delayed reconstruction options

I had a single mastectomy at the end of May and wasn't offered a reconstruction at the time as it was thought that I would need radiotherapy. The tumors were found to be very small and low grade so I haven't needed any chemo or radiotherapy (just Tamoxifen). I have an appointment next week to meet the breast surgeon to discuss reconstruction. My remaining breast is a quite large 36e and quite saggy so I assume they would look at an uplift / reduction? on that side.

Any experiences of delayed reconstruction (I havent had any tissue expanders in or anything like that) . I was thinking of an implant but assume I(d need tissue expander to stretch the skin beforehand and can this be done now three months after surgery?) I'm not really bothered about keeping my breast size just want to look as matched in size as possible. I even thought of asking for a mastectomy on the remaining breast (something I wanted initially but they wouldnt consider) as to decrease the risk of the cancer returning and so i am more matched.

I have struggled quite massively with the lopsided look more than the loss of the breast.

Any thoughts or experiences would be most welcomed , thanks, Mel

17 Replies

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  • Hey Mel,

    Completely get where you are coming from. I feel the same and am booked in for reconstruction next spring.

    Your options will be wider as youve not had radiotherapy -this means your skin will be good (radiotherapy affects the skin so mine cant be used). It all depends on how much tissue you have and whether expanders will work for you. Lots of people do implants.

    I cant do this route so am looking at a flap. For me it will be a DIEP or transflap. This is where they take skin and tissue from the tummy and transplant it to form a new breast. Big op....ugh....not looking forward to it.

    They most certainly will do an uplift of your breast and if necessary can alter the size, to match your new one. They will also offer your nipple reconstruction and tattooing . My surgeon has offered to do the uplift at the same time as the reconstruction -I thought no at first but as times gone on I may just go for that and get it over and done with -hopefully. Your surgeon may have to revise so its possible further smaller ops could be on the cards if they need ti tweak things.

    Your best bet is to make sure you are with a specialist in breast reconstruction. I decided to go to a specialist centre on top of this. This does mean I will have to travel but its too big an op and I want to make sure Ive given myself the best chance of it being a good outcome. You have the right to choose your plastic surgeon....

    A good one will discuss your options through with you carefully.

    Hope this helps..xx

  • Hi Mel. Glad to hear your results are good. I've read the other response and agree totally that you must do your research on specialist plastic surgeons in diep and tram flap operations as they are 7 hour operations and complex. I will be attending a group run by Macmillan to talk with other women who have been through reconstruction operations or about to go through one so I can ask lots of questions from their experience. I doubt they will recommend an implant and it isn't considered the best option for larger breasts, I'm 38F and also considering my options but already found a top surgeon in Oxford.

    Good luck. X

  • Hi, I had a mastectomy 2011 and had to wait a year for reconstruction as they thought my tumour may return on the skin and had chemo too. It is a real pain being lopsided, I know what you mean by saying you wanted rid of the other, but don't. Nicola Jane do a few t shirts you can put your prosthesis in, and basically I just bought loads of lace top camisoles from M&S ans wore them under whatever I was wearing, otherwise you flash everyone your lack of boob when you lean foreword.

    I had. DIEP reconstruction at Salisbury , by Nigrl Horlock, I can seriously say it was totally worth any pain along the way. I am quite thin so taking the tissue was tight, he said he knew it would stretch as I have had 2 children, but I wasn't allowed to stand up straight for 3 weeks. I was back at work at 6 weeks and since have had a nipple made and tattooed and it is brilliant. Your main choice will be. DIEP flap or a latissimus Doris flap. I play a lot of sport so the surgeon thought the former was better. I love my new " mound" as they call it. I also think having no boob for a year helps you accept it all more, my friends who had immediate reckons never seemed as happy with them, they didn't know what a pain it is without one.

    Hope this helps a little...

  • I am having a DIEP by Nigel Horlock in November so was very interested in your response. I have been waiting 2 years as I had Stage 3B breast cancer and both chemo and radio and wanted to recover fully before making my decision. Having now decided to go ahead I can't wait. Mr Horlock has said that he will reduce my remaining breast as I do not have enough abdominal fat to make the same size. Double bonus! Look forward to sharing my recovery and the support from this group.

  • Hello all.

    I'm very interested in hearing how you ladies find the best surgeons and are they NHS?

