If I have the BRCA gene what are the best options or plan of attack for mastectomy and reconstruction?

I'm 35, with a family history of breast cancer.. (mom, stage 4 at age 42, paternal grandmother, maternal aunt). I'm in the process of getting tested for the BRCA1 and BRCA2 gene. I've already decided if I do have the gene I will have a double mastectomy. My problem is insurance. I have medi cal in Ca, right now. and I'm not sure they will cover the mastectomy and reconstruction.

Doctor Answers 6

BRCA gene and mastectomy

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If you have the BRCA gene mutation, whether 1 or 2,  you have an increased risk of breast cancer. The specific type of mutation is very important, as this will determine your exact risk level, which is usually in the 40-80% range depending on your family's specific mutation. Everyone from plastic surgeons to oncologists generally agree that bilateral prophylactic mastectomy dramatically decreases your risk of getting cancer. There is still some debate about when to perform the surgery; most oncologists and geneticists recommend around 35 although I have patients in their 20's routinely. I completely support the operation, as the outcome is generally better and the course of treatment easier for patient undergoing prophylactic mastectomy than patients treating a breast cancer at the same time, who often get chemotherapy, radiation, and potentially must undergo a more aggressive surgery with lymph node dissection. If you are in Southern California and have Medi Cal, the City of Hope is highly reputable and will assist you in coverage by insurance if you test positive. Last I checked, they weren't doing direct to implant reconstructions, but they do perform nipple sparing which has the best cosmetic outcomes.

Beverly Hills Plastic Surgeon
4.7 out of 5 stars 16 reviews

Best Reconstructive Plan For Woman with Strong Family History for Breast CA and BRCA gene

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Without the benefit of an exam, this is the sequence that I would proceed with:

1.A well documented Family History and personal history ( breast cancer incidence, history of biopsies etc)

2.Your surgeon will then forward the above information to your insurance to ensure coverage

3.After coverage:  Bilateral Skin/Nipple Sparring Mastectomies, with immediate Bilateral Reconstruction with High Tension Gel  Sub-pectoral Implants

4.Above nice way to go because: no expansion needed, overnight stay only, no need to sacrifice your nipple areola complexes and  much faster recovery.

Joseph Rucker, MD, FACS
Eau Claire Plastic Surgeon
4.7 out of 5 stars 21 reviews

You will be able to get taken care of if you are BRCA positive!

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There are many options.  Please consider your won tissue at such a young age.  Devices are excellent choices but alwaysPlease find an experienced Board Certified Plastic Surgeon and member of the Aesthetic Society using the Smart Beauty Guide. These Plastic Surgeons can guide you on all aspects of facial surgery, breast augmentation and body procedures including tummy tucks or mommy makeovers!remember that they come with maintenance.

Reconstruction following prophylactic mastectomy for BRCA gene

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Surgeons today generally  leave thicker flaps and save the nipple. In fact following the mastectomy patients. have the same amount of tissue as some patients seeking augmentation.
We are therefore able to treat a prophylactic patient very similarly.

My choice is to use an adjustable saline implant placed above the muscle.
The implant is placed under filled thereby avoiding pressure on the skin flaps
Once healing is assured the implant is further filled.
.The injection port is removed several months later.

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

BRCA and reconstruction

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If you are BRCA positive, you need to consult with a breast surgeon, plastic surgeon, and gynecologic surgeon as well. Breast reconstruction should be covered under this circumstance.

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

BRCA mutation

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Given the increased risk of breast and ovarian cancer, I would recommend consultation with a plastic surgeon, oncologic surgeon and GYN.
In one surgery you should have bilateral nipple sparing mastectomies (if you are a candidate based on the appearance of your breasts) and immediate reconstruction with expanders and/or implants or DIEP flaps if you are a candidate.
In the same anesthetic, you should have bilateral oopherectomy to remove the ovaries.
Good luck.

Gil Kryger, MD
Thousand Oaks Plastic Surgeon
4.6 out of 5 stars 10 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.