Mastectomy and breast reconstruction pros and cons?

Posted by kruzin @kruzin, Jul 8, 2018

Being treated for breast cancer, having a mastectomy and was wondering what people did for reconstruction?

@kruzin

Thanks you for responding. I actually been looking into these surgeons, they seem amazing, actually just listed to Dr. dellaCroce on podcast, and learned so much from it. But I don't think my insurance will cover, but I'm definitely going to find out. I live in Massachusetts so I'm not sure, but this place would be my first choice.

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I urge you to at the very least talk with them. Best of luck and keep us posted.

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@casualobserver

Hi @kruzin – I don't know if I'm too late to post my experience as you may have already gone ahead and done your surgery. But, if not,
I wanted to share my information with you, if it might help you.

I just had my bilateral mastectomy with reconstruction less than a month ago. I had biopsies in both breasts. I learned one breast had cancer the other tested out benign. The diseased breast had several large masses that all tested malignant and a lumpectomy was not deemed 'ideal' due to the amount of tissue removal involved so a full mastectomy was indicated for that one breast.

I am a research nut and did copious research on the subject and also had 2 consults with the breast surgeon and 2 with the plastic surgeon before deciding. I also spoke with my spouse, 2 children and daughter-in-law who's a nurse. During my weeks of contemplation and research, I subscribed to MedScape and read many of their published medical studies on mastectomy and breast cancer, including survival rates, surgery options, decisions made by patients who chose a particular option and comments from nurses and surgeons. I also searched every article I could on the internet and read many patients' comments.

In the end, I decided to remove both breasts and do immediate implant placement in both. I knew I wanted reconstruction as I would be too depressed otherwise. Mental health is equally as important as physical health and should be weighed as carefully, in my opinion.

My reasoning for doing a bilateral mastectomy and immediate reconstruction rather than just doing one breast is as follows:
* If both were done at once, the plastic surgeon would be able to make both breasts match closely, utilizing the new Alloderm artificial skin and identical silicone breast implants.
* I currently have excellent insurance and who knows what I may have years from now if the healthy, remaining breast were to develop something.
* I will never be younger than I am now, and my chance of a good recovery should be better now than years down the road (if cancer were to develop again).
* I would have one time off from work, one (longer) procedure day, one hospitalization, one anesthesia, and one recovery.
* Both breast gone = no further mammos, MRI's, no chemo, no radiation, (hopefully??) and no further worry about the other shoe dropping with the remaining 'healthy' breast developing something down the road. I have read how women who have cancer in one breast must go in and have any remaining breast tissue looked at and poked and prodded yearly for the rest of their lives. I wanted to avoid that if I could. Who needs more stress and worry?
* In addition, my healthy breast had been banged up pretty good with a stereotactic biopsy and had developed a large, hard lump and depression at the point of entry. I felt that it was now injured and may be more susceptible to getting cancer (gut feeling) which further directed me to going forward with both mastectomies.
All-in-all, I am currently glad I chose as I did, however I am still in recovery and may come to a different conclusion later, but I'm hoping for the best!

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Hi I am debating nipple sparing double Mastectomy. How are you recovering are you happy with your decision almost a year and a half later? I loved all the points you made and I have similar thoughts and beliefs, I am 42 stage one IDC.

Liked by trixie1313

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@nataliehope

Hi I am debating nipple sparing double Mastectomy. How are you recovering are you happy with your decision almost a year and a half later? I loved all the points you made and I have similar thoughts and beliefs, I am 42 stage one IDC.

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@nataliehope
Be sure to talk with your oncologist and surgeon regarding mastectomy versus lumpectomy for a Stage 1. I was ready to go with bilateral mastectomies for my Stage 2c infiltrating ductal ca and neuroendocrine ca (2nd tumor), but my surgeon mentioned minds are being changed now since even with full mastectomies, all breast tissue cannot be taken out completely and patients can still wind up with breast cancer. In addition, due to the amount of nerves being cut, sometimes women will have nerve pain for the rest of their lives (again, possibility). We went with partial mastectomies and I'm lucky that I've had some nerve pain but that has gone away. I'm not telling you any of this to frighten you, but just to advise you to look at all aspects prior to any surgery. It is a very personal choice and only you can make. By the way, my nipples came through find and the scars are starting to subside. All the best in your decision making and your future health.

