We have decided to go with a radial incision, slightly sloping downward from my nipple out. I have spoken with a few other ladies who had an under-breast incision so it's kind of hidden from a bird's-eye view. It seems the under-breast incision would be more aesthetic... I emailed Dr. Ferguson again in hessitation:
"Hello Dr. Ferguson!
I am preparing for my upcoming mastectomy and reconstruction on January 24th and am grateful that you are going to perform the reconstruction. I trust you and know you will do a beautiful job.
I know we talked about not doing an under-the-breast incision and instead doing the incision sloping downward and outward from my nipple.
If you don't mind, I just need a quick little reminder as to why the under-the-breast incision isn't preferred. I know we talked about the weight of the implant resting on the incision.
I am also wondering if you have performed an under-the-breast incision reconstruction before and what the results were.
Ultimately my husband says not to worry about the incision placement, but I would love one more reassurance from you.
Thank you for indulging my last minute jitters,"
"Please, now I feel that you are going to do great regardless of where the incision is. Yes, I have performed reconstruction with both approaches. My personal preference is for the lateral oblique incision. My reasons for this are both with the reconstruction and the mastectomy. One reason is that if the incision is at the most dependent portion of the breast, then all of the implant weight will be on the weakest area of the skin. If I do need to use Alloderm for the lower hemisphere reconstruction, then the Alloderm will be directly below an incision repair in a very thin person rather than her own vascular tissue (such as muscle). When I go back to change the expander for an implant, I am going to cut through that repair (whether Alloderm or muscle) and again open a weak area. The other concern is blood flow to the nipple. In my opinion, there is more potential for compromise to the nipple with an incision that cuts perpendicular to a blood flow route through the skin to the nipple. While not entirely the same, if you picture the nipple as the center and all vessels going to and from it like spokes on a wheel, a transverse cut under the breast goes perpendicular (or across) the routes from the lower part of the breast. An oblique lateral would be parallel to the routes and theoretically disrupt fewer blood flow routes. Either approach has potential for nipple necrosis, however looking at mapping of angiosomes or blood flow patterns of the chest skin, the lateral incision makes more sense to me. Another potential benefit (which would be more for Dr. Reading to decide) is access for the mastectomy. The distance from the lowest portion of the breast to the highest portion in most people is greater than the distance from the most medial (central) point of the oblique incision and all other points of the breast. For some women, the downside is that they can see the incision repair more readily than if it is below the breast. I think in your breast shape when you look in a mirror you will be able to see the lower breast incision readily but not as readily from a bird’s eye view (looking down without the aid of a mirror).
I am fine with whichever incision you prefer. These are the reasons I personally prefer the oblique. I think that you would be a candidate for either one.
Hopefully this was helpful,"
His explanation makes so much sense... What to do!
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