As summer comes to a close I’ve starting planning for the winter

This entry was written by Jackie Roth, PhD. Jackie is a Postdoctoral Fellow at The Children’s Hospital of Philadelphia who was diagnosed with Stage III A breast cancer at the age of 28. Every other Friday, throughout the entire year of 2011, Jackie will share a blog entry about her breast cancer experience. This year-long blog series is in honor of LBBC’s 20th anniversary.

To read Jackie’s previous entries, enter “ Jackie Roth” in the search box on this site.

This past week I met with my plastic surgeon to discuss the next steps of my reconstruction surgery.  I really can’t believe it has been a year since I was first sitting in his office, listening to the game plan of what was going to happen over the upcoming many months.  Although I have hit a few road bumps along the way, my overall surgical plan has remained unchanged.

When I had my first surgery back in February, I chose to have a double mastectomy.  I was given the option of a lumpectomy, but I was warned that the outcome would not look as good.  With being so young, I chose to opt for the most drastic surgery in hopes to prevent any local recurrence or second primary breast cancer.  So, at the time of my mastectomy, I had tissue expanders placed in and I was happy with the way that they  looked before my radiation.  But since I had radiation on my right side, the skin and muscle on that side has become much tighter, causing the expander to become misshapen, flatter, and at least one inch higher than the left one.  The difference is not noticeable when I am wearing a blouse, but it is very obvious when I have a tight shirt on, so I am looking forward to the next step in my reconstruction.   

My plastic surgeon gave me three options for reconstruction.  First, he said that I could just swap out my current expanders for implants.  He warned me though that because of my radiation, there is a likely chance that the right implant will essentially fail and there could be complications.  He said that this option was likely only a temporary solution that would last just a few years.  For my second option he said that I could have the latissimus dorsi surgery (lat flap) on my right side and then do a more simple swap out on the left. 

The purpose of the lat flap is that it not only provides a more natural looking breast, but it will greatly reduce the risk that the implant will fail.  During this surgery, your latissimus muscle from your back is brought to the front and placed underneath your pectoralis muscle, thus providing some un-radiated tissue surrounding the implant.  The lat flap surgery will have different looking scars than just a regular swap out surgery because often skin from your back is brought along with the muscle.  Also, the lat flap surgery requires a different shape and size implant, increasing the chances that your breasts would be uneven.  For all of these reasons above, I chose to go with my third option, a double lat flap.  I think it will provide the best and most long-lasting results. 

A few downfalls to the lat flap surgery is that it requires anywhere from 2-4 nights in the hospital and 4-6 weeks recovery at home.  Additionally, you can lose some of your back muscle strength, but I think my days of doing pull ups and push ups are over with anyway!  Since I just started a new job, I cannot take any time off right now for this surgery, so I’ve scheduled it for December.  This gives me the opportunity to be outside and enjoy my summer and then I will hibernate in the winter to recover!

Jackie and her husband, Ron.

If you have any questions about breast reconstruction, be sure to join in on our Ask-the-Expert Forum. Ariel N. Rad, MD, PhD, will answer your questions about breast and nipple reconstruction methods, the pre- and post-surgical process, factors that impact reconstructed breasts over time, the decision-making process or what questions to ask during the consultation process.

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