Preventative Mastectomy and Reconstruction: Plastic Surgeon Benefits

You probably have many questions as you consider a preventative (prophylactic or risk-reduction) mastectomy and reconstruction. Whether you have a family history of breast cancer, certain genetic markers that put you at high risk, or have suffered the disease before, now is a scary time with a lot of uncertainty. The last thing on your mind is your plastic surgeon. But they can help. A plastic surgeon is well-versed in preventative mastectomy and reconstruction, and meeting with one early can help ease many of your concerns. BRCA Positivity and Other Preventative Mastectomy Reasons A preventative mastectomy is usually indicated when someone is considered at high risk for breast cancer. They may have conditions that put them at higher risk of all types of cancers or a family history of them. They may have had breast cancer before or suffered from childhood conditions requiring chest radiation, increasing their chances of a diagnosis later. The high-risk assessment is determined based on an evaluation of all kinds of different factors, so it's important to meet with a qualified physician. Genetic testing is a significant factor in getting a preventative mastectomy and breast reconstruction. With advances in medicine, doctors have been able to isolate key genetic mutations that could increase someone's cancer risk. You may have heard this referred to as BRCA positivity. What is BRCA Positivity? Everyone has BRCA genes, so the term "BRCA positivity" is a bit misleading, as are the names of the genes themselves; BReast CAncer gene 1 and BReast CAncer gene 2. These two genes play a crucial role in preventing cancer by repairing and suppressing DNA that causes cells to grow uncontrollably. Unfortunately, some individuals have a mutation (or harmful variant) in this critical DNA. It doesn't work as effectively as it should, putting them at a higher risk of developing breast and/or ovarian cancer in their lifetime. When that's the case, the patient is presented with two options. They can wait and watch; a BRCA-positive finding does not determine for sure that someone will get cancer. Someone who chooses this route will start breast cancer screening younger and undergo it more often. They may also have magnetic resonance imaging done in addition to regular mammograms. That will help them catch cancer earlier if it does happen. Alternatively, they may choose to get a preventative mastectomy. They can pursue several different types, depending on their risk level.

You probably have many questions as you consider a preventative (prophylactic or risk-reduction)  mastectomy and reconstruction. Whether you have a family history of breast cancer, certain genetic markers that put you at high risk, or have suffered the disease before, now is a scary time with a lot of uncertainty. The last thing on your mind is your plastic surgeon. But they can help. A plastic surgeon is well-versed in preventative mastectomy and reconstruction, and meeting with one early can help ease many of your concerns.

BRCA Positivity and Other Preventative Mastectomy Reasons

A preventative mastectomy is usually indicated when someone is considered at high risk for breast cancer. They may have conditions that put them at higher risk of all types of cancers or a family history of them. They may have had breast cancer before or suffered from childhood conditions requiring chest radiation, increasing their chances of a diagnosis later. The high-risk assessment is determined based on an evaluation of all kinds of different factors, so it’s important to meet with a qualified physician.

Genetic testing is a significant factor in getting a preventative mastectomy and breast reconstruction. With advances in medicine, doctors have been able to isolate key genetic mutations that could increase someone’s cancer risk. You may have heard this referred to as BRCA positivity.

What is BRCA Positivity?

Everyone has BRCA genes, so the term “BRCA positivity” is a bit misleading, as are the names of the genes themselves; BReast CAncer gene 1 and BReast CAncer gene 2. These two genes play a crucial role in preventing cancer by repairing and suppressing DNA that causes cells to grow uncontrollably.

Unfortunately, some individuals have a mutation (or harmful variant) in this critical DNA. It doesn’t work as effectively as it should, putting them at a higher risk of developing breast and/or ovarian cancer in their lifetime.

When that’s the case, the patient is presented with two options. They can wait and watch; a BRCA-positive finding does not determine for sure that someone will get cancer. Someone who chooses this route will start breast cancer screening younger and undergo it more often. They may also have magnetic resonance imaging done in addition to regular mammograms. That will help them catch cancer earlier if it does happen.

Alternatively, they may choose to get a preventative mastectomy. They can pursue several different types, depending on their risk level.

