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Topic: prophylactic mastectomy for larger breasts

Forum: High Risk for Breast Cancer — Due to family history, genetics, or other factors.

Posted on: Aug 20, 2017 06:19AM

Randi74 wrote:

Im considering a prophylactic mastectomy due to strong family history of BC. I am a DD with ptosis I would say of 2-3. Is it possible to do a one step procedure (direct to implant)

AND keep the nipples? I dont mind going small, just would prefer to keep the nipples.



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Aug 20, 2017 06:29AM Mucki1991 wrote:

I was a 140 lbs with a G cup and I wanted that also but my PS said it would be tough because of the distance the blood flow had to travel. You have to have adequate blood flow to keep the nipple alive. May not be the case for you I just wanted to keep the nipple from the healthy side and I was a bit disappointed by that news. Hope it works out for you

Rebekah Dx 5/5/2017, ILC/IDC/IDC: Papillary, Left, 3cm, Stage IIB, Grade 3, 3/7 nodes, ER+/PR+, HER2- (IHC) Surgery 7/13/2017 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 8/21/2017 AC + T (Taxol) Surgery 2/7/2018 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Radiation Therapy 2/25/2018 3DCRT: Breast, Lymph nodes, Chest wall Hormonal Therapy 4/19/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Aug 20, 2017 06:51AM NotVeryBrave wrote:

I would suggest that you meet with at least two PS's to get their advice and experience. Be very clear in what you would like to have so that they can be very honest about your options.

TCHP x 6 with pCR. One year of Herceptin. DTI pre-pec surgery. Quit Tamoxifen after 3 months. Dx 11/21/2016, DCIS/IDC, Left, 2cm, Stage IIA, Grade 2, 0/3 nodes, ER+/PR+, HER2+ (IHC) Targeted Therapy 12/18/2016 Perjeta (pertuzumab) Targeted Therapy 12/19/2016 Herceptin (trastuzumab) Chemotherapy 12/19/2016 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 5/9/2017 Lymph node removal: Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 9/9/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Aug 20, 2017 07:25AM Lisey wrote:

Keep in mind Randi, that even if you keep the nipples - you won't feel them. With mastectomies, you'll be numb and those erogenous parts will be gone. The nerves are all cut when the breast is removed. It's a sad day for that aspect, but a good day to stay alive and healthy. I'm flat and fabulous after being a 34DD my whole life and I have some feeling on my chest - but nothing like before. I have no nipples because I didn't see the point in keeping them attached if I couldn't feel them at all and it would add a slight risk - since they need some fat and tissue to stay alive.

Oncotype =20, ER 95%, PR 5%, ki67= 30%, Mammoprint = Low, Blueprint = Luminal A!!!! TEs= Iron Bra of Death - not worth all the complications for foobs that I'll never feel. Flat and fealess now. Dx 5/11/2016, IDC, Right, 1cm, Stage IA, Grade 2, 0/6 nodes, ER+/PR+, HER2- Surgery 6/1/2016 Lymph node removal: Sentinel Surgery 6/14/2016 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 7/7/2016 Mastectomy: Left, Right Hormonal Therapy 7/14/2016 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Sep 1, 2017 01:30PM dixiechick442 wrote:

I'm was the same.

My surgery is broken into two parts. My first part was a reduction and lift. I went from a DD to a C.

The next surgery is a nipple sparring mastocemy with direct implant.

I will have four months of recovery between the two. I'm been trying to loose 15lbs. I want to go from 145 to 130.

I think they have only been doing it this way since 2015. I'm having it done at NOLA. So far so good.

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Sep 2, 2017 04:08AM annoyingboob wrote:

I had a bilat lx and reduction. I was considering bmx but ps said boobs were too big to do nipple sparing as 1 surgery. So we did reduction and lift and if, down the road, I need to get a bmx, I may have option to do nipple sparing bc nipples healed well and are well positioned now. It's not exactly your scenario, but does support what others are saying about how nipple sparing surgery as 1 surgery with large breasts isn't very feasible. Good luck

Dx 12/2016, DCIS, Right, <1cm, Stage 0, Grade 3, ER+/PR+ Surgery 1/5/2017 Lumpectomy: Left, Right Radiation Therapy 2/21/2017 3DCRT: Breast Hormonal Therapy 3/3/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Dec 14, 2017 07:31PM marcs1234 wrote:

Hi everyone. I have a similar/follow up question if anyone could help. I am also planning a prophylactic mastectomy due to strong family history. I am wondering if immediate reconstruction (without nipple sparing) is an option for larger breasted people? I have read somewhere that you must do nipple sparing in order to do immediate reconstruction - is this true?

