Don’t Forget to Ask This When You Prepare for Mastectomy: Advocate Shares Story and Advice
23 Feb 2017
We’re so grateful to Terri Coutee for sharing her story and advice on how to prepare for mastectomy! Terri had a wonderful experience with delayed DIEP flap breast reconstruction. She now advocates for education on this topic. You can read more about her and her organization at the end of her story.
I’m a two-time breast cancer survivor who had delayed breast reconstruction. I had a breast surgeon who was well informed about all options for breast reconstruction, including the method I chose (DIEP flap). DIEP flap is the type of breast reconstruction that uses the patient’s own skin, underlying tissue and blood vessels from the abdomen or other donor site on the patient to create soft, warm new breasts (editor’s note: you can find more stories about this type of reconstruction, and learn more about it and similar types of autologous reconstruction via this page). Having immediate breast reconstruction, performed at the same time as the mastectomy, is the ideal choice but truly depends on the circumstances for each individual patient.
There are reasons I delayed, and I want to share them so you have an idea of what decisions I went through and why it was delayed.
Lumpectomy, Chemo, and Another Diagnosis Five Years Later!
Being told you have breast cancer once is enough of a shock. The first time I had it in 2002 I had a lumpectomy, chemotherapy, and six weeks of daily radiation to the left breast where the cancer occurred. This was followed by five years of Tamoxifen.
Being told you have breast cancer twice was mind-numbing for me. Not only was it a shock, but I questioned: How did this happen? I did my required course of treatment and adopted a healthy, active lifestyle. Why me, and why again? That laid the foundation for part of the reason I had delayed breast reconstruction: I wanted the vessels that carried this disease gone!
My breast surgeon was leaving town soon and I wanted time to research my options for the best plastic surgeon I could find to do my reconstruction. Those three circumstances told my physical and logical mind to get this mastectomy done and I’d worry about getting reconstruction later.
Don’t Forget to Ask This Question When You Prepare for Mastectomy!
This is something I want to share with readers and an important question for you to remember to ask your breast surgeon.
How long can I wait to have my mastectomy without compromising my health and the chance of the breast cancer spreading or becoming worse?
I didn’t ask that question. I was too mentally rushed to get the cancer out. It’s important to note that the cancer MUST be treated and prioritized, not the reconstruction. However, in most circumstances, cancer is more of an emotional emergency than a medical one and it is possible to discuss having immediate reconstruction at the time of your diagnosis.
Another Important Question to Ask
A key question to ask is if your breast surgeon can coordinate with your plastic surgeon to do immediate breast reconstruction. However, they need to be in the same town for that to happen. I had certain criterion in place for my plastic surgeon and that just wasn’t possible in my case. The plastic surgeon I eventually found to meet my criterion was out of town and I flew 800 miles to have my delayed DIEP flap done.
Fortunately for me, two things were in my favor. I was a candidate for a skin sparing, nipple sparing mastectomy. My breast surgeon did know I was going to follow up with DIEP flap, but just not at the same facility I had my mastectomy at. She preserved as much of the skin envelope as she could, and successfully preserved my nipples. She also prescribed physical therapy for me soon after my mastectomy to keep the skin pliable and to prevent it from “sticking” to the chest wall in preparation for my future DIEP flap. The physical therapist also worked on preventing scar adhesions for the upcoming breast reconstruction.
Find a Skilled Microsurgeon
Another entity in my favor: I did find an amazingly compassionate and skilled microsurgeon to perform my DIEP flap. Finding a skilled microsurgeon in your area to perform DIEP flap surgery is often a challenge. Although it did add another planning component to my breast reconstruction I am happy to report, even though I had delayed, I am thrilled with my results. I do have more visible scars in my breast area when a flap had to be added to that preserved skin envelope to achieve fullness and optimal results. I am two years out and my scars have faded quite nicely with proper care.
The key to immediate or delayed breast reconstruction whether you’re using your own tissue or choosing implant reconstruction is finding a highly skilled, board certified plastic surgeon. I did! I feel so very blessed and am so happy with my results. Breast cancer isn’t an easy road to navigate, nor is breast reconstruction.
Time passes, you heal, and it has truly changed my life and made me feel feminine and whole again.