Tuesday, 27 March 2012

BRCA Part 1 - Surgery Type and Expections

So any BRCA+ gal knows that there are a whole bunch of surgery options available if you decide to go with a prophylactic bilateral mastectomy (PBM), which can be daunting and confusing all at the same time. I was presented with 3 possible options...

DIEP Reconstruction - This is by far the most invasive of all the procedures, but a good way to sneak in a tummy tuck! In this procedure all of your breast issue is removed, including the skin, and fat/skin from another part of your body is transplanted and used to reconstruct the breast. They can use various parts of your body - the tummy being most popular. But they can also use tissue from your back or thighs. It sounds good in theory, but a specific body type is required for this. AKA you must have enough tissue/fat at one particular site to rebuild your breast.You will also have 2 major incision sites.

Note: This was not an option for me because of my size, but can be great option for other women. The recovery is a lot longer, however.

2 Stage Mastectomy and Implant Reconstruction - This is generally the most common option for PBM and it requires 2 surgeries. Because BRCA+ women are not getting breast implants for kicks or *cough*  vanity we are not adding implants to already existing breast tissue. So the implant needs to go underneath the muscle because the skin is obviously not thick/strong enough to support its weight. During surgery #1 the mastectomy is preformed, and a temporary un-inflated implant is placed under the muscle. The muscle wall is not big enough to accommodate a full implant right from the get go. So over the next few months you have to go back and forth to the doctor's for regular "fill-ups" to gradually inflate the implants. Each implant has a port where saline can be injected to stretch out the chest muscle. Once the desired pocket has been made and healed, a second surgery is scheduled and the final implant is implanted.

Note: The port used to mark the injection site is magnetic, so not an option for my little cyborg heart. My pacemaker/defibrillator does not get along with magnets, and would have stopped functioning as a result. In other words no thanks! If its not one thing its another ha!

Prophylactic Mastectomy with Alloderm Reconstruction - So this is obviously the surgery type I chose. Third option is always the charm. It is very similar to the 2 Stage procedure, expect that everything is done at once with the help of Alloderm tissue. The implant obviously still needs to go under the muscle so the plastic surgeon uses a type of donated tissue (known as Alloderm) to expand the chest wall and create the necessary pocket immediately. 
I used paint to create this little gem!

The implant is placed, everything gets stitched back together, and Viola! The muscle eventually heals and integrates itself with the alloderm - absorbing it as part of the body. It is actually amazing medical science and another reason to check that box on your health card and become an organ donor!


I can only talk about my experience with my chosen procedure, but I have been really happy with the results so far. Here is what to expect...
  • This is a one shot deal. One surgery. One recovery. And you are all set!
  • Everything is pretty swollen, and they have said to expect that it will remain that way for 6-8 weeks!
  • For some reason when the full implants are placed there tends to be more bleeding, aka you will need to have those stupid drains for longer (7-10 days is typical. I had mine for 10. BLAH!)
  • They also say recovery for this type of surgery is longer than the 2 stage - anywhere from 8-12 wks. I don't know why exactly?!
  • Because you get your final implants right away you never experience having no breasts, which can be very traumatizing for some women. You go to sleep with your breasts and wake up with your new fake ones!
  • The Alloderm site is tight and kind of itchy
  • You have less of an opportunity to decide exactly how everything will look in the end - a HUGE source of anxiety for me. With 2 stage the "fill-up" process is gradual, so you have the opportunity to say if you are happy with more or less. The 2nd surgery also offers an opportunity to revise the scars if you need to. Whereas with the Alloderm procedure - what you wake up with is what you get.
  • That being said I stressed how I wanted things to look (aka as much like myself as possible) and I think they look pretty darn good so far!
As always please feel free to ask any questions I didn't answer. You can always email me if you want it to be more discreet or you have lots to say!

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