Boobie Traps (and Flaps)

While at the plastic surgeon’s office last week, he mentioned something about surgeons in the USA who tend to [over]use  grafts — I got the sense that they use it because it’s available rather than necessary every time.

A cursory search for this information online does not provide many results so I would recommend that if you are considering implants for breast reconstruction, speak to your surgeon about this tissue grafting … I can’t quite remember the exact terminology the surgeon used so I may not be accurate in callng it tissue grafting.

However, I did find the web site for The American Society of Plastic Surgeons that talks about tissue expansion which is not the same as grafting. For those of us who have had a mastectomy (complete removal of the breast), tissue expansion is necessary and I believe would be necessary whether considering implants or one of the aforementioned flaps (Tram, Diep and Lattismus).

One of the documents I was given entitled “Canadian Society of Plastic Surgeons – Joint Position Statement on Lymphoma and Breast Implants” states the following:

“The Food and Drug Administration (FDA) in the United States published a device safety communiction on January 26, 2011 on the association of breast implants and anaplastic large cell lymphoma [ALCL].

ALCL is a non-Hodgkins Lymphoma – a cancer which can occur anywhere in the body and involves the cells of the immune system. The incidence of this type of lymphoma in the breast  is 1/500,000 per year. The estimated incidence of this type of lymphoma in the breast is 3/100,000,000. To put this in perspective, there are 4,000,000 patients who had breast implants inserted between 1998 and 2009 in the United States and 5 – 10,000,000 worldwide.

It is important to note that this is not a cancer of the breast. It has been found in the scar tissue (capsule) that forms around a breast implant and is not associated with any particular type of implant. It is also important to note that these cases are not typical (they are ALK negative) and the outcomes are more favourable than typical ALCL.

The FDA has clearly stated: “If you have breast implants, there is no need to change your routine medical care and folow-up“. They have also stated: “prophylactic breast implan removal in patients without symptoms or other abnormality is not recommended“.

The Canadian Socieity for Aesthetic Plastic Surgery and the Canadian Society of Plastic Surgeons commend the FDA for working to pursue a collaboration with plastic surgeons to develop a registry to gather additional information to better charactierize ALCL in women with breast implants.

Patients are encouraged to read more details on the following websites from the FDA and to contact their plastic surgeons if they have any concerns …”

The document I received does not provide the links, only the name of the links: “FDA Medical Device Safety Communication: Reports of Anaplastic Large Cell Lymphoma (ALCL) in Women with Breast Implants“; and

“Anaplastic Large Cell Lymphoma (ALCL) in Women with Breast Implants: Preliminary FDA Findings and Analysis“.

These are the links I found but cannot guarantee they are the links that would have been provided in the document had they existed.

Yes, cancer is frightening especially for those of us who have already experienced it, but I like my chances with implants over the other options which could leave me with less muscle control in my abdomen or shoulder (Tram Flap, Diep Flap) and still without a breast should they fail … the amount of surgeries alone for the flaps make them less desirable for me personally.

The surgeon wants me to see him again before making a decision — he’s armed me with lots of information and I have lots to think about.

The document provided to me is dated January, 2011.

Breast Reconstruction

I had all but given up on having 2 breasts again and resolved that I was going to my grave as a Uniboober.

During my appointment with my surgical oncologist a few weeks ago, the handsome Dr. Ewan, I asked him if he knew of a plastic surgeon that might help with my 3 breasts … ok, let me clarify … after surgery, I was left with a mini-tit, a medium-tit and my natural maxi-tit … and I really hated the 2 I wasn’t born with. I was hoping a plastic surgeon would be able to get rid of all these flaps of skin I seem to have.

Dr. Ewan referred me to a plastic surgeon who I saw a few days ago and I’m thrilled to say that I may have 2 breasts again without resorting to those horrible tram-flap or diep-flap reconstruction surgeries that would leave me with little muscle control over my abdomen or shoulder.

He did tell me about a fourth option that I wasn’t aware of: Latissimus Dorsi Flap. This surgery apparently does leave a very large scar from the upper back to the front that connects to the new breast.

I play tennis and the thought of losing any muscle in my abdomen, shoulder or upper back is not something I am particularly interested in.

Ok, ok, the good news … he said that I am a candidate for an implant!

It’s only 2 day surgeries (1 to insert the expander and 2nd for the implant) and I’ll be uncomfortable for a week to 10 days … so I am thrilled of this possibility!

It’s what I wanted initially until I saw that other plastic surgeon 1.5 years ago that said she wouldn’t give me an implant because of my propensity for infections.

I did let the new surgeon know that I get infections easily and he said he hasn’t had a patient with an infection in 10 years and unless I have constant infections with the implant over a long period of time, the implant can be removed which will solve the problem.

Dr. Ewan also said that I may have to have a breast reduction on my other breast if I wanted an implant … and I’m happy to say that the new surgeon will give me a lift on my natural breast and I can go as big as I want.

The new surgeon blushed when I said I wanted to be the size of  a stripper! Of course I really don’t want to be THAT big, but to have 2 nice sized boobs again will be fabulous!

I asked him if the new breast would look like a transgendered male, as I had heard that before, and he assured me it wouldn’t. He only said that there will be a roundness to it that isn’t on my natural breast.

And just as wonderful news is that the flaps of skin I absolutely hate is actually good to have … he can use the extra skin to help with the expander. How terrific is that!

I’m still in a bit of shock that I can indeed have an implant so I’ll wait for a week or 2 until the information sinks in and decide when would be a good time to do this … I’m thinking either just before the December holidays or just after new year when business is also a bit quiet.

It just goes to show how a 2nd opinion is valuable.

If you want more information on breast reconstruction in Canada, visit this web site.