Post # 34 – To Have or Not to Have

 Breast Reconstruction Surgery

Dear family and Friends

I have been thinking about my cancer treatment plan and what i have covered with you so far --my diagnosis, the tests, the Red Devil – Chemotherapy, the Mastectomy, Radiation therapy, my second stage Chemo therapy, but I don’t think we have really talked about having breast reconstruction – so I thought that might be a good thing for today’s post. I want you to have as much information as you need to make this decision.

 I went out to see a plastic surgeon after I was healed up from my radiation treatment to see what needed to happen next. I was told at that time what my options for breast reconstruction surgery were. I was also told that I needed to wait a year because the radiation was still working in my body. Do you think maybe that is why I have killed two phones by keeping them in my pocket all the time:) 

Actually, both of the methods she described sounded pretty painful and time consuming as far as recovery is concerned – I am not so sure that I can afford to be off work for as long as would be necessary for me to heal enough to get back to good working condition. Here is an article I would like to share with you I got the following article from the Cancer Society:

https://www.cancer.org/cancer/breast-cancer/reconstruction-surgery.html

Should I Get Breast Reconstruction Surgery?

A woman who has surgery to treat breast cancer might choose to have additional surgery to rebuild the shape and look of her breast. This is called breast reconstruction surgery. If you are thinking about having reconstructive surgery, it is best to talk about it with your surgeon and a plastic surgeon experienced in breast reconstruction before you have surgery to remove the tumor or breast. This lets the surgical teams plan the best treatment for you, even if you decide to wait and have reconstructive surgery later.

Help and support from someone who’s been there

No matter which options you choose, it’s important to know that there is advice and support out there to help you cope with the changes you’re going through. Speaking with your doctor or other members of your health care team is often a good starting point. If you would like to talk with someone who has had your type of surgery, ask about our  Reach to Recovery®program. Reach To Recovery volunteers are breast cancer survivors trained to support others facing breast cancer, as well as those who are thinking about having breast reconstruction. They can give you suggestions, reading material, and advice. Ask your doctor or nurse to refer you to a volunteer in your area, or call us at 1-800-227-2345.

Benefits of breast reconstruction

A woman might choose to have breast reconstruction for many reasons:

·         To make her chest look balanced when she is wearing a bra or swimsuit --- this would be my reason for this decision – my little grandson asked me when I would e able to go swimming with him again. Now I do not swim, but I used to go into the water with him and we would play together in the water .. but it is kind of difficult to wear aa swimsuit with only one side to hold it up. I could be wrong, but that is my thinking on this one.

·         To permanently regain her breast shape

·         So she won’t have to use a breast form that fits inside the bra (an external prosthesis)

·         To be happier with her body and how she feels about herself – I am perfectly content with how I am now, but I do not like to go out in public without both sides looking somewhat matched. Some days I do better than others. I am fine going around my family in my pajamas, but not when someone other than my immediate family comes over, then I hurry to get myself together😊

Breast reconstruction often leaves scars, but they usually fade over time. Newer techniques have also reduced the amount of scarring. When you’re wearing a bra, your breasts should be alike enough in size and shape to let you feel comfortable about how you look in most types of clothes. I have a very unique prosthesis and I struggle some days to get it to stay put and not have one higher or lower than the other one.

After a mastectomy, breast reconstruction can make you feel better about how you look and renew your self-confidence. But keep in mind that the reconstructed breast will not be a perfect match or substitute for your natural breast. If tissue from your tummy, shoulder, or buttocks was used as part of the reconstruction, those areas will also look different after surgery. Talk with your surgeon about scars and changes in shape or contour. Ask where they will be, and how they will look and feel after they heal.

Some important things to think about

·         You might have a choice between having breast reconstruction at the same time as the mastectomy (immediate reconstruction) or at a later time (delayed reconstruction). This was not a choice that I was given because of the radiation to follow the surgery as immediately as possible after healing.

·         Some women don’t want to have to make decisions about reconstruction while being treated for their breast cancer. If this is the case, you might choose to wait until after your breast cancer surgery to decide about reconstruction.

