Undergoing immediate reconstruction is fairly common, especially in younger patients like myself (I was 37 when I was diagnosed). However, immediate reconstruction means a longer surgery and requires 2 surgeons, a breast surgeon to undertake the mastectomy and then a plastic surgeon to undertake the reconstruction. Whilst I awaited my plastic surgery appointment (which was around a week later) I was to have an MRI of my breasts to check that there was definitely no invasion (the cancer breaks out of the milk ducts). Invasion would have meant a change of plan regarding treatment - probably chemotherapy, mastectomy then radiotherapy. The MRI was only a few days later but was one of the most awful experiences. To explain, you have to lay face down with your boobs in two holes meaning all your weight is on your sternum (breast bone). You have to stay really still whilst the scan is taken which is in a tube and the magnet spinning is very loud. You get ear plugs and I’m not claustrophobic but the pain in my sternum from lying on it was almost unbearable. At one point I had to ask them to stop and put more padding in to try to relieve the pain.
Here is an image from Mayo Clinic that gives an idea of what it is like;
I got through it and returned just over a week later to discuss the results. Thankfully there was no evidence of invasion so the plan for surgery could go ahead.
The decision was then which kind of reconstruction I would have. Given that I had to have a total mastectomy it made sense to have immediate reconstruction. Some people wait to have reconstruction at a later date but that would mean removing the skin as well. By having an immediate reconstruction they could save all the skin barring the nipple.
I was given a booklet from a breast cancer charity which listed all the different options for reconstruction but some were ruled out for me almost immediately due to using tissue from areas where I knew I would not have sufficient fat.
This left me with a few options, firstly some kind of implant and secondly a DIEP flap using abdominal fat and skin to make the new breast and fill in the hole from the nipple.
I had an appointment with the plastic surgeon around 2 weeks later and was examined and options discussed. The NICE recommendations are that reconstruction should be done using autologous (one's own) tissue where possible. My surgeon stated I had 2 options, a DIEP flap or a silicone implant.
I was already fairly sure I wanted my own tissue as I was aware of the long term potential of needing to replace an implant, and issues with contraction of the tissues in response to the foreign object.
I therefore opted for the DIEP flap reconstruction.
A DIEP flap reconstruction is names for the blood vessels that are harvested with the tissue in order to reattach them to a blood supply in the chest. DIEP therefore stands for deep inferior epigastric perforator. In essence, the surgery removes a strip of fatty tissue, blood vessels and skin from the abdomen in a wide ellipses shape. The sides of the ellipses are then pulled together and a new hole cut for the belly button. In layman's terms you get a tummy tuck out of the procedure.
The tissues are then shaped to form a new breast and the blood vessels are then attached to the internal mammary artery and vein to supply blood to the new breast. Finally all skin except a round piece is cut away and the round piece stitches into the hole left by the removal of the nipple.
Below is a link to the reconstruction options page on breastcancercare.org.uk who created the leaflet I was given.
https://www.breastcancercare.org.uk/information-support/facing-breast-cancer/living-beyond-breast-cancer/types-breast-reconstruction#DIEP%20flap
Once I had made this decision a CT scan was needed to check the quality of the DIEP vessels so that the surgeon could be sure that they would be suitable for supplying the new tissue. The CT scan was quick but odd, it was done with contrast which creates a feeling of flushing heat across the body which for a short time left me thinking I had wet myself.
I then returned once more to discuss the surgery again and review the CT results. The surgeon was happy so we were able to go ahead to plan a date for surgery.
Whilst all this had been going on I had taken time off from work as I was anxious and not sleeping. However, once I had been listed for surgery they knew it would be a few weeks to wait so I went back to work before the operation.
This allowed me to accrue more time on full sick pay and kept my mind busy whilst we waited.
Eventually the surgery was scheduled for 23rd May, 2 months after my diagnosis.
The next post will cover the surgery and recovery in hospital.
Here is an image from Mayo Clinic that gives an idea of what it is like;
I got through it and returned just over a week later to discuss the results. Thankfully there was no evidence of invasion so the plan for surgery could go ahead.
The decision was then which kind of reconstruction I would have. Given that I had to have a total mastectomy it made sense to have immediate reconstruction. Some people wait to have reconstruction at a later date but that would mean removing the skin as well. By having an immediate reconstruction they could save all the skin barring the nipple.
I was given a booklet from a breast cancer charity which listed all the different options for reconstruction but some were ruled out for me almost immediately due to using tissue from areas where I knew I would not have sufficient fat.
This left me with a few options, firstly some kind of implant and secondly a DIEP flap using abdominal fat and skin to make the new breast and fill in the hole from the nipple.
I had an appointment with the plastic surgeon around 2 weeks later and was examined and options discussed. The NICE recommendations are that reconstruction should be done using autologous (one's own) tissue where possible. My surgeon stated I had 2 options, a DIEP flap or a silicone implant.
I was already fairly sure I wanted my own tissue as I was aware of the long term potential of needing to replace an implant, and issues with contraction of the tissues in response to the foreign object.
I therefore opted for the DIEP flap reconstruction.
A DIEP flap reconstruction is names for the blood vessels that are harvested with the tissue in order to reattach them to a blood supply in the chest. DIEP therefore stands for deep inferior epigastric perforator. In essence, the surgery removes a strip of fatty tissue, blood vessels and skin from the abdomen in a wide ellipses shape. The sides of the ellipses are then pulled together and a new hole cut for the belly button. In layman's terms you get a tummy tuck out of the procedure.
The tissues are then shaped to form a new breast and the blood vessels are then attached to the internal mammary artery and vein to supply blood to the new breast. Finally all skin except a round piece is cut away and the round piece stitches into the hole left by the removal of the nipple.
Below is a link to the reconstruction options page on breastcancercare.org.uk who created the leaflet I was given.
https://www.breastcancercare.org.uk/information-support/facing-breast-cancer/living-beyond-breast-cancer/types-breast-reconstruction#DIEP%20flap
Once I had made this decision a CT scan was needed to check the quality of the DIEP vessels so that the surgeon could be sure that they would be suitable for supplying the new tissue. The CT scan was quick but odd, it was done with contrast which creates a feeling of flushing heat across the body which for a short time left me thinking I had wet myself.
I then returned once more to discuss the surgery again and review the CT results. The surgeon was happy so we were able to go ahead to plan a date for surgery.
Whilst all this had been going on I had taken time off from work as I was anxious and not sleeping. However, once I had been listed for surgery they knew it would be a few weeks to wait so I went back to work before the operation.
This allowed me to accrue more time on full sick pay and kept my mind busy whilst we waited.
Eventually the surgery was scheduled for 23rd May, 2 months after my diagnosis.
The next post will cover the surgery and recovery in hospital.
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