Reconstruction surgery
Most women have time to decide on reconstruction options and first undergo their breast cancer treatments (chemotherapy, radiation etc). Some women emphasized the importance of waiting for the surgery and taking your time to make this decision after treatment; reconstruction can even be done many years after treatment.
For some women though, a key decision early in their treatment pathway was whether or not to have breast reconstruction surgery after their lumpectomy or mastectomy. Some women could opt for immediate reconstruction which could be done during surgery following the mastectomy. Samantha and Nalie underwent this procedure and described feeling less of a loss as they already had some chest ‘volume’ after the mastectomy. Others explained that they sought immediate reconstruction to combine surgeries and thereby save an additional surgery later on.
Some women mentioned the disadvantages of immediate reconstruction from their experiences. Shelley experienced serious complications which caused a 10-week delay in the start of her chemotherapy.
Malika wanted to decide later on whether or not to have reconstruction so that she could focus on her survival for now.
Transcript
Immediate reconstruction… The goal for me, I told myself: “I must save my own skin, my life. The esthetics, we’ll think about it later. But right now, it is my treatments, it is saving my own skin…” I am trying to survive this and will see after. Interviewer: It is a question […]
Choosing no reconstruction
Women had different reasons for choosing not to have reconstruction after their mastectomy. They were for example concerned about the risks of complications and infection from multiple surgeries. May-Lie, Tina and others did not feel physically or mentally ready for more surgery. Others felt they didn’t want to take the additional time for more surgery and recovery; some were uncertain about whether it was covered by insurance; others factored in their age as a reason for deciding against reconstruction. A few of the women we spoke with could not have reconstruction due to factors related to their illness. Christa, for example, had to get spots removed from her liver before she could think about reconstruction and Iceni, had too much tissue damage caused by the radiation.
Annie had a lot of skin removed due to her inflammatory breast cancer; she was advised to wait 2 years before thinking about reconstruction.
Transcript
No. In my case, in the case of inflammatory cancer, they tell us to wait at least one or two years after the radiotherapy. And in the case of inflammatory cancer, they must remove as much skin as possible because in this case, the skin is affected, which is not […]
Breast prostheses
Some, but not all, women used prostheses – a matter of personal preference. Many women felt that they could be irritating, were too hot or too heavy, that they moved around too much, and certain clothing, like V-necks, could not be worn anymore. Specialized mastectomy bras are more expensive than regular bras and some women could not afford them; they are not covered under public insurance plans in every province. (You can read more about this in Managing within the health care system).
The surgeon would come in, inject Debbra and leave; it was impossible to speak to him.
Transcript
Because that’s a huge thing that I think patients need to understand and have a lot more information in terms of what’s available out there. There are so many products now, mastectomy products that I didn’t know, that I wasn’t aware that they were available. Interviewer: Prosthesis you mean? Prosthetics. There’s […]
Choosing reconstruction
Different women had different types of reasons for choosing to have reconstruction. Younger women seemed to have greater preference for surgery; some women found it difficult to be flat-chested and some hoped to have nice breasts again. They spoke about several different kinds of reconstruction, e.g.: implants, a DIEP or TRAM flap reconstruction, a latissimus dorsi reconstruction, a breast reduction on the healthy breast, and a Goldilocks mastectomy.
Implants
Implants required two steps – an initial surgery to place skin expanders on their chest, and then a second surgery to replace these with implants. Women had different reactions to the procedure and the results. One advantage was the shorter surgery time overall.
Jocelyn was amazed by what surgeons are able to do.
Transcript
When I first did reconstruction, I did…Okay! This is a real boob, this one has a fake one and I’m wearing a little paddy here (pointing at her chest). When you get a mastectomy, there’s nothing there. It’s just like a weird warped looking scar. It had a weird little cleave […]
TRAM and DIEP procedures
With a TRAM flap, pieces of skin, muscle and fat and blood vessels are moved from the belly to the chest, and along with a piece of back muscle (from the latissimus dorsi muscle). In a DIEP reconstruction, no muscle is cut or removed but a piece of skin is used to craft the breast. Women who opted for this kind of procedure, appreciated that the breast was crafted from their own skin and that it had a natural look. Gaye felt very happy with the result and described the natural look of the breast.
Isla, however, said: “if you do the TRAM you’re really losing your stomach muscles, well they’re handy right?” The procedure is long, and Shelley described having a scar from hip to hip which required a long recovery. Christa, who underwent a latissimus dorsi flap, says that the scarring on her back feels like a rope around her trunk and that she prefers not to wear bras anymore.
