Best Option for 60 Yr. Old After Bilateral Mascetomy?

I am in good health other than the cancer and will not require post surgicial radiation or chemo. I am over weight at 140 pounds and am 5'3" tall. I am so incredibily overwhelmed by having to make this choice. I know that I want immediate reconstruction. Any advice would be appreciated. Thank you

Doctor Answers 7

Breast reconstruction options

I am sorry to hear of your situation but glad you are considering reconstruction.  As mentioned, there are many options and if you have not yet had your surgery, implant and expanders are easiest since it can be easily done at the same time as your mastectomy and the resultant symmetry is predictable since you are doing both sides.  And you haven't burned any bridges if you decide you would rather use an autogenous technique (your own tissue - often your tummy) later.  Autogenous reconstruction at the same time as your mastectomy is difficult to do due to the need to coordinate the procedures and the time it takes to do the procedure.  Your plastic surgeon should be able to help you navigate the reconstruction maze.  Best wishes to achieving the result you expect.

Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Bilateral Mastectomy after 60 #breastreconstruction

Well, this is a tough one that I go over time and time again in a one hour consult with my breast cancer patients. I think it is great that you are exploring your options in this venue. This is such a tough choice for all women so know you are not the only one. What you do to reconstruct your breasts is such a fine tuned decision between you and your team of surgeons and treating doctors. I am so happy to hear that you will not need radiation because that can really make things tough. Realize that can change once your final pathology report is back, but it is rare. If you are a non-smoker, non-diabetic then you are worlds ahead of most. Being overweight does put you at risk for some things.  If you have time, start losing weight now, but really make sure your nutrition is strong for what you are about to embark upon. This can be a very trying process. In my consults I try to obtain a clear picture of my patients goals. I try to listen to them about their lifestyle and how much surgery they think they can handle. Breasts are typically reconstructed with your own tissue, Autologous, or with implant based reconstruction. This forum is way to short to be able to write down the pros and cons of each. That is to be done by your board certified Plastic Surgeon. I would seek out several opinions and in the end choose the one you feel will not only technically get the job done, but one who will support your emotionally. I have patients crying to me all the time because it is not easy. There can be peaks and valleys all along the way. I think that most of my patients at the end of the process are happy that they did it. Best of luck, stay strong, this can take as long as one year to complete. 

Richard J. Brown, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 49 reviews

You have time to think!

You still have time to think.  There are advantages and disadvantages to immediate reconstruction.  Both your cancer surgeon and your plastic surgeon will help you decide which is best for you.  Not all patients are good candidates for immediate reconstruction.  Most bilateral breast reconstructions are done with tissue expanders and implants.  Most breast reconstructions have multiple steps, often taking over a year to complete.  Your doctors will help get you through it.  Good luck.      

Michael Novia, MD (retired)
Olympia Plastic Surgeon
4.7 out of 5 stars 13 reviews

Breast reconstruction after mastectomy

There are many options for breast reconstruction after mastectomy.  You can go the autologous tissue route( using tissue from your abdomen, hip, buttock, or back).  Or you can  use a tissue expander and then implant. An exam and discussion in person is the best solution.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast reconstruction

My advice is to think about what would make you happy. One way or another the cancer is going to be treated, but what you are left with is determined by the treatment plan. It is a good thing that you will not need radiation therapy although that can change in rare situations where the final pathology is not what is expected pre-operatively. Ask yourself what size and shape would be ideal. That might eliminate or help prioritize certain techniques. Ask if you are accepting of implants. if so, then implant reconstruction is usually the easiest. Doing bilateral autogenous tissue reconstruction is a quantum leap more effort, time-intensive, and risky than using implants. I always say that if you can be happy with what implants can safely produce, especially when you do not need radiation, then go with the implants. If you cannot tolerate the idea of implants, or they are not safe for some reason, and you are anatomically and physiologically a candidate for autogenous tissue reconstruction, then the latter might be a "better' choice.

Robin T.W. Yuan, M.D. 

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

Using your own tissue versus implants for breast reconstruction

Thank you for your question.

There are a myriad of determining factors that go into this decision including your goals, lifestyle and ability to have down time. Also, it depends on if you have enough of your own tissue to reconstruct an adequate breast mound. There are many, many factors.

I see new patients for reconstruction all the time and the consults are often 45 minutes to an hour. It is best to have a sit down face-to-face consultation two or more board-certified plastic surgeons for a full and complete evaluation to make sure you are a good candidate and that it is safe for you to have the surgery that you would like.This forum is no substitute for that.

I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 182 reviews

Breast Reconstruction Options

It is very difficult to answer your question without knowledge of your breast cancer history and of course a physicial exam. I'm glad to hear you will not require radiation therapy.

For a generic introduction, there are two major categories for breast cancer reconstruction:
(1) implant-based and
(2) using your own tissue (autologous).
There are pro’s and con’s to each reconstructive modality. No one reconstruction is the best. Both implants-based and tissue-only autologous reconstruction can provide outstanding results. It is important to tailor a reconstructive plan that meets the goal of each individual patient and also respects the breast cancer treatment plan.

In terms of autologous (tissue reconstruction), my preference is to look to the excess skin and fat in your abdomen (tissue normally thrown away in a tummy tuck) as a donor site for breast reconstruction - through procedures such as a DIEP or muscle sparing TRAM flap.  Please visit with a board certified plastic surgeon to learn more about your options
I hope this helps.

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 209 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.