·         You might not want to have any more surgery than is absolutely needed.

·         Not all reconstructive surgery is a total success, and the result might not look like you’d hoped.

·         The cancer surgery and reconstruction surgery will leave scars on your breast and any areas where tissue was moved to create the new breast mound, such as the buttocks, tummy, or shoulder areas .

·         A rebuilt breast will not feel the same as the natural breast. The sites tissue was taken from to rebuild the breast might also lose some sensation. Over time, the skin might become more sensitive, but it won’t feel the same as it did before the surgery.

·         You might have extra concerns if you tend to bleed or scar more than most people.

·         Breast skin or flaps might not survive after reconstructive surgery. This tissue death is called necrosis. If it happens, healing is delayed, and more surgery is often needed to fix the problem.

·         Healing could be affected by previous surgery, chemotherapy, or radiation therapy. It can also be affected by smoking, diabetes, some medicines, and other factors. This one might ne a concern for me considering I am still receiving chemotherapy every three weeks which keeps my immune system lower than it otherwise would be.

·         Surgeons might suggest you wait to have reconstruction, especially if you smoke or have other health problems. It’s best to quit smoking at least 2 months before reconstructive surgery to allow for better healing. You might not be able to have reconstruction at all if you are obese, too thin, or have blood circulation problems.

·         The surgeon might suggest surgery to reshape your other breast to match the reconstructed breast. This could include reducing or enlarging its size, or even surgically lifting the breast. This was one of the things that the plastic surgeon had said, was that she would have to reduce the size of my other breast because they did not make reconstructed ones that big😊

·         If it’s known at the time of diagnosis that a woman will need radiation as part of her treatment, the types of immediate reconstruction surgery she can have might be limited. Certain types of reconstruction done before radiation can cause problems and lower the chances the rebuilt breast will look and feel as natural as possible, after the radiation is given.  You should discuss the best options for you with your surgeon before surgery.

At the time of my mastectomy I was under the impression that both breasts would be removed and it wasn’t until just prior to the surgery that I was told that is was unnecessary to take them both. I was going to go ahead and have my surgeon remove both – then I could have any size breasts I chose afterwards, but I was afraid that the insurance would not cover the removal of the second breast because it wasn’t diseased  and I could not afford that– so I opted to keep the one and have only the cancerous one removed. And so here I am one sided 😊

·         Knowing your reconstruction options before surgery can help you have more realistic expectations for the outcomes.

Can breast reconstruction hide cancer or make it come back?

Studies show that reconstruction does not make breast cancer come back. If the cancer does come back, reconstructed breasts should not cause problems finding the cancer or treating it.  

If you are thinking about breast reconstruction, either with an implant or flap, you need to know that reconstruction rarely, hides a return of breast cancer. You should not consider this a big risk when deciding to have breast reconstruction.

Risks of breast reconstruction

Common potential side effects and risks of reconstruction surgery can be found in What to Expect After Breast Reconstruction Surgery.

Certain types of breast implants can be linked to a rare kind of cancer, known as anaplastic large cell lymphoma (ALCL). It is sometimes referred to as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). This lymphoma happens around 8 to 10 years after the implant was placed and more often if the implants have textured (rough) surfaces rather than smooth surfaces.  If ALCL does show up after an implant, it can show as a lump, a collection of fluid near the implant, pain, swelling or asymmetry (uneven breasts). It usually responds well to treatment.

Breast Reconstruction Alternatives

What if I choose not to get breast reconstruction?

Some women who have had a mastectomy as part of their breast cancer treatment decide not to have any type of breast reconstruction.

They might decide they don’t want to have any more surgeries than they need to treat the cancer, or that they want to be able to get back to their normal activities as soon as possible. Some women are just more comfortable with how they look and feel after the surgery to remove their cancer. Cost might also be an issue, especially for women who don’t have insurance coverage. If you change your mind later, reconstruction is usually still an option. But keep in mind that it may be easier to get the result you want if you make the decision before you have your mastectomy .I considered the length of time for the recovery of having both breasts removed , but I would have needed more help from someone else for my daily needs, so this is another reason I opted to keep the healthy one. I could not afford to be off work for a longer period of time for healing and I did not want to burden someone else with more of my care unnecessarily.

