Immediate reconstruction vs. going flat now and possible reconstruction later
Can someone tell me the risks & benefits of having immediate autologous reconstruction in the same surgery as single mastectomy? And the risks & benefits of going flat after single mastectomy now, but considering having autologous reconstruction a couple of years later? The breast had radiation treatment 18 years ago for DCIS, and a new DCIS means mastectomy is necessary.
I can't tolerate the idea of having an expander; I have a sensitive body and they sound like nightmares.
I'm panicking a bit about going flat now (current plan) because that means removing more skin. What would that mean for reconstruction later? Implants aren't a good option for me.
Is there another option besides going flat or having immediate reconstruction? Like skin-sparing mastectomy? My surgeon is great and patient (same surgeon as 18 years ago), but I'm struggling to figure out what questions to ask and how to figure out all the differences between my options. Her hospital does not offer immediate reconstruction during the same surgery; I'd be waiting a year or more for autologous reconstruction with the PS she recommends.
Many thanks.
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Hi @melissa_s
Sorry you have had a 2nd dx and have had to join us, but very glad you found us!
I think the biggest 'risks & benefits' of immediate recon vs doing it separately are more emotional than anything else. I did both. With flap surgeries (especially from the abdomen), I think they can be much longer due to their complexity, so that incurs some risk.
With my 1st dx (22 years ago), I had a single mx with a tram flap (with reduction of other side) 9 months later. At the time, I didn't know what I wanted to do and I just wanted the cancer GONE. Fortunately, my surgeon did a skin-sparing mx so I was prepared for whatever recon I wanted to do later, if I wanted to do any. I think a downside of that would be if you later decided not to do recon, you might want some of that skin removed? For me at that time, it was likely a good thing as it gave me time to research my options. The hard part was having one very large breast and one very small (with skin sparing, it seemed like there was 'something' there, though it wasn't much) which meant I needed to always have something in my bra to balance them out. Once I made my recon decision, it was difficult to wait for the recon surgery—-so emotional more than anything.
With my 2nd dx (2022), I had a single mx with a lat flap and fat transfer (without an implant). Since I already had a tram flap (like a DIEP), my choices were limited and I didn't want an implant. This time doing it all at once had the downside of having to wait 6 weeks in order to have both surgeons available. That was hard again from an emotional standpoint.
In both cases, there were further surgeries to "fine-tune" the recons.
In both cases, there was 'waiting'—-seems to always be part of this journey.
It sounds like you have a good relationship with your breast surgeon. Talk to her. Then talk to the PS she recommends so you know what your options are and to be sure you are comfortable with them. Maybe even talk to another PS. Get all your information together. Then…follow your gut. Once you make your decision, it's a good decision for you. No second guessing. Just feel good about it.
Good luck to you.
Take care.
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@mandy23, thank you. I need to keep reminding myself that this is a bad situation, and there will be no perfect answer or a reconstruction where everything looks exactly as it does now.
With your skin-sparing mastectomy, did you have an expander put in? Or do something else to maintain the shape until reconstruction? I'm trying to understand if there are options other than going flat, delayed reconstruction with expander, or immediate reconstruction in the same surgery.
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Hi @melissa_s! You might find this page from our main site helpful as you weigh immediate vs. delayed reconstruction: When Is Breast Reconstruction Done? It covers the pros and cons of each approach and may help you discuss next steps with your surgeon.
We hope this helps. We’re here for you.💕
The Mods
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Hi @melissa_s
First I should again qualify that my delayed recon was 22 years ago as I noted, so what was done then and what is done today may be different. No, I did not have an expander. As i recall, the skin sparing mx just ended up with excess skin in the area. It's not really formed into a breast. This is why I said if you do this and later decide to just stay flat, you might want another surgery to remove the excess skin.
I should also note that I don't know anything about keeping nipples. The first mx it was something that was rarely done. The 2nd mx, my tumor was too close to the nipple to be able to keep it.
So, on your options list, for me, the 1st time was delayed flap reconstruction (no expander).
Best of luck to you.
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Thank you, both Mandy and moderators. I appreciate the information.
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