Dr. Holmes works with plastic surgeons to plan the best choice of reconstruction for each woman. In most cases, breast reconstruction can be started, and often even completed, at the time of the mastectomy. This is known as an immediate reconstruction. In some cases, reconstruction must be deferred, an approach known as delayed reconstruction. The appropriate type and timing of reconstruction are an individual decision, based on the patient’s body size, the amount of preserved breast tissue, overall physical health, cancer stage, and desired breast size. Dr. Holmes and the plastic surgeon work together to create the best-individualized game plan.
Tissue flap reconstruction uses tissue, muscle and/or fat from other parts of the body to create a natural-looking and feeling breast. Various tissue flap reconstruction options exist. Some of the most common are:
Saline and silicone implant reconstruction are widely used today for women who do not desire tissue flap reconstruction. The implant is usually inserted behind the pectoralis major chest muscle, not directly under the skin. To create an adequate space behind the muscle for placement of the implant, the plastic surgeon might first insert a temporary, empty implant (called a tissue expander) that is injected with saline over several weeks until the overlying skin and muscle have been adequately expanded to accommodate a full-size saline or silicone implant. The need for a tissue expander and the time it takes to fill it is determined by the size of the final breast size desired by the patient. Some patient may undergo implant reconstruction at the time of mastectomy without the need of a tissue expander. This is called an immediate implant reconstruction.
Women with breast cancer may choose contralateral prophylactic mastectomy (CPM) or preventive removal of the unaffected breast to maintain breast symmetry, to eliminate the need for annual mammograms, or due to anxiety about the future risk of cancer in the opposite breast. You can calculate your personal risk of contralateral breast cancer (CBC) by visiting the following link: https://cbc-predictor-utd.shinyapps.io/CBCRisk. CPM is usually covered by insurance. A 20-year risk of CBC of 5% or less is considered LOW.