OP
OP
- Joined
- Sep 10, 2006
- Messages
- 4,089
Plastic Surgeon Visit
Yesterday was a LONG day at the PS's office. Overall, I will say that the surgeon was AMAZING. He spent well over a solid HOUR with us - just talking, talking, talking to us - counseling us on how to make a decision on this, but not pushy AT ALL about any one particular technique. He was so kind, gentle, and empathetic.
Despite how wonderful he was, we did not come away with a good feeling about my options for recon:-(((( And let me just say I am still heeding Rich's advice to slow this down - still considering delaying recon until I have time to process all of what is happening to me.
I'm going to detail this all out, you can read on or not - up to you. Writing this all out helps me to process my options and see the pro's/cons more clearly. If you find the nitty gritty interesting, read on.
Essentially, I can have either implants placed or a tissue flap harvested from elsewhere on my body, or a combination of both. There is one other option that is a new procedure - microfat grafting - but I would have to fly to Miami for treatment multiple times over the next year or so...
Implants
This is the easiest procedure to go through in terms of initial surgery. However, neither of us is keen on the idea of implants. First off, hate the idea of a foreign object in my body. Secondly, they have to cut the pectoralis major muscle and put the implants under the muscle. This area has to be stretched out by internal expanders (filled progressively with fluid) before your final exchange surgery is done. While I know many women have implants placed, the procedure has more incidence of complications for those who have had a mastectomy - a 30 to 50% chance of capsular contracture (scar tissue around the implant) and ongoing chronic pain and tightness/restriction of shoulder motion. Also, ALL implants leak eventually - doc said it is not a matter of if, it is WHEN. Usually in about 10 to 15 years you have to have them switched out. So outpatient surgery is necessary several times over your lifetime. Implants also look unnatural as you age - your body sags, but the foobs ("fake boobs", LOL) don't.
Tissue Flap
This was what I was hoping to do, b/c the result is much more natural with less long term complications. However, because I don't have a lot of body fat, my options are limited. Most women can do a flap from their stomach, essentially getting a "tummy tuck" at the same time. Not me. Doc says he could do a flap from my inferior gluteal region (IGAP procedure: Options for Breast Reconstruction).
However, there are several disadvantages:
1) It requires a significant amount of tissue to be taken. If I only have a unilat mast, he will need to lipo the other side of the gluteal region and inject it into the harvested side to try and make the sides match. Still, most likely it would not be a perfect match. So there would be a defect left in that area. The scar is also supposed to be hidden, but when we looked at his photos, we saw that the scar extends out quite farther from the gluteal fold and was pretty bad. If I have to be bilat, then less assymetry will be noted at the harvest site, but I will still have 2 nasty scars. And, who knows how this will affect my comfort level with sitting, since your "sit bones" are right there. This could be especially problematic as I age and lose muscle mass. Also, I have a history with sciatic nerve issues, and this could flare that chronic pain problem - no way to predict that for sure...but it is a possibility.
2) My surgeon only does about 6 of these types of flaps per year. He is most experienced in doing the abdominal flaps (which, as I said, are easier to do and more common). The IGAP's are more technically difficult to perform and also have a slightly higher failure rate.
3) Length of surgery - I would be under the knife for 8 to 10 HOURS. This is no small surgery. I would be in the hospital for 2 to 3 days afterwards. Oh, and he can only do one flap at a time, due to the length of the surgery. If I ended up needing bilat, I would have to have one surgery, wait 6 wks, then go through it all over again for another 6 wks.
Microfat Grafting
This is a new procedure developed by a doctor in Miami. See Breast Reconstruction & Augmentation Fat Transfer Miami Breast Center
for a description. He has been doing it only about 8 years now. I was skeptical of this being legitimate, but many women on the breast cancer boards have been raving about the results, so I asked my PS his opinion. He actually said he is familiar with Dr. Khouri's work and that he is a well respected PS. He said that the procedure is very promising and certainly is MUCH less invasive. The drawbacks are that the patient has to be highly committed b/c it is a lot to go through - you have to wear a device (Brava external expander - see the website) for something like 10 to 12 hours/day for a month or so, have a lipo procedure, then rinse and repeat for however many procedures are needed to get your final result. Typically, women need 3 or 4 treatments. So, if I did this, it could mean over a year long commitment of repeat trips to Miami for surgeries (which are much less invasive, but still not a picnic) and wearing this device every day for a LONG time (yes, I think some do sleep in it, so that would be good if I could handle that). My doctor said if I am willing to take that on, it looks like a safe, good option for me - but to remember there are no studies yet on long-term results, since the procedure is so new. He also said he would have no problem following my care if I pursue this - if I have any complications he will work with Dr. Khouri to treat me here between Miami visits. I wish he could do this procedure himself, but he is not trained in it yet. I asked about other docs in Atlanta or New Orleans that are starting to do it - but he cautioned me that he would not recommend anyone other than Dr. Khouri yet, since it is so new.
