I am 54 and diagnosed with Paget's disease of the left nipple in Nov 2011. Chose to have left simple mastectomy & sentinel node biopsy with immediate reconstruction in Jan 2012. Dr. Matthew Lynch is my wonderful plastic surgeon. He listened to my concerns about hoping to not sacrifice any of my abdominal muscle as a TRAM can do. Since my anatomy allowed it, he did use the SIEA flap(similar to DIEP flap). However, he also had a 'lifeboat'--he saved(buried) half of my belly tissue just in case the SIEA flap breast did not survive. Thankfully it was viable, so 12 days later, he re-opened the abdominal incision to remove the unneeded tissue, and completed the 'tummy tuck' including creation of the new belly button. I love the result of the flat abdomen as well as the new breast. Will have a Stage 2 surgery in July to reconstruct a nipple and achieve symmetry with a lift & fat grafting. I chose this option because a lumpectomy would have required radiation too, and I preferred no rads if possible. The surgery is long--mine was 9 hours(including mastectomy)--with 2 plastic surgeons in the OR.
Also, mine was unusual because it required the second surgery later that took another 3 hours in the OR. My outcome was even more joyous because the pathology showed that the Paget's malignant cells were limited to the epidermis of the nipple ONLY! No tumor inside the breast(or in any nodes)! The 2nd surgery that I had was done as an outpatient, and I wish I had known how painful it would be post-op--however, with consistent doses of Vicodin for a few days, it was manageable. I also developed a seroma in the abdomen after a drain fell out--required re-insertion of a drain, and aspiration a few times in the office, but is fine now. The surgeon and nurse were so very attentive and available for questions and follow-up in the office. Insurance covers the breast cancer reconstruction, so I had only about $500 out-of-pocket cost(this surgeon not "in-network", but so worth it.) Important to research all options available for your situation and to ask as many questions of the surgeon as you need to! I felt a comfortable and confident connection with my breast surgeon and plastic surgeon and did not feel the need for a second opinion. I feel so blessed with the options I had, and the skill of my surgeons. I am so thankful and want to 'give back' and help other 'sisters' who are facing breast cancer treatment. I would like to submit a photo after my nipple reconstruction to show the finished result though everything looks great already.