Reconstruction Advice

[Julie Gwynn]

I'm really interested in getting feeedback on reconstruction. I've just been diagnosed with a local recurrence (1.2 cm ductal carcinoma, ER+/PR+/Her2-neu+) 12 years out from a Stage I ductal carcinoma, which was treated with lumpectomy and radiation. Presently, I'm scheduled for a mastectomy and TRAM flap reconstruction at MD Anderson the first of June. I'll meet the plastic surgeon for the first time next week, so I'm trying to learn all I can in advance. However the more I read, the more I'm starting to question having the TRAM done.

I've looked into the DIEP perforator flap, and it really looks good to me, especially since I've had a prior nephrectomy for renal cell cancer, so I've already got abdominal weakness. I called Dr. Robert Allen's office in New Oreans, but he only does DIEP procedures there, and I'm told that it's better to do the mastectomy and recontruction at the same time (better result and only one general anesthesia). So I feel conflicted because I really want to stick with my breast surgeon at MDA. Has anyone else had a DIEP flap? If so, where did you have the procedure and what was the outcome? Was it at the same time as mastectomy?

For those who've had TRAM flaps, what were your results and/or complications? Any feedback would be greatly appreciated. FYI, the plastic surgeon I'm going to see at MDA is Dr. Mike Miller. Has anyone else ever been a patient of his?
And although I haven't wanted to consider implants, any feedback from those of you who have had implants would be appreciated. I have concerns about silicone, even the silicone lining of saline implants, although I know that the studies on silicone haven't been conclusive.

I know I need to make a decision soon, so as not to prolong the timeframe for my mastectomy. Thanks so very much in advance for any feedback you can give me.

Julie Gwynn

[jc]

Hi Julie,

I was told by my plastic surgeon about a year ago that the DIEP procedure is done at M D Anderson. If I had chosen that procedure vs. a TRAM flap, free flap, lat flap or an implant, she would have referred me there. I can’t imagine that she is wrong about this since she did part of her training at MDA.

In the end, I chose an implant mostly because I did not want to "damage" a perfectly good part of my body. Also, I was only having reconstruction for a partial mastectomy and I didn’t know long term if I wanted to use my ab or lat muscles when I might need them later if eventually the whole breast had to go. I think there are pluses and minuses to all of the choices you have. Good luck with your decision and I hope you find you can get the DIEP at MDA if that is what you choose.

jo ann

[Julie Gwynn]

Jo Ann:

Thanks for sharing your experience with me. My breast surgeon and also the nurse coordinator in New Orleans told me that the surgeon who did DIEP flaps at MD Anderson just passed away. So I don't think MD Anderson has anyone right now who does them regularly. I'm going to find out more next week when I meet with the plastic surgeon, but I guess I'm wondering whether the number of DIEP cases performed makes a difference. In other words, there may be someone at MDA who trainined under the recently-deceased surgeon and who has done a few cases (the impression I got from talking to the nurse in Plastic Surgery), but would they be much of an expert if they've only done a few cases? And I completely understand your desire to keep your abdomen intact. As I understand it, you can only do an abdominal flap procedure once.

Julie Gwynn

[Paula(Ire)]

Dear Julie,

I can understand your concern about TRAM reconstruction if you already have abdominal weakness. I can only offer my own experience with TRAM. Other women have had a better result.

I had immediate TRAM reconstruction after left breast mastectomy almost a year ago. I had DCIS with negative nodes, no chemo or radiation. Shortly after the reconstruction, it was confirmed that I had an abdominal hernia as a result of the TRAM tissue harvesting. As I write, it is just over four weeks since haveing this hernia repaired. It feels like TRAM surgery all over again!! I had to fight to have it repaired, having been told to live with it; to wear heavy corsets by day, light corsets by night, for the rest of my life!! The success rate for the repair surgery is something like 54% - not very high.

Even without the hernia, I found the TRAM surgery very tough. No information I read prepared me for the huge impact on my body. I would not choose it again knowing what I do now - hernia or no hernia. My whole torso front was completely numb. Feeling was beginning to return almost a year later. To varying degrees women have reduced mobility due to the surgery. If, for example, you enjoy playing sports, TRAM would not be a good idea.

