Lois,
I realize that this is a very late response to your question but the head and neck surgeon told me that, in addition to all of the issues that Brian mentioned, there was also a much greater risk of infection due to the amount of time I would have been on the table - 14 hrs+. In addition to that, I would have required radiation anyway which probably would have caused a pectoral flap failure and I would also be at lifetime risk of aspiration induced pneumonia, not to mention rather severe QOL issues in general.

My team made their recommedations not only based on the medical issues, best odds for survival and QOL but also how it would minimize impact on my current (at the time) life and who I am as a person - somewhat of a holistic approach. I was blessed with a great team from 2 different medical centers, Kaiser and UCSFCCC and they had regular conferences so it was truly an integrated medical team. Five years post I am still seeing them and would not hesitate to follow the same plan. After a lengthly recovery, I have built a building from scratch, started a business, became vice president in another business and resurrected my original core consulting business. I also DJ and play live music as well and have a very busy agenda. The only thing that hasn't come to pass is my oncologist stating "well 2 years from now when you're fat again..." That didn't happen. I lost over 60 lbs and gained 30 back and am at a perfect BMI which has remained stable.

At five years post, I am happy with my decision, not that it hasn't caused me angst periodically or the issues with collateral radiation damage to neck muscles, which Ed (Uptown) eloquently describes in one of his recent posts. I got a lifetime supply of Valium out of it though so it could be worse;-)