A prophylactic mastectomy with immediate reconstruction is a surgery that allows someone with a high risk of breast cancer to protect themselves as they maintain the aesthetic appearance of their breasts. Science has come a long way, and we can now assess a person’s risk of breast cancer in many ways, from basic family histories to advanced genetic testing. Sometimes, removing the breast tissue is safer than watching and waiting. But someone who chooses to do that shouldn’t have to sacrifice the aesthetic side of surgery. When you do a prophylactic mastectomy with immediate reconstruction, you can maintain your confidence and reduce your cancer risk.
Prophylactic Mastectomy with Immediate Reconstruction:Risks and Benefits
A prophylactic mastectomy and reconstruction takes two separate surgeries and combines them into one. This procedure is a preventative measure for individuals at high risk of developing breast cancer due to factors such as carrying certain genetic mutations (e.g., BRCA1 or BRCA2) or having a significant family history of breast cancer.
It starts with the breast surgeon, who goes in and removes the breast tissue based on the type of mastectomy. Then, the plastic surgeon will step in to reform the breast mound. They may do this through a tissue-based reconstruction, where they use your own skin and tissue, or in a direct-to-implant procedure, where a prosthetic is inserted at the time of the mastectomy. In both cases, there are a few risks and benefits.
Single-stage procedure: The first and most obvious benefit is the ability to perform tissue removal and reconstruction simultaneously, reducing the overall treatment time.
Psychological benefits: Waking up from surgery following a mastectomy can be traumatic. Reconstruction immediately after can help individuals cope with the emotional and psychological impact of losing their breasts.
More natural aesthetic: Immediate reconstruction preserves the breast skin envelope, leading to a more natural appearance than delayed reconstruction, where the skin changes or contracts between procedures.
Nipple-sparing surgery opportunities: A simultaneous nipple-sparing mastectomy combined with immediate reconstruction is possible in some patients, allowing for the most natural appearance.
Wound healing issues: Because immediate reconstruction involves placing implants or using tissue flaps soon after the mastectomy, there is a higher risk of infection at the surgical sites.
Long-term unpredictability: While immediate reconstruction may offer better cosmetic results initially, the final outcomes might be less predictable than multi-stage reconstruction. However, this may be corrected with a revision breast reconstruction.
Unforeseen pathology: This is less likely during a preventative mastectomy, but changes to the mastectomy plan would impact the reconstructive procedure.
Higher complexity: Combining a mastectomy and immediate reconstruction increases the complexity and duration of the surgery.
While no surgical procedure is ever risk-free, there are some things that you can do to improve your surgical outcome. Your breast reconstruction surgery will go a lot smoother with the right team in your corner.
How to Get the Best Results from Your Surgery
A mastectomy followed by immediate reconstruction is not a simple procedure; it requires a team. A breast surgeon will handle the removal of tissue; the plastic surgeon’s job will be there to reform the breast. Here are some tips for choosing the right surgical team:
- Meet with a plastic surgeon early: Scheduling a consultation with a plastic surgeon before planning your mastectomy can provide insight into potential aesthetic outcomes tailored specifically to you.
- Look for specific expertise: Breast reconstruction is a broad term that encompasses a lot of different things. Look for surgeons with particular experience in these immediate reconstruction procedures. Ask about their training, qualifications, and the number of similar surgeries they have successfully completed.
- Review before-and-after photos: When meeting with potential surgeons, ask to see before-and-after photos of previous patients who underwent immediate reconstruction. This can give you a better idea of the surgeon’s capabilities and the potential outcomes you can expect.
- Look for insurance coordination services: Under New York law, you are entitled to coverage for both your mastectomy and reconstructive procedures under your health insurance policy. However, navigating this process can be challenging. Choosing an office with an experienced insurance coordination team can be invaluable in helping you manage the financial side of your care. They will work with your insurance provider, handle pre-authorization requirements, and ensure that you have a clear understanding of your coverage and potential out-of-pocket expenses.
- Communicate your goals and expectations: Be open and clear about your goals and expectations for the reconstructive procedure. Work with a team that truly listens and makes a point to understand your desires.
A prophylactic mastectomy with immediate reconstruction is a stressful and emotional experience. Take the time to prepare yourself mentally and emotionally. Talk to your support system, and consider seeking counseling or support groups if needed. A strong medical team, along with a positive mindset, can help speed your recovery journey.
Bringing Patient Advocacy to Breast Reduction and Reconstruction
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.