Bilateral Mastectomy with Immediate Breast Reconstruction, Pre-pectoral Implants

My story actually begins about 5 years ago when my younger sister was diagnosed with breast cancer at age 32. She chose to have a bilateral mastectomy to remove her tumor and to lower the chance of recurrence since the women in my family are BRCA-1+.  Melanie was in excellent hands: her surgery was with one of the top-rated breast surgeons in the world, and she had an excellent plastic surgeon at Mass General Hospital in Boston.

Melanie’s surgery went very well.  She had a nipple-sparing bilateral mastectomy, and tissue expanders in advance of implants.  Her recovery was long and painful. Melanie had no complications, but she stayed 3 nights at Mass General and was in pain for about 2 months until her drains were removed. She then had to return to Boston for weekly visits to the plastic surgeon to have her expanders filled followed by another procedure to replace them with her implants. Each time I drove her to an appointment, she brought a pillow to lessen the impact of the bumpy road on her sore, healing breasts.  She had a limited range of motion and weakness in her arms and chest. She was unable to wash her hair, reach for a cup in the cabinet, or push her chair away from the table for months. 5 years later, she still cannot do a push-up and has significant disfiguration when she lifts her arms or moves a certain way. Thankfully she is healthy, and these drawbacks are a small price to pay to have her cancer-free and lower her risk of recurrence.

When I was diagnosed in August of 2017 at age 40, I was ready.  I had mammograms for 11 years, MRIs for 5, and I knew I would be diagnosed at some point, it was just a matter of “when”.  The decision to undergo bilateral mastectomy wasn’t a difficult one to make; I had helped my little sister go through it so I knew what to expect.  It wasn’t going to be easy or pretty, but I was ready to press on and get to life post-cancer.

My husband and I met with my breast surgeon and decided to have my surgery close to home, in the same hospital that took care of my children and me when they were born.  I wanted to be in the capable hands I knew, with the same doctors and staff that has been in charge of my breast health for the past 11 years. That was when I met Dr. LoTempio, who confirmed that was the right decision.  

As soon as she walked into the exam room I knew that she was the kind of take-charge person I wanted to perform my surgery.  She took photos, asked questions, joked with us, and listened to my concerns – which were numerous, given my sister’s experience.  She immediately put those concerns to rest. I was an excellent candidate for a new procedure, which involved PRE-pectoral implants.  I could have my implants wrapped in Alloderm and placed in the breast pocket – potentially immediately after the mastectomy! At the time, no other surgeons in New Hampshire were performing this procedure.  I felt a bit like a guinea pig, but I liked the idea of having a much easier recovery!

My surgery was a complete success.  Dr. LoTempio was able to place the implants immediately, which meant no expander fills or exchange surgery. I was able to lift my arms above my head and brush my hair that afternoon.  I stayed one night in the hospital and continued my recovery in the comfort of my home. My drains were removed within 4 days, and then 8 days, I was pain-free and getting used to my new normal.  I have no visible scarring, full range of motion, and I am very pleased with the results. Dr. LoTempio was there every step of the way, making herself available via text to answer my questions, look at photos of the bruising and healing process, and to reassure me that all was going according to plan. Her drive to be on top of new developments in plastic surgery was evident throughout the process, and her perspective and outlook were comforting and empowering.  I so appreciate her frequent check-ins, positive outlook, sense of humor, and that she treated me like a sister, not just a patient.