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Topic: Australian reconstruction options?

Forum: Australians and New Zealanders Affected by Breast Cancer —

Australian health care, clinical trials, and life in general in the land down under.

Posted on: Jun 3, 2012 02:40AM

Jennt28 wrote:

Hi there,

After making a quick initial decision to have a lumpectomy I am now considering a double mastectomy early next year and need to figure out my reconstruction options here in Sydney and maybe other cities...

I have positive nodes so will be doing rads with axilla but not with supra-clavicular nodes and I gather there are no surgeons in Australia that will do implants for a woman who has had rads (very different to the USA!). So, my options basically are flaps.

Having done my online research I really would be interested in TUG or PAP flaps as I think I've definitely been carrying my "spare" breasts around on my thighs my whole adult life! Only problem is that I can't seem to find any surgeons as yet that are doing these types of flaps in Australia.

Does anyone know of any surgeons doing these?

It would also be great if those that have had DIEP or TRAM can give me advice on which clinics you interviewed and what your experience was here in Sydney (or elsewhere)?

Since our options here in Australia are more limited than in the USA maybe we can keep this thread going with hints and tips and stories of reconstruction experiences here in Australia???

Jenn

Jennt28 jennt28.wordpress.com/ - 3 x FEC, 11x weekly Taxol, 12 months Herceptin (end March 2013), 12 days rads (quit), BMX with recon, Tamoxifen Dx 12/1/2011, IDC, 2cm, Stage IIA, Grade 3, 1/2 nodes, ER+/PR+, HER2+ Surgery 12/6/2011 Lumpectomy: Right; Lymph node removal: Right, Sentinel Hormonal Therapy 8/1/2012 Surgery 9/27/2012 Lymph node removal: Right, Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Free TRAM flap; Reconstruction (right): Free TRAM flap Surgery 1/27/2014 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction Hormonal Therapy 3/9/2014 Femara (letrozole)
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Jun 5, 2012 10:52PM - edited Jun 5, 2012 11:11PM by SandyAust

Hi Jenn,

I saw your post and googled 'PAP and TUG Australia' and found your recent post on BCNA.  There seems to be a few doctors recommended on there, for DIEP at least.  I wish you luck.

I had a left mastectomy nearly eight years ago at 36.  I was going to have an immediate reconstruction, TRAM, but pulled out the night before due to my plastic surgeon being a jerk and because I couldn't decide then and there not to have any more kids.

I am now wishing in some ways that I had a reconstruction as I think it does affect how I feel about myself with my husband (not his fault). I have other health problems though and I really worry about the recovery from major surgery. What to do?  What to do?

Good luck with your research. By the way the plastic surgeon I was going to use in Perth (I live in Brisbane now) apparently does excellent work, if you can put up with his personality.  If you want his name PM me.  I can't exactly name him on here after I have called him a jerk.

 Edited to add: I think the $18k out of pocket after Medicare and private health is way too high based on what I was quoted. 

Take care,

Sandy

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Jun 5, 2012 11:20PM Linda1966 wrote:

Jenn, you'd need to check and do due diligence, cause I have no idea what those two surgeries are, but perhaps Thailand might be an option if the reconstructive surgery they do is what you are after and Australia doesnt. I had a staff member go there for breast implants (the girl was seriously flat) and she had wonderful results and a comfortable experience and cannot compliment the dr and nurses enough. At least a third of the price, you stay in a hotel attached to the hospital for a week or two until the drains are removed and then fly home. Just not sure if they do reconstructions after masectomy, but it might be worth checking into. If you like I can find out the name of the dr and hospital my staff member used.

Dx 12/4/2008, DCIS, 6cm+, Stage 0, Grade 3, 1/18 nodes, ER+/PR-, HER2- Dx 12/4/2008, IDC, 1cm, Stage IB, Grade 2, 1/18 nodes, ER+/PR-, HER2- Surgery 12/15/2008 Lymph node removal: Left, Sentinel; Mastectomy: Left Surgery 12/19/2008 Lymph node removal: Left, Underarm/Axillary Chemotherapy 1/19/2009 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Hormonal Therapy 8/10/2009 Arimidex (anastrozole)
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Jun 6, 2012 01:02AM Jennt28 wrote:

Thanks Sandy and Lyndal for your replies. I am hoping that now we have a specific Australasian section my message can sit there and maybe eventually get a few replies with Australian specific stories of recon and what is available here.

Lyndal, I just would not be comfortable travelling to another country for this surgery. Particularly since I need to have a combined mastectomy with the recon and I would want my breasts to be very thoroughly checked by pathology for any problems after they were removed...

