Scar tissue and reconstruction

lynn1950

I am such a wibbler/wobbler trying to decide about reconstruction. Do I want more surgery and recovery? What about the costs (even with good insurance), given the economy? Still, I don't want to do or not do anything that will prevent an optimal reconstruction should I choose to go that route.

I have had a bilateral mastectomy with radiation to the left side (completed in October '08). I've noticed that I am very tight across the chest and the skin does not move as easily on the left side as it does on the right (prophylactic) side. Is there something I should be doing with the left side so that it will stretch should I decide to have reconstruction?

I've heard a little about tram flaps and DIEP and implants. I don't have very much fat on my stomach (maybe 2 AAs :} and also I 've heard that with a tram, you lose stomach muscle. Also, I have mild lymphedema. Can breast reconstruction affect lymphedema? I am so conflicted and value your experiences. I don't know if I will ever get used to looking at my body flat-chested and scarred. Help! and thanks.

Lynn

RE

Hi Lynn,

I too have lymphedema and have had all the concerns that you discuss. I have a lot of swelling and pain in the arm on the side I had the lumpectomy on due to node disection and 18 weeks of rads. The skin on that side is more taunt as you described (I will go back to that later). As I noted in an earlier post I go in for recon Friday, I choose the easiest of all the options mostly because of the lymphedema. Here is my reasoning and my findings in regards to this. Since I as a sissy (don't like pain) even though I have plenty of tummy to take from I opted out of that one. The recon that takes the muscle from the back and tunnels it to the breast area does increase the odds of lymphedema even though only slightly, my surgeon suggested I not opt for that one as it would not be good for me to have two damaged arms. The remaining procedure is the expander one where the original scar is reopened and an expander is inserted under the breast muscle and a bit of fluid is inserted. Then on a regular basis fluid is added to allow the chest to expand to a desired size. Once that size is reached the expander remains inside for another 6 to 8 weeks which will allow the skin to stay expanded when the final implant is inserted. This implant is good for 15 to 20 years.

Now back to the taunt skin I mentioned above, my sister has both breasts removed and rebuilt using the back flap procedure. Due to her rads she had to be satisfied with a smaller breast size then she had had previously. Just a note, she also had problems with her back area where the muscle was removed feeling taunt and uncomfortable.

I hope this has been somewhat helpful. Take your time in making your decision Lynn, it took me two years to take the leap into the world of reconstruction. My best to you and many many HUGS!!!!

RE

lynn1950

RE said:

Hi Lynn,

I too have lymphedema and have had all the concerns that you discuss. I have a lot of swelling and pain in the arm on the side I had the lumpectomy on due to node disection and 18 weeks of rads. The skin on that side is more taunt as you described (I will go back to that later). As I noted in an earlier post I go in for recon Friday, I choose the easiest of all the options mostly because of the lymphedema. Here is my reasoning and my findings in regards to this. Since I as a sissy (don't like pain) even though I have plenty of tummy to take from I opted out of that one. The recon that takes the muscle from the back and tunnels it to the breast area does increase the odds of lymphedema even though only slightly, my surgeon suggested I not opt for that one as it would not be good for me to have two damaged arms. The remaining procedure is the expander one where the original scar is reopened and an expander is inserted under the breast muscle and a bit of fluid is inserted. Then on a regular basis fluid is added to allow the chest to expand to a desired size. Once that size is reached the expander remains inside for another 6 to 8 weeks which will allow the skin to stay expanded when the final implant is inserted. This implant is good for 15 to 20 years.

Now back to the taunt skin I mentioned above, my sister has both breasts removed and rebuilt using the back flap procedure. Due to her rads she had to be satisfied with a smaller breast size then she had had previously. Just a note, she also had problems with her back area where the muscle was removed feeling taunt and uncomfortable.

I hope this has been somewhat helpful. Take your time in making your decision Lynn, it took me two years to take the leap into the world of reconstruction. My best to you and many many HUGS!!!!

RE

thank you, RE
I am praying for you on Friday - for peace within and that all goes well, both the surgery and your recovery. Much love to you. You are an inspiration to me. Lynn

dbs1673

w/w
You are not a w/w. I'll share my experience thus far. I also had a bilateral mastectomy with radiation but on my right side. Prior to this I was small built- 34 A. I consulted with the plastic surgeon before my mast. Due to my built some procedures were out. I decided on expanders with implants was the way to go for me. I was not up for any more invasive, extensive surgery. The weekly fills into the expanders were uncomfortable at times but then I guess it was all relative as I was also recovering from the surgery itself. Initially, I did not think I would need radiation but pathology reports directed otherwise. I am tighter on my side that was radiated. I have not had lymphedema but sometimes I feel a sensation of inflamation, not warm to the touch or anything visible just a swelling sensation. I also feel a tightness in the muscle under the breast, like at the bra line. Massaging that breast has been very helpful. I too finished radiation in October. I was not prepared for the fact that drs recommend waiting one month for every week of radiation before doing anything further. patience not being my strong suit and after getting all the thumbs up, I'll be trading in the expanders for the implants in April. There are also things to consider about implants...saline vs silicone. I'm going with the silicone. I never wanted the surgery to be seen by others as a way to get a boob job yet I did take the opportunity to fill out to a 34 B.

