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Topic: Reconstruction went bad

Forum: Breast Reconstruction — Is it right for you? Discuss timing and various procedures and techniques.

Posted on: Jan 9, 2020 04:22PM

1402Rose wrote:

I was diagnosed with breast cancer in October 2019 and had a double mastectomy with expanders put in for both breasts on November 20th, 2019. The plan was to have another surgery to remove the expanders and put in silocons. But.... The drain on the right was taken out a week after the surgery but had issues with the left drain. Dr. suggested to take it out when it was less than 30cc and we did. My left breast swell like crazy and I ended up needing new drain put in. The doctor took it out again and in less than a week I had really bad swelling and stitches opened up with the expander poking out. With that, Dr. took out the expander and now I have one breast with an expander and one without. I am 5,1" and weigh 116pound so not much fat anywhere. Now the Dr. is suggesting I do one of the following:

  • using a flap from your back (latissimus dorsi flap)
  • using a flap from your abdomen (TRAM flap)

Dr is not offering much info and honestly, I am not sure why I am in this situation. Why was not I offered flaps in the first place? I have/had no intention of having large breasts; I told dr I was happy with 200cc or 250cc max. I feel like I paid for a surgery that went wrong and now they want me to have more extensive surgery... I have been in pain all this time and now I have one breast with an expander, and the other one is totally flat. I am very frustrated. Can you please give me some suggestions as to what to do?

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Jan 9, 2020 05:02PM Moderators wrote:

Hi again Rose,

We're so very sorry to hear what you're going through, but we're glad you've found us. You're sure to get some responses here soon that will be helpful.

In the meantime, you may be interested in checking out the main Breastcancer.org site's section on Breast Reconstruction, specifically the Types of Breast Reconstruction pages, which offer in-depth details and photos about the different options available.

We hope this helps and that you get some answers (and relief!) soon!

--The Mods

To send a Private Message to the Mods: community.breastcancer.org/mem...
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Jan 9, 2020 05:32PM AliceKo wrote:

Rose, sorry you are going through this. Unfortunately you are not the only one. you should get a few second opinions. I found that the plastic surgeons were not honest when consulting me. They only told me what they wanted me to know about it. they say, well not every one is like you and can retain and process this much information...Seriously? I wanted an DIEP, but my surgeons wanted an EASIER procedure for me, so that's why I was suffering with an expander for 6 months and then suffered for over a year with the implant. They told me at a year "I won't even feel it". That never happened for me. and then my plastic surgeon did not have a plan for me...

Many women have complications with implants even years (! and decades) after the original procedure. They are not for everyone. Of course, there are many woman who are very happy with their implants (that would be a different thread).

tram and dorsi flap are both using your muscle. that changes how your body functions and changes how the donor part looks. Maybe you should look into APEX DIEP procedure, I believe only available in one or 2 places in the US.

Dx 2/2017, IDC, Left, Stage IIB, 0/2 nodes, ER+/PR+, HER2+ Surgery 6/21/2017 Mastectomy: Left; Reconstruction (left): Fat grafting, Silicone implant, Tissue expander placement Surgery 7/17/2019 Reconstruction (left): DIEP flap Targeted Therapy Herceptin (trastuzumab) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Chemotherapy Taxol (paclitaxel)
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Jan 9, 2020 09:17PM - edited Jan 9, 2020 09:32PM by JRNJ

1402 Rose, I also have a failed reconstruction and struggling with options. See my post "Please tell me implants can be comfortable". BMX and Tissue Expanders in 9/24, out 10/30 due to infection. I'm on hold due to chemo and radiation. I'm surprised waiting to heal and try again is not one of the options offered to you. My PS originally said I didn't have enough fat for DIEP for 2 breasts, but 2 other Drs. (MOs, no PSs) said I did. I also have not gone for second surgery opinion. I went for 2 chemo opinions and both doctors said dump your PS and do DIEP with us (Rutgers and Sloan, both reputable places). But not ready to dump him yet. I don't really want to be an A or B (with DIEP), only because I had huge DDs, and don't want them back, but want to kind of look like myself just to feel normal. He did tell me up front about DIEP and implants. Didn't mention back flap. When I asked about it he told me back flap much more complicated than abdomen and higher failure rate. Does this mean just for him or all Drs. I wonder? I also wonder why your Dr. recommended abdomen TRAM and not DIEP. DIEP is no muscle and supposed to be better for your abdomen not taking the muscle. Maybe because you are so skinny, I am 5'2" 127 pounds. Since I am doing radiation, it might complicate things further and I might also end up with one implant and one DIEP. Are you doing any chemo or radiation? Right now I am leaning towards saline implants size C. And if it goes bad again, or I hate them, DIEP is still always an option in the future.

