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?

Interested in more discussions like this? Go to the Breast Cancer Support Group.

I went to Morristown Medical Center in New Jersey. It’s not the hospital that’s good it’s the doctors. I just love mine!

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@bomashisha

Hi, Catann. I hate that you are having to go through this, but I am thrilled to hear your overall prognosis is very good. I would like to know whether or not your cancer is triple negative. Mine was and I think it is helpful to know in order to figure out treatment, surgery, etc.

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Hi, My tumor is grade 1 ER+/PR+/HER2- invasive lobular carcinoma.

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@casualobserver

Hello catann,
I would like to give my opinion and you can do whatever you want with it.

I had one breast that had 3 tumors and 1 mass of unknown origin (?) and together they spanned from the 6:00 o'clock position all the way around the outside of my right breast to the 1:00 o'clock position. I opted for mastectomy on BOTH sides with immediate replacement with silicone implants. That means I would never need to come back for a cancer in the other one in the future.

Also, it would be one surgery, one insurance claim, two matching breast implants of equal size, matching equal scars, and only one recovery. Plus, no more mammograms, MRIs or biopsies or pokes or prods or worries about the remaining good breast in the future.
Removing that worry and that dread of recurrence in the other breast was important to me, and so it was a 'One and Done'. It has now been 25 months since surgery and I am doing fine and have a nice set of matching breasts that look very nice in clothes and not too bad naked, if you don't mind the single 4.5 inch-long scars on the sides of each breast.

Why choose implants over an autologous fat & tissue transfer? Well, I'll tell you why I did. First, I am a researcher and read everything I could get my hands on and learned everything I could before coming to my decision. I learned that removing tissue from one part of the body and moving it to another is not so simple.

The donor site will have quite a bit of surgery and will be vulnerable to infection and be painful and require care and recovery.
Also, removing large areas of tissue and fat may cause the donor area to look abnormal and deformed, rendering that part of your body unsatisfactory and a source of disappointment. (We have this fantasy that we will remove that spare fat around the hips or the waist and put it in the breast getting a 'Two-fer'). The truth is, that is not what will happen. The preferred technique to liposuction fat for aesthetics, will damage the fat cells, but preserve the aesthetics. The technique to harvest fat and tissue for reuse is focused on preserving the fat integrity and not so much on the aesthetics of the area you are removing it from, if you follow. It is more invasive and will leave large scars and depressions unless you have a very skilled surgeon with much experience in this technique.

Additionally, the donor fat and tissue can sometimes fail to develop an adequate blood supply at its new location, thus requiring multiple attempts. Even when successful, the transplanted fat can develop granulomas which are opaque can be mistaken for potential tumors on an MRI.

Also, there is the issue of shape. Trying to approximate the breast you had with the tissue from your abdomen, flank or thighs may look different from the breast you were hoping for. Sometimes, more surgery or liposuction and injections must be made, to get the shape and size approximation you wish. It may never look like the other breast. Only you can decide if that matters to you, and how much pain and recovery you are willing to go through to create a 'non-implant' breast.

Remember, you will be creating a wound in a healthy part of your body and will have two locations of injury rather than just one.
I say, why deface and injure another part of your body if you don't have to? It is a much simpler procedure to place a perfectly sized and shaped breast implant in the space of your former breast and just recover from that. I think I know that you were hoping to avoid the potential issues that breast implants present, but they truly can last a very long time (20+ years) if you take care of them.

I hope this was of some help. Only you can decide what is best for you. Do lots of research and satisfy yourself.
Good luck.

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Thank you so much for your reply.

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@colleenyoung

@catann, welcome to Mayo Clinic Connect. You'll notice that I moved your message to this existing discussion about breast reconstruction. I did this so you can connect with @bomashisha @nataliehope @sandyjr @lucillem72 @bmerxbauer @casualobserver @jspencer @kruzin and others. Simply click VIEW & REPLY in the email notification to read through the past posts.

While we wait for others to join the conversation, you might also be interested in these videos:
– Videos about Breast Cancer Surgery from Mayo Experts https://connect.mayoclinic.org/discussion/videos-about-breast-cancer-surgery-from-mayo-experts/

Catann, will surgery be the only treatment you'll need or will you have radiation? Feel free to ask questions. There's a whole group waiting to help 🙂

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I will be having 3 weeks of radiation since my tumor is over 5 centimeters. If they find any cancer in the lymph nodes however, the radiation will be increased to 5 weeks.

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@catann

I will be having 3 weeks of radiation since my tumor is over 5 centimeters. If they find any cancer in the lymph nodes however, the radiation will be increased to 5 weeks.