I always thought PS' were usually quite personable but you never know I guess! I'll take a pass on the arrogant(?) one thanks Sandy. I don't put up with crap easily ;-)

Jenn

Jenn

Jennt28 jennt28.wordpress.com/ - 3 x FEC, 11x weekly Taxol, 12 months Herceptin (end March 2013), 12 days rads (quit), BMX with recon, Tamoxifen Dx 12/1/2011, IDC, 2cm, Stage IIA, Grade 3, 1/2 nodes, ER+/PR+, HER2+ Surgery 12/6/2011 Lumpectomy: Right; Lymph node removal: Right, Sentinel Hormonal Therapy 8/1/2012 Surgery 9/27/2012 Lymph node removal: Right, Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Free TRAM flap; Reconstruction (right): Free TRAM flap Surgery 1/27/2014 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction Hormonal Therapy 3/9/2014 Femara (letrozole)
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Jun 7, 2012 04:04PM kyliet wrote:

Jenn - I normally hate the 'Today Tonight' sensationalism, but last night (Thursday, 7.6.12. Channel 9) they had a segment on breast reconstruction using your own stem cells, said it was 'easier' than traditional recon.  They had an australian breast cancer patient as well as others.  Apparently it has just been approved in Australia. Worth looking at online. Kylie x

When life gives you a 100 reasons to cry, show life you have a 1000 reasons to smile. Mulitfocal, ECE, lymph. channel invasion, Chemo. RADs. Arimidex. Monthly Zoladex. Dx 11/11/2011, IDC, Left, 1cm, Stage IIA, Grade 1, 3/26 nodes, ER+/PR+, HER2-
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Jun 7, 2012 06:17PM LouLou40 wrote:

Hi Katopet, it was on a current affair, you can find details on their web site.

I had a consultation with this PS (DR David Chin) who offers this technology in Brisbane at the Wesley Hosp last year when he had recieved TGA approval for the technology, my support group sent information through on it.

I have quite a deformed breast post lunpectomy and he said fat grafting would give me a great result, and stop the effects of the radiation than can continue to cause shrinkage for about 10yrs post. Unfotunately reconstruction for lumpectomy isn't covered by medicare and therefore also not by private health, so it would have been in excess of 10K with him bulk billing his fee, which personally I couildn't justify. He said he would let  me know if and when he got approval from medicare as he was very keen to do the procedure.

When I spoke to him last year he was not offereing breast reconstruction post mastecomy with fat grafting alone, but was usuing it to fill in dents after flap or implants, reconstruction post mastectomy is covered by medicare including fat grafting.

He is a very nice Dr and would recommending ringing jis rooms if anybody is interested.

Surgery 2/10/2009 Lumpectomy: Left; Lymph node removal: Left, Underarm/Axillary Dx 2/11/2009, IDC, 2cm, Stage II, Grade 3, 2/10 nodes, ER+/PR+, HER2+ Chemotherapy 3/10/2009 AC + T (Taxol) Radiation Therapy Targeted Therapy Herceptin (trastuzumab)
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Jun 7, 2012 07:31PM Jennt28 wrote:

Thanks for the info! I was so horrified by the costings for recon I was seeing when researching last week that I told my husband that I would just have the double mastectomy and go flat. He is so sweet - even though we have no money to speak of he assured me that we would find it somewhere and I would get the recon I want. Somehow I think there's a little bit of self preservation there though - sadly the poor guy has always been a breasts man (@)(@).

 Jenn

Jennt28 jennt28.wordpress.com/ - 3 x FEC, 11x weekly Taxol, 12 months Herceptin (end March 2013), 12 days rads (quit), BMX with recon, Tamoxifen Dx 12/1/2011, IDC, 2cm, Stage IIA, Grade 3, 1/2 nodes, ER+/PR+, HER2+ Surgery 12/6/2011 Lumpectomy: Right; Lymph node removal: Right, Sentinel Hormonal Therapy 8/1/2012 Surgery 9/27/2012 Lymph node removal: Right, Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Free TRAM flap; Reconstruction (right): Free TRAM flap Surgery 1/27/2014 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction Hormonal Therapy 3/9/2014 Femara (letrozole)
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Jun 7, 2012 08:41PM LouLou40 wrote:

It's funny my DH didn't think it was necessary for me to even think about having my wonky boob fixed, but when I said no because of cost he said immediately said I should do it if it would make me happy. I can afford it, I just can't justify the cost on principal when I pay a fortune in private health and they won't cover any of the cost. My deformity is only visible when I'm undressed, so happy to live with it for now, but reserve my choice to change my mind.