    I've just had 6 weeks of Letrozole which has shrunk my lump a bit and am having another 4 to 6 weeks on it, then a MRI then a lumpectomy then radiotherapy. I thought I would be able to have an immediate reconstruction and equalizing of the other breast, but it seems not if I have radiotherapy. So much for choice. It's our bodies that do the choosing.

    Anyway, as I was saying, where do you find these top surgeons? My chap might be one, but how would I know?

    Thanks

    Ann.

  • What brilliant,informative replies! Love this site-you can't beat hearing from people who have experienced the same thing! I had a single masectomy in February-am very small anyway (had to pull nearly all the stuffing out of my softy! Lol. Am going to stay as I am. Good luck with your reconstruction 😊X

  • Iv had lumpectomy, mastectomy, chemo and radio.

    And on Thursday had my final implants put in after recon in March.

    Iv had the good boob augmented as well, it's amazing, been a long hard journey but well worth it , good luck

  • I was due for an immediate reconstruction with a DIEP flap procedure when my tumour. I was not due to have any radiotherapy or chemotherapy but I had been advised how important it was to keep my rounded skin shape to maintain the "drape" of any new breast shape. On the day of surgery lack of high care beds at my hospital meant that, at very short notice, I was offered a "temporary" implant or the option to delay surgery altogether and have the entire operation about a fortnight later. As I was desperate to get the tumour removed and thought a two week delay could jeopardise my recovery prospects I accepted the implant option. All went very well and my plastic surgeon was very pleased with the "balanced" look he had achieved with the implant. I then got my pathology results and found that chemotherapy was required so the reconstruction operation was delayed because chemotherapy took priority. One year and three days later (not that I was counting you understand) my temporary implant was removed and this year I have undergone a DIEP reconstruction using my tummy tissues. On the morning of surgery my plastic surgeon offered to let me keep the implant. He was so excited about the look and visual balance that I already had that he spent a moment checking if I still wanted to go ahead with such a major procedure. He had already offered me a lift on my natural boob to balance to the implanted one. The volume was good but my age meant that my own boob was naturally more saggy. The best decision I ever made was to go ahead with the reconstruction surgery. I am in a fairly unique position to directly compare and contrast between a 'natural' reconstruction and a natural tissue rebuild. I found the implant very heavy, cold and sort of oblong shaped - it never draped downwards like my natural breast did. The surgeon advised me that, in his opinion, he considered that muscle/fat tissue would weigh the same as an implant so that alone was unlikely to change because he would have to create the same volume with natural tissue. Well, he was wrong (don't know what feedback he got from other patients, if any) but my new breast is wonderful. It looks and feels great and was worth the trauma of the extra surgery. I now need minor cosmetic surgery to rebalance my older "saggy" boob with a small lift and a nipple adding to my new boob but that is planned as a one hour day surgery procedure, but then that was going to happen had I retained the implant. Incidentally, the term "temporary implant" used on the morning of my first planned surgery misled both myself and my husband in to believing that the quality of the implant would be temporary and that it would have to be replaced by reconstructive surgery with another implant or natural tissue. It wasn't until I went back to my plastic surgeon after chemotherapy and he was strutting around very pleased with the work he had already done that it came to light that I could have kept the implant. The quality of the implant was 100% normal for any implant but what the surgeon had meant was to soften the blow of the news that my natural reconstruction could not take place but that he would replace it as soon as possible. He kept his promise because surgery for a DIEP reconstruction had been booked only four weeks after my tumour removal to replace the implant but chemotherapy got in the way. Junior Doctor's strike is likely to delay my proposed cosmetic finishing surgery but as it is only cosmetic, I don't mind that at all. The best news is that I am free of cancer for now with an excellent prognosis so I am very happy and content with my life. I celebrate life every day. Hope this long tale helps you to make a decision that is right for you. X

  • Hi Mel. I had a mastectomy in May 2014, and could not have instant reconstruction because I needed radiotherapy a month later (I had chemo first). I was a 44DD so larger than the average lady. They matched me up perfectly with a size 12 silicon prosthesis, and when worn with a firm support mastectomy bra, no one could tell it wasn't natural.

    I focussed on getting back into shape and losing weight after my treatment, and returned to my BCN 6 months later to swap for a size 9 prosthesis and was told I needed 38C bras now. Again no one could ever tell.

