Expert: Minas T Chrysopoulo, MD - 9/21/2008

Question
I will have a right mastectomy for IDC on 10/3/08, with no immediate reconstruction.  If I should decide to have a DIEP procedure done later, does that affect the kind of mastectomy I should get now? I read that skin-sparing is preferred for a DIEP procedure, but can this be done without any immediate reconstruction?  If a tissue expander is inserted as a "place holder", then would I need surgery to remove the expander if I decide not to do the DIEP?  How long can an expander stay in place?  Thank you for any help you can provide.

Answer
Dear Nancie,

If you know at this point that you will be seeking breast reconstruction surgery down the road I would definitely recommend a skin-sparing mastectomy. Skin-sparing mastectomy generally allows for a much better cosmetic reconstruction result, regardless of the type of breast reconstruction you decide to have.

The term "skin-sparing" means that most of your breast skin is left behind (as much as possible). This literally provides the plastic surgeon with much more skin to work with at the time of the reconstruction.

The use of a tissue expander as a temporary "place holder" is a good idea in patients that cannot have immediate DIEP flap breast reconstruction (for whatever reason). The inflated tissue expander will hold the tissues out (away from the chest) and maintain the breast envelope shape until you can have the definitive reconstruction.

If you decide not to have a DIEP flap reconstruction then you will need more surgery to have the tissue expander removed whether you have another form of reconstruction or no reconstruction at all. While tissue expanders can stay in forever, they are not designed for that and tend to cause discomfort in most patients. Also, the typical tissue expander breast reconstruction is no where near as aesthetic as the final reconstruction you would have (permanent breast implant or your own tissue). For these reasons alone I think it is very unlikely that you'd want to keep it long-term.

If you don't mind me asking, why are you not a candidate for immediate breast reconstruction? Is that what has been recommended or is it by choice?

Dr Chrysopoulo
PRMA Plastic Surgery, San Antonio, Texas
http://www.prma-enhance.com/index.cfm/PageID/1754