Pleomorphic Multifocal LCIS, Extranodal Extension, Lymphovascular Invasion. TE removed due to infection Dx 8/15/2019, ILC, Right, 2cm, Grade 3, 2/5 nodes, ER+/PR+, HER2- Dx 8/15/2019, LCIS, Right, 6cm+, Grade 3, ER+/PR+, HER2- Surgery 9/23/2019 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 12/1/2019 CMF Radiation Therapy Whole-breast: Breast, Lymph nodes, Chest wall
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Jan 9, 2020 09:59PM 1402Rose wrote:

PS does not talk much at all. He just tells me what he is going to do and that is it. I am worried that I am left in the dark and yes I am going to get second and third opinion and I was not a good candidate for flap from abdomen so I have no idea what changed. I want tug which uses inner thigh skin, tissue and muscle. Any opinion?

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Jan 9, 2020 10:02PM 1402Rose wrote:

I read today that if the PS does not want to discuss the procedure in detail, is not willing to take pictures of his work and put it on your file, stop working with him. This is where I am. I think they just do what they know rather than offer options that is better for me. I want tug which uses inner thighs. Any opinions about that

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Jan 9, 2020 11:44PM Suziefromflorida wrote:

I had one of my expanders, (my cancer side) fail. It happened right after I started chemo. There was an infection in it and had to be removed. I then had to have radiation on the same size. I’ve been waiting to have reconstruction and my doctor suggests the Latissimus Doris Flap. I’m terrified and have been letting my skin heal.

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Jan 10, 2020 08:47PM WC3 wrote:

1402Rose:

Have you discussed with your doctor the possibility of SGAP?

Dx 2018, IDC, Left, 3cm, Grade 3, ER+/PR+, HER2+ (FISH) Chemotherapy 6/1/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 11/15/2018 Lymph node removal: Left, Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Targeted Therapy Perjeta (pertuzumab) Targeted Therapy Herceptin (trastuzumab)
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Jan 10, 2020 10:18PM Jaybird627 wrote:

Hi Rose,


I had lat flap just over 3 weeks ago. In hindsight it's not so bad. (lol) It's been a journey though.

History:

BC R breast 2005, lumpectomy, chemo, rads.

BC L breast 2018, BMX, chemo, rads.

Nipple sparing BMX with expanders. R expander developed open sore so had to have expander removed. When expander was removed PS replaced L expander w/silicone implant. He said I needed 6 months for R breast area to heal before anything else was done.

Spent 6+ months with L bionic boob, R side flat. R side skin adhered to rib, no way to re-expand without donor skin.

PS suggested lat flap as I had no extra skin/muscle anywhere else on my body. I took weeks to do research. I was scared of such a big surgery as I have a very physical job and I can't retire for another 10 years (I'm 59) but agreed to it as I didn't like the breast prosthesis and that was not how I envisioned my future. Had to lose R nipple due to area of previous radiation was damaged skin. My new breast is kind of football shaped bottom and old/normal skin/tissue on top. I expect the scars will fade eventually.

So, I'm just 3 weeks post op for the lat flap. It hasn't been easy but I'm an active single parent home owner with 2 dogs so there is always something that needs to be done. I recently developed cellulitis but an antibiotic has taken care of that. I had 3 drains, got 1 out right away, the 2nd one about 10 days later and the last one will come out next week. Sleep has been difficult until this past week.

It's a fairly common surgery I think? I've been totally mobile even if I haven't had full reach ability without pain until this week. Up until today I was almost regretting the lat flap but now that I finally feel almost 100% like before I'm happy that I had it done. I like my new breast. I'm due for expansion, then exchange. It's a process, this BC crap. We all have our own journey/story to live.

