If you have just received the bad news that you need to have a mastectomy, you will have had an overload of treatment information – mastectomy, sentinel node biopsy, chemotherapy, radiotherapy. It’s difficult then to have yet another consultation about breast reconstruction but since one of the options is to have a breast reconstruction at the same time as mastectomy it is best to have this consultation early.
The options after mastectomy are:
- no reconstruction – no external prosthesis
- no reconstruction – external prosthesis
- reconstruction at the time of mastectomy
- delayed reconstruction
If you have large breasts and don’t want reconstruction, you may want to consider reduction of the remaining breast to allow a smaller, more comfortable external prosthesis.
Depending on the method, breast reconstruction adds a moderate-to-large amount of extra surgery. The plastic surgery consultation is certainly not to apply pressure to have a breast reconstruction but to advise you what is possible and what method and timing is the best for you.
Since the nipple always has to be re-sited higher up, all breast reductions methods result in a scar right around the areola and a scar vertically down from there to the inframammary fold (groove beneath the breast). Usually there is also a curved transverse scar running the length of the inframammary fold. There are “vertical scar” techniques which seek to avoid this transverse scar and this is sometimes appropriate.
Loss of nipple sensation is not uncommon. Numbness of some skin beneath the nipple is usual.
You may not be able to breastfeed should you have a pregnancy after breast reduction.
The nipple has to move up and retain its blood supply. it is possible for this blood supply to be inadequate and to lose part or all of a nipple but this is an exceedingly rare complication.
Symmetry should be very good but may not be perfect.
out of town?
Ideally a consultation should be face to face but is certainly possible to arrange a telephone consultation. If you can email the photos first so much the better. If it is clear what procedure is required then the in-person consultation can be the day before or the morning of the surgery.