Topic: 3-step Reconstruction

Forum: Breast Reconstruction — Talk with others facing decisions about whether or not to have breast reconstruction, and if so, what type and when.

Posted on: Apr 10, 2022 10:56PM

Posted on: Apr 10, 2022 10:56PM

val1127 wrote:

Good evening all. My SIL was diagnosed with IDC in Dec. She is scheduled for mastectomy and SNB next week. She plans to do reconstruction with TE but here’s my concern. Her BS is at one hospital and her PS is at another. That means there will be no TE inserted during her UBX. But 10 days later she goes to another hospital to re-enter (and disrupt) the original incision for the TE insertion. Finally down the road TE removed and implant insertion.

I’m an old OR and MICU nurse but this process concerns me. Not sure I would want my wound being disrupted at 10 day marker then again for TE removal.

I’m suspect of referral games and lack of hospitals’ privileges when there is an entire plastic team at first hospital.

Has anyone gone through this process with a 10-day delay for TE insertion? To me too many different hospitals and risksof infection. Thank you for your insight.

Leslie

Surgery 3/11/2022 Lymph node removal (Right): Sentinel; Mastectomy (Right): Simple Dx IDC, Right, 2cm, Stage IIB, Grade 1, 2/6 nodes, ER+/PR+, HER2-
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Apr 11, 2022 01:47PM exbrnxgrl wrote:

Val,

I am sure that there are some members who have experienced what is being proposed for your SIL. I would say that most patients try to have the mastectomy and TE placement done during the same surgery for the reasons you stated. If her ps does not have privileges at the hospital where she is having her mastectomy then this wouldn't be possible. Has she considered looking for both a surgeon and plastic surgeon who can work together at the same hospital? I know this might delay things a bit but would eliminate a separate surgery just for TE placement. This is the route that most folks take and I hope your SIL can work it out as well. Take care

Dx IDC, Left, 4cm, Stage IV, Grade 1, 1/15 nodes, ER+/PR+, HER2-
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Apr 16, 2022 02:22PM val1127 wrote:

Thanks so much exbrnxgrl. Sounds like SIL has her mind made up but I was hoping for a second opinion

Surgery 3/11/2022 Lymph node removal (Right): Sentinel; Mastectomy (Right): Simple Dx IDC, Right, 2cm, Stage IIB, Grade 1, 2/6 nodes, ER+/PR+, HER2-
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Apr 26, 2022 04:55PM daughterofbarb wrote:

My reconstruction was 3-step. Double Mx, followed by TE placement surgery 13 days later, followed by exchange to implant 3 months after that. Both my surgeon and PS work in the same hospital, but my (now former) PS wouldn’t do expanders during Mx surgery. I was told the reason for this is because he feels that allowing some healing from the Mx surgery gives him a “better result”. It certainly doesn’t seem to be the norm and I wasn’t thrilled about going under the knife again soon, but with everything else going on after diagnosis I just went with it. As soon as I started to feel somewhat normal after Mxsurgery, I was knocked out again by TE surgery, but otherwise the recovery wasn’t too bad. The main issue for me is that I still had one drain in from Mx surgery and they put drains in during the TE surgery, so I had drains for more than 4 weeks. If the TE are placed during the Mx surgery, the drains would usually be removed much sooner and overall recovery should be faster. I live in a fairly large city, yet it was difficult to find surgeons and PSs that work in together during surgery to make this a one step process. Frustrating. If she has any reservations at all, she should consult with other surgeons and PSs. Hopefully she can find a team that works together so TE are placed at time of Mx. Best of luck to your SIL

Dx @ 46, Oncotype DX Score = 7, Nipple Sparing Double Mx, Tamox @ 5mg daily Surgery 7/15/2021 Lymph node removal (Right); Mastectomy (Left): Nipple Sparing; Mastectomy (Right): Nipple Sparing; Prophylactic mastectomy (Left) Surgery 8/1/2021 Reconstruction (Left): Tissue Expander; Reconstruction (Right): Tissue Expander Hormonal Therapy 9/1/2021 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 11/16/2021 Reconstruction (Left): Silicone implant, Silicone textured implant; Reconstruction (Right): Silicone implant, Silicone textured implant Surgery 4/25/2022 Reconstruction (Left): Fat grafting, Silicone implant, Silicone textured implant; Reconstruction (Right): Fat grafting, Silicone implant, Silicone textured implant
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Apr 26, 2022 07:29PM val1127 wrote:

Thanks Kaycee! SIL had her first surgery and they pulled the one drain she had day 2 even though drainage was 75 cc in 24 hours. She has surgery #2 the end of this week.

I wonder if this is a new trend or just a way to make more money for the healthcare system? Being a retired nurse - it just doesn't seem right but I'm not an MD.

Take care and I'm sorry you had to go through all that.

Leslie

Surgery 3/11/2022 Lymph node removal (Right): Sentinel; Mastectomy (Right): Simple Dx IDC, Right, 2cm, Stage IIB, Grade 1, 2/6 nodes, ER+/PR+, HER2-

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