Below is the url for a short piece (a bit technical but statistically interesting) of a study done of 20 women post TRAM flap surgery.

The reconstructed breast is not bad at all. I just don't feel it was worth the price.

Anyway, that's just my humble experience. Whatever decision you make, I wish you the very best with it and hope to hear how you're getting along. It's tough making these decisions when you are also dealing with a diagnosis; I'm glad for you that you have this forum for feedback. I send you loads of love, Julie.
Paula.

http://www.geocities.com:80/HotSprings/8689/tramflip/t10.html

[Lee K.]

Joann,
I had a partial mastectomy, about 1/3 of my breast removed, and am thinking about reconstruction, especially if implant could be used. Please share your experiences. Please email me privately if you would rather not post.
Lee
leekirk@erinet.com

[jean214]

Dear Julie,
I had tram flap and single-side mastectomy in July 1998. The plastic surgeon failed to stitch mesh into my abdominal wound, which caused a huge hernia which had to be repaired 3 mos. later. It was horrible. Today I feel like I have an Ace bandage wrapped around my lower abdomen all the time, and the hernia repair partially failed and is painful sometimes. I have a permanent loss of abdominal strength which inhibits pushing or pulling.
I do feel there is a benefit to having them done in the same surgery, psychologically. I felt as if they had operated on my breast and my gut, and screwed both up, but at least I still had them. My fake breast is numb and scarred but is a good match in any clothing. I often go braless.
I would do tram flap again only with a surgeon who had successfully performed it hundreds of times, literally, and who agreed to stitch in the mesh reinforcement.
If you decide to have this surgery, please post again for more specific help on surviving the first hard 6 weeks. Or you could search the archives of this Forum on tram flap.
best to you,
hjean214

[jean214]

Dear Julie,
I strongly believe it is the number of operations the surgeon himself has performed, not the caliber of surgeon he learned them from or observed doing them, that determines the level of skill you will be hiring. Mine claimed to have done 150 over 12 years, but obviously, that was not enough in the difficult surgical techniques of tram flap.
best to you in a hard decision,
jean214

[Lauren]

Hi Julie,

I'm in Houston & I had to make this decision a year ago after a dx of DCIS. I talked to lots of people & everyone (including my GYN) said Mark Schusterman is the best for any tram surgery. He used to be head of PS at MD Anderson. His # is 713.794.0368.

I've always been very thin & I didn't qualify for the tram & I got saline implants instead. Personally I didn't want the tram anyway because it sounded too scary but I know it's popular.

Good luck with your decision & don't rush into anything - really listen to your inner voice.

[Kim]

Hi,

I had a free tram last year. Although it was very difficult surgery, I would do it again. The results were excellent, mostly because I had a very experienced PS. It is hard on the tummy area mostly, but I was back in the gym pretty quickly and I am now running and lifting weights again. If you have any questions please feel free to ask me and good luck to you.

Kim

[cindi]

Hi Julie,
I just had bilaterals a few weeks ago. My PS will not do reconstruction at the same time. He along with several other doctors have concluded that building up scar tissue, knowing pathology results, and making sure the skin(I had skin sparing masts) has a proper blood flow outweighs a second surgery. He actually has been speaking all over the U.S. about this very issue. Women don't want to wait, but I'm glad I did. I had some issues with fluid and a big scab on my left side which required some serious watching. I opted for implants because I didn't want the long surgery and long recovery period for trams. Also, I really don't have a very big tummy, so that played a part. However, I have been told, spoken to patients, and seen photos of all of the different options. The most important thing is your comfort level and the reputation and experience of the PS. My breast surgeon's wife went to my PS for reconstruction, so I felt some comfort there. I am having stage one(expanders) in about 10 days. Stage two will follow once the breast area has been expanded to whatever size I desire. I just want a B cup, but I may have to go a little larger in order to fill in the area above the breast. I really don't want any tissue taken from my tummy or my back. It's a huge decision, but I feel great physically, psychologically, and spiritually. I guess what more can you ask for. The best of luck with your decision. Cindi

[Darian]

Hello!

