Breast reconstruction

[Notjustabrunette]

Hi, I’m due to have a mastectomy and wanted a view on types of reconstruction.
I found out today that I need a mastectomy, and have an appointment next week to discuss options. They would be stay flat, implant or flap reconstruction. I have never heard of flap reconstruction, so is all very new to me.
To help me get a better idea of the pros and cons it would be good to hear some feedback.
I’m 45, if that makes any difference.

I had a flap reconstruction using my latissimus dorsi muscle with an implant, this was done at the same time as my mastectomy, which I am told they don't do this now.

Essentially the cut into my breast removing my nipple and scooped out all the 'bad stuff' like a boiled egg! I had non invasive carcinoma in situ, so not a lump.
Then they detached my lat dorsi muscle, pushed it under my arm and put it in place along with the implant (saline I think) where my breast had been. I also had a shunt? put in the side of the breast in case the implant needed pumping up, but I never have needed it.

That was back in 2003, and never had a problem, I didn't have my nipple reconstructed or tattooed, by then I had had enough.
My surgeon was amazing and did a fantastic reconstruction,when I wear close fitting tops or t shirts you cannot tell, and I just wear ordinary bras. The only scar I have is on my back, and that was really neat, and has faded with time.
I recovered pretty quickly and was back at work after a month. Oh I was 49 at the time.

All this was 20 odd years ago, and things can change massively and the memories get a little blurred.

Good luck with it all, and I hope everything goes well

Hiya. I had a few ops ending in a double mastectomy and reconstruction. I had to have temp implants initially (due to so many ops) but then they got swapped out for actual implants after a few weeks. Whilst they don’t look or feel real when naked they look completely normal in clothes so I’m very happy with them. I had nipples tattooed on them as I felt a little “Barbie” without them.

Should have said I was offered flap but decided I’d had enough of having ops by that point and just wanted it all over to get back to normal as quickly as I could.

Hi, I had a single mastectomy last year after a couple of lumpectomies which didn’t get clear margins. I was offered flat, immediate implant reconstruction or flat with delayed reconstruction.

I chose immediate implant reconstruction. It gives me a shape and I look ok dressed. However, I’m 3 cup sizes smaller on the implant side as there’s a limit to how big they can implant. I use a prosthesis on top of the reconstruction. They’ve said I can have a reduction on the “real” side to match but I don’t want any more surgery.

I have had reconstructions on both breasts one over 20 years ago and one about 14 years ago, both for early breast cancer but as my sister died at 31 and my Mum at 67 of breast cancer I went for full mastectomy on both sides.

I have had implants, the first time, they said I hadn't enough fat to do the flap reconstruction method - and it is quite serious surgery.

The first op (at 47) was in the US at a time when they wouldn't do silicone implants so I had a saline implant that could be pumped up and then an op to replace the one you pump up with a permanent saline one. In the US I was sent home next day to manage my own drains.

In the UK, the second time I had the same to try and match them. In the UK I was kept in hospital for a week till the drains were more or less done with.

On both occasions I have had saline implants, then pumped up - I did get some capsulation (tightening of it all) of the US one about 5 years ago. My NHS consultant was only able to do anything until it became really bad, so she recommended a private surgeon. I was fortunate enough to be able to go privately to have both removed and replaced with silicone about 6 years ago.

One has slipped slightly out of the pouch (I was trying to windsurf!) but they don't look too bad, although not as large as I was, as the pumping up process was quite painful and I couldn't stand going any larger, They mean I can change at the gym discreetly with no problems.

I have tattoos for the nipples.
The great thing about implants is you don't need any real support, so in the Summer I don't usually wear a bra!

Whatever you have done you will not have any sensation on that side.

Good luck!

I had DIEP delayed reconstruction - initial operation was just a mastectomy, day op, not painful took cancer out but left me needing prothesis which I hated. Nearly 3 year wait and 2 cancellations (one on day of op) before 3rd time lucky for delayed DIEP. 11 hour op and a week in hospital, amazing results and very happy with it, full sensation back in it and under arm which is great, apparently its not common but my nerves all reconnected. Looks perfect. 3 month recovery time but could get out and about in that. I flew around the world alone at 4 months post it. Would do the same again, well I won't as can only do once. I would have preferred immediate but there was a delay for that and would have meant delaying cancer out. Also be careful if further treatment needed as if something goes wrong can delay chemo start. I had a BMI of 24 when did operation and that was perfect. Now I have a flat stomach. I do have scars but are fading quickly and don't bother me. One is hip to hip, one on breast.

Stomach scar at about 4 months

You also get your own room with diep after the operation as they like it heated to 40C, the heat is quite hard but own room and bathroom is nice. I also had view to the air ambulance and fields so nice room. Some people who do not try to leap around after operation get released in 3 days but I was in for 7 days which a maximum for no issues at least. I wasn't very good at staying still.

Thank you for this. I have an aggressive type of cancer, although I have caught it early and is still stage 1. The wait time for plastics is freaking me out, so I want to go down the mastectomy, and then deal with the reconstruction at a later date.

I'm looking into having a preventative mastectomy and reconstruction due to brca gene. There's a Macmillan guide to breast reconstruction which is really helpful in explaining the different options. https://www.macmillan.org.uk/cancer-information-and-support/breast-cancer/breast-reconstruction

Personally I'm leaning towards a direct to implant, over the muscle reconstruction as it's the shortest operation with the quickest recovery time. I'm not a candidate for DIEP flap but not sure if I'd be brave enough to do it even if I was a candidate. The lengthy surgery, multiple surgery sites, and longer recovery times are what I worry about. But I know it's got lots of advantages over implants (natural feel, less likely to need further surgeries, no foreign body etc).
Good luck whatever you decide.

