Evolution: Breast Reconstruction After Mastectomy

“Women who want breast reconstruction after mastectomy have several options with respect to timing, type of procedure, and materials used. Here, plastic surgeon M. Whitten Wise, MD, reviews the options and discusses considerations relevant to each procedure.

“Breast cancer remains a key women’s health issue. When presented with the diagnosis of breast cancer women face the choice of lumpectomy (usually accompanied by breast radiation) versus mastectomy. And while lumpectomy rates remain high, mastectomy numbers are climbing. This is driven in part by several distinct subsets of women: those seeking to avoid radiation therapy, those looking to reduce their risk for disease recurrence, and by a dramatic increase in women seeking prophylactic mastectomy.

“Prophylactic mastectomy may be performed in the contralateral breast or prophylactically in both breasts to help prevent the development of breast cancer (especially among those patients with one of the genetic mutations predisposing women to breast cancer, such as the BRCA gene mutations).

“The majority of patients choosing mastectomy are candidates for immediate reconstruction at the time of mastectomy. This allows them to avoid additional surgeries and recovery times. It provides significant psychological benefits by allowing women to feel ‘whole,’ with reduced incidences of depression, anxiety and low self-esteem. Importantly, immediate surgery improves the aesthetic result of the reconstruction by preserving the breast skin envelope to reduce the extent of scarring and to maintain the natural breast shape. This allows the breast reconstruction to replace only the missing breast tissue under the preserved breast skin.”