I aslo have my concerns that if I did have fat grafting it may be harder to read mammos and ultrasounds and end up with false positives. I have read that there are concerns that stem cells may also casue cancer cells to grow and can can't be 100% sure that there aren't any stray cells left behind laying dormant in my boob.

 Jenn I will PM you with a PS recommendation for Syd.

Surgery 2/10/2009 Lumpectomy: Left; Lymph node removal: Left, Underarm/Axillary Dx 2/11/2009, IDC, 2cm, Stage II, Grade 3, 2/10 nodes, ER+/PR+, HER2+ Chemotherapy 3/10/2009 AC + T (Taxol) Radiation Therapy Targeted Therapy Herceptin (trastuzumab)
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Jun 8, 2012 06:19AM melp27 wrote:

My surgeon recommended a lat dorsi or some type of TRAM flap for my reconstruction. cant afford private hospital so am going to be put on the waiting list. worried if i have the lat dorsi i will have to sleep upright and im usually a side sleeper. Anyone know if i have the tram flap will that affect my ability to bear children because of loosing some of the stomach muscles?

Dx 7/25/2011, ILC, Left, 6cm+, Grade 3, 20/24 nodes, ER+/PR+, HER2- Surgery 8/14/2011 Lymph node removal: Left, Sentinel; Mastectomy: Left Radiation Therapy 2/14/2012 Breast Dx 10/2/2014, DCIS, Right, 2cm, Stage 0, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 10/19/2014 Mastectomy: Right; Reconstruction (right): Tissue expander placement Surgery 6/28/2015 Reconstruction (left): Latissimus dorsi flap, Tissue expander placement Dx 9/2015, ILC, Stage IV, metastasized to lungs, ER+, HER2- Hormonal Therapy Femara (letrozole), Zoladex (goserelin)
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Jun 9, 2012 11:07PM SandyAust wrote:

Hi Melp27.  I was 36 when diagnosed and I was told by my plastic surgeon that I must have finished my family if I wanted a TRAM flap.  This was one of the reasons I didn't have a reconstruction.  This was eight years ago. However I have subsequently read that this is not necessarily the case.  It is possible to have a pregnancy after a TRAM flap.

Sandy

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Jun 10, 2012 12:27AM kerrie389 wrote:

Hi Jenn,

I had a tram flap at Strathfield private and RPA almost 12months ago now as a private patient .

Have just finished with the nipple tattoos and am about 18K out of pocket. The results are great and i am so pleased with my surgeon. Not sure if he does the type of reconstruction you are wanting but maybe worth a visit and a chat. He really is wonderful and i can't speak highly enough of him.

If you want any details let me know and i'll PM you.

All the best. 

DX Oct 2009. 15mm tumour. Grade 2 Stage 2. 2/18 nodes pos. OES/PROG + HER -
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Jun 10, 2012 05:09AM Jennt28 wrote:

Kerrie a PM would be great thanks :-)

Jenn

Jennt28 jennt28.wordpress.com/ - 3 x FEC, 11x weekly Taxol, 12 months Herceptin (end March 2013), 12 days rads (quit), BMX with recon, Tamoxifen Dx 12/1/2011, IDC, 2cm, Stage IIA, Grade 3, 1/2 nodes, ER+/PR+, HER2+ Surgery 12/6/2011 Lumpectomy: Right; Lymph node removal: Right, Sentinel Hormonal Therapy 8/1/2012 Surgery 9/27/2012 Lymph node removal: Right, Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Free TRAM flap; Reconstruction (right): Free TRAM flap Surgery 1/27/2014 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction Hormonal Therapy 3/9/2014 Femara (letrozole)
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Jun 16, 2012 07:36PM Robyn_S wrote:

Hi Jenn. I had a bilateral DIEP last month after my plan for implants went AWOL following an infection after rads that saw me lose the TE on my cancer side. The infection and rads rendered that side a mess of scarring and cooked muscles so DIEP was the only option.
In hindsight I would have planned DIEP from the start after mastectomy. The only downside for me now is that I have my stretch marks from my tummy transplanted to my chest- a planned mx and immediate DiEp may have left the skin there on my chest.
I had my reconstruction at RMH luckily as a public patient so have not been out of pocket at all and have been able to make my own decisions about treatment all the way along the journey. The DIEP results are great considering what they had to work with! I know that the plastics breast unit here do TUG - I spoke with a patient who did exactly as you are planning.
Good luck in your journey! Robyn

