What are your thoughts on having a double mastectomy after finding out you are positive for the BRCA2 mutation?
Doctor Answers 5
BRCA gene mutation
Double mastectomy , BRCA2 after reduction surgery
Finding out you have the BRCA mutation, with a sister who already was diagnosed with breast cancer must be difficult. Also the decision to undergo a mastectomy, never mind a double mastectomy can not an easy one.however in discussing with your breast surgeon, you will find out that there is definitely a role for prophylactic mastectomy to reduce your chances of developing breast cancer.
as a prophylactic mastectomy then you are certainly a candidate for nipple and skin sparing mastectomy, especially having already undergone a breast reduction procedure. your skin envelope is smaller and the nipple has be brought up to the ideal location. despite having had a reduction you can still undergo a nipple paring mastectomy.
the most common procedure in your case would be to use implants rather than a flap. keep the flap option as a 'plan B' in case there are complications with the implant route.
in my practice our go to method is a 'direct to implant' approach , placing the implant in the prepectoral (in front of the muscle) space with Alloderm reinforcement.
you will need a terrific breast surgeon to work closely with your plastic surgeon to try and keep the skin flaps on the thicker side to minimize complications and get the best aesthetic result.
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Nipple sparing mastectomy after breast reduction
For some people with the BRCA 2 mutation, they prefer to have a prophylactic mastectomy rather than undergo more intensive screening or live with the anxiety that you have a higher risk of breast cancer. But the chance of realizing this risk is less than with the BRCA 1 type and actually drops as you live longer and longer without cancer. Antihormonal therapy is also thought to be helpful to reduce risk that some women choose. Surveillance against ovarian cancer and other cancers is recommended as well - so make sure your doctor or genetic counsellor has discussed the screening plan best for you. If you do decide to proceed with mastectomies, it is incredibly important to pick a oncologic breast surgeon who is comfortable operating on a breast reduction and can confidently spare your nipples. It IS possible in most cases to save nipple/areolas even with existing scar tissue present. Ask your plastic surgeon what breast surgeon in your area has the lowest flap necrosis rates and nipple death rates so that your plastic surgeon will be in the best position to have healthy tissue to work with for your reconstruction and you will have the most beautiful outcome.
If you are gene positive, I absolutely recommend you consider bilateral prophylactic mastectomy! Your prior breast reduction does present some challenges but experienced breast surgeons should have no problem removing your breast tissue and successfully preserving your skin flaps. Some surgeons remove the nipples on all patients who have had prior breast reduction surgery because the nipples have already lost some blood supply and the risk of necrosis is increased. However I have had great success preserving nipples in these situations and I urge you to seek multiple opinions discussing this option. I generally recycle one of your prior incisions for the mastectomy. Implants or your own tissue (DIEP or latissmus flaps) should have equal excellent results. Good luck and take care.
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