Liked by elizm

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@trixie1313

@nataliehope
Be sure to talk with your oncologist and surgeon regarding mastectomy versus lumpectomy for a Stage 1. I was ready to go with bilateral mastectomies for my Stage 2c infiltrating ductal ca and neuroendocrine ca (2nd tumor), but my surgeon mentioned minds are being changed now since even with full mastectomies, all breast tissue cannot be taken out completely and patients can still wind up with breast cancer. In addition, due to the amount of nerves being cut, sometimes women will have nerve pain for the rest of their lives (again, possibility). We went with partial mastectomies and I'm lucky that I've had some nerve pain but that has gone away. I'm not telling you any of this to frighten you, but just to advise you to look at all aspects prior to any surgery. It is a very personal choice and only you can make. By the way, my nipples came through find and the scars are starting to subside. All the best in your decision making and your future health.

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Hi thanks for the information, I have never heard of partial Masectomy what is that? Did you do reconstruction? I am really having a hard time debating all the options and figuring out what to do. I get genetic testing back early next week everyone on my Dads immediate side of the family had cancer and 3 people have died from it, I am most likely at risk.

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Partial mastectomy is lumpectomy. I think you should wait until you get your genetic test results before making any decisions. I had cancer in both breasts at different times and had lumpectomies for both then found out after genetic testing after the second cancer I had the CHEK2 mutation. If I had known that after the first occurrence, I would have opted for bilateral mastectomy the second time. Yes, you can get breast cancer after mastectomy, but your chances are much reduced…90-95% that it will not happen. There is way too much to think about and wonder about. If researching on the computer, stick with good sights like Mayo and Cleveland Clinic and Johns Hopkins etc. You can really get messed up going to unofficial sights.

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@nataliehope

Hi thanks for the information, I have never heard of partial Masectomy what is that? Did you do reconstruction? I am really having a hard time debating all the options and figuring out what to do. I get genetic testing back early next week everyone on my Dads immediate side of the family had cancer and 3 people have died from it, I am most likely at risk.

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@nataliehope
I was quite large breasted and since lumpectomies were on two sides of one breast, it would leave me quite misshapen so a considerable amount of breast tissue was removed and then had to be reshaped leaving me about a size A or a bit smaller. Speak to your breast surgeon about options and if you're not comfortable with that surgeon, go to another for a second opinion. The first surgeon I went to was pretty much of the mind of doing only mastectomies on women as she was a general surgeon. The surgeon I went to next strictly saw women with breast cancer.

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So you did not get reconstruction? Yes I’m waiting for results and getting second opinions and going to an integrative oncologist. The similar stories really help, thanks for sharing. I’m worried about necrosis with nipple sparing and other issues.

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@nataliehope

So you did not get reconstruction? Yes I’m waiting for results and getting second opinions and going to an integrative oncologist. The similar stories really help, thanks for sharing. I’m worried about necrosis with nipple sparing and other issues.

Jump to this post

@nataliehope It depends on what you mean by reconstruction. Extensive excision of both tumors on different parts of the same breast as well as removal of more tissue due to large breast size (I was beyond DD breasts and following surgery now about an A/A-). The breast then required reshaping and the surgery lasted about 7 to 7 1/2 hours. Lumpectomies are fairly simple surgeries and my first surgery was just that. This second surgery, however, was not a simple surgery as it reduced the breast size considerably. If your genetic testing has not returned yet, I would wait to see what that report indicated.