Age 46 @ Dx, BMX, FEC/T, Rads, Tamoxifen, Femara, DIEP 2012 ( the works!!) Dx 3/8/2011, ILC, 6cm+, Stage IIIA, Grade 1, 1/5 nodes, ER+/PR+, HER2-
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Jul 6, 2012 05:46AM melp27 wrote:

my surgeon is Dr James kollias he's really good. he suggested either lat dorsi or some version of tram flap but personally i dont think i have enough tummy fat for the tram. im praying its not two years but i dont know how many days a week he does public patients versus private ones. I guess when i get some work i will need to start saving so when i need time off i will have some money saved up. Seeing him on the 16th to talk about reconstruction and have my first mammogram since diagnosis on my other side. a bit nervous about that part of it but thats natural right?

thanks sandy. its good to know if i have that one done i should be able to bear children should i have any. after recon ive heard most people take 2-3 months off work is that just an average?

Dx 7/25/2011, ILC, Left, 6cm+, Grade 3, 20/24 nodes, ER+/PR+, HER2- Surgery 8/14/2011 Lymph node removal: Left, Sentinel; Mastectomy: Left Radiation Therapy 2/14/2012 Breast Dx 10/2/2014, DCIS, Right, 2cm, Stage 0, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 10/19/2014 Mastectomy: Right; Reconstruction (right): Tissue expander placement Surgery 6/28/2015 Reconstruction (left): Latissimus dorsi flap, Tissue expander placement Dx 9/2015, ILC, Stage IV, metastasized to lungs, ER+, HER2- Hormonal Therapy Femara (letrozole), Zoladex (goserelin)
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Aug 10, 2012 03:04AM Jennt28 wrote:

I met with the PS today and after going in wanting implant recon came out with a surgery date of 28 Sept for a bilateral free tram flap.

Looking at the photos of his previous patients you could barely tell they had any surgery. He does a great job!

Jenn

Jennt28 jennt28.wordpress.com/ - 3 x FEC, 11x weekly Taxol, 12 months Herceptin (end March 2013), 12 days rads (quit), BMX with recon, Tamoxifen Dx 12/1/2011, IDC, 2cm, Stage IIA, Grade 3, 1/2 nodes, ER+/PR+, HER2+ Surgery 12/6/2011 Lumpectomy: Right; Lymph node removal: Right, Sentinel Hormonal Therapy 8/1/2012 Surgery 9/27/2012 Lymph node removal: Right, Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Free TRAM flap; Reconstruction (right): Free TRAM flap Surgery 1/27/2014 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction Hormonal Therapy 3/9/2014 Femara (letrozole)
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Sep 9, 2012 11:05AM Jennt28 wrote:

Off today for a CT angiogram so the PS can see where my perforator veins are to plan the flaps. Also have an appt with my BS today to habe a last talk about how she is going to do the BMX.

Wednesday I have a 3.5hr pre-surgery clinic!

Countdown is definitely on...

Jenn

Jennt28 jennt28.wordpress.com/ - 3 x FEC, 11x weekly Taxol, 12 months Herceptin (end March 2013), 12 days rads (quit), BMX with recon, Tamoxifen Dx 12/1/2011, IDC, 2cm, Stage IIA, Grade 3, 1/2 nodes, ER+/PR+, HER2+ Surgery 12/6/2011 Lumpectomy: Right; Lymph node removal: Right, Sentinel Hormonal Therapy 8/1/2012 Surgery 9/27/2012 Lymph node removal: Right, Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Free TRAM flap; Reconstruction (right): Free TRAM flap Surgery 1/27/2014 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction Hormonal Therapy 3/9/2014 Femara (letrozole)
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Sep 9, 2012 10:25PM chrissyb wrote:

Good luck Jenn!

I found my peace which gave me strength. 52 at dx. Dx 12/8/2003, IDC, 4cm, Stage IV, Grade 2, 0/12 nodes, mets, ER+/PR+, HER2-
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Jul 26, 2018 01:55AM Dhanno wrote:

I really need to revive this thread .I will be having UMX at Royal Brisbane Hospital .It seems the PS here do not do DIEP . The PS did not even mention DIEP .He said I can be a candidate for Tram .Any one from Brisbane here who has any idea about DIEP .I think PS in Brisbane do not specialize in DIEP .Any suggestion ?


Dx 5/20/2018, IDC, Left, 2cm, Grade 1, 0/5 nodes, ER+/PR+, HER2-

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