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Mastectomy, Breast Reconstruction with Tummy Tuck?

I'm a BRCA positive 40 year-old in excellent health, normal weight. I'm having a prophylactic mastectomy with immediate, "one-step" reconstruction (using Alloderm and silicone implants).

Could I have a tummy tuck at the same time? I have lumpy results from a previous abdominal liposcution and a nasty appendectomy scar I'd love to be rid of!

Asked 38 months ago by prettymongoose in Westchester, NY

Consider different reconstructive options

There are many different reconstructive options for breast cancer. For patients that are interested in removing abdominal tissue you should talk to your surgeon about using that tissue to reconstruct your breasts. You can get excellent long term results with a very natural looking breast (most would agree more natural than implants) and get the abdominoplasty at the same time. You should speak to a board certified plastic surgeon who performs all types of breast reconstruction. In your... more

Steven H. Williams, MD

San Francisco Plastic Surgeon

ASPS

It could be possible but remember the 6 hour rule

The answer to this question would depend entirely on the opinion and practice experience of your surgeon. Assuming that you could perform the surgeries in less than 6 hours, it might be reasonable to proceed. If it would take longer than that for your doctors to perform their procedures, it would be wise to separate them. Studies have shown an increased risk of complications from elective surgeries performed that take more than 6 hours to complete.

Richard P. Rand, MD, FACS

Seattle Plastic Surgeon

ASAPS ASPS

Tummy tuck with immediate breast reconstruction

This sounds like a combination that would be reasonable. Probably the primary concerns are the risk for DVT with PE and your surgeon will likely utilize common prophylactic measures to minimize this possibility. see video

Otto Joseph Placik, MD

Chicago Plastic Surgeon

ASAPS ASPS

Breast reconstruction with tummy tuck

Using your abdominal tissues in breast reconstruction is a very effective technique. Your plastic surgeon will evaluate your physical condition and determine if you have enough abdominal tissue to re-create your breasts. When they close the wound, they can close it like a tummy tuck. Patients appreciate this reconstruction because it uses their own tissue and can re-contour the abdomen at the same time. To learn more about tummy tucks, see photos, and help you decide which one is... more

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B. Pat Pazmino, MD

Miami Plastic Surgeon

ASAPS ASPS

Tummy tuck with breast reconstruction

I would have to agree with the majority of the surgeons posting on this question. A tummy tuck or abdominoplasty is a significant surgical procedure. To undergo prophylactic mastectomies and reconstruction is typically a 3-4 hour procedure already. Adding a tummy tuck is too much surgery at one time. In addition, the surgical risks, particularly of a DVT or Pulmonary Embolism increase significantly when combining a tummy tuck with other major procedures.

David Bogue, MD

Boca Raton Plastic Surgeon

Safety is most important

Although it would be possible to have a tummy tuck at the same time as your mastectomies and implant reconstruction, it sounds like too much surgery in one setting. The good news is that, even patients who have excellent immediate reconstruction will require some type of minor secondary breast revision surgery about 6-12 months after the first operation. That would be a great time to have your abdominoplasty.

Kevin Brenner, MD

Los Angeles Plastic Surgeon

ASPS

Tummy tuck at same time as breast reconstruction is too much

I assume you discussed using your abdominal tissue to reconstruct the breasts and decided against this option. If you are having immediate reconstruction with implants, I would not have any other surgery at the same time. It is too much. You can have the abdominoplasty at a later date. Good luck.

Tracy Pfeifer, MD

Manhattan Plastic Surgeon

ASAPS ASPS

Different options available for you

There are so many correct answers to this question. You could proceed with the bilateral mastectomy/implant reconstruction option and a tummy tuck. However, it seems wiser to perform this procedure at the time of nipple reconstruction. Another different option is to use the abdominal skin for breast reconstruction. Liposuction is not an absolute contra-indication to TRAM flap. Hope that helps!

Hisham Seify, MD, PhD

Los Angeles Plastic Surgeon

ASPS

Breast reconstruction and Tummy Tuck

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.

Steven Wallach, MD

Manhattan Plastic Surgeon

ASAPS ASPS

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: No one likes the one stage breast reconstruction - nipple areolar reconstruction should be performed at a separate sitting. 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... more

Robert M. Freund, MD

New York Plastic Surgeon

ASPS

You could but maybe shouldn't

I understand the decision making process that you have undergone to get to this point and repect your decision. However, I would suggest reconsidering a one-stage immediate reconstruction. Rarely does this produce a result that rivals a two or three stage reconstruction. In addition dermal grafts, such as Alloderm, need to incorporate into the the skin flaps. If this doesn't occur, which is a known complication, the graft and implant will have to be remove and reconstruction will have... more

Christopher L. Hess, MD

Fairfax Plastic Surgeon

ASPS

You can have the abdominoplasty at the time of your nipple reconstruction.

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... more

George J. Beraka, MD

Manhattan Plastic Surgeon

ASAPS ASPS

Complete your breast reconstruction first!

I agree with many of the central concepts written by the surgeons above. Breast reconstruction with implants following prophylactic mastectomy is usually a straight forward procedure with few complications, however, problems may arise that may not be readily apparent during surgery or even in the days to months following surgery. Specifically, you could potentially have skin loss from the prophylactic mastectomy or significant capsular contraction. If you are a good candidate for an... more

David L. Kaufman, MD

Folsom Plastic Surgeon

ASPS

Assess risks first

I am assuming you are getting bilateral prophylactic mastectomies. While it is possible to do the reconstruction and abdominoplasty simultaneously, you should have your surgeons assess the risk of the procedures. From a healing point of view, the incisions and undermining necessary might reduce blood flow to certain areas of the breast and abdomen such that healing may be a factor. Total blood loss from combined procedures may also reduce oxygen-carrying capacity and thus hinder healing and... more