In the time I have been a breast cancer blogger and coach, I have met many wonderful women who did not want reconstruction surgery. For them, it just didn’t make sense. I celebrate their right to choose.
We don’t HAVE to have breasts! If we have lost one or both breasts to this disease, who says we have to replace them? Even my own mother-in-law chose against reconstruction surgery (she’s in her 80’s after all, and says “Who’s going to look at my chest besides me?”).
There is no simple answer to this dilemma. Many factors influence the decision and each woman must evaluate those factors for herself. Sometimes however, it helps to hear from other women about why they made the choices they made, and how they feel down the road.
Researching for this article was really interesting. There are quite a few websites or blogs written by survivors who really didn’t want to deal with breast reconstruction and they had a myriad of good reasons why they didn’t wish to.
Here are some of their reasons or concerns.
Some Good Reasons to Choose Against Reconstruction
They didn’t want another operation which they felt was unnecessary;
They were unhappy with having an implant or ‘foreign object’ in their body or using muscle from another part of the body to create a breast form;
For some, distance from the hospital or doctor performing the surgery was a big problem;
Some felt have reconstruction surgery might bring risks of further complications (like infection) and after battling cancer, they just didn’t want to risk it;
Several younger women with children said that caring for their children was their main concern and because reconstructive surgery would involve a long operation and recovery, they would not have the time and energy they’d need to care for their children after coming out of the hospital. A couple of women chose to wait until their children were older;
Several women said they were comfortable with how they looked — they didn’t want any more surgery and preferred instead to wear a breast form;
Many older women in their 70’s and 80’s chose against reconstruction because it just didn’t worry them not to have a breast (or both) missing. They were completely at peace with their decision and their body shape.
For those of you considering a breast form, here’s a little information for you.
Breast Forms
A breast form (prosthesis) is worn either inside a bra or attached to the body. It has the appearance and feel of a natural breast. For women who have had a mastectomy, breast forms can be an important alternative to breast reconstruction. Most of these forms are made from materials that mimic the movement, feel, and weight of natural tissue. A properly weighted form provides the balance your body needs for correct posture and anchors your bra, keeping it from riding up.
Prices vary considerably for prostheses and a high price doesn’t necessarily mean that the product is the best one for you. Take your time to shop for comfort, good fit, and a natural appearance in the bra and under clothing. Your clothes should fit the way they did before your mastectomy.
The advantages of having a breast prosthesis are (1) they may give you a more natural shape under clothes, (2) they may give a more “balanced” look, (3) they do not require surgery, and (4) if your natural breast size changes, you can buy a new prosthesis.
There are a few disadvantages, however – (1) you may be less comfortable in revealing clothes than if you had reconstructive surgery, (2) it may be less convenient to do certain things, such as playing active sports, than if you had reconstruction (one swimmer I know had her prosthesis fall out during a competition and that embarrassed her terribly), (3) a prosthesis may be heavy, feel hot, and move around inside the bra, (4) it’s hard to scratch an itch underneath a prosthesis.
The Art of Doing Nothing
There is an art to choosing not to have breast reconstruction. You will, at some point, feel the need to explain your decision to curious friends or family members. I suggest you come up with an answer you are comfortable with and then just stick by it. Everyone will respect your decision – or most will, and if they don’t that’s their problem, not yours!
Here are a few options for doing nothing:
If you have no breasts, no problem – you don’t need a bra. If you still have one, however, and you wish to support it, you will still need to buy a bra that fits well. Just stuff the other side (or both sides) with padding that won’t fall out if you want a balanced look.
Wear a bandeau style bra if you have a surviving small breast – they are comfortable and will still provide you with support.
One woman I know who had a single mastectomy wears a sports bra that’s very stretchy and provides her one breast with sufficient support and the other side clings to her body just fine. She doesn’t care about appearing lop-sided.
Ultimately, the choice is yours. It’s your body and only YOU can choose what makes sense for you. Talk to your doctor, talk to your family, and then be at peace with your decision.
I send my love to everyone taking this journey right now. If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com) and I’ll do my utmost to keep you informed and empowered on your healing journey… and beyond.
