Posted February 26, 2021 in Dr. Aldona Spiegel, Reconstruction
When Considering a Preventive Mastectomy
My personal approach for breast reconstruction after risk reduction mastectomy is primarily to educate the patient as to the best estimate of their risk, the ramifications of the reconstructive options, as well as exploring their personal psychological viewpoint on this choice. Most patients have fears and anxieties that need to be discussed to help them make the best choice that is tailored to them. One particularly important area of discussion, is the need for long-term surveillance. For some patients, preserving their natural breast, especially when sensation is considered, is more important that the anxiety that they may have prior to their annual radiology testing. Other patients find this anxiety difficult to deal with, and make a determined decision to proceed with the prophylactic mastectomy.
Another important consideration, specifically when autologous abdominally based breast reconstruction is chosen, is to inform and discuss with the patient that this is a once only possibility. Knowing this information, particularly with recovery process not being much more if bilateral reconstruction is performed, patients can really make a good decision as to what fits them best. In cases of prophylactic mastectomy for genetic reasons, this decision is usually a difficult one, since these are often young women where aesthetic considerations play a major role. Having the nipple mastectomy option through an inframammary incision gives a very natural breast reconstruction option and makes this decision much easier.
