Before Breast Reconstruction: How Elle Decided on a PAP Flap | Part 1
After a breast cancer diagnosis in 2020, followed by a single mastectomy and DIEP flap reconstruction, Elle thought her next surgery would be a revision.
Then updated genetic testing revealed a CHEK2 pathogenic variant and changed the decision in front of her.
In Part 1 of Elle’s story, she shares how she decided to have a risk-reducing mastectomy on her remaining breast, and why deciding what type of reconstruction was right for her felt so difficult.
While this is Elle’s story, the conversation will resonate with anyone weighing up their breast reconstruction options.
What changed for Elle
A number of years after her original diagnosis, Elle’s cousin was diagnosed with breast cancer at the same age.
That change in family history led Elle back to genetic counselling. Updated testing identified a CHEK2 pathogenic variant that had not been included on the original panel.
The result changed the surgery Elle had been expecting to have. Instead of proceeding with revision surgery, Elle began considering whether to have a risk-reducing mastectomy on her remaining breast.
What reconstruction options were left after DIEP?
Elle had already had a DIEP flap reconstruction using tissue from her abdomen, so that donor site could not be used again.
She considered:
· staying flat
· implant reconstruction
· another form of own-tissue reconstruction
Her physical build, her preference not to use muscle and the importance of returning to gymnastics helped narrow the options.
PAP flap reconstruction, which uses tissue from the upper inner thigh beneath the buttock crease, became the option available to her.
The emotional weight of the decision
The decision was not simply whether to have another operation.
Elle questioned what another major reconstruction would ask of her body, her work and her family. She also wondered whether wanting reconstruction was selfish.
Counselling gave her space to test those thoughts and work through the difference between knowing which option felt right and feeling at peace with choosing it.
Public breast reconstruction in Australia
Elle is accessing PAP flap reconstruction through the Australian public health system.
Her experience reflects an important distinction: breast reconstruction may be covered by Medicare, but that does not always make it simple or easy to access.
Long waiting periods can affect work, travel, family support and the ability to plan for recovery.
Part 2 of Elle’s story explores how she is preparing for surgery while waiting without a firm date.
What this episode explores
· genetic retesting after breast cancer
· CHEK2 and changing surgical plans
· risk-reducing mastectomy
· breast reconstruction options after DIEP
· PAP flap reconstruction
· staying flat versus implants versus own-tissue reconstruction
· physical priorities and donor-site decisions
· counselling and reconstruction decision-making
· accessing breast reconstruction through the public system in Australia
About Elle
Elena Marie Fowler is a Sydney hair educator and colour technician, as well as a qualified remedial massage therapist and lymphoedema practitioner.
She shares her lived experience of breast cancer, lymphoedema, DIEP flap reconstruction and preparing for PAP flap reconstruction through the Australian public health system.
Listen next
In Part 2, Elle shares how she is preparing for PAP flap reconstruction, including the uncertainty of waiting, time away from work, recovery planning and the support she’ll need at home.
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Care note
This episode includes discussion of breast cancer, mastectomy, genetic risk and major surgery.
Listen to this episode
Links:
Learn more about the CHEK2 genetic mutation and breast cancer risk in Australia
Patient information from eviQ about what a CHEK2 genetic variant may mean for individuals and families.Listen to breast reconstruction options when DIEP flap reconstruction isn’t available
Reconstructive plastic surgeon A/Prof Bish Soliman explains alternative autologous own-tissue flap options, including PAP flap reconstruction.Follow Elle on Instagram
Connect with Luan:
Follow Luan on Instagram
If you’ve found any of the content upsetting, please reach out and get help. Breast Cancer Network Australia has a free confidential helpline – 1800 500 258. Beyond Blue has a range of free resources online, or you can call them 24/7 on 1300 224 636.