I had bilateral reconstruction with tissue expanders and then implants. As for the Diep and the Tram flaps..I have friends who have done each one. Both are pleased with their outcomes, but have had to have more surgery to get to a good end result. I think you are doing the right thing about looking at all the options. The Diep seems to be less invasive (if one could say that) than the tramflap. I have heard of more complications/flap failures with the tram...but, I am very far from an expert. I am pleased with my results with just the implants. I hope you find the right reconstruction method for you and that everything goes very smoothly and you are pleased.

Lots of Hugs,
Darian

[Rosanna Bechtel]

Hi, Julie.

I had a bilateral mastectomy followed by expanders and saline implants. I am having a very hard time adjusting to the implants because they're so hard and unyielding, making it impossible for me to sleep on my stomach. Also, I had no idea it was possible to get charleyhorses in your chest muscles, but I've had some humdingers that have left my chest sore for days! Other BCANS correspondents have recommended silicone instead of saline because it's softer and more yielding, so, if you do opt for implants, I'd go with silicone.

At the time I had reconstruction, I had never heard of the DIEP flap, but I'm thinking seriously about it now, especially since I could definitely use a tummy tuck too. The TRAM and latissimus dorsi were offered as options, but I couldn't see compromising the integrity of one part of my body to pad out another; with the DIEP, I'd be using part of me that I wouldn't mind getting rid of anyway!

I didn't want to wait for reconstruction either for psychological reasons, but I might as well have, because my right expander collapsed twice, and I spent a lot of time with a left breast that kept increasing in size and nothing on the right, so even expanders are no guarantee that you won't end up flatchested at some point anyway. Knowing what I know now, I would hold out for the DIEP, even if it meant I had to wait.

xxoo Rose

[Dottie of NJ]

Hi Julie;
I had expansion of my left breast with Silicone implant but it didn't come out right. Now I need revision of some kind.I don't think my PS put enough Saline in to stretch it enough. If I could go back I would have insisted on more, but, she told me after she lifted my "good" one with the implant they would match up. But that didn't happen. Now she's giving me an attitude when I fax her questions so I'm going to see another PS on June 5th! I don't need this aggravation from her!!! I'm not putting expanders down. My sister-in-law's came out great. Don't be afraid of the Silicone either. They feel much more natural than the Saline, mine feels hard on the expanded side but I think it's due to not enough expansion and my surgeon told me a lot of the news is "bunk". No one knows how or why we get cancer.

I wish you luck............Dottie of NJ

[Julie Gwynn]

Paula:

Thanks so much for the feedback. And I'm very sorry you had such a bad experience. This is exactly what I'm worried about: abdominal problems. I tried to get to the URL with the data from the TRAM study, but I'm having a problem. What was the overall finding? Was there even a trend? Again, thanks so very much for your help.

Julie Gwynn

[Julie Gwynn]

Jean:

What a horrible outcome you had! I'm very sorry to hear it. If I do this at all, I'll definitely ask for mesh. And I'm beginning to agree with you: the surgeon really needs to have done hundreds of cases.

Yes, I'd love any advice you have for me re: surviving the first 6 weeks. I know from having had a nephrectomy (and I didn't have any feedback from a discussion group then), that I was not at all prepared for the difficult recovery period. Thanks so much.

Julie Gwynn

[Julie Gwynn]

Lauren:

I'm a patient at MD Anderson, but the plastic surgeon I've been referred to is Mike Miller. I just looked up Mark Schusterman on the MDA website, but I don't find him. Did he leave MDA? FYI, I think I might also be too thin for the TRAM. I know I'm too thin if I have bilateral mastectomies, which I'm considering. So I really think I'm leaning towards saline implants. I'm just not crazy about the saline implant's silicone lining.

Were you happy with your results? What would you consider the down side of saline implants? I've heard that they don't feel very natural. Are they uncomfortable in any way? Thanks so very much for the input.

Julie Gwynn

[Paula(Ire)]

Dear Julie,

Sorry about the dud url... I hate that. Below is the synopsis:-

ABDOMINAL WALL STRENGTH, BULGING, AND HERNIA AFTER TRAM FLAP BREAST RECONSTRUCTION

Abstract: The incidence of postoperative abdominal bulge, hernia, and the ability to do sit-ups was reviewed in a series of 268 patients who had undergone free TRAM (FTRAM) or conventional TRAM (CTRAM) flap breast reconstruction. Minimum follow-up was 6 months.