    I decided right from the start that I didn't want an implant. The best results are always flaps from your own body, and I opted for a DIEP flap which my breast consultant fully agreed with. He referred me to a surgeon at East Grinstead, my local reconstruction hospital. I am pleased to report that after waiting patiently for 25 months this since my treatment finished, I had my DIEP flap op on Thursday 25th August. It took 8 and a half hours and went amazingly well. I came home 4 days later, on Bank Holiday Monday, and am currently recovering well.

    My new breast is smaller than my existing breast, but in about 6 months time, I can go back for Day Surgery to have the other one lifted and reduced. I'll only need about a week off work to recover from that. Then in about 2 years time, I can have nipple reconstruction and henna tattooing to finish it off. This is optional but I do plan to have it, despite having been given a prosthetic nipple to bring home with me.

    Even at this early stage, I can see how, natural and beautiful my new breast is. I am so pleased with it. It was certainly worth waiting for. If you'd like to know anything, please don't hesitate to ask. Sue x

  • Thanks for the replies, I dont really fancy having a large operation but need for my own sanity to get to some sort of normality. I am concerned about the recovery time as I am a single parent and need to have as little time off work as possible. I am struggling with the softie as it rides up high and the prosthesis the hospital gave me is too heavy and makes me sweat. I cant seem to get it to fit properly. I wish I would have been smaller breasted... Good advise to about the chamisole vest tops. I have been wearing normal vests under my baggy tops but have had a few moments where I have bent over and the top of my softie shows ha ha..

  • it might be worth trying to get a better weight prostheses, I have had the luxury of a specialist fitter who attends my local hopital one Friday in four, and is at my next nearest hospital every Thursday. The reason I have never had recon is cos I'm so happy with prosthesis!!

  • Have you thought about Knitted Knockers to get a lightweight, comfortable softie? Just put "Knitted Knockers" into an Internet search engine and you should find their website with ease!

  • I know exactly what you mean. I had my mastectomy 2 years ago with a temporary implant and I'm only just on the waiting list for a DIEP flap reconstruction. I hate being lopsided but have adapted clothes and underwear accordingly. I find sports bras such as shock absorbers where they push together are good to even out and I try not to wear stripes! It is a shame they won't do the other side as well. I also asked if I could have a mastectomy on the other side but because the chances of it coming that side is low they can't justify it at the MDT meeting. See your surgeon and breast care nurses and discuss options and take your time making a decision.

    Good luck xx

  • Hi Mel, I'm not able to advise about recon as I had lumpectomies, but I'd like to wish you well with whichever recon you go for x

  • Mel, are you not wearing post -op bras with pockets in the cups? You need to wear these with prostheses. The silicon won't make you sweat if it's separated from your skin by a layer of cotton, and softies can't become visible inside these bras. You need firm support post-op bras, which your BCNshould have helped you get sized correctly for. If you wear the correct things, you shouldn't have a problem.

    I understand your not wanting a lengthy recovery time with your home situation, which rules out the DIEP flap procedure. You do need to sit down with your BCN or Breast Surgeon to discuss what is the best solution for you.

  • yeah I have the post op bra (scaffolding) that I was measured for with the prosthesis, its in a made fabric so maybe thats the reason I sweat with it in? My scar had healed but ended up getting red and infected when I started wearing it two months post surgery . I am currently wearing a M and S cotton mastectomy bra with the softie. And highly patterned loose tops seem to help disguise the unevenness I hope..

  • My bcn did not help me at all re getting bras for my prothesis -I was advised to go to specialist shops & that was it. I then visited my bcn with bra in hand to get my prothesis fitted. It certainly is true that you do need a proper prothesis bra as it has pockets to hold it in place and away from your skin. Definately worth purchasing. You can ask for the VAT off these bras which the retailer should take off for you (they claim back from the government not you). This helps to bring the cost down. Icould also claim for mine on my private health plan under 'medical appliances' worth trying if you have one -did so for my wigs too!

    I also found my softie constantly made me lopsided -this was because Im big breasted and the softie was much lighter then my real breast. Very annoying and wore a lot of long scarves to disguise.

    I agree with Sue -Do talk to your surgeon and bcn who can discuss your options. Theres a useful single sheet explanation of all reconstruction options on Macmillians website which is good for an overview. Also breastcancercare can put you in touch with someone who's been through it called -'someone like me' they can follow you through and offer support which can be useful.

    Difficult decision.....but one that needs to be taylor made to your needs.

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