Mastectomy or Lumpectomy and Breast Implants for ADH?

The decision of what type of surgery to perform to remove the breast cancer is best answered by a surgeon who specializes in removing breast cancer and has examined your breast, imaging studies, and pathology results.  Sometimes, internal rearrangement of breast tissue (oncoplastic surgery) can be performed following a lumpectomy.  If you undergo a mastectomy, then the plastic surgeon will reconstruct the breast.  Most of the time, this is done immediately following the mastectomy.  Before surgery, your plastic surgeon will discuss options and recommend a preferred technique to achieve an optimal result based on your individual situation.  If your team believes you are a candidate for a nipple sparing mastectomy, there should be enough skin to obviate the need for a latissimus dorsi flap.  The presence of breast implants will not adversely impact your breast reconstruction.  The current implants above the muscle may be removed and a tissue expander or permanent implant may be placed under the pectoralis major muscle supported by AlloDerm to have optimal implant coverage and inframammary fold support.  In some cases, it is possible to place the new implants immediately following the mastectomy, thus obviating the need for a second surgery in most cases.  

In my view, the Alloderm option is preferable for circumstances like yours, as it can give good long term results without the major recovery involved with the latissimus flap. Lumpectomy can leave a deformity so that has issues as well. Your own surgical team is in the best position to advise however.

AlloDerm is essentially cadaver skin minus any living cells.  It is used as a scaffold through which a persons living cells can grow into.  It has many uses, but, in use his in breast reconstruction.  AlloDerm does not help in mastectomy recovery.  It does however help in breast reconstruction. In this application, AlloDerm was used to cover the lower portion of an implant that spans from the lower border of the pectoralis muscle to the breast fold.  Because AlloDerm is a foreign substance in can always get infected and as such your doctor and you need to pay close attention to the signs and symptoms.  AlloDerm has also been used in nipple augmentation as well as augmentation of other body parts.  Its efficacy is really not known in these realms because it is not common.  Some providers may use AlloDerm for these applications but please note that its most widespread use is particularly in breast reconstruction as well as repair for abdominal wall hernias.  Please speak with a board certified plastic surgeon if you have any specific concerns regarding your care.

You should express your concerns with your physician. If you indeed have ADH and not a carcinoma you should discuss the options of lumpectomy with a surgical oncologist.  I have found that often the cosmetic result of lumpectomy is often very good.  Should you require radiation therapy then you should consider removing the implants and having Fat Grafting.

Hello Melinda,
You present a difficult question for anyone even a surgeon who can examine you. There are advantages to both your options here:
Expander/Alloderm - This is lesser surgery and does not involve operating your back.
Latissimus Dorsi Flap - This is more reliable and provides more tissue for reconstruction.
You could always opt for the lesser surgery and use the Lat flap to fix things if they did not work out properly. I hope you do well with your surgery.