All that being said I am a mixed bag of emotions knowing the next surgery is scheduled. The surgery and recovery of what I feel I've worked so hard to heal feels like major steps backward. I am angry and depressed that this ordeal is an everyday inescapable issue that circles around and around. One treatment ends, another recovery begins, etc. I also feel this is kindof like labor...you can't quit in the middle, it will get worse before it gets better but the reward is beautiful.

Hope that helps. Keep asking questions. here's to all our beauty..inside and out!

dawn

mmontero38

Lynn there were many factors
Lynn there were many factors that influenced my decision to have the reconstruction. First and foremost was the fact that I needed to be happy with what I was seeing in the mirror, because I was doing this for ME and my peace of mind more than anything or anyone else. Once that decision was made, I then proceeded to look for and interview many plastic surgeons. After visiting many, I finally found the one that performed the surgery.

I opted for the tram flap, but then again it was only one side, the right. So, though I did lose some muscle in the belly, I still have the left side and by strengthening the abs I haven't noticed any difference in that regard.

My surgeon worked with me on his bill. For the first surgery which was the tram flap, I paid for my deductable and a portion of what the insurance didn't cover. His office made a payment plan with me and I paid him every month until I finished paying him off. For the subsequent surgeries, (nipple reconstruction, fat grafting and tattooing) he accepted what my insurance paid him. So, if you do decide to do the reconstruction, interview many doctors until you find the one that you feel comfortable with, has a good reputation and is willing to work with you. I wish you luck Lynn and keep us posted. Hugs, Lili

lynn1950

dbs1673 said:

w/w
You are not a w/w. I'll share my experience thus far. I also had a bilateral mastectomy with radiation but on my right side. Prior to this I was small built- 34 A. I consulted with the plastic surgeon before my mast. Due to my built some procedures were out. I decided on expanders with implants was the way to go for me. I was not up for any more invasive, extensive surgery. The weekly fills into the expanders were uncomfortable at times but then I guess it was all relative as I was also recovering from the surgery itself. Initially, I did not think I would need radiation but pathology reports directed otherwise. I am tighter on my side that was radiated. I have not had lymphedema but sometimes I feel a sensation of inflamation, not warm to the touch or anything visible just a swelling sensation. I also feel a tightness in the muscle under the breast, like at the bra line. Massaging that breast has been very helpful. I too finished radiation in October. I was not prepared for the fact that drs recommend waiting one month for every week of radiation before doing anything further. patience not being my strong suit and after getting all the thumbs up, I'll be trading in the expanders for the implants in April. There are also things to consider about implants...saline vs silicone. I'm going with the silicone. I never wanted the surgery to be seen by others as a way to get a boob job yet I did take the opportunity to fill out to a 34 B.

All that being said I am a mixed bag of emotions knowing the next surgery is scheduled. The surgery and recovery of what I feel I've worked so hard to heal feels like major steps backward. I am angry and depressed that this ordeal is an everyday inescapable issue that circles around and around. One treatment ends, another recovery begins, etc. I also feel this is kindof like labor...you can't quit in the middle, it will get worse before it gets better but the reward is beautiful.

Hope that helps. Keep asking questions. here's to all our beauty..inside and out!

dawn

You are a warrior!
Dawn, thanks so much for taking the time to "fill me in" (pun intended). I will be a mixed bag of emotions too, if I decide to reconstruct and the surgery date is drawing near. Lynn

lynn1950

mmontero38 said:

Lynn there were many factors
Lynn there were many factors that influenced my decision to have the reconstruction. First and foremost was the fact that I needed to be happy with what I was seeing in the mirror, because I was doing this for ME and my peace of mind more than anything or anyone else. Once that decision was made, I then proceeded to look for and interview many plastic surgeons. After visiting many, I finally found the one that performed the surgery.

I opted for the tram flap, but then again it was only one side, the right. So, though I did lose some muscle in the belly, I still have the left side and by strengthening the abs I haven't noticed any difference in that regard.

