Do I Need Spacers if I Don't Have Cancer or Will Not Receive Radiation?

I have a strong family gene of breast cancer. Im probably going to have a double mastectomy before I get the cancer. I would like to have everything done at one time, the removal and the reconstruction at the same time what are my options?

Doctor Answers 4

Not all implant reconstructions require expanders...

As several other plastic surgeons have suggested, there are a variety of options available to an individual undergoing bilateral prophylactic mastectomies who desires immediate breast reconstruction.  When you go to your PS, the consult will consist of a review of what options are most suitable for your body (i.e. do you have enough tissue on your abdomen to provide suitable volume for bilateral breast reconstruction? are you a better candidate for implant-based reconstruction?).  Additionally, some women who undergo reconstruction with implants are able to avoid expanders and go directly to placement of permanent implants at the time of their mastectomy.  Your PS should be able to look at your breasts to help determine what your specific options are.  Further, in prophylactic mastectomies, some women are candidates for nipple preserving mastectomies or areola-preserving mastectomies, and these options should be discussed, as well.  Make sure you are evaluated by a PS who does a significant volume of breast reconstruction so that these options can be available to you, if you are a candidate for them.  Best of luck to you....


Birmingham Plastic Surgeon
4.8 out of 5 stars 29 reviews

Immediate breast reconstruction for BRCA 1/2 gene mutation patients

anna41811: Given that you have a genetic disposition towards developing breast cancer but have not yet developed it, you are taking a courageous, proactive stance in accepting a double mastectomy and immediate reconstruction.  There are two major reconstructive options: a) autologous (using your own tissue) or b) alloplastic (using expander/implants).  Consult with a BC/PS to find out the risks, benefits and be aware of your health status as well as aesthetic goals. If your surgical oncologist is prepared to offer you a skin sparing, nipple sparing approach, you could theoretically have a permanent implant placed and avoid the spacers, which are generally used for patients who may need chemo and radiation.  Good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Breast reconstruction

There are many options for breast reconstruction. Autologous tissue( using your own tissue) is one option with many choices including free flaps(DIEP, Free TRAM) and pedicled flaps (TRAM, LD).  Non-autologous reconstruction includes tissue expander to implant reconstruction or direct to implant reconstructions.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews


The reconstruction would depend on the type of mastectomy your breast surgeon wants to do.

You need to consult a plastic surgeon who can communicate with the breast surgeon to see what mastectomy is being done and the plastic surgeon then can give you all the options in breast reconstruction

1: Reconstruction with implants

2: Reconstruction with TRAM flap or

3: Reconstruction with Latismuss dorsi flap with or without implants

4: Free Flap reconstruction

You need to understand the risks and the pros and cons of each procedure and decide which type of breast reconstruction you prefer and fits your lifestyle

Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 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.