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CarynRose

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Reply with quote  #1 
Does anyone have any experience with reconstruction after mastectomy for someone who is Stage IV?  When I mentioned the subject to some breast surgeons and plastic surgeons over the weekend, I was met with some blank stares.

Thanks,
Caryn

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Reply with quote  #2 
Carynn, my plastic surgeon does them. He is the kind of doctor who sees the glass half full. Women with mets can live many years- why shouldn't they have the body they want?
This is from the website he conceived with his partner and  a breast cancer survivor/reconstruction mentor is the executive director of it
It is about recon in women with mets
HERE


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CarynRose

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Reply with quote  #3 
Thanks NoSurrender:

My reasoning for considering mastectomy now is that being triple negative and BRCA1+, I still have about a 50% chance of another primary cancer in the other breast.  We had a scare about that a couple of weeks ago and so that started me thinking about having the breasts removed.

Many of my BRCA sisters have had reconstruction, but no one who is Stage IV.  Because I'm on Avastin right now and that really slows healing, I'm leaning towards not having any type of flap recon as that would require all sorts of healing in a number of places.  I am considering one-step alloderm with implants.  It's nipple sparing and leaves scars underneath the breasts.

Still, I need to make sure that someone in my situation is cleared for such a surgery.  The main goal is to remove the real estate on my body (at a DDD, there is a lot of real estate) that could produce another primary cancer.  If no recon is all I can get, then I'll deal with it that way.  I'd rather hate my chest and be alive than love my body and be dead.  LOL

Cheers,
Caryn

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AlaskaDeb

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Reply with quote  #4 
Hey Caryn-
 
I don't know anything about recon, I skipped that step, but I do know that you will have to time your surgery around your Avastin.  It really slows healing, so they might need to adjust your infusion schedule to make sure you are are all healed up before the next Avastin.
 
I say, go for what you want.  Being stage 4 should not keep us from having the treatments we want
 
Deb C

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nosurrender

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Reply with quote  #5 
Caryn, did you have rads?
If you did then you have to get tissue expanders first, unfortunately.
I thought when I got my second dx I would get to do the one step with Allo-Derm, but if you have previously radiated skin, they have to stretch it a bit.
I don't think for long though, just a matter of a couple of months.
I totally see your point in wanting to get this done!

Hey Deb


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CarynRose

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Reply with quote  #6 
It's interesting about needing expanders even for alloderm.  Would that still be the case if I wanted to go substantially smaller?  I'm a DDD and would want to go to a full C.  I'd think there would be lots of skin left over.  Am I missing something?

Caryn

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Reply with quote  #7 
Hi Caryn,
I thought I could get away with it too when I was re-dx'd. But my plastic surgeon told me that the radiation tightens up the skin and the muscle and since they place the expander under the pectoral muscle and not the skin, that has to be stretched.

So you wake up with the expanders in place, usually filled a little bit. You do have breasts and that is reassuring when you first look down.

Then over the next couple of months you get fills from your PS. There is a metal port in the expander that they find with a magnet and then fill with saline.
Since you don't want to go too large, then you won't have to be expanded as much as women who want to be their same size or larger.

If I didn't have to do nine months of chemo and then rads again I would have had my implants by now. I can't wait to get them.

I hope this helped explain the process!

hugs,
g


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energybunny

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Reply with quote  #8 

Hi Caryn and Gina, So I can get the expanders in after radiation and go for the alloderm you sent to that site for info on.  hmmmm....   That is good.  Still, I am going to wait a bit for my 1 year mammo., etc. to consider all that.  When I finish up with rads I just want to leave treatment free for a bit to give my family a rest from this stuff for a bit!    My breast surgeon told me (when I said noway on reconstruction back in Jan 08) that we'd discuss it again at my apt. with her Dec. because she feels I am young and should consider it.  She is very 'feeling' about all this.  -Lee


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Fancy

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Reply with quote  #9 
Lee, before you decide what to do for reconstruction, see if you can find a surgeon who does DIEP, or at the very least free flap reconstruction. It's a tougher first week, but after that there's a LOT less pain. And the reconstruction is easily done after rads. Implants have a poor success rate after rads because the skin doesn't stretch well. I assume your plastic surgeon told you that? The other fact you need to know is that if you have implants, they're not "permanent." They will have to be replaced in about 10 years, maybe less. I wanted something that would stick with me through thick and thin.




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energybunny

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Reply with quote  #10 
Thanks, Fancy.  I had read just what you said and after reading what these ladies are doing with the implants, it seems like a long haul!!    They are very strong and brave!
Off to rads this am!!  Seeya!  Lee

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Reply with quote  #11 
Caryn -

As you know, I'm also a BRCA1, trip neg.   After my mets dx, I got to NED (last 13 mos).    I didn't find out my BRCA status until AFTER my recurr & mets dx.

Thus, I was considering a bi-lat mast (had bi-lat lumpectomies on initial dx and rad'tn on one side).    I gotta say that I hate that phrase "the horse is out of the barn", which is what I got more than once.

I also met with 3 ps's.   I know that implants are tricky when that breast has received rad'tn.   However, for a number of reasons, and after reading Kathy Steligo's great book re:  mast & recon, for me, I was only interested in implants.   I found a very good ps who was willing to do that ... and noted that he would only do immediate implants as the rad'td skin was not going to stretch w/expanders.   

The only catch ... and he was very tactful about it ... but I knew what he was really saying ... was to wait one year post-chemo for my body to fully recuperate.  (I believe he was saying wait another year to see if you're still met-free).   Unfortunately, I lost my NED status and have been focused on dealing with that.

Send me an e-mail if you want some names.

Best to you,

CalGal


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BRCA1, triple neg.
1st dx - 9/04 (bi-lat lump's, clear SNB, 38x rad'tn). Mets 12/05. Liver met, then NED for 13 mos; then a lung met; now liver mets are back.
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