Photo courtesy of freedigitalphotos.net and duron123
When I first decided to write about all the different types of reconstruction surgery, I had no idea how many types there were! Even in the eight years since I had breast cancer, this type of surgery has come a long way and I certainly did not have as many options back then as there are today.
Deciding which type of reconstruction surgery to have will be quite difficult for some, so I’m hoping that this series of articles assists someone in making that decision.
My suggestion? Make sure you discuss your options thoroughly with your surgeon so that you know all of the pros and cons each type of reconstruction surgery will entail and choose the one that makes sense for you and your lifestyle.
The GAP, IGAP, SGAP Flap
This type of breast reconstruction is generally utilized when a patient does not have sufficient tummy fat to have TRAM or DIEP flaps. The GAP (gluteal artery perforator) uses skin and fat from your tushy (buttocks) and depending on whether your surgeon uses the upper portion (SGAP = superior gluteal artery perforator) or the lower portion (IGAP, inferior gluteal artery perforator) will be a decision that you either make together, or solely by your surgeon in the operating room.
The GAP blood vessels are not located within muscle, so your gluteus maximus will be undisturbed during this procedure except for an incision which your surgeon makes to tease the perforator vessels out of the gluteal muscle to create the blood vessels for the transplanted tissue.
Most women have enough tissue in their gluteal area to create a new breast, however, if there is not enough tissue, a small implant can be placed to fill out the size of the new breast.
This type of flap can be taken from one buttock, or can be harvested from both buttocks for bilateral breast reconstruction. Flap elevation is completed while the patient is sleeping (under anesthesia, of course) face down, and then the patient is turned over for the flap to be attached to the chest.
This is another procedure which requires a high degree of proficiency from your surgeon – it’s microsurgery. Please ensure that your surgeon has the requisite experience and skills.
Length of Surgery: for one breast, 5-7 hours, for both breasts, 7-12 hours (this may vary according to your surgical team).
Hospital Stay: 3-4 days (ask your particular surgeon for more information as this varies between hospitals and surgeons)
From A Practical Point of View…
Because no muscle is moved during this operation, most women said the recovery period wasn’t too bad. One who had had the IGAP (taken from the lower buttock) mentioned she couldn’t sit down comfortably or wear jeans for quite a few weeks.
Expect to be off your feet for 3-4 days while you are in the hospital and the surgical donor site on your tush heals.
The SGAP scar lies in the upper buttock and is “easily hidden in a French cut bikini or in underwear” (according to The Center for Microsurgical Breast Reconstruction). The IGAP scar lies within the lower buttock crease.
Have you had the GAP surgery? Perhaps you’d like to comment below on what it was like for you personally so that my readers will have some more good feedback. Thanks!
If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com). You can depend on me to help you through this.
Deciding upon which type of reconstruction surgery to have after losing part of your breast, or all of it, or both of them, to breast cancer is often very difficult, so I decided to devote all of my blog posts this week to a discussion of the various types of reconstruction surgery that are available, together with a little feedback from women who have undergone each type of surgery.
The SIEA Flap
The SIEA flap type of breast reconstruction is a relatively new style of reconstruction and requires microsurgery. The SIEA flap is somewhat similar to the DIEP flap in that both techniques use skin, fatty tissue and blood vessels from the abdomen, but the DIEP flap utilizes tissue from the upper abdomen, while the SIEA flap uses tissue from the lower abdomen to reconstruct a natural, soft breast following mastectomy. Also, the SIEA blood vessels are not located within muscle, so your abdominal muscles never have to be disturbed during this procedure.
The SIEA flap is more technically difficult to perform. Please ensure that your surgeon has the requisite experience and skills. Having said that, I read that the SIEA flap procedure has a less than 1% failure rate.
The SIEP flap is apparently used less frequently since the arteries required are generally too small to sustain the flap in most patients. According to PRMA – Center for Advanced Breast Reconstruction: “Less than 20% of patients have the anatomy required to allow this procedure. Unfortunately, there are no reliable pre-operative tests to show which patients have the appropriate anatomy. The decision as to which type of reconstruction to perform is therefore made intra-operatively by the plastic surgeon based on the patient’s anatomy.”