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@trixie1313

@nataliehope It depends on what you mean by reconstruction. Extensive excision of both tumors on different parts of the same breast as well as removal of more tissue due to large breast size (I was beyond DD breasts and following surgery now about an A/A-). The breast then required reshaping and the surgery lasted about 7 to 7 1/2 hours. Lumpectomies are fairly simple surgeries and my first surgery was just that. This second surgery, however, was not a simple surgery as it reduced the breast size considerably. If your genetic testing has not returned yet, I would wait to see what that report indicated.

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@nataliehope I should also add that this surgery required extensive excision as I have scars from under my armpits, underneath across my breasts, and then the "lollipop" excision up from the breast and around the nipples. With normal simple lumpectomies, you are left with a scar in the area of excision.

REPLY
@casualobserver

Hi @kruzin – I don't know if I'm too late to post my experience as you may have already gone ahead and done your surgery. But, if not,
I wanted to share my information with you, if it might help you.

I just had my bilateral mastectomy with reconstruction less than a month ago. I had biopsies in both breasts. I learned one breast had cancer the other tested out benign. The diseased breast had several large masses that all tested malignant and a lumpectomy was not deemed 'ideal' due to the amount of tissue removal involved so a full mastectomy was indicated for that one breast.

I am a research nut and did copious research on the subject and also had 2 consults with the breast surgeon and 2 with the plastic surgeon before deciding. I also spoke with my spouse, 2 children and daughter-in-law who's a nurse. During my weeks of contemplation and research, I subscribed to MedScape and read many of their published medical studies on mastectomy and breast cancer, including survival rates, surgery options, decisions made by patients who chose a particular option and comments from nurses and surgeons. I also searched every article I could on the internet and read many patients' comments.

In the end, I decided to remove both breasts and do immediate implant placement in both. I knew I wanted reconstruction as I would be too depressed otherwise. Mental health is equally as important as physical health and should be weighed as carefully, in my opinion.

My reasoning for doing a bilateral mastectomy and immediate reconstruction rather than just doing one breast is as follows:
* If both were done at once, the plastic surgeon would be able to make both breasts match closely, utilizing the new Alloderm artificial skin and identical silicone breast implants.
* I currently have excellent insurance and who knows what I may have years from now if the healthy, remaining breast were to develop something.
* I will never be younger than I am now, and my chance of a good recovery should be better now than years down the road (if cancer were to develop again).
* I would have one time off from work, one (longer) procedure day, one hospitalization, one anesthesia, and one recovery.
* Both breast gone = no further mammos, MRI's, no chemo, no radiation, (hopefully??) and no further worry about the other shoe dropping with the remaining 'healthy' breast developing something down the road. I have read how women who have cancer in one breast must go in and have any remaining breast tissue looked at and poked and prodded yearly for the rest of their lives. I wanted to avoid that if I could. Who needs more stress and worry?
* In addition, my healthy breast had been banged up pretty good with a stereotactic biopsy and had developed a large, hard lump and depression at the point of entry. I felt that it was now injured and may be more susceptible to getting cancer (gut feeling) which further directed me to going forward with both mastectomies.
All-in-all, I am currently glad I chose as I did, however I am still in recovery and may come to a different conclusion later, but I'm hoping for the best!

Jump to this post

Hi, this is very helpful, did you have nipple sparing? How old are you, I find your story very similar to mine.

Liked by trixie1313

REPLY
@nataliehope

Hi, this is very helpful, did you have nipple sparing? How old are you, I find your story very similar to mine.

Jump to this post

@nataliehope I'm 68 and am Stage 3 infiltrating breast cancer metastasized to lymph nodes with 1 cancerous node extruding to lymph system as well as neuroendocrine cancer of breast in second tumor. The nipples were not a problem, that is why I have the "lollipop" scars.

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I am having my reconstruction in August. I went to over all the options and decided to go with an implant. I have already done the spacer so now they will place the real implant. I was going to do a flap but I am 72 and my doctor thought the procedure would be too much.

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