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Topic: Is reconstruction still possible if breast skin is not spared?

Forum: Breast Reconstruction —

If you've had or will be having a mastectomy (or in some cases, lumpectomy), you're likely facing decisions about whether or not to have breast reconstruction, and if so, what type and when. Deciding whether or not to have a breast reconstructed is a very personal choice. Take the time you need to learn about how breast reconstruction might affect you, both emotionally and physically, before you decide to have the surgery.

Learn about different surgical options and the medical and personal issues around breast reconstruction.

Intro medically reviewed by: Brian Wojciechowski, M.D.
Last review date: November 22, 2020

Posted on: Mar 14, 2021 10:57PM - edited Apr 6, 2021 08:26AM by

Deleted Member wrote:

Im so confused by this. Is reconstruction from nothing possible with skin grafting and implants or other tissues?

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Mar 14, 2021 11:19PM BCat40 wrote:

Yes, it is possible with the various types of flap reconstruction procedures. Sometimes they can still do expanders and then implants, but it takes longer and would likely be more painful.

Dx at 40. Did not tolerate hormone deprivation treatment. Dx 2/4/2020, LCIS/ILC, Right, <1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- Surgery 3/25/2020 Lumpectomy: Right; Lymph node removal: Sentinel Radiation Therapy 6/2/2020 Whole-breast: Breast
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Mar 15, 2021 12:32PM sbelizabeth wrote:

My left side was completely flat when I had DIEP reconstruction. With this procedure, skin and fat, along with their original blood vessels, are harvested from the abdomen and formed into "breasts" which are then, with microsurgery, connected to a new blood supply in the chest. Not all plastic surgeons can do this procedure.

pinkribbonandwheels.wordpress.... Dx 10/20/2011, IDC/IBC, Left, 1cm, Stage IIIA, Grade 2, 6/28 nodes, ER+/PR+, HER2- Chemotherapy 12/15/2011 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 4/18/2012 Mastectomy: Left Radiation Therapy 5/21/2012 Breast, Lymph nodes Hormonal Therapy 7/19/2012 Femara (letrozole) Surgery 4/15/2013 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Mar 15, 2021 01:38PM lightningblue wrote:

It is possible! I am doing this.

My original plastic surgeon told me definitively that I could go flat at the time of bilateral mastectomy, and then change my mind and decide to reconstruct with flap surgery or implants at any time down the road. That is exactly what I did. Went flat, tried that out, decided I would rather have reconstruction, and started that process.

That original plastic surgeon ended up leaving my hospital before I got the chance to have the first recon surgery, and I'm now working with a different plastic surgeon who has confirmed all the same info. I am reconstructing with implants, and will have one surgery to have tissue expanders (TEs) placed in my chest, and then another surgery months later to remove the expanders and put in implants. There may be an additional surgery after that to do fat grafting and make the implants look more natural on my chest, I believe that one is optional.

It's my understanding that this is a less common route to take, as apparently most women who reconstruct make the decision to do so early on, but it's totally possible and reasonable. All doctors, surgeons, and staff I've seen have been aware of this type of delayed reconstruction process and seem to have seen it before. It seems to be a pretty standard skill set, though if you are concerned with the tiny details of the aesthetics (scars, etc) I might seek a surgeon who specializes in delayed reconstruction.

Diagnosed age 32 in March 2019 Surgery 4/11/2019 Mastectomy: Left, Right
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Mar 15, 2021 02:09PM exbrnxgrl wrote:

coffeepleez,

A doctor may say something is not possible simply because... it’s not possible, not necessarily because they don’t have that skill set. My situation was different than yours but for other reasons, DIEP was truly not possible for me despite my surgeons great reputation for flap surgery. That being said, if you are interested in that and there are no other medical considerations, do find a doctor who is very experienced with this procedure. Flap reconstructions, there are several types, are fairly common these days so you should be able to find an experienced ps. Take care.

Bilateral mx 9/7/11 with one step ns reconstruction. As of 11/21/11, 2cm met to upper left femur Dx 7/8/2011, IDC, Left, 4cm, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Surgery 9/7/2011 Lymph node removal: Left; Mastectomy: Left, Right; Reconstruction (left); Reconstruction (right) Dx 11/2011, IDC, Left, 4cm, Stage IV, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Hormonal Therapy 11/21/2011 Arimidex (anastrozole) Radiation Therapy 11/21/2011 Bone Hormonal Therapy 6/19/2014 Femara (letrozole) Hormonal Therapy Aromasin (exemestane)
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Mar 15, 2021 07:52PM bcincolorado wrote:

I do not know where you are located but there are specialists and one that does work with breastcancer.org I know is from here and they have an extensive website on different surgical options on there. https://www.breastcenter.com/about/st-charles-surgical-hospital/

Dx 8/2009, IDC, Left, 5cm, Stage IIA, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 1/7/2010 Lumpectomy: Left; Lymph node removal: Left Hormonal Therapy 1/15/2010 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Hormonal Therapy 1/30/2016 Femara (letrozole)
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Mar 15, 2021 08:10PM exbrnxgrl wrote:

I was offered both a lat flap or the one where they take skin from your thighs ( sorry, can’t recall the name. Pap? Tug?) The reality for me was that I was not interested in any recon that would create another surgical site. My ps was very clear about presenting me with all of my options even though I told him that I was really interested in implants. I am glad I listened to him as he fully explained my options and gave the pros and cons of each. He even let me play with several different types of implants. My younger dd was with me and we enjoyed the cheap thrills 😂 I still went with implants but it was good to have a clearer understanding of those options.

Bilateral mx 9/7/11 with one step ns reconstruction. As of 11/21/11, 2cm met to upper left femur Dx 7/8/2011, IDC, Left, 4cm, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Surgery 9/7/2011 Lymph node removal: Left; Mastectomy: Left, Right; Reconstruction (left); Reconstruction (right) Dx 11/2011, IDC, Left, 4cm, Stage IV, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Hormonal Therapy 11/21/2011 Arimidex (anastrozole) Radiation Therapy 11/21/2011 Bone Hormonal Therapy 6/19/2014 Femara (letrozole) Hormonal Therapy Aromasin (exemestane)

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