Plastic Surgery: Breast Reconstruction Options

Today, before my usual radiation appointment, I went to meet with a plastic surgeon, Dr. Welk, for a consultation to discuss my reconstruction options. I came away with very different views than when I entered his office, and I have a lot of thinking to do before making any decisions.

It appears that with continued weight loss (which is worth it to me - I think I've dropped another pound or two this week and I'm determined to keep it up) I will not be a candidate for double reconstruction using my own tissue - there simply won't be enough tummy tissue. That means that I will be getting an implant on my right (non-cancer) side. The best kind of implant that I can get would be a procedure that actually uses skin and muscle from my back, referred to as a "lat flap" (I think it's the latimus dorsi muscle - I have to read more about this). This procedure uses some skin from my back, as well as tissue, to wrap the implant, and thus creates a more normal looking breast. The pictures are impressive.

On my left side, where I've already had a mastectomy, I need to do either the lat flap or a TRAM flap. The TRAM flap involves using abdominal skin and tissue, with a muscle to "feed" the flap coming up from the abdomen. Alternately, I could do a lat flap with implant, the same as on the right side, but the doctor thinks that my best results will occur if I do a TRAM on one side and a lat on the other.

I went in all gung-ho about doing the DIEP, which is like a TRAM only doesn't use muscle, but the doctor essentially talked me out of it, and gave me some very compelling reasons why it isn't a superior technique: the results are the same, but the risks are much higher for the DIEP.

The doctor also told me that it is less advisable to do the mastectomy at the time of reconstruction. Damn. He gave statistics about rate of failure that convinced me that it would be best to do the mastectomy, wait two months, and then do the reconstruction on that side. Sigh. All this surgery certainly bums me out.

I will not do any kind of reconstruction until October, as I need to be fit and healthy on the 3-Day walk in August, and then I want to enjoy the beautiful September weather. That's the plan at the moment, anyway.

It's so much to take in. These surgeries are very invasive (though the doctor disagrees with the term "invasive" I say that anything that leaves me covered in scars and moves my muscles around is invasive) - I would end up not only with Frankenbreasts (which certainly would be better than no breasts at all) but also with a foot long (no exaggeration) scar along my belly and another on my back.

Lots to think about.
Kristina

PS Yesterday's radiation was cancelled because all the computers at Swedish were down, so my new end date is Feb. 28. My skin is getting redder, and there are little dots that look like sores all over the radiated area. They're tiny, but they're a sign of things to come, I think.