Can I turn a mastectomy & hysterectomy into a mommy makeover? BRCA2+ (photo)

I'm BRCA2+ & 35 yo. I need to get breasts and ovaries removed as a precaution soon (I've been told before 40). I've had 2 caesarians, 1 gall bladder removal, and 1 bowel obstruction + diastasis recti. Can I make lemons out of lemonade and get my abs fixed during my ovary removal or breast reconstruction?

Doctor Answers 9

A Lot of Surgeries!

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Thank you for your question.
Of course, eventually you could have an #abdominoplasty and #breastimplants in a #mommymakeover to recreate the body you once had. However, a #mastectomy and #hysterectomy are both very invasive procedures and I would recommend waiting before pursuing more cosmetic procedures.  Surgeries take their toll on the body.  If you can wait, I would give yourself some time to recover before your mommy makeover.
Consult a #boardcertified plastic surgeon in person for more details.

Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Yes you can but.....

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You can have all you are requesting done, but maybe not in one surgery. I respectfully disagree with one of the answers about a TRAM flap. You do not have any fatty tissue, in your abdomen to rebuild your breasts. An Abdominoplasty with a reconstructive repair can be performed in conjunction with a robotic or laparoscopic oophorectomy ( ovaries removed). Depending on the method of reconstruction, it appears a single or two staged implant type reconstruction is best suited for you, will determine when to have the abdominal portion. Your surgeons may not wish to perform Mastectomy and reconstruction and the abdominal portion in one surgery. If you have two staged reconstruction, it is easier and arguably safer to perform the abdominal portion then!

Michael S. Beckenstein, MD
Birmingham Plastic Surgeon
4.9 out of 5 stars 21 reviews

You can make lemonade: reducing your cancer risk and a beautiful body are within your reach!

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First, I wish you the best in reducing your risk of breast cancer and ovarian cancer with preventive surgery.  Half the battle is won simply by identifying your risk, which you have. Second, the question is how to achieve a beautiful result safely and effectively...that is, to make the "lemonade".  
First, analysis: your photos demonstrate a bulge due to "rectus diastasis" which is separation and stretching of the 6-pack ab muscles - this stretching was caused by your prior two pregnancies. You otherwise appear to be slim and trim and the bulge is emphatically not excess fatty tissue. If you had enough abdominal fat then you'd be a candidate for breast reconstruction with DIEP flaps (a DIEP flap refers to the transfer of lower tummy tissue to rebuild, most commonly, the breast.)  The bad news is that you almost certainly don't have enough excess fat to rebuild both breasts to any significant cup size. Not only is the TRAM flap (which transfers the tummy tissue but sacrifices your 6-pack ab muscles entirely) an outdated procedure, but it is simply a bad idea as it would take away all core abdominal strength (i.e. no "boat pose in yoga, and even getting out of bed is challenging) and it would potentially worsen your bulge or even put you at risk for hernia. 
The good news is that your rectus diastasis is correctable by extending your C-section scar, performing a mini-tummy tuck and tightening your core muscles back to where they used to be.  You likely also have a small umbilical hernia (a small hole in the muscle layer where your belly button is), and this can be repaired during muscle tightening. This will give you a beautiful abdominal contour without the sacrifice of muscle strength. 
With regard to your breasts, I would likely recommend teardrop shaped implants placed above the pectoralis muscle and supported by acellular dermal matrix - this is a cutting edge breast reconstruction technique called "pre-pectoral implant reconstruction" that is gaining popularity. If you want your own tissue for reconstruction then you'd likely be a candidate for the love handle flap (which my colleagues and I developed at Johns Hopkins). The downside of love handle flaps is that it would have to be done separate from your abdominal work, whereas breast implants can be placed at the time of your mastectomy and abdominal work, thus saving you a surgery and recovery.  All in all, with the right surgeon on your side you can achieve beautiful results.
All my best in your search!- Dr. Rad

Ariel N. Rad, MD, PhD
Washington DC Plastic Surgeon
5.0 out of 5 stars 57 reviews

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Mommy make-over with BRCA2 prophylactic mastectomy and ovariectomy?

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Thank you for asking about your BRCA2 surgery and a mommy make-over.
  • This is an excellent question and the answer is quite complex.
  • I am sorry you have to go through this but glad we live at a time where enough is know so you are protected from these cancers.
  • You clearly will benefit from a tummy tuck. But to do it at the time of the other procedures, depends on what kind of breast reconstruction you choose - expander/implants, muscle flap, free flap.
  • There are pros and cons to each - a muscle flap gives a prettier result but if taken from the abdomen, the abdomen in weakened.
  • With an expander implant, you can have a standard tummy tuck - if the other surgeons approve in advance.
  • I suggest you ask your BRCA2 surgeons, consult one or more plastic surgeons about your reconstruction and be guided by your surgeons and by what reconstruction you feel is best for you.
Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Removal of Ovaries and Breasts, and Lemonade

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Hi gpisces.I wish you all the best with your upcoming surgery and prognosis.In answer to your question, YES, you can make lemonade.You should see a board certified plastic surgeon with experience and a passion for immediate breast reconstruction.  Arguably, the best reconstruction would be a TRAM Flap, which uses the part of the tummy that is usually removed during a tummy tuck.  This would greatly benefit you as you have an umbilical hernia, and possibly another hernia vs. Diastasis recti.  Of course there are other types of reconstruction and this needs to be a decision between you and your doctor.
Best of luck to you.

Can you get your mommy makeover done via BRCA reconstruction

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In a word, yes, but not easily. It will depend on how large you want your final breast result. Doing a bilateral free flap transfer from your abdomen to your breasts can be done, but likely only at a major university. When your stomach muscles are exposed, they can be repaired. Alternatively, Skin sparing/Nipple areolar sparing mastectomies with reconstructions can be done with implants and end up with excellent cosmetic results. An Abdominoplasty would likely be done at a later time, and could be done in coordination with a laparoscopically assisted oophorectomy. The repair of your obvious muscle diastasis would likely be covered, which helps toward the cost of the abdominopasty. Best of luck to you!

David Janssen, MD, FACS
Oshkosh Plastic Surgeon
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Can I turn a mastectomy & hysterectomy into a mommy makeover?

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Than you for your excellent question and for sharing your photographs.  Talk to all of your surgeons to ensure that they can all work together in your procedure but if you are an otherwise healthy individual and good candidate for surgery, you should be able to have an abdominoplasty performed at the same time as your mastectomy/hysterectomy procedures.  

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 80 reviews

Can I make the best of an unfortunate situation?

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Thanks for your question and photos. Typically people stage the Gyn and Breast surgery separately as it is a lot to undergo in a single stage, especially in the prophylactic setting. Theoretically doing a bilateral breast reconstruction using your abdomen would be as close as you could get to the 'mommy makeover' concept. However, based on the photos it appears your abdomen does not have enough tissue to make a bilateral breast of a meaningful size. Your case is complex, so be sure to have a consultation with a board certified plastic surgeon. Best.

Bryan Correa, MD
Houston Plastic Surgeon

Mommy makeover

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wow, that is a lot of surgery at one time. I think that you can do an abdominoplasty at the same time as the hysterectomy. Later if you did nipple sparing mastectomy you could end up with the result that looks like an augmentation as well. But I think you would be better served by dividing those two areas of operations. Is a lot to expect from anyone with that amount of recovery.Good luck! 

Mark T. Boschert, MD
Saint Louis Plastic Surgeon
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