Skin Sparring Mastectomy and Large Breasts, What Are my Options?

My breasts are so big that I'd be dreaming of a breast reduction anyway. So now that I have cancer in the one I'm going to request a reduction as part of my overall breast reconstruction breastreconstruction. None of the typical donor sites on my body are good (eg. stomach has bad stretch marks from pregnancy) I wondered if they could make a flap to create a new breast from my non-cancerous breast?

Doctor Answers (8)

Breast reconstruction options

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The typical options we offer patients are either breast reconstruction with your own tissue (e.g. DIEP flap from the abdomen) or similar procedures and implant-based reconstruction.  The decision depends on patient preference, prior radiation, and body status, etc... I would not recommend reconstructing the breast with your contralateral breast. 

 

In a patient with large breasts (a lot of skin), no matter what type of reconstruction they choose a majority of that skin will be removed to tighten the breast envelope. 


Jacksonville Plastic Surgeon

Breast Reconstruction after Cancer Surgery on Large Breast

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There are basically two very good options for you. First, if a lumpectomy is indicated, this can be done through a reduction incision with the required cancer resection done as part of the reduction. Secondly, you could have a total mastectomy through an inferior “T” type reduction incision. A very wide inferior pedicle is maintained to use as protection of the other incisions. If the nipple can be spared, it is maintained on this pedicle with a wide de-epithelized margin. If not, the pedicle is just used to add protection behind the other incisions. An implant is placed to replace the breast tissue. Both of these require good cooperation between the cancer surgeon and the plastic surgeon.

 

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 4 reviews

There is the option of oncoplastic surgery

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If you find the right set of doctors an option would be to incoporate a lumpectomy into a breast reduction pattern and then have radiation.  Sometimes the irradiated breast will shrink after the radiation so a touch up may be neccessary on the oppposite breast to make it match better. You need to have a plastic surgeon and breast surgeon who will work together on this to be sure the tumor can be resected through the reduction incisions.

Good luck,

Dr T

Scott Tucker, MD
Winston Salem Plastic Surgeon
5.0 out of 5 stars 5 reviews

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For a large breast, you have great options for breast ca

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You can't make a new breast from the breast on your other side.

option 1: lumpectomy and reduction: You can, however, get a lumpectomy on the cancer side, and have the plastic surgeon lift that side and reduce and lift the opposite side at the same time, essentially giving you the lift and reduction you want. The only downsides are 1)You will still need radiation on the cancer side and 2)Surgical margins must be cleared at the time of the lumpectomy to make sure the plastic surgeon doesn't "rearrange" potentially cancerous breast tissue when the oncological or general surgeon is done.

option 2: mastectomy w vert scar: If you are considering mastectomy, my strong opinion is that you have the incision placed vertically and not horizontally. In today's world where we know skin sparing is safe, there is never a reason to have a long horizontal mastectomy scar, except to reflect that your gen surg or ps can't think outside the box. The scar should look like a breast lift scar NEVER like a mastectomy. Your opposite breast can be reduced to match, same scar.

Lisa B. Cassileth, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 6 reviews

Large breasts and skin sparing mastectomy

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A skin sparing mastectomy is often not the best choice in a large breast because the skin often hangs.  Of course, an exam is critical to determine what the best options are.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

Skin-sparing mastectomy can leave too much skin if breasts are large

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Thamk you for your question. If you have large pendulous breasts, then I do not recommend a skin sparing technique for breast reconstruction. You will have too much skin left over and it won't look good. A skin reduction pattern through an inverted-T technique can be a good option because it is the same scar pattern as a breast reduction. If you get a breast reduction on the opposite side, then the scar pattern will match on the left and the right sides.  See your surgeon to discuss the specific details. I hope this helps.  Best of Luck.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 32 reviews

Skin sparing mastectomy does it work with a large breast?

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You definitely can have a mastectomy with a transverse scar, sparing enough skin to give you an adequate shape and size breast. Then the other breast is reduced, usually at the second stage to give you a symmetric results. The tissue from your abdomen can definitely be used even though you have stretch marks because the breast skin will cover the tissue from the abdomen and there will not be any stretch marks showing.if you are not a candidate for the abdominal tissue and expader ADM reconstruction could be done with good results. See my web site betterplasticsurgery.com under photo gallery, breast reconstruction for pictures.

Farhad Rafizadeh, MD
Morristown Plastic Surgeon
5.0 out of 5 stars 19 reviews

Breast reconstruction

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All options are on the table!

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+

Robert Whitfield, MD, FACS
Austin Plastic Surgeon
5.0 out of 5 stars 7 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.