Total left mastectomy vs expander/implant?

vickitennant

Hi  everyone - I’m newly diagnosed and have found BCN hugely helpful and reassuring.

I have bilateral early cancers - invasive ductal (left side) and invasive lobular (right side). ER + PR + HER2 -.I believe ‘low grade, slow growing’. 

My treatment recommendation is: left side mastectomy, nipple/skin sparing with expander then later implant and right side lumpectomy.  Followed by radiation and letrozole. Surgery scheduled for 22/11 at Chris O’Brien Lifehouse. 

The choice I have is left side total mastectomy or the reconstruction? For context, I’m middle aged, slim/small breasted and physically very active.  Apart from the obvious surgery and post operative worries, my other concern is around the possibility of spending many months with ongoing breast related issues.

Wondering if any of you have had a similar experience….and any thoughts/advice you might have? Thank you 🎀

Beginner

I had a nipple- sparing double mastectomy with immediate implant reconstruction (after right side stage 2 breast cancer). I went for the mastectomy after the lumpectomy didn’t get clear margins on 2 occasions. I wasn’t recommended radiation if I went for mastectomy (only if I had a lumpectomy). I am pleased with the result. I went for the double mastectomy for peace of mind as well as symmetry. From memory it took me about 3 months to recover but could go walking before this time. I have a little bit of restricted movement lifting both arms up but not much.

Such a personal decision to make. Wishing you the best as you weigh up your options.

Suki

Hi @vickitennant

I was 47 at surgery, slim and fairly active (swimming, running, circuit).  I had triple positive IDC in the left breast, but widespread microcalcifications across both breasts.  I had a bilateral skin sparing mastectomy, direct to implants in May 2024 (as not enough tissue available for DIEP flap).  I also had a sentinel node biopsy on the left side and didn't need radiotherapy.

My natural breasts were small, so I chose the smallest implant to match my frame. I confirmed with my surgeon that the implant would be over the pectoral muscle so my shoulder movement would be minimally affected.

Surgery was about 4 hours and I saw a physio prior to surgery - both my surgeon and physio provided me with exercises to do in hospital, which I started the day after surgery.  The hospital stay was 5 days and I discharged after the drains came out on the 5th day.  Having two drains in made movement hard and uncomfortable.

I got an infection 1 month after surgery in my non-cancer breast.  My surgeon was onto it quickly and did  a surgical wash-out which saved the implant.  No problems since.

My new breasts are heavier and more firm than my natural ones, but I am used to that now.  I am back to swimming with my squad in the pool and doing the same amount and type of exercise as prior to surgery.  Almost back to the same strength and fitness 6 months later!

Aesthetically, my new breasts look different because I have scars instead of nipples (you won't have this if you are having nipple sparing), although I will probably get 3D nipple tattoos eventually.  They are symmetrical (which is important to me) so look good in clothes and bathers etc.

Feel free to ask any questions and all the best.

vickitennant

Hi - thank you so much for such a detailed reply. It’s so reassuring to read about your experience.  I’ll definitely get onto the physio early and I’ll check with my surgeon beforehand that it’s  over the over the pectoral muscle. 

I’d love to go to a direct implant vs the expander first. There’s no sign of lymph node involvement at this stage so I’ll double check that option. My surgery is booked for 22/11. 

It’s very useful to know re the  2 drains making movement harder - I’ll try for a longer hospital stay especially as I live alone. 

Wonder if you’re taking hormone blocker meds and if so how they’ve made you feel?
Really love that you’re back to squad swimming 6 months later. That’ll be my goal! 

Thanks again! 

Vicki

Suki

Hi Vicki

I was pre-menopausal at diagnosis.  I take Tamoxifen as a hormone blocker once per day - the only side effect is hot flushes which generally only occur overnight.  I am a "cold" person so haven't found it too bad, although I haven't had a summer on them yet so will see how that goes!

The swimming is so good to stretch out your chest, shoulders and back - just make sure you get approval from your surgeon before getting back into training or a swimming pool.  I feel really great after a session

MelCBusby

Hi Vicki,

I'm 58 years old, only two weeks, post my second mastectomy (fourth surgery), my circumstances are very much similar to one of the responses (no name) to your question. I was diagnosed with invasive DCIS - right breast, in May this year. I had two unsuccessful attempts, then in August, a nipple sparing mastectomy with reconstruction/implant and for symmetrical reasons, I had a lumpectomy on the left side (tissue tested also but was cleared). I chose to have a mastectomy on the left for peace of mind. My surgeon did a great job.
There is still some numbness along the side of my right breast and the nipple, it's too early to say what's happening with the left side.  I'm happy with how I look, the scarring on the right has been healing well. I use a cream to help with reducing the visibility of the scar. 
I was a DD cup and now I'm a C. Quite a difference when comparing how clothes looked on me before and after, but still able to retain all my clothes.
After all of this, I'm all clear, no need for further treatment, just follow-up appointment in 6 months' time. 
My right nipple is a little higher than my left (due to the location of the DCIS I think), but overall, I appear quite symmetrical, and no one would notice it but me. With that in mind I'm grateful that I've been able to get through this journey without having chemo or radiation treatments.
The whole Breast Cancer team from the time off diagnosis to post surgery are invaluable. They have some insightful advice but, in the end, it's your decision as to what you want to do.


Wish you good health and all the best on your journey.

vickitennant

Hi Mel
Thank you for your reply. It’s reassuring to read that you persevered and that you’re happy with the results. 

May I ask what you mean by unsuccessful attempts? That sounds hard to me! Also wondering where you had your surgery? 

I’m only a C cup now (prior to surgery) and I honestly don’t mind if I’m even smaller afterwards! And as you say, it really doesn’t matter if I’m a bit asymmetrical afterwards. That’s so good to read that you didn’t need either radiation or chemo afterwards ….. I’m so hoping for the same. I have a meeting with my breast nurse tomorrow to discuss some of my questions prior to surgery on Friday - as you say, the whole team is amazing and so valuable at this time. 

Thanks again, and best wishes to you!