bilateral mastectomy then immediate reconstruction results

Renners

I have just finished chemo and now deciding on surgery. I am having a  bilateral mastectomy with nipple removal and then immediate reconstruction with implants. Has anyone had this with the implant over the muscle? Did they look ok? Also then had radiotherapy after? Where you happy with the result? How many other surgeries did you have? I am having a hard time picturing it and aligning my expectations with what can be done. Worried I will not be satisfied and it will affect me emotionally as I have been coping ok with breast cancer diagnosis until now.

Zoffiel

I think the implant over the muscle sounds a lot less complicated, way back when I had mine done, it wasn't an option.
Coping with your appearance is a complex issue. I don't like anything about my retreads, but I could forgive them if I could only ignore them. Yes, the result is disappointing but that is, quite literally, not what keeps me awake at night.

Ask to be admitted to the Choosing Reconstruction private group and you may be able to find some photos of a similar approach. Please ask your surgeon if they have some images of their work as well. Mxx

primek

I didn't think they could  do it over the muscle after the breast was removed. Unless they are going to create a dermal matrix support as the skin is very thin after mastectomy. Is the radiotherapy just to your axilla? If not I'm unsure how you could have the permanent implant in if they need to do the chest wall. Are they considering expanded tissue expanders then changeover?. My understanding is radiotherapy can damage the implant and compromise and thin the skin, hense why I didn't think it could be done this way. I expect many of these questions need to be discussed with your surgeon.

primek

Well having said the above there is a new photo story on the reconstruction page of a lady who has had the procedure sitting above the muscle. But she didn't have radiotherapy. So it woukd definitely be good to go in and have a look. 

Renners

I’m not sure on where the radiotherapy will be as haven’t really discussed it with my oncologist. If I did expanders first I would have to get implants before the radiotherapy as it will damage the skin. I don’t want too many operations so getting implants straight away. 

primek

@Renners the radiotherapy can damage the implant also. By having the expanders, doing radiotherapy  ..waiting to heal then the swap over. The chanfeover is fairly minor. Much less than the original surgery.

Silba

I haven't had reconstruction  but I was advised that if I did want it , it would be with expanders first as the radiation will damage the skin ( and it did severely) then they can  the implants.

Check with your surgeon

MessyJ

Hi @Renners, I recently had a double mastectomy (Skin and nipple sparing) with immediate implant recon over the muscle. I am also currently having radiation. My surgeon is very up to date with new surgical trends and he said that the cosmetic results were far better doing it this way than other options and if there happened to be any issue with the implant from radiation then we would do revision surgery to replace the implant. During the same operation I also had a oophorectomy (ovaries and tubes out), this way I have minimised the number of surgeries I need to have and also getting a great cosmetic result. So far radiation has caused a lot of skin irritation, redness and peeling to my upper chest but my breasts and axilla have had no significant issues, just redness. Happy to answer any further questions. 

Renners

Thanks @MessyJ, I feel more comfortable knowing someone else had what I’m having. Are you happy with the result? How are the implants held in place? Do you need to wear a bra 24/7 until healed?

RobynAnne

Hi@Renners. I too have opted for a double mastectomy (skin and nipple sparing) with immediate implants. Will have surgery in middle of May. Although my implant will be under the muscle with mesh for support. Hoping for a reasonable outcome. I don't know what follow up I will need as yet but my surgeon seems confident that the implants will be ok with radiation with a small risk of encapsulation or hardening. I figure its worth a shot...hoping for the best.

Gemima

I have had a double mastectomy(skin and nipple sparing) with immediate implants. I'm still waiting on lymph node test results. Just wondering if anyone has this similar reconstruction and do they have numbing. Do we get sensation back?

mum2jj

Hi @Renners,
Glad to see @MessyJ has been able to help you. Radiation and implants is a much sought after question in our choosing breast reconstruction group. My own reconstruction was in 2013 and it was a delayed. I had had previous radiation and the skin was apparently damaged and so implants were not an option. Many surgeons will not put implants in if radiation is needed. The risk of encapsulation is higher as @RobynAnne has mentioned. However as time goes on and new techniques are developed things do change. One of the things some surgeons are doing is some fat grafting over the implants. I realize you all have lots going on at the moment. When things settle down it would be great if you could maybe share your stories and results in our choosing breast reconstruction group as it is really helpful for others (like yourselves) coming behind you to have these stories to read. Our group is private and any photos shared there can’t be accessed in the main forum. I link the photos together in groups for easy access. 

i wish you all the best in your reconstructions and recoveries. 

Paula xx

mum2jj

@Gemima Just realizing you had commented on an old post. Have you joined choosing breast reconstruction group? My reconstruction was a bilateral TRAM. so no implants. Whilst I have a little sensation on the skin of one of my new breasts,  they are mainly numb. I don’t have implants, but imagine it is the same as the breast tissue has been removed. Any implant ladies can you help?
Paula x.