Any new creative options to be aware of for breast reconstruction?

Question

I am in the consultation stage of getting a prophylactic mastectomy with reconstruction, following a diagnosis last year of BRCA2 mutation. I am wondering if there are any new techniques or options to be aware of.

Alan Gonzalez, MD, FACS · Answer

Hello @oreogirl, thank you for your question. Since every case is different and multiple factors must be taken into consideration in order to plan a successful surgery, you can consult in a personalized way. There are some techniques that allow reconstruction based on a plan adapted to the recovery process. Best wishes! Alan Gonzalez MD, FACS.

Ryan Rebowe, MD · Answer

Many women considering a prophylactic mastectomy would benefit from a nipple sparing procedure in order to achieve the best postoperative cosmetic outcome. However, many women who are of the age to consider mastectomy have too much ptosis (breast drooping) to be considered for this procedure as lower nipples are predisposed to postoperative ischemia (death from lack of blood supply). However, if there is no current diagnosis of cancer then you may be a candidate for a staged procedure in which you initially receive a breast lift (mastopexy) to raise your nipples followed by a nipple sparing reconstruction. This increases the chances that the nipples will live following the mastectomy and can also improve the cosmetic outcome by improving the shape of the breast. Of course, consultation with your plastic surgeon will determine if you are a candidate for these staged procedures.

David Branch, MD · Answer

Yes, well I'm not sure how up to date you are but a lot has changed over the last 20 years. today's mastectomy and reconstruction is entirely different from that of your grandmother's generation. Primarily, loss of the nipple and areola is no longer necessary unless a tumor is invading this structure. A nipple-sparing technique with an incision only underneath is now standard of care unless the breast is very large or droopy. Otherwise a reduction or lift pattern can be used for the mastectomy and the nipple replaced as a graft. Lastly, safer implants and fat shifting have made the expectations for the "normal" appearing reconstruction actually a realistic result.

Gary M. Horndeski, MD · Answer

The technique I recommend is where the breasts are scanned pre-operatively and then a skin pattern called The Bellesoma Method is used for the mastectomy. This allows the incision to be hidden in the inframammary fold at the time of the reconstruction. It does not require the patch of skin or vertical scars. Depending on the nature of your surgeon, he may or may not be able to spare your nipple. With this technique, the nipple can be spared.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Neil Tanna, MD, FACS · Answer

There are absolutely new techniques to consider:a. nerve reconstructionb. hybid breast reconstructionc. robotic reconstructiond. robotic mastectomy

Lisa F. Schneider, MD · Answer

Good morning,

Breast reconstruction should always be creative since we have so many options available. We are able to take tissue from your abdomen, back or other areas of your body to create a natural, soft breast. A newer development is being able to attach the nerve from that tissue to the nerve in your chest to return sensation to your breast after mastectomy surgery.

I hope this helps!
Take care,
Dr. Schneider

M. Shuja Shafqat, MD · Answer

These are great questions! Breast reconstruction is highly individualized and dependent on your health conditions, size and shape of breasts, excess skin/fat in other areas of the body, and many other things. 
With regards to implant reconstruction, putting implants above the muscle is definitely the gold standard now. You can discuss going through a traditional 2 stage reconstruction versus going direct to implant as well depending on your breast size and shape. 
With regards to using your own tissue, using the abdominal tissue is still the gold standard but there are other areas such as the inner thighs and love handles that are also areas to use. 
You can also discuss nipple sparing mastectomy with your breast surgeon and plastic surgeon. 
Hope this helps!

Peter Andolina, DO · Answer

As far as I know the only options available are:1 stage direct to implant reconstruction2 stage implant reconstruction with tissue expanders placed first followed by implantspedicle flap reconstruction (ie TRAM, LD, etc)Free flap (ie DIEP)

Any new creative options to be aware of for breast reconstruction?

Answers (8)

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