Ask the Doctor: ‘How soon after a double mastectomy could I have reconstructive surgery?’

“I am a female in my 40s and have recently tested positive for the harmful BRCA gene, meaning my risk for breast cancer is high. This combined with the fact a number of my female relatives have suffered from breast cancer has made me decide to have a double mastectomy. I have children who I would do anything for and I feel like this decision will reduce the risk of me falling seriously ill or worse. How soon after the double mastectomy could I have reconstructive surgery? Also, I am worried about my breasts looking unnatural after this. I don’t want to look like I have had a ‘boob job’. I would just like to look like me but have the peace of mind that I have taken all the steps I can to protect myself and my family.”

Answer from Dr Carmen Torre, Consultant Plastic, Reconstructive & Aesthetic Surgeon, Beacon Hospital

Your concerns and doubts are absolutely normal as it’s an important decision to make, with pros and cons that need to be known and balanced with your oncological surgeon and your plastic and reconstructive surgeon. When you finally decide to opt for bilateral mastectomies, breast reconstruction should be the next step to consider, as it’s widely accepted that it has an important impact on female patients, improving their self-esteem, body image and quality of life in general.

It is not selfish or vanity, it’s more than justified. It is an important surgery, which means that you have to know and understand what it involves, as you’ll go through that whole process. In most cases, it can be done as immediate reconstruction (in the same operation), as other treatments such as chemotherapy or radiotherapy are not usually needed (unless there’s also a breast cancer risk already involved).

There are different types of breast reconstruction techniques, the two main groups being autologous reconstruction and implant-based reconstruction. Autologous reconstruction means using your own tissue (from a donor site) to make your new breasts. These sites commonly use free flaps from the abdomen (DIEPs), but can also use other donor sites too.

Not all patients are suitable for this surgery. It needs an adequate donor site, good vessels and a microsurgery team to reconnect the blood supply in the new position. It is worth mentioning that this option does mean that you will have some new scars in the donor site too. If everything goes as expected, you won’t require revision surgery (other than some adjustments or contralateral symmetrisation) in the future as your tissue will stay and change with you.

Implant-based reconstruction is the other main group widely used. In this case, an external device (breast implant) is used to reconstruct your breast, so it’s a shorter surgery initially and you won’t add scars to any other area of the body. But, as you have this external implant, you will need to be reviewed forever as implants can potentially have complications in the long term. You may also require revision surgery at some point in the future. The shape and volume can be very good and many patients have a normal life with breast implants.

There are also other options, and it’s key to consider and discuss all options with your reconstructive surgeon, as they need to be individualised according to your personal circumstances and desires.

In summary, there are different types of breast reconstruction so it’s important to be seen by a reputable plastic surgeon to decide what techniques would suit you best. Consider and discuss the pros and cons of each of the options, your expectations and characteristics to evaluate which one would be most suitable for you personally.

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