Jaybird

Jaybird. My hopes are not always realized, but I always hope - Ovid. Dx 3/5/2005, IDC, Right, Stage IIB, Grade 2, ER+/PR+, HER2- Surgery 4/18/2018
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Jan 13, 2020 11:29AM Hiddenledge wrote:

I agree with WC3. I'm very small (5'4 and 100 pounds). Even given how thin I am, my PS was able to fashion a breast out of my right buttock. You need a different PS. Not good that he simply tells you what to do. A reconstruction procedure like the SGAP takes a lot of expertise, maybe your current PS just doesn't have the skill set. But you deserve a reconstruction that works for you, don't give up.

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Jan 23, 2020 09:17AM JRNJ wrote:

jay bird, did they put an expander in same time as flap?

1402rose. Do you have a plan?

I’m struggling with different opinions from 2 surgeons now and probably need flap. I was shocked new ps recommended lat flap. I said I would rather have diep why would I have lat? She said ok and didn’t explain.

Pleomorphic Multifocal LCIS, Extranodal Extension, Lymphovascular Invasion. TE removed due to infection Dx 8/15/2019, ILC, Right, 2cm, Grade 3, 2/5 nodes, ER+/PR+, HER2- Dx 8/15/2019, LCIS, Right, 6cm+, Grade 3, ER+/PR+, HER2- Surgery 9/23/2019 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 12/1/2019 CMF Radiation Therapy Whole-breast: Breast, Lymph nodes, Chest wall
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Jan 23, 2020 10:46AM Jaybird627 wrote:

JRNJ, yes the expander went in at the time of the flap. I'm quite healed on my back 5 weeks post lat flap. I'm having breaast skin issues though because of some cellulitis. Put on antibiotic for 10 days, wasn't cleared up 100% so I'm on antibiotic for another 10 days. ugh! No issues with lat flap recovery just the fragile radiated skin. I was expanded with 60 cc, he took out 40 cc when cellulitis issue appeared, took out the remaining 20 cc this week and stitched up a spot that opened up and was leaking fluid. So that's where I am at. My skin hates the hard edged expander but I can't get it out until I am expanded.

Jaybird. My hopes are not always realized, but I always hope - Ovid. Dx 3/5/2005, IDC, Right, Stage IIB, Grade 2, ER+/PR+, HER2- Surgery 4/18/2018
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Jan 23, 2020 07:06PM JRNJ wrote:

jaybird, thanks. I hope your infection clears up and they don't have to take out expanders, that really stinks. I had to have mine removed. But it would be more traumatic after flap surgery.

So after meeting with 2 plastic surgeons this week, it seems it is not that weird to recommend Lat Flap, specially if issues with radiation or infection. Both said I could have Lat or DIEP. DIEP makes more sense for me, I have some fat and a C-section shelf I would like removed, rather than using a muscle in my back. He also confirmed that he would put an implant in at the same time as lat flap, but not with DIEP. He did say final implant, not TE though.

Rose, I'm guessing they recommended TRAM, because you are too skinny for DIEP, in which case I would rather have a muscle taken from my back than my stomach. What is your plan, did you find someone to do one of the other procedures? Neither of my surgeons said a word about the other ones.

Pleomorphic Multifocal LCIS, Extranodal Extension, Lymphovascular Invasion. TE removed due to infection Dx 8/15/2019, ILC, Right, 2cm, Grade 3, 2/5 nodes, ER+/PR+, HER2- Dx 8/15/2019, LCIS, Right, 6cm+, Grade 3, ER+/PR+, HER2- Surgery 9/23/2019 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 12/1/2019 CMF Radiation Therapy Whole-breast: Breast, Lymph nodes, Chest wall
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Jan 23, 2020 08:50PM Jaybird627 wrote:

JRNJ, while it is a back muscle its a muscle that works the shoulder. There isn't a big noticeable difference in my back except for the long scar. lol. Yes, the radiation messes with the skin and the lat flap is very common for reconstruction. I did a lot of research, as much as I could on the Internet, before I was okay with the surgery. I watched a lot of videos on youtube!

Have the surgery that works best for you. I have read that the stomach area surgery takes longer to recover from? Since it's your core and it affects more of your everyday movements? Good luck!


Jaybird

Jaybird. My hopes are not always realized, but I always hope - Ovid. Dx 3/5/2005, IDC, Right, Stage IIB, Grade 2, ER+/PR+, HER2- Surgery 4/18/2018

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