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@catann
In my area, they offered intraoperative radiation that would be a one-time only radiation treatment. If they have that in your area, please check into it. Sadly for me, my lymph nodes had eroded into the lymphatic system so I was awarded with 30 radiation treatments. However, the personnel there and doctors were so very supportive and it was over before I knew it.

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@catann

Thank you so much for your reply.

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Thank you for the info on decision making. I am 70 and considered a good candidate for reconstuction by the surgeons The plastic surgeon showed realistic pics of the procedure and it was traumatizing to me! I am now reconsidering my choice as I have become quite anxious about having 2 surgeries mastectomy and abdominal tissue reconstruction at the same time 6 hours. Surgeon also gave me the silicone implant to hold and feel as another choice. It seemed quite heavy and I feel it would feel like a foreign object and be irritating.
Now I am thinking I can't handle this and will just have the mastectomy, get it done and get rid of the cancer and accept this amputation as it is, but I am not wanting to have regrets either.

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@gbnana

Thank you for the info on decision making. I am 70 and considered a good candidate for reconstuction by the surgeons The plastic surgeon showed realistic pics of the procedure and it was traumatizing to me! I am now reconsidering my choice as I have become quite anxious about having 2 surgeries mastectomy and abdominal tissue reconstruction at the same time 6 hours. Surgeon also gave me the silicone implant to hold and feel as another choice. It seemed quite heavy and I feel it would feel like a foreign object and be irritating.
Now I am thinking I can't handle this and will just have the mastectomy, get it done and get rid of the cancer and accept this amputation as it is, but I am not wanting to have regrets either.

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I cannot tell you what either surgery is like, only that I really wanted a mastectomy with no reconstruction. My local surgeon refused and 17 years ago I was not savvy enough to fight for what I wanted and I believe that surgeon thought he was giving me the right choice of a partial mastectomy. My grandmother had a Halstead mastectomy back in the day and she wore a prosthetic so she would look balanced but she never regretted them being gone.
I met a woman who had a bilateral in her 60s and got tattoos that were floral and beautiful on her chest. I don’t feel like we have to be reconstructed, especially if you are traumatized by the thought. Cancer shouldn’t have angst over this on top of everything else. Have you discussed this with family? Significant other/spouse?

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@auntieoakley

I cannot tell you what either surgery is like, only that I really wanted a mastectomy with no reconstruction. My local surgeon refused and 17 years ago I was not savvy enough to fight for what I wanted and I believe that surgeon thought he was giving me the right choice of a partial mastectomy. My grandmother had a Halstead mastectomy back in the day and she wore a prosthetic so she would look balanced but she never regretted them being gone.
I met a woman who had a bilateral in her 60s and got tattoos that were floral and beautiful on her chest. I don’t feel like we have to be reconstructed, especially if you are traumatized by the thought. Cancer shouldn’t have angst over this on top of everything else. Have you discussed this with family? Significant other/spouse?

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I had both breasts removed (one at a time, my doc wanted to see how I did with the surgery). I am flat and actually don't mind at all. I don't wear any prosthesis or padding. Clothes look fine on me I think.

My doc and nurse practitioner kept saying I needed to think about how I would feel losing my breasts. I feel like it was harder than it should be for THEM to accept it was okay. I had no qualms.

It is a personal decision but my surgeries were pretty easy. Also I had a paravertebral block so I didn't need pain meds, which make me sick.

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@gbnana

Thank you for the info on decision making. I am 70 and considered a good candidate for reconstuction by the surgeons The plastic surgeon showed realistic pics of the procedure and it was traumatizing to me! I am now reconsidering my choice as I have become quite anxious about having 2 surgeries mastectomy and abdominal tissue reconstruction at the same time 6 hours. Surgeon also gave me the silicone implant to hold and feel as another choice. It seemed quite heavy and I feel it would feel like a foreign object and be irritating.
Now I am thinking I can't handle this and will just have the mastectomy, get it done and get rid of the cancer and accept this amputation as it is, but I am not wanting to have regrets either.

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I don't understand the abdominal tissue reconstruction. I had my right breast mastectomy, and at the same time the plastic surgeon put in an expander. I now can have the per?permanent implant put in. I'll hopefully get that done before the end of the year.

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@d13

I don't understand the abdominal tissue reconstruction. I had my right breast mastectomy, and at the same time the plastic surgeon put in an expander. I now can have the per?permanent implant put in. I'll hopefully get that done before the end of the year.

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Abdominal tissue reconstruction is where they can take the tissue from the stomach area to use to fill in the breast instead of an implant. The joke of course is you get breast reconstruction and a tummy tuck all at once.

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