If I Have a Bilateral Prophylactic Mastectomy, What is my Best Option for a Natural Looking Reconstruction?

I am a 23 y/o female of Ashkenazi descent (w/ 1 case of breast cancer in the family) about to be tested for BRCA mutations. If needed, I plan to have a double mastectomy. As someone who has never considered breast augmentation before, I am concerned about reconstructing natural looking (& feeling) breasts. I am 5'3, 112 lb, & 32B. I'd like to stay a B or maybe a small C. While I wait to find out the results, I would like to learn about my options (fat transfer, silicon, etc.). Thank you!

Doctor Answers (2)

Breast reconstruction if you are BRCA+

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Three basic forms of breast reconstruction exist. You can use your own tissue, implants or a combination of the previous two techniques. Your own tissue can be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting. Implants can be done in one stage or two stage. Two stage reconstructions are started by placing expanders at the time of mastectomy. Once they expanders are placed they are able to be inflated as determined by wound healing. The final time consists of combining any of the above techniques.

If you are interested in being seen in Austin please give us a call. I know this is a difficult time for you. The majority of my practice is devoted to reconstruction for women with breast cancer or who are BRCA+


Austin Plastic Surgeon
5.0 out of 5 stars 14 reviews

Reconstruction after Prophylactic Mastectomy

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Hi. Hopefully your test results are negative and this post is irrelevant.

Prophylactic mastectomies can provide a very natural looking reconstruction.  Given your height and weight, you will not have enough fat to reconstruct your breasts without implants. You can still have a great outcome using implants.  The volume you would need is roughly 300 cc per side and in order to perform fat transfers you would need about 5-600 cc of fat per side (a total of over 1000 cc of fat).  Even if you try to "fatten" yourself up by over eating, your body will eventually return to its set point and you will lose the extra weight so that is not an option.

I also seriously doubt that you have enough abdominal tissue to make two breasts (bilateral DIEP flaps) but a picture can help determine this.

The best option is nipple sparing mastectomies with either a two stage reconstruction (expanders and then anatomically shaped silicone implants) or a direct to implant reconstruction (a little more challenging to perform).

Make sure you consult a plastic surgeon because in some areas the plastic surgeon will perform the mastectomies and reconstruction (for prophylactic mastectomies). Often a plastic surgeon will do a better mastectomy than a general/breast surgeon... Just my opinion.

Gil Kryger, MD
Thousand Oaks Plastic Surgeon
5.0 out of 5 stars 8 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.