High risk patient seeks natural breast reconstruction

I would strongly suggest that you request your surgical oncologist (the physician performing the prophylactic mastectomy) send you to a PS, with whom (s)he can work and offer you an immediate reconstruction, using either a) tissue expanders or b) one stage "direct to implant" with an Alloderm sling. Irregardless of which option is adopted, your PS should ideally mark your breasts for a "reduction" mammoplasty, so that the excess skin can be removed and the reconstructed breast reshaped to provide a smaller but natural appearing set of breasts. I also agree that unless your surgery is performed at an academic facility which has great interest and experience in autologous (own tissue) reconstruction (i.e. TRAM or DIEP flaps), your results may be suboptimal. Good luck.