself. Let me know what you decide and I look forward to getting to know you as well as all the other wonderful women out there.

Becky

anet

Hi Rita,
I am recovering from mastectomy and I do not have much experience with anything that follows, but when I was looking at options my plastic surgeon (who only does breasts) showed me pictures for each option. I do remember lat-flap picture that looked very good...he said that the lady used to lift weights and still does! She did have to go a little lighter on her training but the surgery did not stop her.
Do not feel bad about wanting reconstruction, we deserve it!!! I am thinking about becoming a 'B' cup since I was only an 'A', why not???? We will see how this goes...
Hugs!
Anet

Dodge

January 2006 I had bilateral mastectomy and had salilne implants put in place during the breast surgery. After four or five months of weekly injections of saline into the implants to stretch the skin, I had the saline implants removed and silicone implants put in place (July 2006) August 22, 2006, the left breast silicone implant had to be removed. I had a major infection (not due to the silicone implant), but rather because my own skin and tissue were not accepting the change. I had breast cancer in that breast in 1998 with chemo and radiation. The reason for the bilateral in January 2006 was that I now had cancer in the right breast.

After several months of the left side healing from the infection (Dec 20. 2006), I had a latissimus dorsi flap reconstruction breast surgery. In addition to the skin, muscle, etc. tunneled from the back to the front, I also had to have a smaller silicone implant put in under the skin, muscle, etc. in order to have it the same size as the right silicone implant.


This surgery takes more time to heal and, actually, the back is more sore than the implant area. I am pleased that I had an alternative for the left breast area.

I hope this is helpful as you make your decision. I am still not completely healed but my surgeon assures me that everything looks great.

Lora57

Dodge said:

January 2006 I had bilateral mastectomy and had salilne implants put in place during the breast surgery. After four or five months of weekly injections of saline into the implants to stretch the skin, I had the saline implants removed and silicone implants put in place (July 2006) August 22, 2006, the left breast silicone implant had to be removed. I had a major infection (not due to the silicone implant), but rather because my own skin and tissue were not accepting the change. I had breast cancer in that breast in 1998 with chemo and radiation. The reason for the bilateral in January 2006 was that I now had cancer in the right breast.

After several months of the left side healing from the infection (Dec 20. 2006), I had a latissimus dorsi flap reconstruction breast surgery. In addition to the skin, muscle, etc. tunneled from the back to the front, I also had to have a smaller silicone implant put in under the skin, muscle, etc. in order to have it the same size as the right silicone implant.


This surgery takes more time to heal and, actually, the back is more sore than the implant area. I am pleased that I had an alternative for the left breast area.

I hope this is helpful as you make your decision. I am still not completely healed but my surgeon assures me that everything looks great.

I had a bilateral mastectomy due to DCIS. I am looking for advice from women that have had the tram flap surgery performed in the Seattle area, specifically at Virginia Mason Hospital. Any advice would be much appreciated, Lora

msphil

Lora57 said:

I had a bilateral mastectomy due to DCIS. I am looking for advice from women that have had the tram flap surgery performed in the Seattle area, specifically at Virginia Mason Hospital. Any advice would be much appreciated, Lora

Hello, I had reconstruction surgery right after total mastectomy,(L) but the expander had to be taken out cause it hardened and was very painful, my body rejected it, the mastectomy was due to DCIS, I did not have any discharge either, found the lump during a shower, chemo, radiation. God Bless Us All, I am 13 yrs cancer freePraise the Lord, it was He (The Lord) who kept me in HIS arms, I pray that He also holds U. God Bless U. PS I now wear a prothesis in my bra. msphil

plv1973

Dodge said:

January 2006 I had bilateral mastectomy and had salilne implants put in place during the breast surgery. After four or five months of weekly injections of saline into the implants to stretch the skin, I had the saline implants removed and silicone implants put in place (July 2006) August 22, 2006, the left breast silicone implant had to be removed. I had a major infection (not due to the silicone implant), but rather because my own skin and tissue were not accepting the change. I had breast cancer in that breast in 1998 with chemo and radiation. The reason for the bilateral in January 2006 was that I now had cancer in the right breast.

After several months of the left side healing from the infection (Dec 20. 2006), I had a latissimus dorsi flap reconstruction breast surgery. In addition to the skin, muscle, etc. tunneled from the back to the front, I also had to have a smaller silicone implant put in under the skin, muscle, etc. in order to have it the same size as the right silicone implant.


This surgery takes more time to heal and, actually, the back is more sore than the implant area. I am pleased that I had an alternative for the left breast area.

I hope this is helpful as you make your decision. I am still not completely healed but my surgeon assures me that everything looks great.

I really would like to talk to someone about latissimus dorsi flap reconstruction. I had the tram flap done on my right breast in 2002. I just found out I have a new primary cancer in my left breast. The platic surgeon is saying I will have best results with the back flap surgery. I need someone that can tell me the good and the bad of this surgery. I have concerns about back strength after, pain after surgery, appearance, recovery, and anything else you can tell me. Thank you so much.