Expert: Minas T Chrysopoulo, MD - 12/22/2008

Question
Due to four generations of breast cancer, I will be having a prophylactic bilateral mastectomy (skin sparing). My husband and I would like to have a baby as soon as possible after the mastectomy. I currently have implants but understand that although my skin is already stretched, I still may need tissue expanders in order to prevent compromising the skin.  We're on somewhat of a time crunch to have the baby because of my age (42 years). Would you recommend immediate reconstruction or delayed reconstruction after the baby?

Answer
Kristine,

Immediate breast reconstruction almost always provides a far superior cosmetic result compared to delayed reconstruction, especially if you're having a skin-sparing mastectomy. I would definitely recommend immediate breast reconstruction whenever possible.

You may even want to consider a nipple-sparing mastectomy where the nipples and areolae are preserved as well as all the breast skin.... the surgeon literally just removes the contents of the breast through an incision and the reconstruction literally provides "new stuffing". Sorry if that sounds a bit crude but it really is that simple. You will still have to monitor your breasts closely as it is possible to develop breast cancer under the nipples in the future. Though this is only a very small risk, it is still important for you to consider.

You do have several options for reconstruction - make sure you research all of them thoroughly so that you pick what's best for you.

For more info about breast reconstruction options see here:
http://www.prma-enhance.com/index.cfm/PageID/1571

If you want to stick with breast implants in terms of the method of reconstruction, then you may or may not need tissue expanders. I cannot say without examining you. It is sometimes possible to merely replace existing implants with larger ones at the same time as the mastectomy and skip the whole tissue expander process.
More info here:
http://www.prma-enhance.com/index.cfm/PageID/1758

The most cutting edge procedures available today use the patient's own tissue (like the tummy) to reconstruct a "natural", soft breast. Unlike older procedures like the TRAM flap, this "DIEP flap" leaves all the patient's abdominal muscle in place. Recovery is easier, risk of abdominal bulge and hernia are much less, and the patient maintains her abdominal muscle strength long-term.
More info here:
http://www.prma-enhance.com/index.cfm/PageID/1754

Hope that helps.

Dr Chrysopoulo
PRMA Plastic Surgery
http://www.prma-Enhance.com
http://Breast-Cancer-Reconstruction.blogspot.com
http://DIEP-Flap-Breast-Reconstruction.com