Breast

There's a Certified Mastectomy Fitter in Chicago, Pattie Cagney Sheehan, owner of Second Act. While the prostheses are not low-cost, many insurance providers cover them. Here's the information for Second Act:

3020 N. Lincoln Avenue

Chicago, IL 60657-4208

phone: 773.525.2228

mobile: 312.560.3076

fax: 773.348.2228

pattie@secondactchicago.com

www.secondactchicago.com

Thank you, that really does help. It never occurred to me to consider adjusting the unradiated side, but, that makes a lot of sense. It is the side that looks fake, feels fake too. I am considerably smaller than before reconstruction, which is fine. But, I really hope that I can end up with something that is not so obviously different on both sides.

I really like the surgeon I have now and I will do as you suggest and discuss all options with him. I think your suggestion of perhaps making the adjustments to the un-radiated side may really be a solution.

You are correct in assuming that the tissue expander was replaced with an implant. I was told I was simply not a candidate to use my own tissue for reconstruction. I asked if I could gain weight to do that, but, nobody seemed to think that was a good idea :) (Darn).

Thank you again for your answer. It was very helpful.

Lisa (aka Cancerfree2b)

Anyway, I will

Great question!

There are 2 procedures that use the tissues you describe: the DIEP flap and the SIEA flap. Both use the patient's own abdominal skin and fat to reconstruct a natural, warm, soft breast after mastectomy.

The DIEP flap procedure is the most advanced form of breast reconstruction available today. Unlike the TRAM flap, the DIEP flap preserves all the underlying abdominal muscles. Only abdominal skin and fat are removed similar to a "tummy tuck".

Since the abdominal muscles are preserved, patients experience less pain after surgery, enjoy a faster recovery and maintain their abdominal strength long-term. The risk of abdominal bulging and hernia is also significantly reduced. Women also enjoy the added benefit of a flatter abdomen with results that mimic a “tummy tuck”.

More info on the DIEP flap can be found here:
http://www.prma-enhance.com/index.cfm/PageID/1754

The SIEA flap differs from the DIEP flap only in terms of the blood vessels that supply the tissue. While the surgical preparation is slightly different, both procedures spare the abdominal muscle and only use the patient's skin and fat to reconstruct the breast.

More info on the SIEA flap can be found here:
http://www.prma-enhance.com/index.cfm/PageID/1755

Again difficult to say without examining you, but things that come to mind are - change in hormones, blockage in fluid draining the breast (breast lymphedema), tumors - benign and malignant, fat necrosis, diabetic calcinosis, and other rare diseases. Best thing for you to do is seek out a breast surgeon to evaluate you.

Difficult to say without examining you. There are small specialized 'oil' glands on the areola (brown part by the nipple) that are small (~2-3 mm). In general, any mass should be evaluated by a doctor - preferably a breast surgeon to make sure it is nothing to worry about.

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Alternatives to whole breast radiation revolve around accelerated partial breast irradiation (APBI) techniques. These can be done via non-invasive methods such as AccuBoost HDR treatment, balloon-based HDR treatment (MammoSite, Conura, Savi), or in some cases using external beam radiation techniques.

Generally if there is retraction of the nipple, that is because there is cancer behind the nipple or areola, and it "draws" the nipple inwards. Depending on the exam and findings of the imaging studies (especially MRI), preserving the nipple and areola might not be possible. If the nipple and areola do need to be removed, sometimes a "central lumpectomy" can be performed - again this depends on the location and size of the tumor as well as the size and appearance of the overall breast. If a central lumpectomy is performed, radiation therapy will be needed, as with any lumpectomy. Radiation is generally not needed after mastectomy, unless there is a very large tumor, if there is invasion of tumor into the skin, or if multiple lymph nodes are involved by tumor.

I would make sure you get a good idea of the cosmetic results after central lumpectomy. In addition, remember that mastectomy is not necessarily a "better" operation - in most cases there is no long-term survival advantage to mastectomy compared to lumpectomy / radiation.

I would reinforce some of the points made by 20questions - there are many options and one technique is absolutely not right for everyone. The best results are when reconstruction is done once (although it is not uncommon to need revisions or minor tweaks). Interview more than one plastic surgeon, and also make sure that they are not only experienced with cosmetic surgery, but post-mastectomy reconstruction surgery - a completely different procedure.