Preventive Mastectomy and Breast Reconstruction Surgery

Preventive mastectomy is an effective way to reduce breast cancer risk. Breasts are important to many women’s body image, however, and removing them can be a blow to self-confidence. Centers for Neurosurgery, Spine & Orthopedics (CNSO) offers breast reduction and breast reconstruction surgery to restore patients’ natural appearance at locations near you in northern New Jersey. Led by the award-winning surgeon, Dr. Hakan Kutlu, CNSO delivers a high level of care and excellent patient satisfaction.

Quick Facts About Preventive Mastectomy

• Preventive mastectomy is a surgical procedure that removes one or both breasts to reduce a patient’s risk of breast cancer.
• Breast reconstruction surgery restores a natural appearance to the breasts after a mastectomy, helping to improve the patient’s body image and self-confidence.
• CNSO offers implant-based breast reconstruction in addition to multiple types of autologous tissue-based (flap) reconstructions.

What Is a Preventive Mastectomy?

A preventive mastectomy, also called a prophylactic mastectomy, is a surgical procedure to reduce the risk of breast cancer. It works by removing one or both breasts. By eliminating breast tissue, a mastectomy theoretically removes cells where breast cancer can form. This makes it an effective cancer prevention strategy for individuals at high risk of breast cancer.

Though preventive mastectomies and therapeutic mastectomies are technically the same procedure, they are performed for different reasons. Therapeutic mastectomies are the preferred treatment for established, biopsy-proven breast cancer. By removing the tumor and surrounding tissue, surgery effectively eliminates the cancer. Preventive mastectomies, meanwhile, are performed on healthy patients with known risk factors and/or a genetic predisposition for developing breast cancer. The goal is not to treat cancer, but to prevent it from developing in the first place.

Who May Benefit from a Preventive Mastectomy?

Preventive mastectomy is recommended for patients who are at a higher-than-average risk of breast cancer. While anybody can develop breast cancer, certain health factors can make it more likely for some people than others. The major risk factors for breast cancer include:

• Genetic mutations: Mutations in the BRCA1 and BRCA2 genes, as well as other genes, make patients more susceptible to cancer, especially breast and ovarian cancer.
• Family history: Cancer is sometimes related to hereditary factors. Patients have a higher risk of developing cancer if their relatives have also had cancer.
• Prior radiation therapy: Exposure to radiation, often through treatment for previous tumors, can increase a person’s cancer risk.
• Prior breast cancer: If a patient has already had breast cancer, then they are at higher risk of developing cancer a second time.

Breast removal is a difficult decision that can affect a person’s self-confidence. For many patients, however, a preventive mastectomy provides peace of mind that is worth the extra efforts involved with undergoing surgery. This highly personal decision depends on the patient’s unique values and risk tolerance. Counseling services are available for patients who need help with making the best choice for their physical and mental health.

Types of Breast Reconstruction Surgery After Preventive Mastectomy

Breast reconstruction is a procedure to reconstruct breasts that have been removed. It can restore a natural-looking appearance for patients who have had a mastectomy, which can be valuable to their body image. CNSO offers several different approaches depending on the patient’s goals and the size of the breasts to be reconstructed. The patient’s care team will help them understand the options:

Implant-Based Reconstruction

Implant reconstruction uses synthetic implants to restore breast shape. The implants are made of medical-grade silicone with a gel or saline (salt water) filling:

• Silicone: Silicone gel provides a more natural feel. Implants are typically pre-filled, however, meaning that they require a larger incision and leave a longer scar.
• Saline: Saline solution feels firmer and may be prone to unnatural rippling. Implants can be filled in place. However, higher rates of leakage are noted as they are filled at the time of placement.

Implants may require replacement due to leakage or changes in the patient’s body with the aging process. They may also have a less natural feel than natural tissue reconstruction. An implant-based reconstruction procedure is a shorter, less involved procedure relative to autologous tissue-based reconstruction, allowing for a shorter operation and an easier recovery.

Autologous (Flap) Reconstruction

Flap reconstruction replaces breast tissue with a flap of tissue taken from elsewhere on the patient’s body. There are numerous types of flap reconstruction depending on where donor tissue is sourced:

• Deep inferior epigastric perforator (DIEP) flap: The surgeon takes fat and skin from the belly, but no muscle.
• Transverse rectus abdominis myocutaneous (TRAM) flap: The surgeon takes fat, skin, blood vessels, and muscle from the belly.
• Latissimus dorsi: The surgeon takes fat, skin, blood vessels, and muscle from the back.

Natural tissue reconstruction is a complex procedure with a lengthier recovery relative to implant-based reconstructions. It also requires the patient to have adequate donor tissue of good quality, whether from their back or abdomen, meaning that not every patient is a good candidate. The results from flap construction feel more natural than implant-based reconstruction. They are also long-lasting with no replacements or imaging required.

Immediate vs. Delayed Reconstruction

In addition to the type of reconstruction, patients must also decide on the timing. Some patients are candidates for immediate reconstruction, meaning that the breasts are reconstructed at the same time as they are removed. This allows for fewer procedures and less scarring but requires a longer recovery. Delayed reconstruction, meanwhile, is performed after the patient has healed from their mastectomy. It gives patients extra time to consider their options before they commit to reconstruction, although this results in multiple procedures and the inability to tailor the original mastectomy surgery towards a better reconstructive result.

Recovery and Results After Breast Reconstruction Surgery

Implant-based reconstruction patients are usually home the same day as the procedure, while autologous reconstruction patients usually require a three-to-five-day hospital stay. This period allows patients to begin their recovery under the observation of experienced medical professionals. Once it is safe to leave the hospital, the surgeon will provide instructions for continued recovery at home. Instructions will cover topics such as:

• Taking medications to prevent blood clotting
• Using prescription or over-the-counter drugs for pain management
• Keeping incisions clean and dry
• Performing daily stretches and exercises
• Wearing a compression garment
• Gradually returning to normal activities

Recovery from breast reconstruction takes up to eight weeks, depending on the type of procedure used. Full healing may take a year or longer. The surgeon may provide referrals to physical therapy, which helps patients regain their previous strength and mobility. Meanwhile, support groups and counseling help cope with the strong emotions caused by body changes.

Find Preventive Mastectomy and Breast Reconstruction Surgery Near You in New Surgery

Breast reconstruction surgery can boost self-confidence after a preventive mastectomy. The comprehensive care team at Centers for Neurosurgery, Spine & Orthopedics provides both mastectomies and breast reconstruction at locations near you in northern New Jersey, including Bergen, Passaic, Essex, Morris, Union, Middlesex, and Hudson counties. Contact CNSO today to learn more about reconstruction options or to schedule a consultation for a preventive mastectomy.

Frequently Asked Questions About Preventive Mastectomy and Breast Reconstruction

Is preventive mastectomy the only way to reduce breast cancer risk?

Preventive mastectomy is not the only way to reduce breast cancer risk, but it is the most effective. Patients can also reduce their risk by eating a healthy diet, exercising regularly, and avoiding excessive alcohol use and smoking.

How do I know if I qualify for a preventive mastectomy?

Qualification for preventive mastectomy depends on the patient’s cancer risk. Patients can speak with their primary care physician or breast oncologic specialist to find out whether they qualify.

What is the success rate of breast reconstruction after mastectomy?

Breast reconstruction after mastectomy has a high success rate, with most patients expressing satisfaction after surgery.

Will insurance cover preventive mastectomy and reconstruction surgery?

Insurance usually covers preventive mastectomies and subsequent reconstruction performed for necessary medical reasons. Coverage is mandated by New Jersey state law.