Abstract
Bilateral prophylactic mastectomy without reconstruction is not accepted by the majority of patients. Successful reconstruction is therefore a mandatory condition for prophylactic mastectomy. Of the many options for autologous breast reconstruction, the deep inferior epigastric perforator (DIEP) flap best meets requirements for bilateral reconstruction in selected patients. The goal of this study is to verify the feasibility of the procedure in our conditions and to find out how it is accepted by patients.
We present 55 consecutive patients who were scheduled for bilateral DIEP flap reconstruction during a 4-year period. We reviewed medical charts, performed clinical assessments and processed anonymous questionnaires. There were 77 immediate and 33 delayed breast reconstructions.
There was 100% flap survival and no microanastomoses revisions. In 11 patients (10%) the surgeon preferred to convert the DIEP into a mini transverse rectus abdominis muscle (miniTRAM) flap in order to provide adequate blood supply. Complications: revision for haematoma under the flap in four patients (7.2%), excessive blood loss in four patients (7.2%) and partial mastectomy skin flap necrosis in 10 immediate breast reconstructions (12.9%). Patients' evaluation of the aesthetic result was good or excellent in 96.2% of cases. In 33.9% of patients the postoperative quality of life was considered unchanged and 50.9% of them it even improved.
The DIEP flap is recommended for bilateral breast reconstruction. Occasional conversion into a miniTRAM flap can increase the total flap survival rate. Bilateral prophylactic mastectomy and DIEP flap reconstruction are very well accepted by patients.
Showing posts with label Breast Cancer Diagnosis. Show all posts
Showing posts with label Breast Cancer Diagnosis. Show all posts
Tuesday, January 19, 2010
Monday, September 28, 2009
Reflections on Early Detection
Here is an overview of my conversation last winter with my second opinion oncologsit:
ME: "I have LCIS and want to know what I should do"
Oncologist: "You should go home and come back if you get 'real' cancer."
ME: "But isn't LCIS something to worry about?"
Oncologist: "There are a number of things that could kill you before breast cancer."
______________________________________________________________
That conversation pretty much threw me for a loop. I was embarrassed that I had wasted her time, upset that I had worried so much, and felt foolish that I would even considered a PBM.
I went home, stopped going online and generally forgot about my LCIS. It was always there, but in the back of my mind. Maybe the oncologist was right. Who am I to think that LCIS is a bigger deal? So why did my general practice doctor send me a sympathy/support note? Why did my OB/GYN tell me to get it out of my body? Why did my local oncologist tell me that she would not disagree with my decision if I chose a PBM? Were all these people wrong?
There were many times when I would think to myself, "Damn this early detection stuff. What is the point?" If you can't do something about, why bother to get tested? I was mad that I had entered into this whole world of "should I or shouldn't I?" There are no patient advocates for me. It's just me having to make this decision. There is no manual for early detection.
I know that I am lucky. I have choices. I have time. But the problem is that I have CHOICES. I have TIME. What should I do? Nothing? PBM? When should I do something? When is a good time to get her breasts removed and have your stomach opened from hip to hip?
About being lucky. Yes, I truly am lucky. A friend is going in for a mastectomy in two days - she's happy to have found it when she did. Her advice to me - get the breasts off. Other friends who have traveled this route say the same thing. Friends who haven't tell me to 'lop them off' - oh, if it were that easy.
I don't have any particular attachment to my breasts, other than they have always been a part of my body, much like my ears. The thought of removing any part of my body is unnerving. Yes, my breasts can be replaced, but at what cost?
And if I don't? Then what? Coulda, shoulda, woulda? Do I want to kick myself for not acting sooner? Hell no. So, in reflecting on early detection, I do realize that although I am told that I have choices and time I really don't. Combine LCIS with family history, dense breasts, increasing # of biopsies, no children by birth, etc. the writing is on the wall and I need to be smart about being here for as long as I can to take care of the most adorable, loving little girls in the whole world.
ME: "I have LCIS and want to know what I should do"
Oncologist: "You should go home and come back if you get 'real' cancer."
ME: "But isn't LCIS something to worry about?"
Oncologist: "There are a number of things that could kill you before breast cancer."
______________________________________________________________
That conversation pretty much threw me for a loop. I was embarrassed that I had wasted her time, upset that I had worried so much, and felt foolish that I would even considered a PBM.
I went home, stopped going online and generally forgot about my LCIS. It was always there, but in the back of my mind. Maybe the oncologist was right. Who am I to think that LCIS is a bigger deal? So why did my general practice doctor send me a sympathy/support note? Why did my OB/GYN tell me to get it out of my body? Why did my local oncologist tell me that she would not disagree with my decision if I chose a PBM? Were all these people wrong?
There were many times when I would think to myself, "Damn this early detection stuff. What is the point?" If you can't do something about, why bother to get tested? I was mad that I had entered into this whole world of "should I or shouldn't I?" There are no patient advocates for me. It's just me having to make this decision. There is no manual for early detection.
I know that I am lucky. I have choices. I have time. But the problem is that I have CHOICES. I have TIME. What should I do? Nothing? PBM? When should I do something? When is a good time to get her breasts removed and have your stomach opened from hip to hip?
About being lucky. Yes, I truly am lucky. A friend is going in for a mastectomy in two days - she's happy to have found it when she did. Her advice to me - get the breasts off. Other friends who have traveled this route say the same thing. Friends who haven't tell me to 'lop them off' - oh, if it were that easy.
I don't have any particular attachment to my breasts, other than they have always been a part of my body, much like my ears. The thought of removing any part of my body is unnerving. Yes, my breasts can be replaced, but at what cost?
And if I don't? Then what? Coulda, shoulda, woulda? Do I want to kick myself for not acting sooner? Hell no. So, in reflecting on early detection, I do realize that although I am told that I have choices and time I really don't. Combine LCIS with family history, dense breasts, increasing # of biopsies, no children by birth, etc. the writing is on the wall and I need to be smart about being here for as long as I can to take care of the most adorable, loving little girls in the whole world.
