I am waiting on BRCA test results. Due to DCIS in 2007. I have saline implants in the chest wall on both sides. I am a D cup. If the BRCA is positive, I face a double skin/nipple sparing mastectomy with new implants. What will I look like when this is over? Will my breasts be lot smaller? How long is recovery? I cannot find info on the internet about this procedure on someone who already has large, chest-wall implants. Information?
L May Have to Have Bi-lat Skin/nipple Sparing Mastectomy. I Have Chest Wall Implants Now. Results?
Doctor Answers 4
Reconstruction after NSM with pre-existing implants
Assuming your breasts look great now, these reconstructions usually turn out fantastic with the right team of surgeons. My advice is to find a great - and I mean great - surgical oncologist who performs NSM (nipple sparing mastectomies) routinely. And I mean routinely. The mastectomy flap necrosis rate - that means the skin dies and/or your nipples can be lost - is as high as 15%. However, with a great oncological surgeon, this rate will be pretty much 0%.
Next, choose a busy reconstructive plastic surgeon and ask your questions regarding size, recovery etc. You should easily be able to stay the same size, and the final implant will need to be your current implant size + your breast weight in grams (checked by surgeon intra-op, and on your path report).
My personal preference is to perform a One-Stage reconstruction (immediate implant), which has a 3 week full recovery. I sometimes perform fat grafting 3 to 6 months down the road for those with thinner skin, just to hide the implant and give the breast a very natural result. (Tissue expanders can yield good results as well if your doctor doesn't feel comfortable performing one stage breast reconstructions.)
For the incision, it's best to go through your old scar if it's at the inferior areola or at the inferior mammary crease. If your scar is off-breast (as in a TUBA or trans-ax) then don't use the areola incision, only use the inferior mammary crease. Finally, ask your oncologist about how the nipple tissue will be followed. Remember, since you are BRCA carrier, and this surgery leaves duct tissue in the nipple, most oncologists recommend light surveillance.
Mastectomy with existing implants
In some respects you have the best situation for this scenario since you already have implants. If you think about your current situation, your breast are probably predominantly comprised of the implants. Doing a skin and nipple sparing mastectomy will result in a similar situation except that your breasts will entirely made up from the implants. Think of what your ultimate desired goal is and see if your surgeon can produce that in cooperation with the general surgeon. Sometimes a skin-sparing mastectomy is not necessarily a positive thing, especially if you want to go smaller. Scars, safety, survival of the nipple are primary considerations.
Robin T.W. Yuan, M.D.
You have few options
The options post nipple sparing mastectomy are implant reconstruction or flap reconstruction. You can get great results with either . In general flap breast reconstruction is more involved,but give more natural and lasting results. Please get in person consultation with board certified plastic surgeons.
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Many questions about the results of breast reconstruction
Thank you for your question.
You have many questions about the results of reconstruction which is completely normal.
This forum is no substitute for a face-to-face consultation.
I recommend you see two or more board-certified plastic surgeons for a full and complete evaluation to make sure you are a good candidate for breast reconstruction and that it is safe for you to have the surgery that you want.
I hope this helps.