• My Mom was diagnosed with breast cancer last week. She needs a mast and reconst. Deciding between standard with expander or trans flap?

    Asked by Moneysavingmom on Friday, August 3, 2012

    My Mom was diagnosed with breast cancer last week. She needs a mast and reconst. Deciding between standard with expander or trans flap?

    Need to make decision by Monday. We would love to hear about other peoples experiences and outcomes. She needs to have her right breast removed. Dr. thinks she is good candidate for Trans with the tummy tuck but my mother is looking for the safest/most comfortable outcome. Any advice would b helpful.

    7 Answers from the Community

    7 answers
    • leepenn's Avatar

      The safest would be to skip reconstruction. In the end, that is what I chose to do, for a number of reasons. I did bilateral with no reconstruction, and, to be honest, I quite love being flat.

      One thing to consider is symmetry. Her left breast will "age" differently than the reconstructed right....

      My impression *(and it's impression only)* is that the trans with tummy tuck would be more comfortable long term... but harder recovery short term. The tissue expanders, I am told, are quite uncomfortable, and it's six months before the exchange surgery... at least.

      Wow - decision by MONDAY? That seems so fast... Will she need chemo? Is it possible to do chemo and then surgery? That would give her time to make the decision but would not delay the start of her treatment...

      I'm so sorry she has this diagnosis - what a stressful thing - to have to make this decision with so little time.

      My heart goes out to you all.


      about 4 years ago
    • debsweb18's Avatar

      This is just my experience, not necessarily advice. Everyone is different. I was given a choice of doing nothing, 2 different types of flaps and immediate implant. I chose the implant. One, I didn't want the extensive surgery on different parts of my body and it kind of freaked me out about having my body moved around. Also my sister-in-law had a flap done for a regular "boob job" and was very unhappy with it and ended up having an implant. My implant was on my right side. Because of my age (58 at the time), my left side was sagging and I was very uneven. 6 months later I had a lift on the left at the same time as nipple reconstruction. I didn't have chemo, but this was after radiation. After things settled, I felt like my implant didn't stick out as far as my lifted side even though there was more on the top side. I understand radiation can shrink implants, ever after treatment. (I'm assuming that's why some PS do the expanders and wait until after for the final implant). So 4 months later I had the original implant replaced with a different size. I'm much happier with them now. The nipple reconstruction flattened out to almost nothing and it's higher than the left now because of the exchange. My left side still sags a little more than the right. I can have the nipple redone, but I'm thinking of not doing it and just getting the tattoo. Is it perfect? No, but I wasn't that symmetrical before, either. Could I have more surgery to get it better? Probably, but I probably won't. Do I have any regrets with my decisions? Absolutely not. With clothes on, they look better than before, especially without a bra (which is only at home). They almost look better without clothes too!

      Hope this helps and sorry about your Mom.

      about 4 years ago
    • nancyjac's Avatar

      I agree 100% with what Lee said. I've seen 100s of women on various boards like this and others who were very dissatisfied with reconstruction, both implants and flaps. Many have said the expanders prior to implant are extremely painful 24/7 and can be required for lengthy periods of time. On the other hand, trans flap surgery is pretty tricky and necrosis is quite common and requires basically a re do of the surgery. Necrosis occurs when there isn't adequate blood and oxygen flow from the chest wall to the new breast. I had trans flap surgery but mine was medically necessary. I had to have extensive skin removal due to inflammatory breast cancer and the flap was required to close the wound after my mastectomy. With any kind of reconstruction, she will not be symmetrical unless she has a bilateral mastectomy and reconstruction of both breasts.

      On the other hand, if she has a bilateral mastectomy with no reconstruction, she will be symmetrical, have the least pain, discomfort, and risk of complications, and the most options for thereafter (e.g. no bra, mastectomy bra, regular bra with foam inserts, etc. My decision to have a bilateral mastectomy with no reconstruction ultimately was a no brainer for me, but it was not a decision I could have made in any informed way in a week. I would strongly recommend that your mom speak with her oncologist about the pros and cons of holding off on the mastectomy a little longer to give you mom time to make an informed decision.

      about 4 years ago
    • DianaL's Avatar

      I will have reconstruction after chemo. My surgeon did a skin sparing bi-lateral mastectomy in June. He recommended the implants for ease of recovery at my age (65). I had large breasts so have quite a lot under both arms (about the size of a baseball). He tells me I will be glad of that when reconstruction starts. I talked with my oncologist as well as the surgeon. Decision by Monday is a difficult!

      about 4 years ago
    • hikerchick's Avatar

      I chose a double mastectomy without any reconstruction even though I was only 49 and had been a D cup. I have no regrets. I did not want any further surgeries or opportunities for complications, plus I knew I would likely feel like a reconstructed breast was foreign and not be comfortable with it anyway, because I'm athletic and feel close to my body and parts, if that makes any sense. To me, the normal consequence of scars is easier to accept than a breast that isn't like mine was. I was even uncomfortable with results after I had a lumpectomy (before I knew I had additional problems) so it was apparent I'm picky. Plus, I have yet to speak with a woman who has had reconstruction and not had any complications. That's not to say that they're not happy with having chosen reconstruction, just that it can be suprisingly complicated.

      about 4 years ago
    • nancyjac's Avatar

      Just one other thing to add......you said "She needs a mast and reconst". Why does she need reconstruction? Is it cosmetic or medically necessary? If it cosmetic, then not having reconstruction is an option that should also be considered. Don't let the surgeon push her into making a snap decision. She can decline reconstruction now and still opt for it anywhere down the road.

      about 4 years ago
    • Ydnar2xer's Avatar

      HOLD ON! Why the hurry to decide? TRAM using stomach muscle is now being phased out. I am facing a mastectomy myself, having already had radiation on my right breast, only to find out on Friday that I now have IDC on the same breast--9 years later! I have done my research and don't like the idea of implants--fear of rejection, leakage, etc.--would much prefer using my stomach fat (YES!) and a DIEP to make my perfect new boobies. Either DIEP or that fat injection technique that takes months--even though it might take me a while to find a doc who can perform that. I say, don't let anyone tell you what to do. Get exactly what you want--you've suffered enough with cancer--don't quickly make this decision and then have regrets! Good luck & be strong!

      about 4 years ago

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