For other women, breast reconstruction might be difficult, or even not possible, because of other health issues they have. For example, you might not be able to have reconstruction if you are obese, too thin, or have blood circulation problems.

Women who don’t have breast reconstruction after surgery have two main options:

• Using a breast form or prosthesis (inside the bra or attached to the body to wear under their clothes) I wasn’t sure that the insurance would pay for this and reconstruction surgery and I needed to get back to work before I could get in to see someone about getting measured for a prosthesis – and they do not make them big enough to match the one I still have --- so I made up one of my own and have been doing okay with it since then --- sort of on most days😊
• Going flat (not wearing a breast form) this was not an option for me with still having one breast, that'stoo big to hi

Using a breast form or prosthesis

A breast form is a prosthesis (artificial body part) worn either inside a bra or attached to the body to simulate the appearance and feel of a natural breast. Wearing a breast form is an option for women who have decided not to get reconstructive surgery but want to keep the same look under their clothes. If you haven’t decided about reconstruction, or are having reconstruction later, you might decide to use a breast form temporarily.

Most breast forms are made from materials that mimic the movement, feel, and weight of natural breast tissue. A properly weighted form provides the balance your body needs for correct posture and anchors your bra, keeping it from riding up. At first, these forms may feel too heavy, but in time they should feel natural.

If you are planning to use a breast form, your doctor will tell you when you have healed enough to be fitted for a permanent breast form or prosthesis.

Choosing the right bra for your breast form

The right bra for you may very well be the one you have always worn. It may or may not need adjustments. If there is tenderness during healing, a bra extender can help by increasing the circumference of the bra so that it does not bind the chest too tightly. Heavy-breasted women can relieve pressure on shoulder straps by slipping a bra shoulder pad under one or both straps.

If you decide to wear your breast form in a pocket in your bra, you can have your regular bra adapted. There are also special mastectomy bras with the pockets already sewn in. If the breast form causes any kind of skin irritation, use a bra with a pocket. If your bra has underwires, you may be able to wear it, but be sure to clear this with your doctor.

If you want to wear your prosthesis under sleepwear but would like something more comfortable than a regular bra, look for a soft bra, sometimes called a leisure or night bra. These are in most department stores.

Finding and paying for breast prostheses

Prices for breast forms vary considerably. High price doesn't necessarily mean that the product is the best for you. Take time to shop for a good fit, comfort, and an attractive, natural appearance in the bra and under clothing. Your clothes should fit the way they did before surgery.

Insurance coverage of breast prostheses can vary. Be sure to contact your health insurance provider to find out what will be covered and how you must submit claims. Also, ask your doctor to write prescriptions for your prosthesis and for any special mastectomy bras. When purchasing bras or breast forms, mark the bills and any checks you write "surgical." Medicare and Medicaid can be used to pay for some of these expenses if you are eligible. The cost of breast forms and bras with pockets might be tax deductible, and also the cost if you have a bra altered. Keep careful records of all related expenses. So far, I have not experienced this as I said before I came upon my unique prosthesis, in the beginning I tried a lot of various materials before I found a few things to put together that worked for me. I did consider this cost before I made my decision.

Some insurance companies will not cover both a breast prosthesis and reconstructive surgery. That can mean that if you submit a claim for a prosthesis or bra to your insurance company, in some cases the company will not cover reconstruction, should you choose this procedure in the future. Make sure you get all the facts before submitting any insurance claims. -- this was my concern as well, that is why I have not gone in to find out about getting a real prosthesis. It may all sound a little weird, but my own designed on -it is working for me so far😊

Going flat

Some women, who do not have reconstruction surgery, decide not to wear a breast form, either.

