Confused

I was diagnosed last month with a recurrence of my +++ IDC after 10 years. I also have DCIS on the other side. The next right step seems to be a DMX, but I’m getting totally confused about reconstruction options.

I originally had a lumpectomy and radiation (plus chemo of course). Because of that previous radiation I’m not a good candidate for an implant reconstruction. I probably won’t need radiation this time unless there’s lymph node involvement (which didnt appear an ultrasound but god knows this disease can surprise us). Chemo is TBD based on DMX pathology - the MO wants confirmation of my biopsy results.

I have talked to several (maybe too many) plastic surgeons to try to figure this out. I’m getting conflicting info and am feeling pretty distressed and don’t know how to decide.

One local PS who doesn’t do DIEP said I could do an implant reconstruction. This doc would be doing an expander placement if I had surgery locally.

His partner, local PS2, does do DIEP. He didn‘t express any concerns about expanders. DIEPs are newer in my area but he’s well trained and experienced.

I talked to a PS at a big academic medical center, and he said he would never do implants, and would not even recommend expanders even as they have a 20% failure rate in pts with radiation. He recommended a direct to DIEP, but for complicated scheduling and referral reasons cannot offer it to me himself.

I have starting talking to some out of state places for DMX direct to DIEP, but I feel stressed about how slowly it’s moving, and stressed about traveling for this surgery.

I am also seeing where a lot of direct to DIEP is done for prophylactic DMX not for active cancer.

I liked the local breast surgeon and am thinking maybe I should just go back to him and delay reconstruction until I know what additional treatment I’ll need. At this point I don’t trust the local PS that would be scheduled to work with him; I don’t think he’s been honest with me about my risks after radiation.

I’m trying to be a good self advocate but am feeling totally confused at this point. I would love an outside perspective or to hear about others’ experiences.