Patients were divided into four groups: unilateral FTRAM (FT1P; n = 123), double-pedicle bilateral FTRAM (FT2P; n = 45), single-pedicle CTRAM (CT1P; n = 40), and double-pedicle or bilateral CTRAM (CT2P; n = 60).

The incidence of abdominal bulges (3.8 percent) and hernia (2.6 percent) was similar in the four groups. Synthetic mesh, however, was required for reinforcement of donor site closure twice as often in the CTRAM patients.****

The ability to perform sit-ups was greatest in the FT1P group (63.0 percent), slightly lower in the CT1P group (57.1 percent), still lower in the FT2P group (46.2 percent), and lowest in the CT2P group (27.1 percent; p = 0.0005). Patients reconstructed with an FTRAM flap were more likely to be able to do sit-ups (58.3 percent) than were those reconstructed with a CTRAM flap (38.2 percent; p = 0.0074). Patients who had only one muscle pedicle used were more likely to be able to do sit-ups (61.7 percent) than were those who had two muscle pedicles used (35.6 percent; p = 0.0003).

We conclude that the incidence of abdominal bulge or hernia is relatively independent of the type of TRAM flap used and the number of muscle pedicles harvested. On the other hand, postoperative abdominal strength, as measured by the ability do sit-ups, is influenced significantly by both of these factors.

BACK TO PAULA: Another study I can't locate just now showed an incidence of 1 in 20 of herniation, 2 in 20 of abdominal bulge. 1 in 20 is 5%, higher thant he study above. This study, as far as I remember, was British. I think it's possible that the reason for the higher percent was that mesh was less likely to be inserted to strengthen the abdomen as part of the TRAM proceedure.

Again, the very best to you making your decision. Much love, Paula.

[Julie Gwynn]

Kim:

Thanks for sharing your experience. I guess I'm pretty much hearing the bad TRAM outcomes, so it's good to hear a success story. Where did you have your surgery? Did you have mesh placed in your abdomen? How long was it until you felt back to normal? Thanks again for the feedback.

Julie Gwynn

[Julie Gwynn]

Cindi:

This is the first time I've heard that it's actually better to wait to have the rescontruction done in a subsequent procedure. This makes a lot of sense. Who is your physician and where does he practice?

Regarding your bilaterals, you say that you had skin sparing mastectomies. Did you have an invasive tumor in one or both of your breasts? I was under the impression that if so, you couldn't have a skin sparing procedure. I'm considering bilaterals (one for prophylaxis), but I thought could only do a skin sparing mastectomy in the unaffected breast. How much of the skin is actually saved with a skin sparing procedure anyway? Another point I'm not clear on is if you have a skin sparing procedure, doesn't that obviate the need for skin expanders? Finally, did you choose saline or silicone implants? Thank you so very much for your input.

Julie Gwynn

[Julie Gwynn]

Darian:

How many surgeries did you have to have? And were any of them possible with local anesthesia? I'm trying to limit the number of procedures with general anesthesia. Also, I had thought that implants required fewer potential procedures than TRAM. I'm very glad that you're pleased with your outcome. Thanks for your input.

Julie Gwynn

[Julie Gwynn]

Rose:

Oh great, I didn't know that saline implants could cause problems sleeping. I had heard that they didn't feel as natural as silicone, but it sounds like yours are bad enough so that you're considering having them removed. From what you're saying, I'm wondering if I should go with the saline implants now and then if I have problems, consider having a subsequent DIEP procedure done in New Orleans by Dr. Allen (who evidently has the most experience). One thing I'm wondering is whether most insurance companies would pay for two reconstructions, even if the second one is necessary to correct the first one. Have you looked into that? I'm sorry you're having problems and I hope you can find a good outcome. Thanks so much.

Julie Gwynn

[Julie Gwynn]

Thanks, Dottie, for the feedback. I'm sorry you're having so much trouble. I guess this is all pretty unpredictable. Good luck with your new plastic surgeon!

