I am so grateful for this message board! It is a great resource.
I have a few questions but I'll try not to make this too long!! I am in my early 30's, non-smoker, overall very healthy. Mom to 3 small children all born before cancer diagnoses.
I had a non-nipple sparing bilateral mastectomy in the fall of 2015 due to early stage cancer with implant recon Feb 2016. Through testing, they also found papillary thyroid cancer at the same time, but it was not related to the breast cancer. I did not have to do chemo or radiation.
The implants LOOK amazing and as natural as implants can look in my opinion, but are very tight with my pec muscle stretched to the max (I have a pretty large implant size for my frame) and are also uncomfortable while sleeping, working out, and pretty much any other activity involving my chest. The side I had the cancer on (right side) is also painful more often than the left.
I also never realized how cold they'd be and I've had to overdress no matter the season just to stay warm. I am a thin person to begin with. Is this a common issue?
Anyway, I'm considering stacked flaps at NOLA and am really interested but have a few questions...
1. This first one might sound crazy...I have heard that silicone implants can be toxic to the blood vessels in the chest and that sometimes going from implants to flaps can be risky due to the fact that the blood vessels wouldn't "take" as well as they might have before implants, especially if you have large implants? Is this just a myth? Does it matter how long you've had implants before attempting flap surgery? It would be at least 2 years with implants in my case before being able to afford NOLA for flaps.
2. If I decide to go forward with flap surgery, I really don't want implants at all but am worried about projection. (I realize I can't expect perfection and I honestly don't - in fact I'd be fine if the flap results didn't look as great as my implants look in clothes, but I'm pretty sure I'd like them better because of the natural feel and warmth that would be back in my body again).
Back to the projection question - I have the 2 straight scars across my chest right now and a BMI around 18.5. I am completely fine with a smaller cup size than what I am now (about DD matching my old breast size) and I've already sent pics to NOLA and they/you said that I could be a small B with bilateral gap flaps or a small C with the body lift perforator procedure. Could this be accomplished without implants? (I realize it's probably hard to answer that one not having examined me or operated on me personally but any info would be helpful).
One of the main pulls for me with flap surgery is not having future surgeries years later to change out the implants. I would love to be "done." I also really like the idea of having my pec muscles put back into place and it's my understanding that this is accomplished through flap surgery without implants. Is this correct?
3. Because of insurance issues, it would be the most feasible for us financially to have all the surgeries completed within one year. I'm hoping I can make it to NOLA in January 2018 (coming from the west coast) and have stage 1 then, stage 2 a few months later, and then back again for nipple tattoos if nipple recon has already been completed during stage 2. Is that normally a realistic goal to have all the surgeries completed within a year's time frame?
4. I work from home and as mentioned have 3 small children and of course I worry about the toll of going through more surgeries/recovery, especially traveling to them, would take on my family (not to mention the financial strain). I don't know if I'm being unrealistic to want to love my chest again and have a more natural appearance and warmth there. I don't know if I'm being too picky to want to change what I already have - my plastic surgeon did an amazing job and I don't look deformed at all, not at all like what I know other women have gone through. I also know there are some thin women that have regrets or feel "deformed" in a way on their backsides (flat bums) after going through gap flap surgery. Is this a common thing from your viewpoint?
I know there are pros and cons to all types of breast recon and I also know of your talent and the renowned successes at NOLA. I just want to make the best longterm decision and feel like flap surgeries could be it, but I don't know if the risks outweigh the benefits in my case. SO hard to know what to do. Anyway, I know it's a personal choice but I'm hoping you might be able to give some of your expertise and wisdom here .
Oh wow this sure turned into a novel! Thank you in advance for any info and thoughts you have about my many questions. I wish I could talk to someone in a similar situation to my own and hear honest opinions of how they like their flap surgeries! Before and after photos are so helpful but not like "living" in the results. There are so many things I wish I had known about implants before going through with that. I might be overthinking it all too, but then again I'm so young and this is the rest of my life we're talking about!
Thank you for everything Dr. D!!!