To flap, or not to flap?

Heck, that’s only part of the question. Even if you answer that and yes, thank you very much, I’d like flap reconstruction, now you have to decide which flap. TRAM flap? DIEP flap? Lat flap? (Who knew our bodies were so flappy?!)

Or perhaps you’d like to leave as much of your body intact as you can, and implants sound like a better option.

Or, bless you, you’re thin enough that maybe flap reconstruction wouldn’t suit your desired end results. (In that case, I love you dearly, but you may not find this article helpful.)

First and Foremost

First off, I’d like to say that the decision to do reconstructive surgery after breast cancer is a huge, personal decision! No matter whether you decide on flaps, implants, rocking the uniboob, or staying flat and fabulous, absolutely no one has a right to tell you which you should do! (Except, of course, your doctor if he or she has a viable medical reason. But that’s it!)

No matter what, YOU are the one who has to live with this choice and its consequences, so don’t let your best friend, parents, or even your significant other bully you into a decision you’re not comfortable with.

There are pros and cons to each method of reconstruction, so take your time making your decision.

Don’t Rush It

I had started off with a single mastectomy, leaving the healthy breast alone. My doctor figured I would prefer to keep a natural breast, especially since I’m young. I appreciated that advice and having a regular breast for a year until I got through treatment. It meant I only had two drains after my mastectomy instead of four, and only one side I had to be cautious with as opposed to both.

Having that year before making a decision about reconstruction also gave me ample time to do research on what I wanted, meet with a couple different plastic surgeons, and feel peace with whichever route I chose.

Right after the initial diagnosis, we’re often rushed here and there for scans, tests, and appointments, and we don’t have a chance to sit with a decision and feel at peace with it. I had 12 days from the day of diagnosis to the day of my mastectomy. That may sound like a long time, but that’s 12 days for additional scans, researching what triple negative breast cancer even means, researching how to be prepared for a mastectomy and acquiring those items, and, I dunno, processing the fact that I had cancer?!

Taking a lap in the hospital after my DIEP flap surgery. You’ll likely be a bit hunched over after surgery due a section of your middle being taken.

I Wanted As Few Future Surgeries as Possible

Breast cancer often requires a few surgeries between the lumpectomy and/or mastectomy, port placement, reconstruction, possible revisions, expander placement, etc. By the time I’m done, I’ll have had four: single mastectomy, port placement, reconstruction, and revision with port removal.

That’s a heckuva lot of surgery and anesthesia to deal with!! Not to mention the chemo, radiation, or other treatment options and side effects going on!

Implants aren’t meant to be a one and done – they generally only last 10 to 20 years. Granted, that’s a long time to go between replacements! But if you’re young, that means you’ll likely have a couple (or few) replacement surgeries. And what happens if you’re 70 or 80 and it’s time to swap out implants, but you’d rather not deal with surgery?

These were concerns of mine, and another reason I found DIEP flap favorable. DIEP flap generally has one main reconstruction surgery, followed by one or more revisions to tweak results. (The number of revisions depends on several factors; I have one friend who didn’t need any, some need just one, whereas I’ve heard of others needing two, mayyyybe three.)

Granted, that first surgery is a doozey! And revisions can be just a few months after the first one, though they have a much shorter healing time. So DIEP may mean more surgeries in a shorter period of time, but then (knock on wood) you should be good for life.

I Had The Resources Available for DIEP

Let’s be real, DIEP flap won’t happen if you don’t already have some tummy pudge to work with. Some people may have to gain or lose a bit of weight before DIEP is an option. Courtesy of my disliking exercise and my enjoyment of pasta and craft beer, I had enough fat reserves to be eligible for DIEP.

So heck, if I’m going to have all these new scars to get used to anyway, might as well repurpose some of that belly fat I’m not using and make some warm, squishy foobs from them! This was certainly a large factor in why I chose DIEP flap reconstruction.

When it came to latissimus (lat) flap reconstruction, I did not have those resources. Though I’m of average build, my plastic surgeon estimated that a lat flap would only get me to an A, maybe a B cup, and I would need implants to get me back to my original C cup. Personally, I felt if I’m going to need implants anyway, then I’d rather just go that route than cut out part of the muscle in my back and still need implants to go with it.

Implants Kinda Scare Me…

I’ve heard enough stories about implants rupturing, infections occurring, and the pain and possible infection caused by expanders that I was really turned off to the whole idea of implants. Obviously they’re safe enough to still have this procedure done. And clearly they’re not so horrid or no one would opt for implant reconstruction, much less implants for cosmetic reasons.

There are conflicting opinions about the risk of breast implant illness and problems caused by implants. In all honesty, seeing as I never considered implants as an option for myself, I never put in the time to research the statistics or details of implant complications. If you’re considering implants, I advise you to do some research on them and talk to your plastic surgeon about the pros and cons – same as with any type of reconstruction you’re considering.

Comfort Level

Though I didn’t do research on implants, I did hear real-life experiences from those who had them. The general consensus of expanders is that they’re hard, uncomfortable, and all-around sucky.

I heard many women talk about their disappointment in their implants. They felt heavy, their breasts felt cold due to the lack of tissue under the skin, their new breasts were hard instead of squishy like their OG boobs. Granted, most of these conversations were women in my DIEP flap support group who had gone the implant route and decided to try DIEP instead because of their dissatisfaction with implants.

I know many other women who love their implants! Their new girls are perky, the perfect size, stable enough to stay in place without a bra. For them, the discomfort of the expanders was well worth the results of the implants.

Rockin’ my HealinComfort shirt and surgical bra. You can also see my four drains and brand spankin’ new abdominal incision.

Some Notes about DIEP Flap…

Just as implants make me nervous and I’d rather not deal with that discomfort, I’ve met some women who feel the same about DIEP flap. Recovery from DIEP is no joke – it takes a few months to be able to fully stretch again, and it takes even longer to get your abdominal muscle use back.

My oncologist’s wife has the BRCA mutation and underwent a preventative mastectomy with DIEP flap reconstruction. He warned me that I would likely be regretting my decision for about a month after surgery, but that I would be happy with the results afterwards. And he was right. He was soooo right!

DIEP can be painful and uncomfortable, and it creates more parts of your body to heal. There’s also the chance of necrosis and the flap not taking.

But now, more than six months out from my DIEP flap, I can confidently say I’m happy I went with this type of reconstruction. If I knew then what I know now, I’d still go to the DIEP side. If you decide DIEP is the way you’d like to go as well, here’s my article on how to prepare for DIEP flap reconstruction.

Final Thoughts

No matter what you decide, you have the right to be happy and love your body. Cancer and its treatments can be traumatic. A mastectomy is an amputation, leaving not only physical scarring but also emotional pain in its wake.

As I said above, whatever reconstruction option you choose is entirely up to you and your preferences. And you should never feel bad about what option you choose! Want to go flat? Rock it! Want bigger boobs than you had initially? Go for it!

No one would give you a hard time if you chose to replace an amputated arm or leg, nor should anyone give you crap for wanting a beautiful new set of boobs! Yes, you’ve survived and I’m sure you’re grateful just to be here. But you also have the right to gain back some of what you’ve lost to cancer.

You’re allowed to want a beautiful new rack, gorgeously flat chest, or inspiring and scar-covering tattoos. Advocate for yourself, find a plastic surgeon who listens to you and understands your wants, and don’t give up till you get it.

Note: If you’re in the area, I highly recommend Midwest Breast & Aesthetic in Columbus, Ohio! Dr. Kocak and Dr. Tiwari were my DIEP flap surgeons and they’re amazing!

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