26 Year Old Wants Natural Looking Breasts After Mastectomy?
Doctor Answers 10
Natural appearing breasts following mastectomy.
Thanks for your question. Let me start by saying that I am really sorry for your present situation, its never fair when a person gets breast cancer but 26 is especially an unfair situation. To answer your question the most natural appearing breasts following mastectomy will always result from using your own tissue. I would suggest a DIEP flap for someone who is your age with a skin sparing mastectomy performed by the General Surgeon. This can result in an almost "scarless" reconstruction when done properly. A DIEP would also be better than a TRAM flap in your case due to your age and the lower associated loss of abdominal wall function.
Hope this helps.
Consider fat micro grafting for reconstruction
You may want to seriously consider fat micrografting for reconstruction of the breasts after mastectomy. It is a completely natural and 100% outpatient procedure without additional scarring and without implants, and the added benefit of liposuction for body contouring. My own wife has undergone this procedure. We perform this procedure in our federally certified ambulatory surgery center, and are able to work with your insurance company for coverage.
What is the Best Technique for Breast Reconstruction?
Each patient must be evaluated as an individual and therefore, the optimal technique for breast reconstruction will vary from patient to patient.
That being said, as a general notion, I favor autologous tissue breast reconstruction procedures where no breast implants are used, and it is the patient's own skin and fat that are fashioned into a warm, soft, natural breast.
These tissues are transplanted from the abdomen, buttocks, and inner thigh using microsurgery. They are known as perforator flaps. The DIEP flap is among the best know of these flap.
See nybreastreconstruction.com for more information on these and breast reconstruction techniques.
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Natural looking vs Natural feeling
There are a lot of factors, both from a general surgery standpoint and a plastic surgery standpoint, that will affect the reconstructive options available to you. Natural "looking" could simply mean the best looking reconstruction that you can obtain with what tissue and skin is leftover after mastectomy. An example is whether or not your nipples can be spared. Scars can sometimes be minimized or controlled, but discuss this with both the general and the plastic surgeon. Lastly natural "feeling" breasts can often be reconstructed with your own tissue, most commonly you lower abdomen (ie, TRAM flap, free TRAM, DIEP). These options usually mean a longer recovery but they will ultimately be your own tissue and thus feel much more like breasts. Be sure to find a plastic surgeon that is experienced in all these techniques so that they could provide you with an informed choice.
Usually the best breast reconstructions are often with autologous tissue if the donor sites are available. This is often obtained from the abodminal region but can be taken from the inner thigh or backside region.
Best Method of Breast Reconstruction
The "best" method of breast reconstruction depends on your starting anatomy (breast, chest, and available skin flap donor sites), individual preferences for implants vs. autogenous tissue, type and stage of your breast cancer, and the type of mastectomy performed. In general, as other responders have alluded to, the less breast skin taken with your mastectomy, the better the result. Dr. Suzanne Klimberg and colleagues from the University of Arkansas recently published a study confirming that for many women, nipple sparing mastectomy is the best choice. If you are in this category, my recommendation is to spare the nipple(s) and all breast skin, just take the breast gland with cancer or DCIS. This recommendation does not apply if your cancer is near or involves the nipple, is advanced, or if your oncologic surgeon doesn't believe nipple sparing is a wise choice. If your breast skin and nipple are successfully spared, you will look fine whether an implant or autogenous tissue is used for breast volume restoration. For simplicity and to leave the abdomen alone for pregnancies, provided you don't need radiation, implant reconstruction probably preferred in my opinion. If you don't plan children, have abundant donor tissue, and/or need radiation, TRAM flap may be preferred. Latissimus also a possibility, but may need implant also to achieve adequate size, depending on your build. The question is simple, the answer, not quite so simple.
Breast Reconstruction techniques to achieve natural appearing results
I would recommend that you first have a thorough discussion with your breast surgeon and oncologist as to your most appropriate treatment for cure and/or future risk reduction. In general, the more breast skin that can be preserved, the better the reconstruction that can be achieved. Skin-sparing mastectomy leaves the majority of the breast skin, while a nipple-sparing mastectomy goes one step further by preserving the entire breast skin and nipple/areola. In such cases, you can achieve an excellent reconstruction by having the mastectomy performed through the breast crease, as well as placing the implants through the same incision ( parvaplasticsurgery.com/gallery/nipple-sparing ). The final scar remains under the breast and not across the front of the breast. The breast can look very natural because you have essentially replaced the breast gland with an implant, while preserving the entire breast skin envelope. This assumes that your present breast position and size is good (ie you do not need a breast lift or reduction). Again, confirm with your breast surgeon and oncologist that you are a good candidate for nipple-sparing mastectomy and consult with a board certified plastic surgeon who is experienced and focused on breast reconstruction surgery. With my warm regards and best wishes for an excellent result and good health.
Behzad Parva, MD
Breast reconstruction technique in younger women
It's difficult to answer this question as there's a lot to consider. One issue is one-sided versus two mastectomies. With only one mastectomy, it is very difficult to get an identical match to the opposite breast. One breast is natural and the other is doctor-made. They will be similar but not the same.
Also, it depends on the size of your breasts now and what size you want to be after. For small to medium-size breasted women (A to C cup), immediate reconstruction with an implant and AlloDerm internal bra can give a very nice and aesthetically pleasing result. For large-breasted women (D cup and up) or for women with lots of sag and extra breast skin after childbirth, it is difficult to get a good result with all the extra skin present. Sometimes, skin reduction with the mastectomy is indicated. Immediate implant placement may be more problematic in this situation.
Also, it depends if the mastectomies are preventative or for cancer. Sometimes, the surgical oncologist will offer nipple-sparing mastectomies to women who are undergoing preventative mastectomies. Please be informed that leaving the nipple behind does leave some breast tissue behind which may have a risk for developing breast cancer. This is a discussion that you must have with your mastectomy surgeon and listen to your surgeon's advice on this one. Keeping your own nipples does help the result look more natural out of clothing but you must also ask yourself what risks you are willing to assume to keep you nipples.
It is okay to ask your plastic surgeon for before and after photographs.
The first priority is to have a consult with your breast surgeon, Plastic surgeon, and oncologist to see what is the
recommendation for treatment, ie the mastectomy? the need for chemotherapy and radiation therapy.
Then Your plastic surgeon , based on those informations, can discuss the options available for you.
Logicaly a skin sparing mastectomy, reconstruction with implant, or flaps and which type of flap.Implant reconstruction will require maintainance. Flaps add scars else where. then you can make a decision.
Best options for breast reconstruction in younger women
A few assumptions are necessary in order to answer your question: since you are young, I am guessing that you are BRCA positive and considering a bilateral prophylactic mastectomy. In that instance I would recommend as the top option to have a skin-sparing mastectomy and direct-to-implant immediate reconstruction with Alloderm to form an internal bra. In expert hands, that should produce natural-appearing results.
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