What are your thoughts on having a double mastectomy after finding out you are positive for the BRCA2 mutation?

I had a final reduction correction surgery just over a year ago before knowing any of this was possible. I'm 40 & my sister had breast cancer at 43. If you recommend the double mastectomy, how would you suggest having it done knowing I have a lot is scar tissue.

Doctor Answers 4

Bilateral mastectomy

There are two broad categories of breast reconstruction, implant based reconstruction and natural tissue based reconstruction.  Each type of surgery has advantages and disadvantages. Typically when I meet with a new patient to discuss breast reconstruction it takes about an hour to review all the options, so a complete description is beyond the scope of this post. In the case of a prophylactic mastectomy much of the decision about what reconstruction to have is based on your preference.

New York Plastic Surgeon
5.0 out of 5 stars 1 review

BRCA gene mutation

Thank you for sharing your story.  It's imperative that you seek consultation with a breast surgical oncologist (if you already have not) and a geneticist to explain your risks of developing breast and/or ovarian cancer.  The majority of patients seeking prophylactic bilateral mastectomies are patient with genetic mutations such as BRCA 1/2 or other genes that cause breast cancer.  Nipple sparing mastectomy is something that you need to discuss with breast surgeon.  With respect to your reconstruction options, implant or natural tissue reconstruction are both options.  These surgeries should be done simulatneously in one operation. In general patients that use their own tissue for reconstruction have higher statisfaction rates with their reconstructed breasts.  

Ali Sadeghi, MD, FACS
New Orleans Plastic Surgeon
4.8 out of 5 stars 20 reviews

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.

BRCA gen

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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