That's it.
Yesterday was a LONG day at the PS's office. Overall, I will say that the surgeon was AMAZING. He spent well over a solid HOUR with us - just talking, talking, talking to us - counseling us on how to make a decision on this, but not pushy AT ALL about any one particular technique. He was so kind, gentle, and empathetic.
Despite how wonderful he was, we did not come away with a good feeling about my options for recon:-(((( And let me just say I am still heeding Rich's advice to slow this down - still considering delaying recon until I have time to process all of what is happening to me.
I'm going to detail this all out, you can read on or not - up to you. Writing this all out helps me to process my options and see the pro's/cons more clearly. If you find the nitty gritty interesting, read on.
Essentially, I can have either implants placed or a tissue flap harvested from elsewhere on my body, or a combination of both. There is one other option that is a new procedure - microfat grafting - but I would have to fly to Miami for treatment multiple times over the next year or so...
Implants
This is the easiest procedure to go through in terms of initial surgery. However, neither of us is keen on the idea of implants. First off, hate the idea of a foreign object in my body. Secondly, they have to cut the pectoralis major muscle and put the implants under the muscle. This area has to be stretched out by internal expanders (filled progressively with fluid) before your final exchange surgery is done. While I know many women have implants placed, the procedure has more incidence of complications for those who have had a mastectomy - a 30 to 50% chance of capsular contracture (scar tissue around the implant) and ongoing chronic pain and tightness/restriction of shoulder motion. Also, ALL implants leak eventually - doc said it is not a matter of if, it is WHEN. Usually in about 10 to 15 years you have to have them switched out. So outpatient surgery is necessary several times over your lifetime. Implants also look unnatural as you age - your body sags, but the foobs ("fake boobs", LOL) don't.
Tissue Flap
This was what I was hoping to do, b/c the result is much more natural with less long term complications. However, because I don't have a lot of body fat, my options are limited. Most women can do a flap from their stomach, essentially getting a "tummy tuck" at the same time. Not me. Doc says he could do a flap from my inferior gluteal region (IGAP procedure: Options for Breast Reconstruction).
However, there are several disadvantages:
1) It requires a significant amount of tissue to be taken. If I only have a unilat mast, he will need to lipo the other side of the gluteal region and inject it into the harvested side to try and make the sides match. Still, most likely it would not be a perfect match. So there would be a defect left in that area. The scar is also supposed to be hidden, but when we looked at his photos, we saw that the scar extends out quite farther from the gluteal fold and was pretty bad. If I have to be bilat, then less assymetry will be noted at the harvest site, but I will still have 2 nasty scars. And, who knows how this will affect my comfort level with sitting, since your "sit bones" are right there. This could be especially problematic as I age and lose muscle mass. Also, I have a history with sciatic nerve issues, and this could flare that chronic pain problem - no way to predict that for sure...but it is a possibility.
2) My surgeon only does about 6 of these types of flaps per year. He is most experienced in doing the abdominal flaps (which, as I said, are easier to do and more common). The IGAP's are more technically difficult to perform and also have a slightly higher failure rate.
3) Length of surgery - I would be under the knife for 8 to 10 HOURS. This is no small surgery. I would be in the hospital for 2 to 3 days afterwards. Oh, and he can only do one flap at a time, due to the length of the surgery. If I ended up needing bilat, I would have to have one surgery, wait 6 wks, then go through it all over again for another 6 wks.
Microfat Grafting
This is a new procedure developed by a doctor in Miami. See Breast Reconstruction & Augmentation Fat Transfer Miami Breast Center
for a description. He has been doing it only about 8 years now. I was skeptical of this being legitimate, but many women on the breast cancer boards have been raving about the results, so I asked my PS his opinion. He actually said he is familiar with Dr. Khouri's work and that he is a well respected PS. He said that the procedure is very promising and certainly is MUCH less invasive. The drawbacks are that the patient has to be highly committed b/c it is a lot to go through - you have to wear a device (Brava external expander - see the website) for something like 10 to 12 hours/day for a month or so, have a lipo procedure, then rinse and repeat for however many procedures are needed to get your final result. Typically, women need 3 or 4 treatments. So, if I did this, it could mean over a year long commitment of repeat trips to Miami for surgeries (which are much less invasive, but still not a picnic) and wearing this device every day for a LONG time (yes, I think some do sleep in it, so that would be good if I could handle that). My doctor said if I am willing to take that on, it looks like a safe, good option for me - but to remember there are no studies yet on long-term results, since the procedure is so new. He also said he would have no problem following my care if I pursue this - if I have any complications he will work with Dr. Khouri to treat me here between Miami visits. I wish he could do this procedure himself, but he is not trained in it yet. I asked about other docs in Atlanta or New Orleans that are starting to do it - but he cautioned me that he would not recommend anyone other than Dr. Khouri yet, since it is so new.
That's it.
