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Choosing FLAP Reconstruction After Mastectomy

18 Sep, 2016

 

Everyone Has A Different Wants List Post-Mastectomy. Own Yours.

Guest Post by Michelle Marie

When I was diagnosed with breast cancer, I was immediately faced with some serious decisions to make. Decisions about my body, how to deal with removing the cancer and what type of reconstruction were incredibly difficult. These decisions would literally affect how I look and feel for the remainder of my life.

My first decisions were made for me; the medical ones as testing progressed and we learned more about the size of my tumor. Then we discovered an additional mass in the other breast. As a result, I had a bilateral mastectomy at the suggestion of my doctors and it all happened very quickly.

The only decision that remained my own throughout the process was the type of reconstruction I opted to have. My plastic surgeon provided me two options. I could choose to have standard silicone implants or a TRAM flap - a procedure which I had never heard of. There were pros and cons to each, and both sides weighed heavily in my decision-making process.

Now I know lots of ladies are so strong - and probably stronger than me - who’ve gone into their mastectomy with their natural breasts and come out of surgery with nothing; either opting to delay or omit reconstruction. Admittedly I was fearful of that possibility. I know if that were the only option for me, I would have handled it with strength and grace, but if immediate reconstruction was possible for me, that was what I wanted.

 

 

With implant reconstruction, you don’t actually receive the implants right away in most cases. An expander is typically placed in the breast pocket and then you’ll visit your doctor regularly to inflate those over time. This wasn’t something I really wanted to deal with. I didn’t want to have to explain the expanders or their purpose to my children, nor did I want to go into the office so frequently for the inflation.

Another risk I considered with the implants was that my body could reject them. While rare, it is always a possibility. I felt like I’d be going through enough already and should my body reject the implant I would be back to the TRAM flap option. And if that were the case I know I would have been kicking myself for not choosing the TRAM flap in the first place.

I also felt it was a significant disadvantage for me to have the implant replaced in roughly ten years. I am really hoping that after my last reconstruction surgery coming up, I can be finished with surgery for the remainder of my life. I realize I may not be that lucky, however I didn’t see the point in making a choice now that would lead to another inevitable surgery down the line.

Another consideration I weighed with implants is the possibility they could leak or burst. Sure, this is a pretty rare occurrence, but I know someone whose implant had burst and she said it was extremely painful. Again, this was another complication I didn’t want to deal with at any point in life following my cancer recovery.

 

 

Being a mother also affected on my decision. As silly as it may seem, I didn’t want to be at a pool party with my kids one day, with my silicone implants and worrying about whether the other moms were assuming I’d had boob job out of vanity, when the real story is so far from that.

Last but not least, I considered my husband’s opinion. I know he’s never been a fan of fake breasts so I was hoping for something a bit more natural. Let’s be honest ladies, we know that our men get more enjoyment from our breasts than we do ourselves. So, while my doctor was explaining the options, I literally handed my husband the implant and asked what he thought. He was the one who would honestly be adjusting to the change almost as much as I would.

The TRAM flap procedure sounded like a much better option for me personally. Basically you undergo a tummy tuck and they use the removed tissue to form new breast(s) using microsurgery to reconnect the blood vessels. They can also perform other flap procedures using tissue from other parts of the body like your upper back or glutes if your abdominal tissue isn’t significant enough.

I was happy to have the silver lining of a tummy tuck of course, but the breasts are also much more natural looking and feeling.  I mean they are natural, they are made of my own tissue. This also means when I gain or lose weight my breasts will do the same just like my old ones did. Not only that, the possibility of regaining feeling in the new breast is much more likely than with an implant.

As with any procedure, there is a risk for complications with the flap surgery, which is why I was in ICU for four nights following surgery so they could monitor the blood flow closely. If blood flow isn’t fully restored, tissue breakdown, or necrosis, can occur and the tissue can essentially die. I felt confident in how closely they monitored this. If there was any issue they would have returned me to surgery in attempt to correct the problem before I would ever leave the hospital.

The biggest disadvantage with the TRAM flap of course is the lengthy recovery time. You are undergoing quite a surgery, in fact mine was nearly 14 hours. I won’t even lie, when I woke up, I felt like there was a semi parked on my entire midsection. Thank goodness for modern pain meds and that little clicker button in the hospital - I would have been miserable without it!

When I left the hospital I looked like a monster, and yes, it was scary looking in the mirror. I had stitching on both breasts and across my abdomen, spanning from hip to hip, as well as a total of five drains coming from my underarms and from each hip. I remember sitting on the bathroom counter while my husband worked to cover all of my surgical sites so I could shower (such a big task)!  I could see the reflection of my back and thought, wow it’s amazing I still looked completely normal from the back, you would never know. The front however, was quite horrifying at first until the healing really started and the drains were all removed.

 

 

The most difficult part of it all was absolutely not being able to hold my children, who are two and five, like I normally would. I had to always be sure to have a pillow nearby to put between my new breasts and the kids if they wanted to sit on my lap. It got to the point where they would bring a pillow with them each time they approached me because they knew the drill.

Drains with kids are scary also. Now I will preface this with the fact we already called our son, “Logan the Destroyer.” And, there is good reason for that,. He’s 100% boy and all destruction! I had four of my five drains removed a few days following surgery, but one last drain remained a bit longer. The day before I went in to have that final drain removed my son yanked the tube pretty hard and pulled the stitches that held the tube in place completely loose. That meant the drain tube was able to shift and move, causing a lot of discomfort to say the least. I couldn’t have been happier to be rid of that last drain tube!

Once I got that final drain removed, I had a new found freedom and false sense of security. I returned home from the appointment feeling like a million bucks and let my son sit on the couch next to me without the pillow. I had my arm around him and in typical toddler fashion he jumped across my lap abruptly elbowing me in the breast in the process. It hurt pretty badly and didn’t seem to get any better, so I called my doc the following day. I had to go into the office, and it appeared my son managed to undo some of the internal stitching. So it’s something that will have to be corrected later once I am finished with radiation and chemo.

I still have one more surgery to complete the reconstruction process. I will have nipples reconstructed from my skin-sparing mastectomy (I lost the nipple but kept my own skin, as opposed to a nipple-sparing mastectomy where they saved the nipple but had to replace some skin). At that time we’ll repair the internal stitching where my son left his personal stamp to this process.

It’s been a long road to recovery, but I’m so happy with my reconstruction, and after several months I am healing beautifully. Best of all I feel confident that I made the right decision. Recovery has been hard on my family and myself, but I am grateful to be alive and happy to have a nice flat tummy for the first time since having kids. And it’s wonderful to have new cancer free-breasts made from my own tissue.

Michelle is a 37-year-old mother of two in treatment and fighting breast cancer. She is married to an amazing man who is a fighter in is own right, also currently undergoing cancer treatment for a lymphoma recurrence. Both are staying positive and each other's strongest support systems. You can follow her journey on her blog Positively Surviving Cancer. Michelle is also very active on Instagram, Facebook and Twitter.

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1 comment

Amanda Boser

November 07, 2016

Thank you for sharing! I was diagnosed with breast cancer 2 weeks before delivering my 2nd son. I am finishing up chemo and will have my double mastectomy on January 18th. Do you have a list of items that were helpful to have at home post-mastectomy to make life a little easier or more comfortable at home? My family has asked me what I want for my birthday, that is two weeks away, and also for Christmas. I thought of asking for items to help me in my recovery. Any suggestions? Thanks!!!

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