Prophylactic Bilateral Mastectomy Reconstruction

While there were two surgeons involved (General...

While there were two surgeons involved (General and Plastic), this review is for the plastics work.
The general work was done very cleanly and correctly.

I decided, at 36, to have a prophylactic bilateral mastectomy as there is a strong history of breast cancer in my family.
When speaking to Dr. Ewings, she was very attentive and took my wishes for reconstruction to not include any messing about with flaps, tissue expanders, or implants, and just leave me flat without trying to push me toward reconstruction with implants.
I wanted to just be flat, still have nipples, and hopefully not left with a concave chest (which can be common after mastectomies).

She also went over, in great detail, the options we had for reconstructing the area while still leaving it flat, as well as discussed saving the nipples vs. not saving them and, at no point, did I get the feeling she was pushing me in a certain direction. She was great at just giving the pros and cons of all the procedural options I had for reconstruction, and allowing me to choose which one I felt would work out best for me.

That was a distinct (and welcome) change from some plastic surgeons I'd spoken with prior who really pushed for implants or tissue expanders because "I'd want them later" or would "regret not having them".

Dr. Ewings told me if, down the road, I changed my mind and decided I wanted to have breasts again, it would be perfectly possible to have tissue expanders put in and work my way up to implants, whereas other surgeons I spoke with spoke as if it was a 'now or never' sort of deal.

8 1/2 Weeks Post Op Pics.

These pictures are from 8 1/2 weeks post-op. There appears to be a very small dog ear forming on the right incision, which I plan to have revised in about 8 months if it does not resolve on its own.

2 1/2 months out.

Swelling continues to go down.

Some areas are still numb, but most have feeling in them. The grafts are pretty much healed, and their color has settled down to where it looks like it's going to stay (some pink areas, some brown areas).

A little over 3 months post-op

Swelling continues to decrease, scars continue to flatten.
The dog ear has shrunk a bit too but, based on the look of it, I'll still likely want to get it revised in the future.
At the last appointment I had in August, she wanted to wait for at least 6 months to let swelling settle, which is fine with me. I'd rather wait until it's all settled than not have enough removed the first time revising the dog ear.

As you can see on the pics, things are flattening nicely, and the nipples have settled into their close to final weird piebald coloring.

I did mention in previous reviews that Dr. Ewings discussed that the mottled type coloration may happen with the grafts, and that it's fairly common for people with tan or brown nipples to end up with nipples that are a mix of their original color plus varying shades of pink. Since I plan to tattoo over my chest area in late 2107, it doesn't matter to me that they're multiple colors.

For others that might have the same issue, the nipples (after at least 6 months of healing time, preferably a year) can be tattooed over with a color similar to the original tan/brown to even them out a bit.

3 month follow up visit today.

Some of the scars around my grafts have already faded to white, which is a good sign.
The double incision scars are still pretty red (normal for this time of healing), but they're flat and smooth and as the swelling continues to subside the puckering above the incision line starts to smooth out as well.
I typically scar well, and the other small surgical scars I have faded to white after about 10 months after being bright red/pink for the previous 9 or so months, so I have no reason to think these scars will be any different.

The dog ear is still there, of course, but we're not going to deal with it until the 6 month appointment in January just to make sure the swelling in that area is resolved and it doesn't need multiple revisions. The dog ear doesn't bother me in terms of pain or being in the way/getting pinched, I just don't like how it looks and want the area flat as I plan to tattoo over it.

Other than that, the dr took 3 month pics to go in my file, everything looks good, and it's just the long, slow slide of waiting for the swelling to fully resolve.

Swelling continues to go down.

I'm about 4 months into the, "It can take 6-8 months for all the swelling to resolve" part. I do get a very specific 'ache' feeling in areas when the swelling goes down, which is interesting to me.

The process is slow, but it is happening; at the moment I still look like I have very small pecs on my otherwise undefined torso, but it only looks funny without a shirt on. Under clothes, I have a normal looking, flat chest that isn't abnormally flat (very few people who aren't children are literally 'flat as a board').

Both nipples are fully popped out and look pretty normal, despite being multi-colored; in terms of their structure, they appear normal.

The scars are doing well, but I don't expect to see much change in the two big incision scars for a few more months. The scars around the nipple grafts have gone white and thin in 98% of the areas; there are just a couple pinkish-red areas of the graft scars.
The big incision scars are still pinkisn-red, but they're thin and flat; I expect they'll fade to white after about 10-12 months as that's what's happened with other, larger surgical scars I've had.

The dog ear is tentatively planned to be dealt with in January at my 6 month follow up; the PS isn't figuring it'll require anything beyond local to excise and re-stitch it and did warn me that a dog ear revision will result in a longer scar but, as I plan to tattoo over the area, I need it to be as flat as possible which makes even a small dog ear out of the question. A scar that's an inch or two longer isn't a big deal to me.