[Sally]

Julie - I had a left mastectomy and after 4 years decided on reconstruction. I have the expander in place, first fill in another week. I'll have the saline implants, unless I change my mind to silicone. My good right breast will receive a lift to better match the other one. I have a lot of confidence in my ps, as I've seen first hand his "handiwork". It's extremely important to go to someone who really knows what they're doing, I can't emphasize this enough, and I'm sure you know. IF, this doesn't work out, I can always opt to have the TRAm procedure later. I doubt if I will though, I saw the procedure on TV....if I had had the Tram first, there would be no other options if something went wrong.
Good luck.
Sally

[Barbara W]

Julie: you may have de4cided by now but the TRAM is no picnic. Diep sounds like a good alternative. I DID the tram and am not sorry but think the other might be easier...take care bw

[Darian]

Hello.

After my expanders were placed immediately following my bilateral mastectomy....I had another surgery after the final expansion to replace the expanders with the implants, and had an 'instant' recovery. The expanders were so firm and 'ungiving' and not very comfy, so when I had them replaced with silicone implants....it was WONDERFUL!!! Also, I had no nausea and felt as if I had woken up from a nice sleep. I also woke up from surgery in minor discomfort and the worst I could say it every felt was as if my ribs were sore from coughing too much...that was it. I had my nipple reconstruction this March, and I stayed awake and just had a brilliant time with the Verced to make me VERY HAPPY to be there. Hahahha. My breasts look great...in fact, once the tattooing is complete, they will look more like breast augmentation than reconstructed. I have to say since I received the implants...it's been great....can't really complain. I had this done at UCSD (San Diego, CA) and the surgeon is a God-send. I have 4 friends that have gone to the same surgeon to have their breasts reconstructed or 'touched-up'. One of them, was even a previous diep-flap patient. To be fair though...all of us had our initial mastectomies at the Naval Hospital (LEARNING Hosp), and that is probably why weren't jumping for joy until after we went to UCSD...even though they are a learning hospital also......the difference between the two are HUGE! But, I am not putting down the naval hosp community...I am very pleased with their staff and care, it us just one of those things at that time. So, from start to finish 3 surgeries. The implant surgery, for me was a cake-walk...2 hours, easy recovery from the anesthesia and physically. I'm glad I took the route I did. If I can answer anything else, please just ask. Best of luck to you!!!

Love,
Darian

[jc]

Hi Lee,

My story is kind of long so I will e-mail you with the details. The short story is my partial mastectomy left me with one third less breast tissue in an already small breast, so I looked very lopsided. My goal for reconstruction was to look symmetrical in a jog bra (I love to run) and my PS pretty much accomplished that goal. I was her guinea pig since she had never done a reconstruction on a partial mastectomy using an implant before. Then again, I was also a rare patient because I had not had radiation to my breast. This, however, is not a requirement. From what I understand, there are women on this forum who have had reconstruction with implants after having radiation.

Anyway, I had a crescent shaped expander (also known as the alien) for 4 months and a regular saline implant as a replacement. I also had a smaller implant placed in the healthy breast to achieve better symmetry between the two breasts. My breasts are not perfect, but they certainly are perky. Now if only the scars would fade, the ripples to the far side would disappear, and they would feel soft like the originals, I would say they would be prefect.

I’ll e-mail you soon.

jo ann

[jc]

Hi Julie,

I hadn’t heard that the surgeon that did the DIEP at MDA had died. Considering that there is a higher failure rate for DIEP vs. TRAM (including free flap), I would think you would want someone who was very skilled at microsurgery and this particular procedure. The microsurgery for DIEP is much more involved than with TRAM, which is why fewer surgeons are trained on the former. If I remember right, the failure rate for DIEP is 2% and free flap is 1% - still pretty good odds of having a successful surgery which ever route you take. And yes, you are right, you can only do the DIEP or TRAM once, so if it doesn’t work out, you have to seek other options.

