Plastic Surgeon Visit

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.

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DIEP:

-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

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Implants:

-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.

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Fat-Grafting:

-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.

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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.

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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.

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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/)

Surgery set to go for Mom

My mom went to see Dr. Ferguson today about possibly having her breasts reconstructed using the Khouri method. She tried reconstruction years ago, but after some serious complications and platelet issues, she gave up and sort of resolved herself to the fact that she would never be able to have reconstructed breasts.

When I learned about this fat transfer technique, I thought for sure it might be an option for my mom...after today's visit....looks like she's a good candidate.

It sort of broke my heart to see Mom's excitement as she told me about the possibility of getting her breasts reconstructed. For so long, she just supressed her disappointment and acted like boobs were no big deal. You have to cope somehow.

So the surgery she has lined up next month is for a revision of the original "botch job", as she calls it. They need align the breast properly and clean up the scars. Then after a bit of recovery, they'll go ahead and start the fat transfer procedure. She needs to wait 5 weeks between each time they do the fat transfer. They'll do at least 3 fat transfer procedures.

I'm so excited for her. I'm so glad that there is a surgeon in our area who performs this technique. Many blessings...

Khouri Method

I noticed a girl on the FORCE message boards posted that she was going to have her mastectomy and then have reconstruction using the Khouri Method. I had to research it to find out what it was.

http://www.miamibreastcenter.com/reconstruction/after-mastectomy-miami.html

Brava system (vacuum bra) is placed over removed breast area. External expansion of the breast occurs. Your own fat is injected to fill new void. Expansion continues to occur. More fat is added to enlarge the breast.
BRAVA system is placed over removed breast area. Extenal expansion of the breast occurs. Your own fat is injected to fill a new void.

Expansion continues to occur. More fat is added to enlarge the breast.

This method would reconstruct me and I don't have to worry about future implant surgeries. I don't have to have a tummy tuck scar from a FLAP. It seems like a great procedure.

I look forward to a visit with the plastic surgeon in Salt Lake City that performs this type of procedure. The original Dr. Khouri performs this procedure he pioneered at his clinic in Miami. I am grateful there is a surgeon in Salt Lake who performs this method.

I want to learn more about it and see if it is an option for me. Even though I'm thin, it seems that the physician can find enough fat to fill the breast area. I wonder what the BRAVA/Khouri method reconstructed breasts look like after many years...

Lots of questions, but I'm grateful I found out about it. It may even be the answer to my mother's reconstruction issues (high platelets prevent her from invasive surgeries like expanders and implants).

General Surgeon Visit

Dan came with me to visit with Dr. Teresa Reading, general surgeon. My first impression was that she was intelligent, kind and understanding and she listened well. She was highly recommended by the oncological gyn I interviewed about my upcoming hysterectomy/oophrectomy. She does a lot of breast surgeries. Another FORCE friend used Dr. Reading and has all good things to say about her. I feel comfortable about using Dr. Reading as my general surgeon. I still might interview one more general surgeon. I am looking forward to meeting with plastic surgeons so I can feel like I am towards the end of my information gathering.

Dr. Reading talked about my options...
-just the oophrectomy alone can decrease my percentage of cancer and I can do surveillance
-I can do the skin-sparing mastectomy with an incision under the breast, but it would need to be a pretty long incision to be able to reach all the way to the top of my breast area so she can remove as much breast tissue as possible.
-I can have a skin-sparing mastectomy where the areola and nipple would be removed, so it's just a circle incision...and have the plastic surgeon reconstruct the nipple
-I can do a nipple-sparing mastectomy where she cuts an incision horizontal to the armpit side of my areolas. She said this is the procedure she favors since it allows for more blood flow to the nipple and there is a higher percentage that the nipple will survive. She said she doesn't really do the nipple-sparing where they remove the areola and nipple and put it back on.

I asked Dr. Reading why nipple-sparing might have a higher chance of breast cancer vs the total removal of the nipple. I didn't realize that, as she explained, the whole nipple is actually tissue. Overall, the incidence of breast cancer is higher in the nipple tissue, so if someone keeps the nipple, their chance of getting breast cancer is slightly higher than someone who doesn't have their nipple. But, Dr. Reading did point out that I don't have cancer yet and the reason for the mastectomy is to reduce my risk. Having a nipple-sparing mastectomy would drastically reduce my risk for breast cancer...she will not be able to remove ALL tissue anyway. It's a choice I have to make. Do I accept a slightly higher chance of getting breast cancer for more beautiful breasts?

I think I'll wait till I see what the reconstructed nipples and the pictures of nipple-sparing breasts look like when I speak with the plastic surgeons.

Dr. Reading also recommended a few plastic surgeons that she works with.

I loved having my husband with me. It helps that he is right there listening with me. Then we are both on the same page to discuss future options together and he's a part of this process.