Game on!

After six hours and four doctors yesterday, plus tons of questions and lots of great answers, I now have an official plan for surgery.

(My description below might be too graphic for some. If you're one of those people, stop reading!)

I am lucky that the tumor had no skin involvement, so I am a candidate for a skin-sparing bilateral mastectomy. Since I had lymph node involvement, I will also be having a full axillary dissection on my right side. The surgeon will cut around my areola, remove it and remove my breast tissue through the incision, which will result in a smaller scar than is common in a traditional radical mastectomy. I will also have a small incision in my armpit to facilitate the lymph node removal.

The plastic surgeon will then place tissue expanders (temporary, fillable implants) underneath my pectoral muscle on each side, using an Alloderm (synthetic tissue) patch to insure that the implant is completely covered. He will fill the tissue expanders with saline to keep the preserved skin stretched. So I will wake up with two breast mounds, which I like much better than the idea of waking up completely flat chested. I will go to the plastic surgeon's office once or twice before starting radiation for a saline fill, and will then resume fills until I get to my desired size once my skin has healed from the radiation.

A lot of plastic surgeons do not recommend implants in patients who need radiation. The failure rate is higher (specifically in women who undergo full radical mastectomies) as radiated tissue does not have the ability to stretch like normal tissue. However, since I'm young and am having a skin-sparing, my plastic surgeon thinks I'll do fine.

This is a study I found from 2009 where the patients had immediate/delayed skin-sparing mastectomies with Alloderm followed by radiation. The results are very promising!

If I'm an exception (as I've proven to be throughout this process!) I'll move on to more invasive procedures like the IGAP or SGAP. But for now, I'm happy with my reconstruction decision.

Happy Easter to everyone. Count your blessings!