Wednesday, August 24, 2011

Reconstruction options

When we met with LC Monday, they didn’t have a plastic surgeon available to meet with us. The general surgeon told us that they offer three types of reconstruction.
1.      An implant.  This would require two surgeries. After the mastectomy they would insert a tissue expander behind the pectoral muscle which would be inflated over a period of 4 to 6 months. After that its outpatient surgery to remove the tissue expander and put in the actual implant. The doctor indicated this was easiest option as the initial surgery would be relatively easy going this route with a short recovery (two weeks). But you have to have a 2nd surgery it’s probably similar down time added up? Also the 4 to 6 months is dependent on how well you tolerate pain because the tissue expanders hurt.
b.      I’m not crazy about having an implant. They don’t last forever, though it’s difficult to figure out how long they do last. 10 to 20 years? So if I live until I’m 90 and they last 15 years, that’s at least two more surgeries. Does insurance cover replacing it years later or will that be on my dime? Also, in January 2011 FDA reported a possible link between both saline and silicone breast implants and a very rare form of lymphoma -- anaplastic large-cell lymphoma (ALCL) -- in the tissue near the implant.

2.      Latissimus Dorsi Flap. They move a muscle from your back and that muscle holds the breast implant. So I’d wake up with a new boob. Longer recovery and scars on back. Also the muscle on your back is gone forever. The doctor said if I was left handed this would be his recommendation but because I’m right handed…  I’d lose strength on that side.  I’m curious to talk to a plastic surgeon about this – how much strength do you lose? How does this really impact you the rest of your life? and still… it’s an implant.

3.      TRAM Flap – They remove an abdominal muscle and fat from the same side (right) and build you a new breast (no implant). I like this idea best because there is no implant but downside is – that abdominal muscle is gone for good.  I’m not sure how that would impact my life in the future. Also a big tummy scar. And I’m not sure if I have enough tummy fat to make a nice C cup.  A plastic surgeon would need to decide so… this might not even be an option for me.

So two involve implants, two involve moving muscles from other parts of my body and one, I don’t know is an option for me until I see a plastic surgeon. Now let’s add more decisions.
·         If genetic testing comes back that I am positive for the breast cancer gene – Bill and I agree that I will have a double mastectomy. Then implants will have to be the way to go and I’d probably just do your basic implant as I wouldn’t want my back muscles gone from both sides.
·         The doctor suggested, and I thought he was nuts at the time, that lots of younger women, opt to have a double mastectomy, regardless of the results of genetic testing. They do this to reduce the risk of getting cancer in the remaining breast and to have both breasts be the same (i.e. implants).  While at first this seemed crazy to me… if I can’t have the TRAM and I have to get implants… maybe it doesn’t seem so crazy?

And I'm not even thinking about the nipple reconstruction after all of that!

Big decisions!  And I can barely decide what t-shirt to wear and what to cook for dinner!  I’m hoping that talking with a plastic surgeon will make this easier.  My appointment with Dana Farber is Thursday September 1st.  We are meeting with a plastic surgeon first at a different location, then the breast surgeon and oncology. I expect we'll make a decision that day on where I'll go for treatment.

This slideshow - kind of scares the crap out of me.

Any thoughts, opinions, links to websites are all welcome.

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