As you weigh your future risks of breast cancer against the risk of major surgery, you have much to consider. While you may want to focus on the mastectomy first and talk about reconstruction later, your prophylactic mastectomy reconstruction options will entirely depend on how that surgery is carried out. That’s why many women consult with a plastic surgeon before their mastectomy to get a full picture.
Three Prophylactic Mastectomy Reconstruction Options
The type of mastectomy you get will affect your breast reconstruction surgery. Very broadly, there are three types of mastectomies that your breast surgeon may recommend. They are:
- Total (skin-sparing) mastectomy: This procedure involves the removal of both breasts, including the surrounding breast tissue, nipple, and areola, and may also entail the removal of lymph nodes from the underarm area. It’s typically only done in very high-risk cases.
- Nipple-sparing mastectomy: This is a more common approach where the breast tissue is removed while the nipple and areola are spared. This approach is very common for individuals with a BRCA-positive finding, meaning they have certain genetic markers that make breast cancer more likely.
- Contralateral mastectomy: This is specifically for individuals with a prior breast cancer diagnosis in one breast. The other healthy breast will be removed to reduce the risk of cancer spreading.
Consulting with a plastic surgeon before undergoing any of the above procedures can give you a head start on the reconstruction process. A skilled surgeon will tailor a surgical plan to your unique situation to achieve a balanced and natural look.
Reconstruction for a Total Mastectomy
Reconstruction after a total mastectomy is technically two surgeries. First, the breast mound is recreated, and then the nipple/areola is reformed. In reforming the breast mount, your plastic surgeon may use implants, autologous tissue (tissue from another place on your body), or a combination of both. At times, a breast skin-reducing approach will be used for the mastectomy to produce a smaller, lifted contour of the reconstructed breast.
Nipple reconstruction is typically performed in the final stage of breast reconstruction. During this phase, the plastic surgeon employs various techniques to recreate the nipple and areola for a more natural appearance.
One approach involves using local tissue flaps, where skin from the surrounding area is reshaped to form the nipple. Rarely, the surgeon may use tissue from another part of your body to reconstruct the nipple in a grafting approach. Finally, tattooing might be used to add pigmentation, providing the finishing touch to achieve a natural appearance. The choice of technique depends on individual preferences, medical considerations, and the desired outcome.
Nipple-Sparing Mastectomy Reconstruction Options
A nipple-sparing mastectomy offers many options, including both the implant and tissue-based reconstruction options listed above. As the nipple was preserved during the mastectomy, there’s no need for nipple/areola reconstruction. In some cases, surgery can even be done as part of a one-stage reconstruction.
This method involves an immediate transition from mastectomy to reconstruction. Once the mastectomy is completed, the plastic surgeon proceeds directly to the reconstruction phase. Often, no additional surgeries are required, creating a more efficient and consolidated process.
However, revision procedures, or “tweaks” to the reconstruction within the first year are not uncommon, to balance the final result. These revisional procedures are covered by insurance as part of the reconstructive process.
Regaining Symmetry after a Contralateral Mastectomy
In a reconstruction following a contralateral mastectomy, the surgeon is working on one breast. A skin sparing or nipple sparing approach can be used for the contralateral mastectomy, based on several factors, such as the amount of breast sagging, the desire to have smaller breasts, or other aesthetic concerns. However, as only one breast is being worked on, there are additional considerations around symmetry.
When choosing between the three prophylactic mastectomy reconstruction options, it’s wise to consult with a plastic surgeon beforehand. Plastic surgeons specialize in achieving aesthetic outcomes, which means they can provide valuable insights to help you mitigate your cancer risk while preserving the visual appearance of your breasts.
Bringing Patient Advocacy to Breast Reduction and Reconstruction
Harris Plastic Surgery can assist you in navigating your prophylactic mastectomy reconstruction options. To schedule a consultation, please contact us.
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.