Wishing you the best,

jo ann

[cindi]

I totally understand all of your questions because I asked the same ones. Two people I personally know have had reconstruction by my doctor, who by the way is Dr. Welk in Seattle at the Polyclinic. He and his partner work in conjunction with my surgeon who only does breast surgery with primarily cancer patients. My surgeon told me there were only three doctors he would even recommend in the entire Northwest for reconstruction following mastectomies. I know of many women who have lousy results. I had an invasive 1.1cm tumor on the right and started with a lumpectomy and subsequest chemo. Upon starting radiation I really felt I wanted to just get both of them off. I quit radiation after a few times and proceeded with bilaterals. Insurance covers it all even if only one breast has cancer. I have a strong family history and very dense breast. Mammography does not work well for me. I actually found the tumor myself. It did not show up on a mammogram. Also, if you do choose reconstruction the other breast usually needs some sort of surgery to match them up. I figured I might as well get it off for peace of mind since it would probably have been operated on anyway. Also, skin sparing still needs some expanding. The advantage is the process is easier and goes a bit quicker. If your margins are clean, there is no problem leaving lots of skin. I am having saline implants since silicone are a bit more dangerous. My PS said new implants will be available within the next 3-5 years which are going to be awesome. They are being used in Europe, but it takes so long for anything in the U.S. to get approval. I figure if I'm totally unhappy, I'll switch. However, I don't anticipate being unhappy at all. Hope I've answered all of your questions. I'll be getting my expanders in on 5/23. Let me know if you need any more information. Stay positive! Cindi

[Lee K.]

Thanks, Jo Ann, looking forward to your email.
Lee

[jean214]

Dear Julie,
After finding a highly qualified surgeon who has done this procedure many times, ascertain that he/she believes you will get good nursing care at the institution where he/she plans to operate.
After that, the key to surviving the reconstruction surgeries that take tissue is pain control. You should have a morphine pump that is programmed to deliver a small amount of the drug even while you are sleeping. This will prevent letting the pain get ahead of you, which can cause muscular cramping that is excruciating. Be sure you have oral demerol or another opiate pain drug at home, waiting for you. Get onto oral pain meds right away, as soon as you lose the IV, and stay on them for 4-6 weeks until you can stand up straight without too much pain. You will not become addicted.
You will come home with surgical drains. They are a pain, mentally and physically, but they do help healing, so try not to press your surgeons to remove them until they are draining less than 20 cc's daily. I pinned mine to a necklace so I could shower.
Lift nothing over 5 pounds for a month, nothing over 10 pounds for at least another month after that. I mean NOTHING. If someone isn't around to do the lifting, put off the job.
When the pain is manageable, you can start exercises that will help you regain much of your range of motion. Walk your fingers up the wall, etc. I got a booklet from the American Cancer Society 8 weeks after surgery (neither surgeon thought to suggest physical therapy) and did those post-mastectomy exercises, as well as careful swimming. For weeks I dog-paddled with my good arm next to the wall of the pool for safety.
I believe this was the best exercise I could do. Nothing will replace the lost abdominal muscles if you have tram flap (I do not know what damage DIEP causes) and you will have to give up some exercises and yoga movements, and learn to live with permanently reduced ability to push or pull. I can carry 25 pounds now, but it hurts my hernia.
Don't expect any of these useful tips from your surgeons. In my experience, once you are out of the anesthetic, they are deaf to complaints of pain or loss of motion.
I once was an advertising writer for a team of heart surgeons who were introducing a minimally-invasive version of open-heart surgery which avoided the long zipper-like incision and reduced pain. The surgeons were keen to use their new toys but when I asked them about how much pain reduction this technique accomplished, they looked at me as if I were from Mars. It wasn't an issue on their radar screen. My plastic surgeon couldn't care less that I suffer continuing damage, he is so blinded by his beautiful symmetry. I think (anyone who saw "Wit" will understand this) that if they called him in on the day of my death, all he would do is exclaim how perfectly my real breast and his fake one match.
best to you, you can get through it if this is what you want,
jean214

[Daisy/Indianapolis]

Dear Julie,
I had a tram in '99, second stage nipple graft and reduction of the good breast in '00. This year I had to have a hernia repair (this is a risk factor for tram). My mastectomy was in '93. If you have the mastectomy and tram done at the same time they can do skin conserving mastectomy and that helps because they don't have to take as much abdominal skin. I still have tightness along the abdominal incision. Pay close attention to the written risk factors they will have you read before consenting. Only do this surgery if you are willing to undergo more surgeries. You have to be tough--you feel like you have been hit by a truck and the recovery period is long and arduous. Good luck with your decision. I haven't regretted mine, despite all the setbacks afterwards. Many hugs, and
HEART, Daisy

[Lauren]

Hi Julie,

Mark Schusterman did leave MDA & he's now on his own in the medical center. I feel pretty comfortable with the saline. At first I did feel like I had a big plastic chest on but as time goes by it's become more comfortable. I didn't want the silicone because I was afraid of the possibility of leakage that might go undetected. Good luck with whatever you decide.