My surgeon worked with me on his bill. For the first surgery which was the tram flap, I paid for my deductable and a portion of what the insurance didn't cover. His office made a payment plan with me and I paid him every month until I finished paying him off. For the subsequent surgeries, (nipple reconstruction, fat grafting and tattooing) he accepted what my insurance paid him. So, if you do decide to do the reconstruction, interview many doctors until you find the one that you feel comfortable with, has a good reputation and is willing to work with you. I wish you luck Lynn and keep us posted. Hugs, Lili

Thanks, Lili
That was good information about the financial stuff (which has me worried) and about the tram flap. What is fat grafting? Lynn

mmontero38

lynn1950 said:

Thanks, Lili
That was good information about the financial stuff (which has me worried) and about the tram flap. What is fat grafting? Lynn

Hi Lynn: Fat grafting is
Hi Lynn: Fat grafting is when they remove fat from one area and place it where it is needed on the breast. My chest above the breast mound is very concave, since the surgeon removed the muscle also. So, when they did the breast, I have a rather large indentation which is very noticeable, especially when I wear a bra since the left breast is all there and the right is the made one. So, I feel very self conscious about this. So, my surgeon suggested the grafting. I still am very concave (even after the last surgery and grafting), so tomorrow, I go back to the plastic surgeon for my 3 month check up and we'll see what he suggests. Hugs, Lili

Joycelouise

Ok, Lynn, here is the down
Ok, Lynn, here is the down and dirty. The surgery hurt more than a mas. when it came to recovery. I have an expander on my mas. side. Due to radiation, the skin is slow to stretch and the expander is expanding over the top (area of least resistance) before filling out below. I am very lopsided and have to wear camoflauge clothing. (If I wore a strapless gown it would be one in, one out!). My surgeon tells me the scar will eventually stretch and the expander will fill out more to the bottom as indeed it has started doing.
STILL, I am not sorry (yet?) I did it. Surgeries are a pain, yes, but the pain is over in a couple of weeks for the most part. When all is said and done, I like the adventure of this proceedure and that dreamed of day when I try on new bras at Victorias secret. I am going to wear a scoop neck shirt and bend over and pick up pennies all day long! Love to you in this decision. I too went back and forth alot before plunging (lol) in, especially since the proceedure has cut into my yoga practice.
love, Joyce

lynn1950

Joycelouise said:

Ok, Lynn, here is the down
Ok, Lynn, here is the down and dirty. The surgery hurt more than a mas. when it came to recovery. I have an expander on my mas. side. Due to radiation, the skin is slow to stretch and the expander is expanding over the top (area of least resistance) before filling out below. I am very lopsided and have to wear camoflauge clothing. (If I wore a strapless gown it would be one in, one out!). My surgeon tells me the scar will eventually stretch and the expander will fill out more to the bottom as indeed it has started doing.
STILL, I am not sorry (yet?) I did it. Surgeries are a pain, yes, but the pain is over in a couple of weeks for the most part. When all is said and done, I like the adventure of this proceedure and that dreamed of day when I try on new bras at Victorias secret. I am going to wear a scoop neck shirt and bend over and pick up pennies all day long! Love to you in this decision. I too went back and forth alot before plunging (lol) in, especially since the proceedure has cut into my yoga practice.
love, Joyce

Whew and wow
How long does the expansion process take? To liken it to an adventure is outstanding. Thanks for your support and I will be cheering you on as you try on new bras! Lynn

lynn1950

mmontero38 said:

Hi Lynn: Fat grafting is
Hi Lynn: Fat grafting is when they remove fat from one area and place it where it is needed on the breast. My chest above the breast mound is very concave, since the surgeon removed the muscle also. So, when they did the breast, I have a rather large indentation which is very noticeable, especially when I wear a bra since the left breast is all there and the right is the made one. So, I feel very self conscious about this. So, my surgeon suggested the grafting. I still am very concave (even after the last surgery and grafting), so tomorrow, I go back to the plastic surgeon for my 3 month check up and we'll see what he suggests. Hugs, Lili

Fat grafting
Why don't they just fat graft in the first place? Hope your checkup was a good one and that all is going well. Please let me know how it went. Hugs back, Lynn

mmontero38

lynn1950 said:

Fat grafting
Why don't they just fat graft in the first place? Hope your checkup was a good one and that all is going well. Please let me know how it went. Hugs back, Lynn

Well, due to the snow storm
Well, due to the snow storm we had (12 " in my area) my appointment was postponed to next Monday, But, I will let you know what he says. Hugs, Lili

Joycelouise

lynn1950 said:

Whew and wow
How long does the expansion process take? To liken it to an adventure is outstanding. Thanks for your support and I will be cheering you on as you try on new bras! Lynn

I think it can take from six
I think it can take from six months to a year. They put some expansion fluid in at the time the expanders are put in and you come home from the hospital with preteen breasts. Someone had written to me that it is like puberty all over again. I got my first office "fill" of 25 cc's within three weeks of the surgery and have been going every week for a tiny bit more for the last two months. I think I have a few more months of this till I am stretched (and a few more months of weekly $15 copays, grumble grumble,). Then, the next surgery. Then healing. Then nipple work. But the bra shopping is definitely going to come before the nipples. It will take all the restraint I can muster when I get the new girl not to wear a sexy bra with a drain still in!
For the total time period, it will be a while (but hey, I wasn't doing anything anyway). I plan on being thankful for my breasts by Thanksgiving. I also plan on flaunting them, giving new meaning to "who wants a breast?" at the thanksgiving table, but thats another story!
love, Joyce