For most women, there aren’t likely to be any added health issues from going flat, especially if both breasts were removed. But if you’ve only had one breast removed, you might notice issues with balance, posture, or back pain, especially if you’ve always had large breasts. This is one reason some women prefer to wear a breast form – to balance out the weight on their chest. Talk to your doctor about your options if you think this might be an issue for you.

Some women might use a breast form when out but not when at home. This might be because they find breast forms uncomfortable or too expensive, or just because they’re comfortable with how they look and feel without a breast form and don’t feel the need to wear one.

If the idea of going flat appeals to you but you’re worried about what others might think, try going without a breast form in different situations, such as at home, out with friends, or while out running errands. You might find that most people won’t notice a difference. If you find you still feel self-conscious, you can always go back to wearing a breast form.

If you decide to go flat, you might want to consider wearing clothing that might help you feel more comfortable with your appearance. Try wearing tops that are not tight fitting and that have busy patterns, or layer sweaters or jackets over close-fitting tops. Scarves and shawls can also cover all or part of your chest.

Some women might like the idea of going flat but are uncomfortable about not having nipples. Some companies now make nipple prosthetics, which are made of silicone or other materials and look and feel like real nipples. They can be attached to the chest and then taken off when you choose. My friend's wife had breast cancer years ago and has had a process over time getting hers done. He said she was getting ready to get her nipples Tattooed on the last time I spoke with him about it.

Breast Reconstruction Options

Women who have had surgery to treat breast cancer can choose from several types of breast reconstruction. When deciding what type is best for you, you and your doctors should discuss factors including your health and your personal preferences. Take the time to learn about what options are available to you and consider talking to others who have had that procedure before you make a decision.

Choosing which type of breast reconstruction to have

If you’ve decided to have breast reconstruction, you’ll still have many things to think about as you and your doctors talk about what type of reconstruction might be best for you. Some of the factors you and your doctors will need to think about when considering your options include:

• Your overall health (including issues that might affect your healing, such as smoking or certain health conditions)
• The size and location of your breast cancer
• Your breast size  -- for me this is an issue that the plastic surgeon brought up.
• The extent of your breast cancer surgery—my surgery was down to the breast bone and all of my lymph nodes as well.
• Whether you will need treatments other than surgery for your cancer – I still have chemotherapy treatments every three weeks to keep my cancer from growing.
• The amount of tissue available (for example, very thin women may not have enough extra tummy tissue to use this area for breast reconstruction)—I am sure that I have plenty of tissue for them to choose from.
• Whether you want reconstructive surgery on one or both breasts – I will need a reduction on the one side and a reconstruction on the other side.
• Your desire to match the look of the other breast
• Your insurance coverage and related costs for the unaffected breast
• How quickly you want to be able to recover from surgery
• Your willingness to have potentially more than one surgery as part of the reconstruction – this is a concern for me as well because I will need to go to another city to have the surgery done and then there is the time off from work to heal  and the plastic surgeon did say that one of the reconstructive surgeries will take more than ne surgery to complete it.
• How different types of reconstructive surgery might affect other parts of your body  -- the plastic surgeon talked about one that would take muscle from my abdomen and one that would take muscle from my back.

Your surgeon will review your medical history and overall health and will explain which reconstructive options might be best for you based on your age, health, body type, lifestyle, goals, and other factors. Talk with your surgeon openly about your preferences. Be sure to voice any concerns and priorities you have for the reconstruction and find a surgeon you feel comfortable with. Your surgeon should explain the limits, risks, and benefits of each option. 

Types of breast reconstruction procedures

There are several types of reconstructive surgery available, and sometimes the process means more than one operation. Give yourself plenty of time to make the best decision for you. You should make your decision about breast reconstruction only after you are fully informed.

Two main types of operations can be done to reconstruct the shape of your breast or breasts:

• Using silicone or saline breast inserts (known as breast implants) – this would be the one I think they mentioned to do for me.
• Using your own body tissues (known as tissue flap procedures)

Sometimes the implant and flap procedures are used in combination to reconstruct a breast.