@WhereAreWeNow that is a really helpful booklet. I must just comment that I wish my direct to implant (on operation 3) looked as good as the photos. I have very different sized breasts but only had one size done - there is a limit to the size of implant that can be used. There’s also quite a bit of rippling and a dent from where I had a seroma. I’m told I could have fat transfer but don’t want any more messing.

my friend has had both sides done and they look good, nicely balanced.

I did not have the bravery to go for the reconstruction using my own body tissue, even though it was thought of as the best option by my (male) surgeon. The female surgeon, head of team advised immediate reconstruction with implant when I had a meeting with her.

If it wouldn't distress you too much OP on a recent episode of "surgeons life in their hands" (available on iplayer) there was a woman who had a rare gene and she had also had BC for a very aggressive type so she had a double masectomy with the reconstruction from flaps from her belly. It may give you an idea of what happens and outcome. I will say it is quite graphic so please do not watch if it will distress you.

I wish you all the best whatever you decide.

I have just looked and it's series 7 episode 3 if you want to watch it.

I had a single mastectomy 6 weeks ago. I was going to have an immediate DIEP but the CT Angiogram for the blood supply found a large ovarian cyst so I need that removing first.

I've had a skin sparing mastectomy with an implant so I can keep my breast skin for the flap so I should have the same outcome as if it was immediate.

At the minute I'm not sure whether I will ir not, but it's a good 'holding position'

I know you're asking about reconstruction but i see that going flat is one of the options you've listed so i thought my experience might be helpful too, by all means ignore of course!
I had a double mastectomy (well, 2 single mastectomies 6 months apart, first due to cancer, 2nd due to discovering i am brca positive). Did not have immediate reconstruction either time to keep things simple and avoid delays or complications (especially as this was all during covid). 4 years on i am still flat and happy enough this way at this time. My scars are nice and neat, no pain or discomfort. I'm mid 40s, I guess I might yet opt for reconstruction at some point but I'm still not in a place where i feel like I want to volunteer for more medical treatment. There's an amazing woman who is flat and has just run the London marathon topless, if you Google "topless london marathon" you can see her being interviewed on This Morning. Obviously the pros and cons are different for being flat after a single mastectomy as you may still need a bra etc (although i understand a second mastectomy for symmetry is often possible for women who prefer that approach, in case that is a consideration).
Wishing you all the very best with everything.

That's what I did too Notabrunette I wanted the cancer out asap and the mastectomy was such a relief though found it in one lymph node so did a second op to remove all lymph nodes on that side a month later, easy operation and no more cancer found but don't know how that would have worked if had gone for immediate. It also meant no delays from op for chemo starting so felt was doing all I could re getting cancer out. I did find the 3 year wait for delayed and being bumped off when an immediate case came in and op cancelled twice incredibly difficult. But the diep op itself and recovery was fine and very glad I did that. It looks quite natural apart from lack of nipple and scar.

Funnily enough I was watching that episode of this morning in the waiting room right before I went in to be told I had breast cancer.

I’m a bit worried that I’m going to look a bit lopsided though, as will still have one D size boob on the other side.

I've had 2 flap recons. One diep, one tram (not enough fat for 2 dieps shockingly, despite being overweight!). They were done quite a while ago. It was a 13 1/2 hour op and I was in ITU for 48 hours afterwards. Took quite a while to heal and I had wound dressings twice weekly for about 3 months.

I absolutely didn't want implants and I'm happy with that decision.

i think I saw this at the time, but forgot about it. I’ll go back for a rewatch. Thanks for the tip.

I know, i found it impossible to guess how I'd really feel post surgery. For the six months between my surgeries I was a c-cup on one side and flat on the other. It was fine, I mostly wore my normal bras, or post surgery ones from m&s, with a prosthesis (either a "softie" given to me on the ward immediately after surgery, or a silicone prosthesis i was fitted with a few weeks later).

I'm not sure if I'd have chosen to stick with a single mastectomy without reconstruction, I might well have done, but instinctively i preferred the idea of eventually having a second preventative mastectomy (with or without any recon). I felt i should wait until I'd recovered and then take a view but of course once I had the brca info that immediately crystallised things.

I think these are such hard decisions to make. I didn't know how I would feel once flat - but it turns out that relief has been the overwhelming emotion so far along with the joy of feeling fit and healthy again! I still wouldn't rule out reconstruction but it'd be a big op for me (implants aren't an option) so a bit daunting.

I think your feelings can change over time - initially I just felt overwhelming relief the cancer was out and when you are going through treatment and the months after cancer tends to occupy a lot of thoughts. Then as you recover you think less about cancer and want to get back to living as much as you can and for me the single mastectomy reminded me of cancer even clothed. And especially photos. I feel much better after DIEP and if unsure I would advise going on the list as its 3 years or so before you reach the top of it and can always opt out at the end. Now I feel like I did pre cancer though some people do not get feeling back. The diep breast matches the other well, which often doesn't happen with implants especially as people age. Its different having both breasts done as then they will match.

That's such helpful advice @MsPenguins - for me as well as OP - thank you!