You would NOT be a good candidate for the SIEA flap if there is not enough tummy fat (for instance if you are very thing or have had a tummy tuck already), or if you are an active smoker — your abdominal scar will heal slowly, and your fat tissue is more likely to turn into scar tissue.
The SIEA flap can be used for reconstructing one or both breasts. Since you will have two surgical sites, you will have two scars.
Length of Surgery: for one breast, 5-7 hours, for both breasts, 7-12 hours (this may vary according to your surgical team).
Hospital Stay: 3-4 days (ask your particular surgeon for more information as this varies between hospitals and surgeons)
From A Practical Point of View…
One of the things that bugs me about my latissimus dorsi flap reconstruction is that I have a lot of numb areas on my breast and back. With the SIEA flap, sensory nerve reconstruction can also be performed in most patients and this can really improve long term sensation in the reconstructed breast.
Also because no muscle is moved during this operation, most women said the recovery period wasn’t too bad. Another plus is that there is little risk of developing an abdominal hernia later as there is with the DIEP flap.
One thing to note – if the SIEA flap reconstruction fails, the tissue flap may die and will have to be completely removed and you would not be a candidate to try it again for another 6-12 months.
My suggestion? Make sure you discuss your options thoroughly with your surgeon so that you know all of the pros and cons each type of reconstruction surgery will entail and choose the one that makes sense for you and your lifestyle.
If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com). When you’re in a desperate situation, you need an ally. You can depend on me to help you through this.
Photo courtesy of freedigitalphotos.net and Apple’s Eyes Studio
Deciding upon which type of reconstruction surgery to have after losing part of your breast, or all of it, or both of them, to breast cancer is often very difficult, so I decided to devote all of my blog posts this week to a discussion of the various types of reconstruction surgery that are available, together with a little feedback from women who have undergone each type of surgery.
The TUG Flap
The TUG flap is a relatively recent type of reconstruction surgery, it certainly wasn’t available 8 years ago when I went through breast cancer. It is recommended for women who, due to a slender body type, or due to previous abdominal surgery, can’t have the more utilized TRAM or DIEP flap procedures.
In the TUG flap procedure, your surgeon will utilize fatty tissue, muscle and blood vessels from the inner thigh to reconstruct your breast. TUG is an acronym for “transverse upper gracilis”.
The gracilis is a muscle on the inside of your upper thigh. It’s a relatively small muscle responsible for helping to move your leg closer to the center of your body. It is reasonably expendable and does not create any noticeable loss of strength, because other muscles exist which can compensate for its function. The skin and fat carried by the inner thigh flap can be a transversely oriented ellipse just below the groin and buttock crease, which allows the donor site to be closed similar to a thigh lift, resulting in a well concealed scar. Alternatively the incision can be extended vertically along the inner thigh to capture more tissue volume in a sort of fleur-de-lis design, and this allows larger breasts to be reconstructed with the inner thigh flap.
The TUG flap can be used for reconstructing one or both breasts. The scar runs along the inner upper thigh and is well hidden. An added benefit might be a leaner inner thigh similar to what you might receive after a thigh lift procedure.
Length of Surgery: for one breast, 2-3 hours, for both breasts, 4-6 hours (this may vary according to your surgical team).
Hospital Stay: 4-7 days (ask your surgeon for more info)
From A Practical Point of View…
After this surgery, it’s normal to have some wound healing issues because of the location of the incisions on the inside of the thighs. You will most likely need a compression garment for the inside of the thighs.
Most survivors mentioned that they needed to avoid sitting in a chair for any extended time during the first two weeks post-surgery, but that laying in bed, sitting in a reclining chair, or walking did not cause problems. Most complaints were just about the 4 drains they needed to carry around with them after surgery. That part was a little irritating, but most everyone seemed pretty pleased with this type of reconstruction.
This is microsurgery, a highly specialized field, so please ensure that your surgeon has the requisite experience and skills.
My suggestion? Make sure you discuss your options thoroughly with your surgeon so that you know all of the pros and cons each type of reconstruction surgery will entail and choose the one that makes sense for you and your lifestyle.