I would love my breast size to be smaller post-reconstruction but I have heard I may need to do a reduction first - like many of you mentioned having done. Does anyone know if even a little bit smaller without a separate reduction surgery is possible? My bra size is currently a 32F and have large areolas. I'm wondering if the removal of those might contribute to a smaller breast size? (not sure if this is a silly question - new researcher on this...I have a consult with a PS in a month but am just curious if I could get some answers sooner)

Thanks so much for any advice or info!

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Dec 14, 2017 10:05PM Sopho wrote:

I just had a Goldilocks mastectomy for my G cup left breast and am very happy with the results. They removed my nipple, took out all the breast tissue and then they use the tissue from skin sparing to create a small a/b breast. From there you can do fat grafting/reshaping to get to a full B or a smaller implant for a c/d if I choose. You can learn more about it here...


Surgery 8/16/2017 Lumpectomy: Left Dx 9/8/2017, DCIS/IDC/IDC: Papillary/IDC: Cribriform, Left, 1cm, Stage IA, Grade 2, ER+/PR+, HER2- Surgery 12/7/2017 Mastectomy: Left
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Dec 29, 2017 04:00AM MightyMightyMunson wrote:

Hello ladies. I am BRCA1 positive and just had a preventative double Mastectomy on December 15. I was a DD. After consults with a my oncologist and a couple of Plastic Surgeons we decided to go not nipple sparing and this was due to the risk that would still exist because of my mutation. I also asked about a direct implant option because I didn’t really want to have expanders. The two plastics surgeons that I spoke with said that with larger breasts, direct implant arevery difficult. So I went with expanders and they are a treat. Not. Anyway, I just wanted to share my experience and wish you the best of luck in your decision making process.

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Jan 10, 2018 06:17AM MayDayMelK wrote:

Thank you Mighty for sharing that. I am high risk and considering the same thing, and definitely want to go smaller. My breasts are a D/DD and I want to go smaller for sure.

Fibrocystic Disease, Columnar Cell Lesions
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Jan 12, 2018 10:05AM Mistyb1234 wrote:

I had the same concern wanting to save the nipple as was told something similar to above. I am a D , I would have to have a breast reduction to a C 1st then complete mastectomy and reconstruction.

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Feb 1, 2018 08:14PM joy2 wrote:

hello! I just found out that i carry the BRCA1 and my surgeon suggested bilateral mastectomy. I am 34 DDD and i am not candidate for nipple sparing. I want to go smaller i am very concerned about my esthetic breast looking. Any idea what is the best procedure, or better implants?

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Apr 13, 2018 10:08AM Louise69 wrote:

I found out I am BRCA 2 positive in july 2017. I had my tubes and ovaries removed. I had consult with plastic surgeon last week and she said I could get a breast reduction as nipple are a little low for breast implants. I am a 36D. Then second surgery bilateral mastectomy and tissue expanders and third surgery breast implants. I hadn't heard that with gene positive that nipple sparing remains to increase risk of breast cancer.

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Apr 13, 2018 11:03AM Recap wrote:

It makes sense to me that removing nipples as well is safer when risk of cancer is high, or cancer is already present. The breast seems to be like a busy system of canals where all kinds of cells are being transported from point a to b to c and back again. I am 48DD/E and would love to have mine removed entirely (no interest in implants) but I would want the nipple sculpting/tattooing done. I haven't heard much about tattooing here but I think they can use safe tissue from elsewhere to construct a nipple-like bump and the tattooing is then done on that skin to make it very realistic looking both in texture and color. I googled post-mastectomy tattoos and was amazed at how far it has gone as an art form-it is actually difficult to find the images of plain old nipple tattoos with so many extensive works of art. Next time I visit my mother I am going to show her on the internet the new frontiers of post-mastectomy appearance-I know she will be quite amazed. ~40yrs ago she didn't have all of these options.

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Apr 13, 2018 12:29PM Lula73 wrote:

if you are large breasted the problem with implants is that they max out in size and often aren’t big enough to replace the tissue lost during mx. Natural tissue recon, on the other hand, can often be a viable alternative. In addition, the recon can be done at same time as mx, the results look & feel more natural than implants, the breasts are soft & warm, they move with you and they will age with you. Plus no need to ever replace them for those that are on the younger end of the age spectrum. You can learn more about these types of procedures at the link posted below. I was a 36C/D, initial natural tissue recon gave me 36 DD-DDD. I opted to reduce later back to 36C/D. And I am thrilled with my results. Feel free to ask any questions you may have.


-Lula Dx 1/2017, DCIS/IDC, Right, 1cm, Stage IA, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 2/13/2017 Lymph node removal: Sentinel; Mastectomy: Left, Right; Prophylactic ovary removal; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Hormonal Therapy 3/2/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 11/1/2017 Prophylactic ovary removal Hormonal Therapy 1/2/2018 Femara (letrozole)

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