Total (skin-sparing)
mastectomy

Nipple-sparing mastectomy

Contralateral mastectomy

Both breasts are completely removed, including all breast tissue, nipple and areolar complex, ducts, and lobules. This is typically only done in the highest-risk cases.

In nipple-sparing mastectomy, breast tissue is removed, but the nipple and areola are kept for better cosmetic results during reconstruction. Most women who are at higher risk due to genetic mutations without any cancer identified in the breast may be candidates for this approach.

For individuals with a previous breast cancer diagnosis in one breast, this procedure involves removing the opposite healthy breast to reduce the risk of cancer developing.

Your surgery will depend on your anatomy and your particular risk factors–as well as your medical team. For those undergoing a preventative mastectomy, meeting with a plastic surgeon first will give them more reconstruction options.

Surgical Roles in Preventative Mastectomy and Reconstruction

A breast surgeon has a singular purpose when it comes to preventative mastectomy; remove the risk of cancer as much as possible. Unfortunately, that doesn’t leave a lot of room for aesthetics. They’re more focused on the function of the breast and the risk it poses in the future. They don’t typically have a lot to do with the reconstruction process.

That can lead to a disconnect with your breast reconstruction surgeon, who is typically a plastic surgeon. A plastic surgeon will look at a mastectomy differently because they have an aesthetic goal from the very beginning. Meeting with one to plan your reconstruction before your mastectomy offers many benefits. Here are just a few:

  • Comprehensive understanding: Most patients don’t have a ton of experience with breast reconstruction for obvious reasons. You probably don’t even know what questions to ask! If you did, your breast surgeon may be unable to answer them. By meeting with a plastic surgeon first, you can understand the types of reconstruction options available to you for the best aesthetic result.
  • One-stage reconstruction: One popular option, especially in preventative mastectomies, is one-stage reconstruction. In this, an immediate reconstruction is performed during the mastectomy itself. This reduces downtime, helping you recover faster.
  • Coordination with the breast surgeon: By meeting with a plastic surgeon first, you can align your medical team and eliminate the gap that occurs from mastectomy to reconstruction. Your plastic surgeon can coordinate with your breast surgeon to ensure they are on the same page, optimizing the surgical approach and minimizing potential complications.
  • Psychological benefits: A preventative mastectomy is a big, frightening decision. Knowing about your reconstruction options can help you overcome some of those fears.
  • Better aesthetic outcome: Plastic surgeons are highly skilled in breast reconstruction and primarily focus on achieving optimal cosmetic results. Their expertise in shaping and contouring breast tissue allows them to create a more natural-looking and symmetrical appearance after mastectomy. By understanding your aesthetic goals and working collaboratively with the breast surgeon, a plastic surgeon can tailor the reconstruction plan to your preferences and body proportions, enhancing your overall satisfaction with the results.

A plastic surgeon can guide you through preventative mastectomy and reconstruction when you’ve made the decision to reduce your risk of cancer. Unlike breast surgeons, we see both sides of the mastectomy from a functional and aesthetic perspective. A plastic surgeon should be your first stop if you’re considering a preventative mastectomy and reconstruction due to a high risk of breast cancer.

Bringing Patient Advocacy to Breast Reduction and Reconstruction

At Harris Plastic Surgery, every consultation includes a thorough evaluation of your Empire Plan coverage for breast reduction surgery. We take a concierge approach to treatment, which includes working to minimize your out-of-pocket costs. Contact us to schedule a consult!

Stephen U. Harris, MD FACS

Dr. Stephen U. Harris is a board-certified cosmetic surgeon and recognized expert in breast reduction and reconstruction surgeries, having performed thousands in his career. When it comes to patient care, his philosophy is that every surgery should improve his patient’s overall quality of life, not just their appearance. Dr. Harris stays up-to-date on all the latest advancements in breast augmentation, reconstruction, and reduction and is a recognized innovator in the field. In fact, he was the first surgeon at Good Samaritan Hospital to offer primary prepectoral implant breast reconstruction, as well as secondary prepectoral revision surgery.

Dr. Harris also serves as Chief of Plastic Surgery at Good Samaritan Hospital in West Islip, New York and is an active staff surgeon (and former Chief of Plastic Surgery) at South Shore University Hospital in Bay Shore, New York.

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