Impact of Prior Breast Reduction on Cancer-related Mastectomy with Immediate Reconstruction?

i am one of the few whose breast reduction pathology found DCIS-grade 3 comedo+necro ER+ HER+ in rt breast (no assessable margins). Considering options including mast. How would BR affect the options available to me (if i have mast, would prefer either tram or diep from what i'm reading). BR took about 3.5 lbs from each breast, healing going well. post BR diagnostic mammo found "somewhat" suspicious sporadic microcalifications (mri bx pending). Know i'm an unusual case; any comments/advice?

Doctor Answers 2

Breast Cancer in a breast reduction - where to go from here

Dear j_self

Sorry to hear of the findings, but in a way, very lucky that you had the breast reduction, so the DCIS was picked up.

Here in the UK, in East Grinstead, a large part of my practice is DIEP flap breast reconstruction, where I work closely with breast oncological surgeons.

I have done several immediate reconstructions after DCIS found in breast reduction specimens, and there are several approaches.

If deemed safe by the breast oncologist, a neat and aesthetic approach is to excise all the breast reduction scars (and nipple/areola) and "shell out" the breast, leaving an empty skin envelope. A DIEP flap can then be used to fill the breast skin, with the possibility of an immediate nipple reconstruction. The appearance in the long-term, is just as if you had had your breast reduction.

However, this is not always possible, as sometimes more skin needs to be removed. 

Please consult with a plastic surgeon who regularly performs DIEP flaps and who works closely with a breast oncological surgeon.

I wish you all the best


London Plastic Surgeon
5.0 out of 5 stars 47 reviews

Breast reconstruction after breast reduction

Thank you for your question.  You will have the best chance of getting a good result by working with a plastic surgeon who works hand in hand with the breast surgical oncologist.  Together they can tailor a plan for you.  Having a prior reduction can affect the plan but this can be managed.  I suggest having a consultation with a plastic surgeon to discuss all your reconstruction options and the pros and cons of each method.  For example, it seems you prefer reconstruction using your own tissue. I assume you have also considered implants but maybe you have not.  If you use your own tissue for reconstruction, there are many ways to do this surgery and you really need an in-depth physical examination and consultation.  This way you will know the pros and cons of each method as well as whether or not you a candidate for a particular procedure and  the expected post-operative recovery period.  You might also consider more than one consultation with at least 2 plastic surgeons.  Naturally, whoever you choose should routinely perform the type of surgery you are having, as opposed to occasionally.  You can find a plastic surgeon board certified by the American Board of Plastic Surgery through the American Society of Plastic Surgeons.  As I said above, look for someone who routinely works with the breast surgical oncologist.  This means they are a team and can work together in an optimized fashion to give you the best care and result.  Hope this helps.

Tracy Pfeifer, MD

Tracy Pfeifer, MD
Manhattan Plastic Surgeon
4.8 out of 5 stars 27 reviews

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