Let’s face it — no matter what you’re going through your experiences are going to differ from someone else. Others who have had breast cancer, a mastectomy and reconstruction can tell you all about it but your journey will be different than your best friend’s, your neighbor’s or the woman sitting next you in chemo.

However, you are still going to have some expectations of how things may — or may not — happen following your reconstruction. The question is: How do you manage them?

You expect that reconstruction should be easy.

Ann* said that she educated herself immensely throughout her journey, but she was not fully prepared for the magnitude of her reconstruction surgery. She knew it would be a big deal and it would take a few months to recover, but for her, it took multiple surgeries

and her recovery took a lot longer than that. Your body has been through so much and it’s going to take time to heal. Don’t get dejected. Everyone heals at a different pace, but if you’re concerned about how fast your recuperation is going, talk to your doctor.

You expect everything done in one procedure.

Most breast reconstructions require more than one surgery, and, if desired, a nipple tattoo will be added months later to complete the process.

You expect to look the same after reconstruction.

You’re missing your breast and want the new one to look the same. While doctors do what they can to recreate your natural-looking breast, the new one will be a little different. It may end up slightly smaller or higher or rounder or feel different. Expect that there will be changes. It might take time to get used to these changes, but it’s easier to do it if you expect them going in.

You expect that your breast will feel the same.

When Susan had her reconstruction, she expected that the new breast would feel the same as it did before. Instead, it had no feeling at all and made her self-conscious, especially when she was intimate with her spouse. Of course, losing sensation can happen, but fortunately, The Center for Natural Breast Reconstruction offers ReSensation™, where donated nerve tissue attaches to a patient’s remaining new tissue in the affected area. Over time, nerve-endings regenerate and feeling returns.

You expect adjustment to be easy.

Jill said there are many things she misses about not having her natural breast. She didn’t expect to feel so down after a procedure that is supposed to help. To help her cope, Jill reminds herself of her goal to stay healthy for herself and her family, including her beautiful grandchildren and she said that she is grateful for everyday she can do that. Over time, she has learned to accept her new breast and enjoy her life.

You expect limited options.

Your doctors should work with you throughout the process. All breast reconstruction options should be discussed to help you to make a smart, informed decision.

Q: I have a history of benign proliferative breast disease with associated atypical ductal hyperplasia. I have had two needle biopsies and three surgical biopsies in my left breast. I took Tamoxifen for five years and currently am taking Evista. Last year I completed the Myriad My Risk Test resulting in a 37.9% remaining lifetime breast cancer risk. My monitoring plan since 2006 has been alternating diagnostic mammogram and breast MRI. My most recent MRI located an enhancing nodule in my right breast. My oncologist has referred me to a local surgeon to begin the process for prophylactic double mastectomy. I am interested in natural breast reconstruction. I would like to schedule an appointment to discuss my options with your plastic surgeons. I also will need to set up an appointment with the surgeon you use for the actual mastectomy. I am not sure which appointment should be first.

A: Hi Stacy, thank you for contacting us. I am sorry you are having to make very difficult decisions in order to prevent getting breast cancer. I commend you for being very vigilant with screening. As you are aware screening alone won’t prevent breast cancer unless you act on the results of the tests that indicate your risk is high. Many women would consider preventive mastectomy in your situation. For many women knowing that

they can have immediate natural breast reconstruction for a permanent natural result makes the decision a little easier to make. If you feel like you have any amount of extra fatty tissue anywhere on your body then chances are you can use your own natural tissue. I’ll be glad to answer any other specific questions just let me know.

Dr. Craigie

Q: Hi, I was wondering if I would be able to schedule a phone consultation. I was recently diagnosed BRCA1 positive. I’ve been working with a breast surgeon and plastic surgeon and am interested in a double mastectomy with immediate DIEP reconstruction. After the initial consult with our local plastic surgeon, he thought this would be possible. In addition to that he wanted to do a mastopexy in preparation for nipple sparing mastectomy and DIEP. We did complete the mastopexy almost 4 weeks ago. At my last appointment, our plastic surgeon told us that he is not comfortable doing the immediate DIEP reconstruction after the mastectomy due to limited resources and being the only microsurgeon capable of doing this in my area of the Midwest. We are interested in looking into second opinion, as we would like to try and complete both surgeries in one step if possible. We are also wondering what a schedule or timeline to get in for this type of procedure would be. In the consult I would also like to discuss my journey so far, including screening results, and my past recommendations. Thank you!