Other than that, everything is really back to normal; I still feel some tightness when I stretch due to the residual swelling, but that lessens as the swelling lessens.
I've got full range of motion and have gone back to doing some light (under 45lb) weight lifting and weight training upper body exercises with no abnormal sensations or pain, though if I overdo it, the left side swells a little bit for a few hours.

I can also safely say I'm still in love with the fact that I don't have to wear bras, and can just throw on a shirt and leave the house; my breasts prior were large and saggy (34DD by the time I was 12!), as well as full of cysts and fibrous tissue so they were physically painful as well (the tissue felt a lot like someone always stabbing me with hot needles, and it was confined to the breast only; mammograms showed nothing abnormal aside from cysts and fibrous tissue), so I can't say I was ever attached to or in love with having breasts due to that.

I also enjoy being able to wear button down shirts that fit EVERYWHERE--I'm broad shouldered, was large breasted, and have a waist about 10" smaller than my chest measurement, finding button down shirts that fit and didn't look boxy or inappropriately 'busting out' was impossible!--without having it look like a button is about to pop open.
Granted, I sometimes miss the nice near hourglass I had going (34DD-30-41), but if I want the top half of it back, that's what mastectomy bras and silicone inserts are for! ;)

Don't miss 'em one tiny bit, and I have no regrets about not choosing to go with DIEP, tissue expanders to implants, or any other form of reconstruction beyond, 'just make it look like a normal, flat chest.'

Breasts and breast size absolutely do not determine how feminine or beautiful someone is, after all.

A few updates.

The main incision scars are starting to turn white around the edges, and the scars around the nipple grafts have faded to white.

I have an appointment on Jan. 9th to discuss some revisions, including:

- Removing the dog ear on the right.
- Removing excess fat that was left/moved in an effort to make my chest look naturally flat instead of concave; unfortunately, it healed weird, and the right side looks 'folded' (fat on the left and right side, flat in the middle, this also results in the nipple looking like it has a crease in it) and the left side looks like a deflated AA cup, which I dislike.

I had anticipated that I'd need some level of revision as I had large, droopy breasts prior to the mastectomy and I'm slightly overweight, both things that can make it difficult to achieve fully flat in one go, so this isn't a surprise to me. We just need to go over planning steps to get the revision done and hopefully get everything fully flat.

To me, right now, they look like sad little uneven breasts when I stand normally, and the plan is to get that fixed.

Preauth sent in for revision.

After showing my PS the things that concerned me, she agreed that I definitely need some minor revision as there was too much fat left behind in the initial surgery (they wanted to make sure I wouldn't have a concave chest and just left too much).

As I've mentioned before, I expected I'd need some revisions as I'm overweight and it can be difficult to figure out just how much to remove in terms of fat tissue in overweight patients. I also swell VERY easily, which made it harder to properly anticipate how much fat to leave/move around so I wouldn't be left concave (which I also do not want).

The results that need fixing:

- Too much fat tissue left on both sides after the mastectomy. On the left, it resulted in something that looks like a cake roll with a nipple, and it's obvious under t-shirts. On the right, the dog ear is visible under t-shirts, and there is fat on the left and right of where the breast used to be, but it is flat in the center, which results in it looking like a set of three small lumps in a t-shirt. The nipple also folds over itself due to being squished in by the fat bumps on either side, and that is also noticeable under a t-shirt. It ended up looking a bit like two deformed, very small breasts.

Both the PS and I agreed that this was not the outcome that had been aimed for (obviously! :) ).

What's on the plan to be fixed:

- A large 'bra roll' on the left side; that will need excision and lengthening of the scar, which I don't mind.

- The dog ear on the right side; that will also need excision and lengthening of the scar which, again, I don't mind.

- They're hoping to be able to remove the excess fat on the font of my chest that's currently making it look like I have pancake shaped, uneven small breasts via liposuction to avoid having to re-open the area to get it out, but they won't know for certain until it gets to that point. If liposuction won't do the job, the area will be opened back up again to get the fatty tissue out.

They're not anticipating I'll need drains, but the recovery period (i.e. the restrictions) will be back in place for 6-8 weeks. This is something I'm fine with, however, as I'd rather have revision and (hopefully) get the results I'm after than just be okay with something that I don't find aesthetically pleasing.
Eau Claire Plastic Surgeon

Amazing. Dr. Ewings and her staff were always friendly, willing to help, responsive, and good about working with me to achieve the aesthetic outcome I was looking for following the prophylactic bilateral mastectomy. At all steps, from pre-op through post-op, she was good about explaining to me what was going to be done, what I could expect (visually, physically, etc...), and gave a good majority of it in printed form in a folder so I could have it as a reference after leaving the hospital. If she was unavailable to answer questions due to being in surgery, the staff were great about either seeing if her associate doctor was available to answer questions or to at least get back to me quickly and let me know that it might be 24 hours before they could get me an answer. In the recovery area, the nurses for the night I stayed over were friendly, attentive, and responsive.

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
5 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
5 out of 5 stars Wait times
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