Although rare, some complications were mentioned. Deann, for instance, developed fat necrosis post-surgery, and Shelley had a blood disorder which had not been detected before; eventually her breasts had to be removed due to a necrosis. Shelley and Sirkka both underwent further surgery after the DIEP and the TRAM flap did not work for them. They have implants now.
Deann describes her experience with DIEP and the complications she had.
Transcript
I ended up with fat necrosis, probably a week to 10 days post-op(eration) and I know when I had my surgery… If you’re not familiar with a DIEP flap* (Deep Inferior Epigastric Perforator Artery Flap), it’s a free flap. They use the tissue and blood vessels from your abdomen and […]
Other options
Patricia’s operated breast could not be reconstructed although she was able to have a reduction on the healthy breast. Laurie researched options and found the ‘Goldilocks mastectomy’, where healthy remaining skin flaps are used to create smaller breasts during a single surgery. She presented this idea in a PowerPoint presentation to her surgeon, and convinced him to try this procedure for the first time in his life. See here to learn more about the Goldilocks procedure.
Laurie wondered if there were other options than a mastectomy.
Transcript
And then I thought well okay there must be something better and I looked in the (name university) library online and found the most recent textbook on breast surgery. At the very end of the chapter on mastectomy there was a short section on this new thing called the Goldiloks […]
Creation of nipples and aureole
After reconstruction, it is possible to create a nipple and get a tattoo to re-create the aureole. Not all women opted for this, feeling they didn’t want another procedure or that it was not needed. Gaye’s tattoo was not too great, and she didn’t return for another intervention. Sirkka didn’t want to get a tattoo but her doctor advised her to consider it, given their experience was that so many women felt much better after the tattoo.
Christa was satisfied with the results even though the tattoo faded over time.
Transcript
I’ve had them done a few times. The lady that does it is just awesome. She does it… because I didn’t have another one to look at, she looked at the inside of my lip, at the pigment there and what it looked like, to see what colour your… because […]
Decision-making and reflections on results
Women were highly varied in their decision-making and in their feelings post-surgery. Women who didn’t experience any surprises or complications were generally satisfied with the results and thought the new breast looked good or at least acceptable. Shelley described being happy with her surgery, after waiting two years without reconstruction, because she no longer had hollows on her chest. She wore a bathing suit for the first time in three years. Most women mentioned some disadvantages of reconstruction. They spoke about differences between expectations and the actual result, the consequences of the complications, and the importance of having a good surgeon. Debbra and Sirkka described being unhappy with the results and felt that the results were different from what they expected. It is important to keep in mind that women described undergoing sometimes only one surgery but more often they had to undergo several surgeries to get the desired result.
Kathryn's new breast was never what she expected. After an encapsulated implant she visited three surgeons before she decided with whom to do the operation.
Transcript
He sent me to another doctor. Most of them are plastic surgeons and because any time you have cancer, it’s all done here under Medicare, so it’s free. You can choose any plastic surgeon you want. So I went to see the doctor he recommended and he looked at me. […]
Sirkka selected her own surgeon and opted for a TRAM flap, but was not told that a mesh would be placed in her body as part of the procedure. She wished that she had been told about this; when she noticed a lump in her belly, a biopsy was done through the mesh (something that she learned later should not have been done) causing a serious infection. Debbra described how every procedure has its own risks and benefits and how important it is to ask questions or get a second opinion if that can help you.
Being a nurse helped Deann decide between doing nothing, implants, a DIEP or TRAM flap reconstruction.
Transcript
Well I had done a lot of research because they’re, when they tell you “You have breast cancer and you need to have a mastectomy.” Well that’s it. But then when you decide to have reconstructive surgery, there’s so many. You can have nothing done, or you can have this […]
A Goldilocks mastectomy was exactly what Laurie wanted.
Transcript
Actually I went back and I looked at my Facebook page. All the pictures I’d put up of me doing stuff and in no picture did my breasts figure as an important part of what I was doing. So I thought well, why not just remove the breasts because that […]
Challenging relationships with health care team
Gaye and Debbra had a surgeon who was rude to them; Gaye decided to find a different surgeon who was more kind and attentive. Debbra felt pushed in opting for implants. She did not feel happy with the results and later thought she should have responded to the red flags she felt with regards to the surgeon’s behavior.
Debbra describes the variety of prosthetic products.
Transcript
So we’re going to go into reconstruction. So as I said, the first, I guess my first clue to this plastic surgeon that I originally had should have been that he asked why I was here. Obviously he didn’t read my file or anything. I knew nothing about plastic surgery […]
Review date: 2018-04