Christine is a natural woman's blog: "Cancer musings & info"

When I met with the plastic surgeon last month, I got a grim report:

#1 option - expanders placed at time of mastectomy, filled with saline over time & replaced with implants after recovery from radiotherapy was ruled out, because the risk of infection is reported to be around 30%, and the radiation would cause the expanded skin to dimple, harden & scar

#2 option - build a new breast with skin & fatty tissue from the abdomen was ruled out, because of my prior abdominoplasty...not enough fatty tissue remaining

#3 option - latissimus dorsi flap procedure was ruled out, because this would give me a size A breast on one side & leave me with DD on the other...I would still need to wear a prosthesis in my bra

#4 option - my only viable option per the plastic surgeon is to take skin & fatty tissue from the inside of both thighs & build a new breast after radiotherapy. I ruled this one out, because of the dual knee to groin scars up the back of both legs, the 2nd surgery that would be required on both legs to remove the "dog ears" of skin, and because the risk that the newly constructed breast would not survive is doubled when two tissue transplants are used.

Needless to say, this was distressing news, and I have fretted & prayed about it since. Today I met with my oncology surgeon to tell her all of this. She explained several things to me.

1) While my insurance refused to pay for a dual mastectomy, even though I have tubular adenomas in my right breast that increase the risk of future cancer there, my surgen explained that the FCC dictates that insurance companies MUST provide some sort of coverage for reconstruction on the "healthy" breast in cases of unilateral mastectomy, in order to provide some symmetry to the body. I didn't know this, and it is very good news!

2) Plastic surgeons are used to dealing with women who want to look better & pretty after surgery. They know that a mastectomy patient who also goes through radiotherapy will NEVER have pretty breasts, so they try to sway patients from deciding on reconstruction. If I can & do get reconstruction, I will basically have a breast shaped lump that is scarred & ugly when naked, but will look more normal in a swimsuit & clothes. To me, this is not an issue. I think that having one droopy DD breast on one side & an incision on the other side is way more ugly that having a small, ugly lump on one side & a small, reconstructed breast on the other. Easy decision for me.

3) I can do one of two things, should I decide to have reconstruction. a) I can do the latissimus dorsi flap procedure on the cancer side & a reduction on the other,  so that I am size A on both sides. This would be done in two separate surgeries. The cancer side would be 4-6 months after completion of radiotherapy and the other breast would be reduced 4-6 months after the latissimus dorsi flap procedure or b) I can get an expander put in at the time of mastectomy & face the risk of infection with radiotherapy. My oncology surgeon has a network of plastic surgeons outside of Duke that do this stuff all the time. This would require at least three different surgeries & would take 1.5 -2 years to complete. I could opt for size B or maybe size C breasts this way, which would balance out my body better, because I am a big girl. I am 5'8" and weigh 200 pounds. Size A breasts just wouldn't balance me well.

While it would be lovely if I did not have cancer, or at least not the kind of cancer that requires radical mastectomy/lymph dissection and radiotherapy, I am just so relieved to know that I won't be forced to live the rest of my life lopsided so terribly. It feels good to have options. Now to research & pray!