After my genetic test came back positive for the BRCA1 mutation I have had a lot to think about.  First thing to think about is my second breast (yay, I still have one of those). Reconstruction of the right side had always been in my plans, but now I’m thinking of a possible mastectomy on my left side. This means that there will have to be two reconstruction surgeries right after the mastectomy.

I have decided to go with the mastectomy because I do not want to go through this process ever again. Without the mastectomy there is a 60 percent chance of developing BC in the second breast, with the mastectomy it goes down by 90 percent!!!

With all of these new decisions, I made a consultation appointment with a reconstruction surgeon and this is what I found out. There are several ways to do a breast reconstruction, I prefer implants and I’ll explain why.

One way is to do a flap surgery. This procedure uses your own skin, muscle and fat from a specific site on your body either the back or the abdomen. This type of surgery is complex and can vary depending on your body type. This surgery is permanent and once the surgery is done you can never go back. The patient needs to have adequate fat tissue to get the desired effect. Fortunately, I do not have enough fat in my belly. Also the scar left from this surgery is quite extensive. This option of flap breast reconstruction is not what I’m interested in.
#1 The less scaring the better, this option will leave scars at the site where they take the skin and at the breast.
#2 I do not have enough fat for one of the procedures, it is similar to a tummy tuck.
#3 Once the surgery is over, I can never go back to enhance or redo anything.

In this flap procedure, the surgeon takes tissue from the latissimus dorsi muscle in your back, tunnels it underneath your skin to its new location and uses it to form a new breast mound.

In a pedicle TRAM flap procedure, the surgeon cuts a section of skin, muscle, fat and blood vessels from your abdomen, tunnels the tissue underneath your skin to its new location, and uses it to form a new breast mound.

During a free TRAM flap procedure, the surgeon disconnects a section of abdominal tissue — including skin, fat and sometimes muscle — from its blood supply and attaches the tissue to blood vessels in your chest area using microsurgical techniques.

 The next option is reconstruction with implants 🙂 I was always interested in implants but never really considered them before this whole ordeal. This reconstruction option looks most promising. The surgeon will first insert tissue expanders, a soft implant filled with saline, and over time my skin will stretch and I will achieve my desired cup size. The skin stretching will take up to 6 months. After I reach my size, permanent implants will be replaced with the tissue expanders. As long as my body does not reject the implants, I will carry on with my life with no complications. If they need to be changed there will be no problems in doing so. The implants will be placed on top of the muscle. By placing the implant over the pectoral muscle, this limits chest wall spreading of any recurrent tumors. Therefore, if a new breast cancer or the same one comes back, God forbid, the tumor will only have room to go towards the skin and will be visible. My chest wall will be spared.

The disadvantages of implant reconstruction is that the breast will be more firm than a natural breast and my body could reject the implants 🙁

Lastly nipple areola reconstruction will be the last step when the permanent implant in placed. The areola reconstruction is a tattooing procedure and there are different nipple reconstruction procedures.

After your breast has healed from reconstruction or mastectomy surgery, a plastic surgeon can reconstruct a new nipple and areola. The surgeon makes a star-shaped incision to form the new nipple and then adds a tattoo to shade in the new areola.

A week later I went to go see the surgeon who did my first mastectomy in order to talk to him about my second mastectomy. Turns out, he will not be the surgeon the second time around because he is leaving Buffalo to become a medical director of another cancer institution in another state 🙁 Luckily, I was able to be seen by him one last time before he left me, forever. I am ready to go back under the knife as soon as my chemotherapy is over so that I can put all this behind me. NOT gonna happen! Firstly, the surgery can happen as soon as 4-6 weeks after chemotherapy. Secondly, my doctor recommended that I wait 3-4 months so that my body can get back to normal and lessen the chances of rejection or any complications. The earliest I can be start is in DECEMBER. So for the time being I will sit quiet and wait patiently.