A lot of advice, but different answers

Dear Pretty Mongoose,

I have reviewed the answers from the other doctors and they are all slightly different, which means that there is no right answer. Just to summarize:

1. No one likes the one stage breast reconstruction - nipple areolar reconstruction should be performed at a separate sitting.
2. Breast reconstruction can be performed many different ways a) implants with alloderm - added risks. b) implants with lattissimus dorsi muscle flaps is another option with great results. The muscle is harvested through very smal incisions on the back and the results are the most natural that I have witnessed.

As for the tummy tuck - try to limit any elective surgical procedure to less than 4 hours.

To Prettymongoose,

Hi.  Based on our experience with bilateral prophylactic mastectomies with immediate reconstruction, I seldom recommend one stage reconstruction  --even though it sounds so appealing --  because it is associated with frequent  need of revisions and it is most applicable for quite small breasts.

I certainly would recommend that the nipples and areolas be reconstructed later.  If done together with the breast mound reconstructions, the nipples can end up misplaced and they cannot be moved.  So you could have the abdominoplasty together with the nipple reconstructions; the idea is to have shorter anesthesia time.

This suggestion assumes that you are not having "nipple sparing" mastectomies, which are occasionally indicated in women who have no sagging.

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A single stage implant and alloderm can be done provided that you have a skin sparing mastectomy, although it is much harder to "get it right" in a single stage.  I would defer the tummy tuck to a later stage. Too bad you had liposuction of the abdomen, becasue you could have been a good candidate for a DIEP flap, which would also give you the benefit of a tummy tuck.

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