Best Breast Reconstruction Procedure After PBM (Prophylactic Bilateral Mastectomy)?

One step PBM (Prophylactic Bilateral Mastectomy)? I recently tested BRCA1+ (Breast Cancer 1). How does a Dr know what type of Reconstruction is best for the patient? How do I find a Dr who will preform the one step procedure? Is it possible to go from an A to a B or C with this type of procedure?

Doctor Answers 4

Options for breast reconstruction

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There are two major categories for breast reconstruction: 1) Implant-based reconstruction, and 2) autologous (own tissue) reconstruction.  You decision should be based on 1)your social need (can you take 3-6 weeks off from your work for autologous reconstruction), 2)cancer staging (need for radiation), 3) your preference.  Some people like the "look of implants" whereas others want to look more natural.  With implants, you can go from size A to C.  If you decide on autologous reconstruction, you can go from size A to C if you have enough tissue on your tummy or buttocks. You should discuss all breast reconstructive options with your plastic surgeons as there are many variables to consider.  Find a plastic surgeon who is board certified by American Board of Plastic Surgery who is very familiar with breast reconstruction.  

Many options to restore breast after mastectomy

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You have many options to restore yourself after prophylactic mastectomy given your recent BRCA diagnosis. And the good news is that all aspects of your reconstruction will be covered by your insurance.

The two major categories for breast reconstruction are 1) implant-based and 2) autologous (using your own tissue). With proper patient selection, we obtain outstanding results with both modalities. However, reconstruction is a process that requires some steps to achieve the best results.

Options will include Saline/Silicone Gel implants, Autologous reconstruction with DIEP or SIEA or TRAM flaps, etc. There are pro's and con's to each option. No single reconstruction is the best for everyone.

We often visit with out of town patients to help them with their reconstructive journey.

Best wishes.

A DIEP flap may be a good option

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First, I want to recognize that you have gone through a lot to decide on this surgery, so I recognize the importance of having your breasts restored to as natural as possible.

The best reconstructions are by far those that use your own tissue, generally the stomach or back fat. You have to have the excess tisuue to begin with, so if you've had children the abdomen may be a good source of extra skin and fat.

Taking the stomach tissue is best done using the DIEP flap, which spares disturbing the abdominal muscles and makes recovery and future problems much less common.

If you do not have enough of your own tissue, an implant or expander may be needed.

You will likely have a skin-sparing masetctomy and no other therapy, so immediate reconstruction usng whatever technique should be possible.

You and your doc will need to explore all the options in detail. Best wishes and keep us posted.

John LoMonaco, MD, FACS
Houston Plastic Surgeon
5.0 out of 5 stars 276 reviews

Breast reconstruction options

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There are many options for breast reconstruction including tissue exapnders and implants, latissimus flaps with implants, fat grafting for small contour problems, TRAM flaps, DIEP flaps, SGAP, and IGAP flaps to name a few. You require an exam first to figrue out what is best for you..

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.