Partial mastectomy & Tdap flap experience
Thought I would share my experience here for future users as I didn't find many examples for partial mastectomy and Tdap (thracodorsal arterial perforator) flap reconstruction. I was diagnosed at 43 with stage 1 idc of 3.5cm in my right breast. It was found in my first ever mammogram which I only had as baseline because I was starting HRT for perimenopause. Thank god it got caught early. My Surgeon was very thorough and ordered CT, bone scan and MRI, which didn't show any spread to lymphs or beyond. The tumour was located at about 10o'clock between the nipple and armpit. Due to its largish size of 3.5cm the Surgeon recommend partial mastectomy but indicated would be able to spare my nipple and key sensation nerves. Understanding the options available to me was really important including the pros and cons of each. In particular I wanted to understand options that would maintain sensation. My breast surgeon put me in touch with the plastic surgeon to talk through options. I strongly recommend you ask for this consult if it isn't offered to you. Given the size and location of my tumour if I had opted for a reconstruction only the breast size would be very small, and then I would have needed to consider reduction of the healthy left breast for symmetry. The Plastic surgeon identified I was a good candidate for a TDAP flap reconstruction as part of a single surgery. While there are some risks a flap might not take, I felt it was the best first choice option for me. And I was positive that if everything went well I would only need one surgery rather than subsequent later reconstruction surgeries. Involving both breast surgeon and plastic surgeon did add a few weeks and a number of appointments to the first month after diagnosis. Luckily for me with my particular diagnosis the surgeon wasn't concerned it would impact on my prognosis. I am very aware how lucky my circumstances have been to allow me these choices. My surgery was about 4 hours I'm told. The breast surgeon removed the tumour, x-rayed to check the margins and then handed over to the plastic surgeon. In the end the flap needed to be taken from between Tdap and ldap area on my back close to my armpit area in order to have suitable arteries for blood connection. 1 lymph node removed. Thankfully when I came out of surgery I didn't have any nausea and ate a meal that evening! I was in hospital for 6 nights afterwards as you have two drains for flap surgery and the plastics team like to Closely monitor the flap and drains. The main discomfort I had for first few days was a sore shoulder because my arm had to be above my head for the four hours surgery. So anti-inflammatory cream was in high use. I was able to walk from day 2 and pretty much just on Panadol for pain. The bruising all over the entire breast was epic so arnica cream was essential. After 6 nights in hospital I was allowed to go home with my drains and have daily nurse visits to check. I also had direct mobile number for my specialist nurse if I had any questions. Being home in a quiet bedroom was a relief after the noisy nights of hospital ward. Currently on day 10 post surgery and still have the two drains, although I think they will be out in next few days. Flap surgery can also mean longer period of recovery before you can drive-up to six weeks. Although that is very individual and I'm hoping I might be able to drive in another week or so. Still early days but thought I would share my experience so far. S