If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com). When you’re in a desperate situation, you need an ally. You can depend on me to help you through this.
Deciding upon which type of reconstruction surgery to have after losing part of your breast, or all of it, or both of them, to breast cancer is often very difficult, so I decided to devote all of my blog posts this week to a discussion of the various types of reconstruction surgery that are available, together with a little feedback from women who have undergone each type of surgery.
The Latissimus Flap
The latissimus flap is a pretty standard breast reconstruction method, first utilized way back in the 1970’s. Your surgeon will take a flap from your latissimus dorsi muscle (located on your back), with or without attached skin. The flap is elevated off of the back and brought around under the skin under your arm to the front of the chest wall. The main vessels remain attached to the body to ensure proper blood supply to the flap. The latissimus flap provides soft tissue to allow complete coverage of an underlying implant if one is utilized.
The latissimus flap is most commonly combined with a tissue expander or implant, to give the surgeon additional options and more control over the aesthetic appearance of the reconstructed breast. This flap provides a source of soft tissue that can help create a more natural looking breast shape as compared to an implant alone. Sometimes, for a thin patient with a small breast volume, the latissimus flap can be used alone as the primary reconstruction without the need for an implant.
The latissimus flap can be used for reconstructing one or both breasts. You will have a horizontal scar (although some doctors create vertical scars) running under your shoulder blade on the reconstructed side, approximately 5″ long.
Length of Surgery: for one breast, 2-3 hours (this may vary according to your surgical team).
Hospital Stay: 1-3 days
From A Practical Point of View…
After this surgery, it’s normal to have some restriction of range of motion of the arm on the affected side. Also, because you now have muscle tissue in your new breast, when you contract your latissimus dorsi muscle, you will feel your breast contract as well. This may annoy some women. I chose this type of reconstruction for myself and I’m used to the muscle contraction now – it’s a great party trick (lol).
Some survivors say they wish they had never chosen this surgery because they have suffered from a great deal of post-surgical back pain, presumably there was some nerve damage done. For myself, I have experienced no such problem. I have had to be extremely proactive with stretching and yoga to regain my muscle strength and range of arm motion, as well as a particular type of massage to reduce adhesions from scar tissue. Since I’m a massage therapist, I created a video to explain the procedure so others could get their massage therapists to do this for them.
One further thing I have noted – the area around the scar on my back is still numb, eight years later, and it itches sometimes. It’s also numb along the side of my body over the area where the tissue wraps around and I have a lot of loose, slack skin on the side of my body where the muscle wraps around. If I were younger and worried about such things, I might need a further surgery to correct that.
My suggestion? Make sure you discuss your options thoroughly with your surgeon so that you know all of the pros and cons each type of reconstruction surgery will entail and choose the one that makes sense for you and your lifestyle.
If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com). When you’re in a desperate situation, you need an ally. You can depend on me to help you through this.
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About Marnie Clark
Hi I'm Marnie Clark, breast cancer survivor, and breast cancer coach. I have 20+ years of experience in natural medicine. In 2004/05 I battled breast cancer myself. You can see more about my journey on my page Breast Cancer Diary.
I've been healthy and recurrence-free since 2004 and in 2012 I became a Breast Cancer Coach because I became aware of the fact that whilst there is now a wealth of information on the Internet, much of it is confusing, conflicting, and sometimes just wrong!
Why should you work with me? Because:
(1) You don't want to go through this journey alone, feeling unempowered, frightened or just plain
clueless about what to do to help yourself.
(2) You will have someone working tirelessly on your behalf, putting together a healing plan for
you so you don’t have to lose your precious energy researching what food you should eat,
what supplements you should take, and what other things you can do that will give you the
best chances for survival. Instead you can spend that time resting, meditating, healing.
(3) You will learn what questions to ask your doctor (and have someone to turn to for the
questions they can't or won't answer).
(4) You will be armed with the tools and strategies you will need to get through the therapies you
choose so you can make your body hostile terrain for cancer.
You can also “like” me on Facebook (Marnie Clark, Breast Health Coach) to get my inspirational snippets, news and updates. I promise to do my utmost to keep you informed and empowered on your healing journey… and beyond.