Lauren

[Sharon]

Hi Julie,

Like Cindi I went to Dr. Welk in Seattle for my reconstruction with a saline implant. I had dcis and had a skin sparing mastectomy. I am very happy with the saline implant although I probably will have to have it adjusted.

I waited 30 days after my mastectomy for my reconstruction. He wants to make sure that the skin flap doesn't die. My results turned out great.

I would suggest going to a reconstructive group if you can. Dr. Welks office has a meeting every month were women who are getting reconstruction meet. There are women from many different plastic surgeons. It is a great way to see what they have gone through first hand and see the results. Some of the women are done some are in the process. This is experience was very healing for me.

My thoughts are with you.
Sharon

[Tina From Texas]

I had a mastectomy on the the left in 1999 and decided to have a skin sparing mastectomy on the right feb. of 2000. Even though I had a skin sparing mastectomy and asked my plastic surgeon why it is smaller that my left, of course, I could tell he didn't like me questioning his work, and his reply was its smaller because I had less skin tissue on that side. That made a lot of sense, when it was the skin sparing side, makes sense..more skin thank you. I think he did not keep up with how much saline he put in my expanders before the reconstruction. He put a silicone implant with 50 cc's less silicone on that side and its not as high as the right. I hate him when I look in the mirror. And then, what if I fixed it and had some sort of problem...infection or something. So, I go on telling myself, I should be happy I am alive and do they look bad? The doctor, I could tell, was insulted at my questions.

confused..Tina from Texas

[Julie Gwynn]

Paula:

Thanks so much for the data on abdominal wall problems. I just got back yesterday from a consult at MD Anderson, and they said that they don't routinely use mesh. I guess this means that it's not always needed, since they don't typically compromise the abdomen enough to require it(?) Thanks again for this reference.

Julie Gwynn

[Julie Gwynn]

Jean:

This is exactly what I wanted to know! Thanks so much for the in-depth account of your recovery. I'm so sorry that you had a bad experience; your abdominal problems seem especially bad. This is the very thing I'm worried about. Thank you for your candor.

Regards,
Julie

[Julie Gwynn]

Cindi:

Thanks again for all the feedback. I think you were smart to discontinue radiation when you did. I just found out yesterday during a consult with a plastic surgeon that implants don't do well in irradiated breasts (like mine). Also, I ran across a little information on the new soybean oil implants (Trilucent) used in Europe. When I asked the plastic surgeon about them, he didn't have any input on the status of their approval for use here. But I think they sound great, too.

Julie

[Julie Gwynn]

Sharon:

Did you have radiation before having your implants? I just found out yesterday during a consult with a plastic surgeon that implants frequently develop problems in breasts that have been irradiated. Which is just great because I had radiation, yet I was hoping that implants would be possible. Thanks so much for your input.

Julie Gwynn

[Julie Gwynn]

Darian:

Thank you for sharing your experience. Too bad I don't live in San Diego! I do have one question: if you had a second procedure for nipple reconstruction, I'm assuming that it was a graft. Where was it taken from and also why do you need to have a tattoo if you had a graft? The plastic surgeon I saw yesterday told me that he doesn't do grafts anymore. Instead, he fashions a nipple directly onto the new breast mound and then uses tattoo for color. He said this looks as good as the ones that are grafted. Do you think this is true? Thanks again for the imput.

Julie Gwynn

[Julie Gwynn]

Sally:

Thanks for the feedback. I wanted to do exactly the same thing (do implants now, reserving an autologous procedure for later if need be), but I found out yesterday from a plastic surgeon that implants aren't a good idea in breasts that have been irradiated. Did you ever have radiation? Thanks again.

Julie Gwynn

[Julie Gwynn]

Daisy:

Well, I didn't know that you could develop a hernia two years after a tram! But what a good attitude you have even though you've had complications. Thanks so much.

