Prophylactic Mastectomy Reconstruction Options

A patient discusses her prophylactic mastectomy reconstruction options

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.


Pros

Cons

  • Complete restoration: Reconstruction following a total mastectomy involves the comprehensive recreation of the breast mound and areola, resulting in a more natural and balanced appearance.
  • Personalized outcome: Surgeons tailor the reconstruction to match individual preferences, body contours, and desired nipple-areola appearance.
  • Peace of mind: The reconstruction gives a patient back their confidence, while a total mastectomy offers a higher chance of avoiding breast cancer.
  • Complexity: The combined reconstruction process of the breast mound and areola might involve a more intricate surgical procedure.
  • Potential complications: The increased complexity might slightly elevate the risk of surgical complications, although advancements have minimized these risks.
  • Surgical expertise: Given the detailed nature of recreating the breast mound and areola, consulting with an experienced plastic surgeon is essential to achieve desired results.

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.


Pros

Cons

  • Efficient timeline: Often, a one-stage approach eliminates the need for separate surgeries, resulting in a quicker overall reconstruction timeline.
  • Reduced disruption: By combining mastectomy and reconstruction in a single session, there’s less disruption to daily life and fewer instances of downtime.
  • Simplified planning: Patients can avoid the complexities of scheduling multiple surgeries and coordinating recovery periods.
  • Immediate results: With immediate reconstruction, the aesthetic outcome is apparent shortly after the procedure, enhancing emotional well-being.
  • Suitability factors: The eligibility for one-stage reconstruction depends on individual medical conditions, surgical considerations, and patient preferences.
  • Potential for additional procedures: While immediate reconstruction is the goal, some cases might necessitate minor touch-ups or adjustments in subsequent procedures.
  • Recovery considerations: The recovery process after one-stage reconstruction might vary depending on the individual, the extent of the procedure, and overall healing.

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.


Pros

Cons

  • Targeted treatment: Focusing on a single breast allows for dedicated attention and precision, optimizing the reconstruction process for the affected breast.
  • Comprehensive restoration: The approach sometimes involves a total mastectomy, ensuring the complete removal of breast tissue in the treated breast to address cancer concerns.
  • Recovery time: As only one breast is being reconstructed, recovery time is shorter.
  • Symmetry: Reconstructing only one breast can lead to aesthetic differences between the treated and untreated breasts, requiring additional measures for achieving symmetry.
  • Complexity: Ensuring symmetry while recreating the breast mound and areola/nipple requires careful planning and surgical expertise.
  • Potential for additional surgeries: A revision breast reconstruction may be needed later as the patient ages and their breasts change.

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.

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