Friday after my chemo treatment, I met with the plastic surgeon for my consultation. I knew going in that my reconstruction options were going to be limited since I will be undergoing radiation, and I don't have a lot of extra body fat, so I tried not to be discouraged. The only option for me given my slim size (no tummy tuck option) is to have implants. Radiation, however, will make it a little more challenging. After radiation, my own tissue is needed to support a permanent implant. Most of the times, an implant is used in combination with a latissimus dorsi or t-DAP flap. This would be done at the time of the mastectomy. At this point, I am not a good candidate for this. So, we have a few challenges. One of them is figuring out the best way to hold the implant in while making it symmetrical with the other (non radiation) side. Another is dealing with the skin changes as a result of radiation. The surgeon did say it might be possible to use liposuction and injecting some fat into the reconstructed breast where needed to improve the symmetry and contour.
The most troublesome problem with using implants as opposed to my own tissue, is something called capsular contracture. This occurs if the scar or capsule around the implant begins to tighten. Capsular contracture can be treated in several ways, and it sometimes requires either removal or scouring of the scar tissue, or perhaps removal or replacement of the implant. Radiation therapy dramatically increases the risk of tightness around the implant due to radiation fibrosis of all the surrounding tissue. This could mean many additional procedures and problems post reconstruction.
Since I will be undergoing radiation after the mastectomy, I will need tissue expanders beneath my skin and chest muscle. This tissue expander is a silicone balloon which will be filled (expanded) with saline to help stretch the muscle and remaining breast skin to the reconstructed breast size. I may be able to get a couple expansions in before I start radiation, but once I start treatment I will not be able to be expanded until radiation is complete. Reconstruction will be done somewhere between 3-6 months after radiation is complete. Everything will hinge on how I heal, skin conditions, and how the expanding is going.
All things considering, the appointment went well, and I have lots more information to think about and research as we move forward with everything. I have read a lot about how some women grieve the loss of their breasts. I think I am ok with it at this point. I think it will be difficult if I do end up having more children not to have the option of breastfeeding, but that's something to deal with/think about another day. Given everything that I have been through so far, I feel like it's just one of the next steps to a long healthy and happy future. So, whatever it takes................bring it on.