Breast Cancer Blog

Tuesday, September 04, 2012

Today we went to see the plastic surgeon to learn about our options for reconstructive surgery. We are considering two options:

A double mastectomy with implants,

A double mastectomy with a DIEP Flap.

With implants, a balloon type tissue expander is placed behind the chest muscle after the mastectomy and partially inflated with saline solution to stretch the skin. Every so many weeks, more saline solution is injected to stretch the skin further. After the desired size is achieved, another surgery is performed to take out the balloon and replace it with an implant, either filled with silicone, or saline solution.

The draw back to implants is they only last about ten years, and then replacement implants are required. Sue would also have to endure pain from the pressure of inflating the balloon, which the surgeon said feels like having a brick in your chest. Other people who have had this procedure claim it is not painful. However, Sue has Fibromyalgia, and we are worried this would be painful to her as a result. The plastic surgeon said in her condition, the implant option would probably be more painful.

The DIEP Flap takes tissue from her stomach fat and moves it up into the breast area after the breast tissue is removed. The skin from the breast remains, so it is basically trading the breast tissue inside her breast for the fat tissue around her stomach. The plastic surgeon performs micro-surgery to save the artery and vein feeding the stomach tissue, and that is re-attached to an artery and vein in her chest which keeps the tissue alive.

The advantage to this procedure is it can all be done at the same time as her double mastectomy. One operation, one healing period. It is also more natural looking than an implant.

We were not sure yet which option to choose, but the double mastectomy and breast re-construction is tentatively scheduled for September 21, 2012, at the St. Cloud Hospital.

Bad news. We called Juli after meeting with the plastic surgeon to find out the results of the additional testing from her biopsy. The results indicate that she has an aggressive kind of cancer, which means she has to have 6 cycles of chemotherapy, once every 3 weeks, even if there is no sign that it has spread to her lymph nodes. She will also have to take Herceptin for about a year to block the HER2/neu receptor in the cancer cells, thus cutting off the food supply to the cancer cells.

We decided to schedule surgery as soon as possible to have her sentinel nodes removed, to see if the cancer has spread to any of her lymph nodes. The sentinel nodes are where the cancer spreads to first when it spreads beyond the initial tumor.

If the cancer has not spread, then we can schedule the regular surgery for the double mastectomy and breast reconstruction as planned for September 21, and start chemotherapy about three weeks after the surgery.

If the cancer has spread, then chemotherapy would probably begin right away. Breast reconstruction surgery would be put on hold, if radiation is also required, as the radiation would otherwise damage the tissue reconstruction.

Juli is also finding and scheduling an appointment with an oncologist for Sue.

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