A: Hi Laura, sorry you are having to go through this, but congratulations on having a great plastic surgeon. I’ve never met him, but I know he’s good because 1) he suggested /did the preliminary mastopexy, and 2) he is obviously putting your welfare first by referring you for bilateral DIEP.

We would be honored and delighted to help you through the next stage of your journey. I will be happy to discuss the details with you by phone as soon as it can be arranged.

Richard M. Kline, Jr., MD

Baby, it’s hot outside! You want to feel cool and confident in your summer wardrobe, but you’ve been through a lot lately — your breast cancer diagnosis, surgery and now breast reconstruction. You might be feeling a little unsure about stepping out. Here are some tips to help you feel more confident in how you’re dressing post-reconstruction so you can enjoy the summer sun.

Don’t sacrifice your own sense of style and comfort.

You’ve gone through many physical and emotional changes since your diagnosis and having a sense of control is important to feeling more confident. So wear what makes you feel good. Do not think you need a new style or a new wardrobe to bring back your sense of self.

For example, you know that favorite summer t-shirt or sundress that you’ve worn for years because it brings back great memories? If putting either of them on makes you feel good, wear it. When you feel good, you will automatically smile and feel better about yourself.

Dress up another asset.

Feeling insecure? That’s fine. Accentuate a different part of your body for now. Got great legs? Draw attention to them. Or consider getting your hair done to invite conversation about that instead.

Wear the right bra.

It’s already a hot summer, so the last thing you need is to feel sticky and sweaty in your bra. What you wear underneath your clothes is just as important as what you wear on top of your clothes. You should wear a post-reconstruction bra that is soft and provides breathability. Fabrics like cotton make bras more comfortable on sensitive skin and any scar tissue that is still healing. Your current bras might not fit or may be uncomfortable as you heal. Use a company that specializes in post-mastectomy bras, such as Masthead Elizabeth Pink Surgical Bra. They will fit better after reconstruction which, in turn, will provide a much-needed confidence boost.

Find the right swimsuit.

If you have been given the all-clear from your doctor to go into the water, then make sure you’re prepared with a properly-fitted swimsuit. After reconstruction your breasts may not be the same size, so you may need to purchase one with a better fit. If you’re concerned about swimsuits that show scars, don’t be. Many companies offer post-surgical swimsuits that come with a higher neckline and more underarm coverage, so your scars should barely be noticeable.

Keep a positive attitude.

What you see as a breast cancer patient may differ from what others see. Your scars may not be as visible as you think and the change in the look of your new breasts may

not be as extreme as you think they are. It’s important to maintain a positive attitude throughout your entire journey. Then, it won’t matter if you wear a potato sack if you feel good about yourself. You’ll rock any look. Be comfortable and cool and the confidence will show.

woman sitting looking out in the distance in front of a lake

Q: I see post bariatric surgery plastic surgery referenced on your site. I didn’t realize you also offered these procedures. Which doctor cares for this? Thank you for any information you can provide.

Thanks,

M

A: Hello, M.

Currently, 90% of our activity is microvascular breast reconstruction. I did a lot of post-bariatric surgery some years ago, which is where the pictures came from. We stopped actively promoting this service (despite leaving the pictures up) because: 1) Unfortunately, insurance doesn’t usually pay for it, and 2) Most patients can’t afford to pay for it themselves. The surgeries are fairly large and serious, and as a rule, complications can be serious and patients usually need to stay in the hospital at least one night. If you can find a surgeon close to you with an express interest in performing this surgery, that would probably be your best bet. If you can’t find one and you determine we are your closest reasonable option, I would be happy to see you to discuss your options.

Thanks for your great question!

Sincerely,

Richard M. Kline, Jr., MD