Julie Gwynn

[Julie Gwynn]

Tina:

Where did you have your procedure done in Texas? I live in Dallas, but I'm a patient at MD Anderson in Houston. Also, did you ever have radiation to your breast? Maybe this contributed to your result. I'm really sorry that you're not happy with your outcome. Best of luck to you.

Julie Gwynn

[Tina From Texas]

Hey Julie, what a small world. I live in Fort Worth. I had the best plastic surgeon in Fort Worth, which is Shujaat Ali Khan and my surgery at Harris Methodist Hospital. Two weeks before my scheduled mastectomy on the right side, which I had done so I wouldn't have to worry about lumps anymore and didn't want to "wait" as the doctors wanted me too, my right saline implant from 1991 went flat. Perfect timing, right! So, I ended up putting expanders on both sides and going one size larger. I had my reconstruction with silicone implants, which are really nice and soft. I took tamoxifen from 1991 to 1996, thats the only treatment I had to have. I don't know, maybe some doctors get to confident, why didn't he tell me I would have 50cc's less on one side. I know by looking at it that it could have used 50 cc's more My nipples ended up being crooked too. He does get upset when I ask why its smaller and his nurse tells me even women with real breast have breast that that are different sizes. Maybe next year I will consider seeing what another doctor suggest. My husband says they look great and that I should be happy to have what I have.

Take Care and keep me updated, Tina from Texas

[Darian]

Hi Julie,

My nipples weren't from grafts, there were a couple incisions/skin flaps made on my breast in the center and she sewed them up together and formed nipples....truly incredible! I think it may have taken an hour or less. I was awake, VERY COMFY...love Verced....and had no discomfort afterward...but, it is usually numb there anyway. I will have tattooing soon. But the lady who does it is on leave from her own surgery. I am excited and ready for it! Good luck on this and tell us what you've decided.

Hugs,
Darian

[Sharon]

Hi Julie,

You're welcome.

No, I did not have radiation. I did not need it. We did have some women who had implants after radiation. I know it depends on how the skin healed (elasticity).

You should shop a few plastic surgeons and see what they say.

Sharon

[Sally]

Hi Julie - yes, I had radiation, everyday for 6 weeks. My ps did warn me that I may not be able to have the implants, but I went ahead anyway. So when he was "in there" during surgery, he said I had a pretty healthy looking bed of tissue. He had to cut away alot of scar tissue due to the radiation, and that made my healing period alot longer (and painful!)than what I had heard. But I have no pain now, can move my arm around full range again and have very little numbness under my armpit, and I can't even feel my expander, forget it's even there; and my first fill, after a month, is this wednesday. I'm in no rush and I'm sure nutrition had a big part in keeping my cells strong during radiation. I can let you know how everything goes, just ask ok?!
Take care.
Sally

[Nina]

I had a tram flap the doctors make it sound so nice you will have a flat stomach new breast What you dont hear is the way you feel like you have a ace bandage on your stomach and you can not walk far and it is almost 3 months after surgery.They do not tell you that I was a very active person andi still can not walk like i use to . If i had it to do again I would not of messed with another perfectly good body part.I am cut hip to hip with a nasty scar.A inplant would of been just fine. Nina

[cindi]

Hi Sharon,
I had my tissue expanders put in last Wednesday in Dr. Welk's OR room. Quite a bit of pain, but it gets better each day. Where do you live in the Seattle area. I know a couple of other women who have used Dr. Welk for reconstruction and are very happy. I'd love to talk to you more in depth. A friend of mine just finished reconstruction after having DCIS. Actually, the DCIS turned out to be a bit more, as Dr. Clarfeld found a few cancer cells on a lymph node when he did the sentinel node biopsy. Nobody was 100% sure how they got there, so she needed to have chemo. It turned out to be a big mess. I had stage one, no nodes and small non-aggressive tumor which I found myself. It did not show up on a mammo at all even when they were specifically looking for it. I took the most aggressive route which I am glad I did. Did chemo and had a bilateral. I'll be glad when the reconstruction is over. Anyway, get in touch with me if you have time. My telephone number is (425)778-1146. I live in downtown Edmonds which is about 25 minutes from downtown Seattle. Hey, Julie if you end up getting this message instead of Sharon, would you mind forwarding it to her. I still can't figure out how this forum works. I hope your situation is going well. Hope to hear from you soon. Cindi