Great visit with the plastic surgeon. He took the time to answer my questions and relay the various options that are best for me. We talked about the *DIEP procedure, implants, and fat grafting (I've also seen this called the Khouri Method, fat sculpting, fat transfer...). I'll give the run down of each of the pros and cons that I can remember.
-This procedure uses your own tissue
-Fat is taken from the abdomen (or buttox) but the stomach muscle remains
-This does leave a long scar across your abdomen
-There is a foreign object in your body
-He uses alloderm to help cradle the implant and keep it lifted
-Implants may need to be switched out- another future surgery
-There may be "rippling"- you can see the implant's ripples underneath the breast skin (normally a "boob job" has a woman's tissue and fat to cushion under the skin so you don't see that.
-Could be easier to feel a lump since the implant will be under the skin, pushing the breast tissue/skin to the outer area.
-The size of your breast depends on the amount of fat you have do donate from other parts of your body. He said he could probably get to the size I have now with the amount of fat I have.
-Your own tissue is inside of you and not a foreign object
-The process is long, starting with a fat injection immediately after the mastectomy. Then at least two fat-injection treatments after that. Each treatment would be liposuction from a part of your body and then injecting that fat into the breast area.
-Before and after surgery, patients wear two plastic suction domes called BRAVA. BRAVA is to be worn 4 weeks prior to surgery and many weeks after. BRAVA is worn for 10 hours a day! Compliance is very important for the blood vessles to form throughout the grafted fat, and for the desired effect to be achieved.
He said that I am a good candidate for all options and that the decision depends on the individual's preferences. Some people like the look of the implant, others do not. Some people will not be compliant with the BRAVA because of the duration of treatment and hours wearing it each day.
He also said that if I decided to go with the fat-grafting, he could only harvest fat from areas other than the abdomen... then if I didn't like the final results the DIEP could still be an option. Implants could even still be an option. Many times when patients get implants first, the fat-grafting is used to transfer fat to the breast area to "pad" around the implant so you don't see "wrinkling" and other deformities, or to even out the breasts. He studied with the pioneer of fat grafting, Dr. Sydney Coleman. Dr. Coleman's site has some good photos of the procedure before and after (just fat grafting and with implants-http://www.lipostructure.com/breast-reconstruction). The plastic surgeon warned that many times the BEST photos are posted to prove a point and the worst photos are posted to discourage readers from certain procedures. He said you can expect somewhere in between.
I asked about what incision would be best for my mastectomy. He said that the incision is very important for aesthetic outcomes. I mentioned that one general surgeon I spoke with said they do the nipple-sparing with an incision on the side of the breast from the areola to the armpit. He suggested that it might be more aesthetic to angle that incision down at a 45 degree angle. I explained that one of my FORCE friends had her incision under the breast. He said that this wasn't his favorite spot, since the implant or fat would be weighing on top of that incision and be adding pressure.
I thought I might have a better idea of what I wanted to do, but I am still not positive. He did suggest that I see another surgeon and get a second opinion. I was planning on that anyway, but appreciated his forthright concern that I learn about all my options.
*One can find important positive aspects to utilizing the DIEP Flap process. In this sort of reconstructive surgery, the goal is usually to use the patient’s tissues to make a new breast mound. This procedure, which stands for deep inferior epigastric perforators, permits for the use of tissue from the abdominal region. Surgeons will remove a portion in the abdominal tissues, which includes the blood vessels, skin and fat, after which reposition them below the flap developed by this process when the mastectomy occurs.Why is it a superb choice? For quite a few ladies, this process does have clear benefits over other people. Using the DIEP Flap procedure, the tissues are removed from the abdomen however the actual muscle remains in spot. In other types of reconstructive surgery, the muscles are moved together with the tissues. This leaves troubles for this area from the body. It could lead to bulging or hernias. Then again, since the muscle is left in place, the physique remains in its classic shape.(http://geekpowwow.com/coolingdevices/2012/03/14/benefits-of-the-diep-flap-procedure/)