The Answers
Updated: Nov 24, 2021
Below are the answers to the questions compiled in my last blog post.
But first, a word from Snow White.
Having a Mastectomy and then reconstruction is not the same as a "boob job", these fun drains coming out of my breast are because when all my breast tissue was removed and the implants added my body still thought it needed to provide hydration to all that tissue, so until my body adjusts to the amputation this bloody water will come out. When that stops the drains can come out and I can take a shower.
And without further hesitation I present the answers to yesterdays questions.
What’s the best reconstruction option for me based on my body/shape?
A. It is my choice if I would want to do the flap surgery or implants however I don't have enough fat on my stomach to make breasts that are as big as my current ones, and they would likely need to take from a few different places if they wanted to make breast exclusively from my own body material with no implants
How many surgeries will I need for this type of reconstruction?
A. If I get only implant there would be two surgeries, I would have spacers put in at the time my double mastectomy was performed. Then when I get to the desired size, they would wait about 4 months and do a second surgery replacing the spacers with the implants
Will I be included with the decision of size and shape?
A. Yes. they would fill the spacers a little day of surgery then I would return every two weeks for a fill until I get to the size I want to be
Approximately how many visits will I have with you? Pre-post, fills, etc.
A. Many. But that all depends on what size I choose to be
When would the first follow up appt be?
A. Two weeks after surgery
How long will I not be able to drive?
A. about a week, though I likely will not have the energy to do so for awhile
How long will I not be able to shower?
A. Depends on if I need drains (probably) and when they come out. Likely a week
Overnight in hospital? If so, how many days?
A. not likely, but perhaps one night
Where would the incisions/scars be?
A. They would be horizontal across my chest, possibly on a diagonal /
How long after the first surgery will the exchange surgery be?
A. Again, depends on how big I choose to go, but when I get to desired size, then they would overfill a bit, and then wait 3-4 Months to do exchange
OTM or UTM?
A. under the muscle. They only do under the muscle as there is less risk for infection. Once the implant has been in contact with anyoutside substance there is more chance for infection, so if the wound didn't heal properly etc. If under the muscle there is less risk of infection
What supplies are provided?
A. All medical supplies needed.
What do you recommend buying for recovery to make it easier?
I asked the resident this but he wasn't sure and I forgot to re-ask the surgeon.
What brand implants do you use?
Mentor (click link for info)
Is there a max on cc size
They have gone as big as 1400cc. But that is much bigger than someone my height and width would need/want
How long do I have to wear a compression bra?
forgot to ask
Do I have to sleep in a bra for life?
resident didn't think so but I forgot to ask the surgeon which the resident told me to do
How often do implants need to be switched out, and if they come out is it relatively easy to go to aesthetic flat closure?
In 15 to 20 years. They said someone who had this done at between ages 40 and 60 would likely only have it done once. When they come out it is very easy to go to aesthetic flat closure if that is what I choose.
How long will this surgery take?
If I go direct to implant, no flap surgery then the procedure should take a little over two hours. If I chose flap or partial tissue with implant then possibly up to 8 hours.
Will my insurance cover this procedure?
100%
What is the percentage of infection?
2-3%
What is your flap or implant failure rate?
very low the failure would happen due to infection or if there is a rupture
What kind of complications can occur with this type of surgery?
infection, capsular contraction, and regular risks associated to any surgery.
How long should I expect my recovery to take?
Basic recovery is a few weeks
How long should I be off work?
Depends on what I do at work, should not be lifting my arms or weight of anything for quite sometime
What is in the implant
Silicone smooth shelled
How will I be screened for breast cancer in the future, I've heard mammograms aren't safe with implants, will MRI's be done or ultrasounds.
That is up to the oncologist however mammograms are safe with these implants. (the Doctor then squeezed it really hard, threw it on the floor and stepped on it to demonstrate) But it is questionable wether breast screening will need to be done as my chance of getting breast cancer will sit at around 2%
How will your lymphnodes be monitored? Will the ones in your armpit and upper breast be removed?
Another question for the breast surgeon not reconstructive surgeon
Will OHIP will pay for any and all reconstruction and if no will surgeon make he application to OHIP to have it covered.
100% covered, as are all follow up surgeries, tweaking, if I waited and then had it done, regardless OHIP covers all
I would also ask the time frame for reconstruction.
The breast surgeon is actually the one who takes care of this but this should come up quickly likely in the next 3 months I will be booked
Will OHIP still pay if I wait a year or more to get reconstruction
yes
Are there disadvantages to waiting a longer period.
yes. If I go straight to flat they would remove more skin, thus The reconstruction would be a seperate surgery, there would be more fills, and then still an exchange surgery.
Other info When the expanders/spacers are put in they have magnets on them, so to fill they just use another magnet to find where the hole is to fill. I wont have feeling so it wont hurt when they poke into it to add fluid.
They only do under the muscle in Ontario, this is because it lowers the chance of infection, and there is more protection and less shifting. They also do not use textured, and as the tear dropped implants are only textured they are not used either. There is less choice in Canada and this is because of a few things, but the main one being that everything is covered in Canada. In America you have more selection but a lot of the reconstruction is out of pocket.