Mastectomy skin/nipple sparing reconstruction results

[backdoc]

I am scheduled for bilateral mastectomy in 10 days. Skin/nipple sparing with expanders and reconstruction with implants.  Diagnosed with IDC right breast, had lumpectomy mid June and was clean but with 4mm found in one sentinel node.  At time of mastectomy will also have further lymph node dissection. Question is this...how long is recovery time and am I waiting too long to begin chemo?  Should I reconsider and only do the dissection of nodes, wait to recover, have chemo and then radiation?  And....with reconstruction what scarring am I looking at and will the reconstructed breasts look good or will they look awful by comparison to my original breasts which are very nice.  Please give me your opinions.  The breast surgeon does not feel I am waiting too long with the surgery to have chemo....although the reason for the wait is because of his busy schedule....and extra 3 week wait time.  I have an excellent surgeon and have consulted with a top plastic surgeon as well. Both are world renowned.  Please give me your opinions and experiences with this procedure....thank you.  I am concerned about both the healing time and also scarring, appearance and complications.  I hope this goes without any problems.  I need to begin treating the disease.  The only reason I am doing this is to avoid recurrence although the surgeons say radiation gives you the same advantage as mastectomy.  Yet there is still an increased chance of recurrence and then the thought of beginning this again is horrific.  Either way, I feel this is a gamble.  Please respond ASAP. Thank you all.

[bluebutterfly2222]

Since you have an excellent surgeon and top plastic surgeon, both world renown, Your best bet would be to address all your questions about appearance, recoverytime, etc. to them.

You did not mention whether you have consulted an oncologist yet. I think that would be the best person with whom to discuss concerns about the time that will elapse before you begin chemo.

As you are probably aware, IBC is a very aggressive type of cancer. The latest approach is to do pre-operative chemo. See below:

"Preoperative chemotherapy is saving lives.  While Dawood and Christofanelli want to see more studies to determine the best chemotherapy drugs for IBC, the switch from doing chemo after surgery to doing it before surgery has been a major factor in increasing the average  median overall survival from 15 to 40 months.  First, it helps doctors to be able to see whether the chemo is working by gauging changes in the breast over the course of the treatment.  The doctor can change drugs if the first does not work.  It is also important to start chemo before surgery because the cancer is already in the lymph system where it may easily travel to other parts of the body.  A systemic treatment like chemo helps to kill any cancer cells that have already metastasized.


So far the data show that IBC patients should have their chemo drugs chosen from two families:  the anthracyclines and the taxanes.  Combining these types of drugs has significantly improved survival rates with many more patients now living for years past the median survival rate."

Best wishes,
bluebutterfly

[bluebutterfly2222]

Oooops!!  Major mistake!!

I read your post as saying IBC, rather than IBC. Please ignore the final 3 paragraphs in my answer above!

My sincere apologies. Apparently I need to get my glasses changed. :-(

bb

[bluebutterfly2222]

And I can't type either! :-(

That should have said:"I read your post as saying IBC, rather than IDC."

I apologize for ALL of my errors, including the typos in my first reply.

bb

[SueYoung55]

You mention having radiation. Radiation and expanders/implants don't play well together. Radiation damages everything in it's path. It will weaken your rib cage, bones, heart, lung..and most importantly.. your tissue. So, say you get expanders placed before radiation. Radiation will most likely damage them. If you wait until after radiation, your skin will be hard and won't stretch. So, if they put the expanders in, one on each side, the healthy tissue on the non radiated side will stretch and expand outward as it should. The radiated side will expand some but may also push the weakened ribs inwards. The skin could tear and the expander poke through. Or it may go fine and then you could have capsular contraction. It's got between 70 and 90 percent failure rate. Those odds aren't worth messing with in my opinion.

You may want to consider a tissue transfer instead. Your own tissue can be used for reconstruction and won't be an issue for you after radiation. Please research this some more for your own peace of mind. Best wishes.

[SueYoung55]

This may be of some use for you.

http://www.medhelp.org/posts/Breast-Cancer/Trans-flap-vs-implants/show/1308880?personal_page_id=384050

I'd not wait several months. You could have DIEP reconstruction and then chemo & rads within 6 weeks. You may want to check out my surgeons in New Orleans. I flew from Florida to go to the best. Dr. DellaCroce & Dr. Sullivan. Breast center *******.

[backdoc]

First, here is some of the latest treatment info.  It IS adviseable to have surgery of lymph nodes prior to having preop chemo.  This is because if you have chemo first it will shrink the tumors, yes, but will also not show how much lymph node involvement because the cancer may have been reduced due to chemotherapy.  Why is this not optimum?  Because it interferes with staging and will not give you an accurate picture of how advanced the disease is.  It will also not give oncology an accurate idea of what level of chemotherapy to administer so they will have to give the strongest does to be safe when you actually may not need that level of toxicity.  

As far as DIEP Flap reconstruction is concerned....many people are too thin to have that as per plastic surgeon and as a result are still recommending implants.  Implants are also an easier surgery and are actually a faster procedure, believe it or not, as I am told by the top plastic suregeons.  Any opinions are always welcome.  Thank you.  You are all terrific!

[backdoc]

One more comment on having chemotherapy before surgery.  If you have chemo first...your white cells and immune system takes a big hit and, depending on the reaction you have to chemotherapy, may actually delay surgery due to immune dysfunction.  There are no good answers here.  It sounds like we are gambling no matter what we do.  It seems, according to the specialists, chemo is usually used as a preop procedure when the tumor is very large and they give a small chemo dose to try and shrink it so they can operate easier or try to save the breast when some women want to opt for lumpectomy.   Any ideas are always welcome. Thank you.

[SueYoung55]

Good luck! Best wishes!