In our previous blog, we discussed the various ways that the appearance of an abdominal tissue donor site can be improved following DIEP flap breast reconstruction.
In this blog, we’ll continue our discussion of breast reconstruction aesthetics with the topic of nipple preservation in the context of prophylactic mastectomy.
Some members of the population carry genetically inherited mutations that put them at greater than normal risk for developing breast cancer in their lifetime, the most common of which are BRCA1 and BRCA2. Once an individual becomes aware of this genetic status, they may opt to undergo a prophylactic mastectomy (PM). PM is defined as the preventative removal of one or both breasts to significantly lower or eradicate the likelihood of developing breast cancer.
One of the ways that we can improve the final result of mastectomy and reconstruction is to preserve the nipple(s). While nipple-areolar reconstruction and nipple tattooing are both options, the aesthetics can be challenging to recreate accurately and thus preserving the original form is ideal when possible.
For patients with sagging or uneven breasts, whether as a result of breastfeeding, weight changes, or the natural aging process, a breast lift in conjunction with a mastectomy/reconstruction can be key to creating a well-positioned final result. This procedure can lift the breast to a more proportionate, youthful position, and can also move the nipple higher on the breast or correct downward-facing nipples.
It is important for patients to understand however that these procedures cannot be done in unison, and as a result a significant amount of staging needs to be done. The reason for this relates to the blood flow of the nipple. A mastectomy alone already challenges the blood flow to the nipple; to then perform a breast lift at the same time would only cause further insult and as a result necrosis/loss of the nipple.
Instead, planning a breast lift for 6-9 months prior to the mastectomy allows your surgeon to ensure that blood flow is intact and the nipple can then be preserved during the mastectomy.
If a prophylactic mastectomy is something you’re considering, the sooner you can meet with a plastic surgeon to discuss your reconstruction options, the better. We recommend booking a consultation up to two years in advance to allow plenty of time for planning the stages of your surgery.
Following a mastectomy, you will have several different options for reconstructing your breasts to a more familiar form. Implant-based reconstruction replaces the volume of the breast with the same types of implants used for breast augmentations. Implants can sometimes be placed at the same time as a mastectomy (direct-to-implant reconstruction), or a tissue expander may be used for several months in advance to stretch the tissue and allow for the creation of a breast mound. Alternatively, autologous reconstruction uses your own tissue taken from another area of the body to reconstruct the breasts. Common autologous techniques include DIEP flaps and TRAM flaps, and you can read more about those options here.
Our surgeons Dr. Somogyi and Dr. Jalil have extensive breast reconstruction experience and would be happy to walk you through the decisions to be made—don’t hesitate to book a consultation.
