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Updated: December 2011

Nipple-Sparing Mastectomies, DIEP flaps


pre-operative Nipple-Sparing Mastectomies, DIEP flaps
post-operative Nipple-Sparing Mastectomies, DIEP flaps
Before
After

This patient is seen before and after bilateral nipple-sparing mastectomies and DIEP flap breast reconstruction. This approach was chosen in order to preserve all of the patient’s breast skin, including the nipple and areola. The characteristics of her breast cancer (small size, sufficient distance from the nipple, and no invasion) made her a good candidate for nipple-sparing mastectomies. Her preoperative breast shape showing an appropriate position of the nipple and no sagging was favorable for nipple/areola preservation; the presence of sufficient lower abdominal tissue allowed for DIEP flap reconstruction.

Margaret's Breast Reconstruction Story:

 

My cancer was diagnosed at the time of my annual/routine mammogram in December 2010 and was followed by a bilateral mastectomy in February 2011. The radiologist who had performed the diagnostic testing and my OB/GYN provided me with references for several breast surgeons and I made consultant appointments with two. The first was able to see me within a few days and was the surgeon who had performed my sister’s mastectomy in 2000. The second surgeon was recommended by both my OB/GYN and the radiology center, and although there normally would have been a wait of several weeks or more for an appointment, she was kind enough to squeeze me in within the week. Both surgeons outlined a similar course of action for further testing (surgical biopsy) and possible BRCA genetic testing. However, I immediately felt secure and comfortable in the care of the second surgeon and without delay moved forward with her. My breast surgeon recommended a plastic surgery practice with a specialization in breast reconstruction and I met with two of their three surgeons, as well as members of their staff, to review options and make the decision of which reconstruction procedure was best for me.

My diagnosis was DCIS. Because I tested negative for the BRCA gene, I was given the option of a lumpectomy with radiation and hormone therapy, or bilateral mastectomy with reconstruction. For reconstruction, I was again fortunate in that I was offered several options; expander/latissimus implants, DIEP flap, or TUG flap. For me, the decision process was the hardest part. Naturally, I sought guidance from the breast and reconstruction surgeons, and valued/trusted family members and friends. But what I also found tremendously helpful was speaking with other patients that the surgeons put me in touch with through their Patient to Patient Caring Team. I was pleasantly surprised at how willing, candid and helpful each of these previously unknown women were to me. They offered information that I hadn’t even thought to ask and am a very grateful to them. While the decision of which course of treatment to take was very difficult, I ultimately felt more comfortable doing the most I could to eliminate the chance of a recurrence. Although my choice was more surgically radical, I felt in the long run it would be less stressful and give me the most emotional security.

My younger sister was diagnosed with breast cancer in 2000, and sadly lost her battle in 2006. I also have three cousins diagnosed with breast and ovarian cancer. This strong family history was a heavy influence in the decision to undergo a bilateral, nipple sparing (again I was fortunate to be a candidate for this) mastectomy. While I was very tempted by the TUG flap, in the end I decided on the DIEP flap for reconstruction.

The first few days after surgery were challenging and it was a bit scary to feel helpless and so dependent on others, but after the first week and the removal of the drains I felt tremendously better. I was very fortunate that my husband was able to take several weeks off of work and I had a wonderful network of family and friends to help with carpooling for the kids and cooking healthful meals for us. The brilliant medical care that my surgeons and their support team provided, combined with the incredible love and support of family and friends made my recovery calm and comfortable. While I did tire easily, I was able to attend some family events after about two to three weeks. I did not drive for about five weeks and missed six weeks of work. It took a few months to be able to walk briskly or lift heavy items without feeling it in my abdomen.

In terms of my overall experience, the testing and diagnosis processes were obviously stressful. The decision process was consuming and at times overwhelming, in part because I was lucky enough to have been given treatment choices. The treatment process was made very manageable by competent and kind doctors, and their wonderful support staff. The recovery process was also more manageable than I had anticipated because of the tremendous support of family and friends. Overall, my experience has been better than I feared, thanks to the wonderful care I received.

It has been five months since my surgery and I can honestly say that I feel like myself again. I wear the same clothing, including swimsuits and most bras, I wore before my surgery. My breasts look fantastic (as I’ve been told by anyone who has seen them and believe me in the past six months there have been many), and most importantly, I feel normal and healthy.

 

Photos and Doctor Commentary
 

pre-operative Nipple-Sparing Mastectomies, DIEP flaps

pre-operativeNipple-Sparing Mastectomies, DIEP flaps Pre-operative Nipple-Sparing Mastectomies, DIEP flaps

Pre-operative photos

Margaret presented for consultation for bilateral breast reconstruction concurrent with her bilateral mastectomies for DCIS and a family history of breast cancer. As her tumor was small in size and distant from the nipple, she was offered nipple-sparing mastectomies. On examination both breasts had no excess skin or sagging, and showed an appropriate position of the nipple and areola. This finding made her a good candidate for nipple/areola preservation; even though she had a thin body type, lower abdominal tissue was considered sufficient for bilateral DIEP flap reconstruction. A reconstruction with the TUG flap or implants was offered as alternative. Based on her preferences, the plan of nipple-sparing mastectomies and DIEP flap reconstruction was chosen in order to provide the most natural and long-lasting reconstruction.

 

 nipple sparing mastectomies DIEP flaps after first stage

Post-operative bilateral nipple-sparing mastectomies and DIEP flap breast reconstruction

Here is Margaret 2 months after her bilateral nipple-sparing mastectomies and DIEP flap breast reconstruction. The reconstructed breasts show good symmetry and contour. The vertical breast scars below the nipples are chosen for nipple-sparing mastectomies and DIEP flap reconstruction instead of a circumareolar scar, and generally heal very well. As her nipples were preserved, she essentially has completely reconstructed breasts after a single procedure. Even so, a small second stage procedure was offered to allow for some tweaking of the scars and contour.

 

 nipple sparing mastectomies DIEP flaps postop

 nipple sparing mastectomies DIEP flaps postop  nipple sparing mastectomies DIEP flaps postop

   nipple sparing mastectomies DIEP flaps postop  nipple sparing mastectomies DIEP flaps postop  

Completed bilateral DIEP flap breast reconstruction

This is Margaret’s completed breast reconstruction. She is seen 5 months after her areola-sparing mastectomies and DIEP flap breast reconstruction. The scars will fade as they mature over the course of a year. As Margaret has a reconstruction with her own tissue, a natural appearance is expected to last for her life without the need for additional procedures.