In addition, nipple/areola tattooing and fat grafting can be done to help make the reconstructed breast look more like the original breast. The reconstructed nipple and areola do not have any sensation.

Reconstruction after lumpectomy or partial mastectomy

Most women who have breast conservation surgery (lumpectomy or partial mastectomy) do not need breast reconstruction. However, some women might end up having a breast deformity as a result of the cancer surgery; for example, if a woman has a large tumor in a small breast. These women may be candidates for different types of breast reconstruction (such as smaller implants or fat grafting) to reshape the breast. This type of surgery has outcomes similar to lumpectomy or partial mastectomy without reconstruction.

Questions to Ask Your Surgeon About Breast Reconstruction

If you’ve had surgery to treat your breast cancer and are considering breast reconstruction, it’s important to know as much as you can about what to expect. Your breast surgeon can help you find a plastic surgeon who should be able to explain all of your choices and answer your questions. Here are some questions to ask to help get you started. Be sure you get all of your questions answered, so that you can make the best decisions for you about breast reconstruction.

Finding the right plastic surgeon for your breast reconstruction

If you decide to have breast reconstruction, you’ll need to find an experienced board-certified plastic surgeon. Your breast surgeon can suggest doctors for you. -- My oncologist referred me to my plastic surgeon.

To find a board certified plastic surgeon in your area, or to find out if your surgeon is board certified, contact the American Society of Plastic Surgeons (ASPS).

Getting a second opinion

It’s common to get a second opinion before having surgery. Don’t rush to get reconstruction surgery, or even mastectomy, before you know all of your options. It’s more important for you to make the right decisions based on complete information than to act quickly.

Questions to ask about breast reconstruction

It’s very important to get all of your questions answered by your plastic surgeon before having breast reconstruction. If you don’t understand something, ask your surgeon about it. You might want to take notes or bring a partner or friend with you to the doctor to help remember what was said and to help ask other questions.

Here are some questions to get you started. Write down other questions as you think of them. The answers to these questions may help you make your decisions.

• Can I have breast reconstruction?
• When can I have reconstruction done?
• What are the pros and cons of doing it at the same time as my cancer surgery (immediate reconstruction) versus waiting (delayed reconstruction)?
• Will reconstruction interfere with chemotherapy?
• Will reconstruction interfere with radiation therapy?
• What types of reconstruction could I have?
• What are the pros and cons with each option?
• What type of reconstruction do you think would be best for me? Why?
• What’s the average cost of each type? Will my insurance cover them?
• How long would it take me to recover from each type?
• How many of these procedures have you (plastic surgeon) done?
• What results can I expect?
• Will the reconstructed breast match my other breast?
• Should I consider surgery on the other breast as well to help them match?
• Could I have the nipple reconstructed if I choose to? How would this be done?
• How will my reconstructed breast(s) feel to the touch?
• Will I have any feeling in my reconstructed breast(s)?
• What possible problems should I know about?
• If using a tissue flap, will there be pain, scars, or other changes in the parts of my body where the tissue is taken from?
• If I get a breast implant, how long will it last?
• What kinds of changes to the breast can I expect over time?
• How will aging affect the reconstructed breast?
• What happens if I gain or lose weight?
• Are there any new reconstruction options that I should know about, including clinical trials?
• Can you show me pictures of typical results?
• Can I talk with other women who have had the same surgery?

 This sure seems like a good comprehensive list of questions for us to ask before we make our decision to have breast reconstruction. I hope this information was helpful for some of you or those you love. Remember if you are a support person it is good for you to have this information as well so that you will be prepared ahead of time and ready to help out where you are needed. here is another website you can go to for more information about breast reconstruction surgery. https://ww5.komen.org/BreastCancer/BreastReconstruction.html
In one of my next posts I will cover the next phase of this – preparation for breast reconstruction surgery.  I did not want this one to be too long for you all. Until then you all have a very good eek and remember we can do all things in the strength of the Lord.