Prophylactic Nipple-Sparing Mastectomy and Methods of Reconstruction
Though once popular in the 70s and 80s, the prophylactic mastectomy fell out of favor with doctors and patients in the 90s. However, the advances of mammography in the 90s and beyond have lessened the number of women who are choosing to have one or both of their breasts removed to prevent the advent or spread of breast cancer.
Fewer people are as supportive of preventative mastectomies nowadays because of the potential complications and reports of low patient satisfaction. Thinner skin used over implants can cause capsular contracture or hardening of the tissue lining surrounding the implant.
In a chapter written for the textbook Surgery of the Breast, Dr. Franklyn Elliott writes regarding patient satisfaction:
Patients did not believe they were properly prepared for some of the results of these major surgical procedures, and because they did not have frank breast cancer, were not in the mind-set to deal properly with major surgical extirpation and reconstruction.
However, in a recent study only 5% of patients regretted undergoing prophylactic mastectomy and reconstruction surgery. Many felt that were inadequately prepared for the pain and incapacitation of the recovery period.
For this reason, it’s important that a plastic surgeon is one of the many consulting surgeons who advise a potential mastectomy and breast reconstruction patient.
Many women who are at a high risk for potential breast cancer and those who’ve had one breast removed because of cancer seek preventative mastectomies. There are many factors that oncologists, general surgeons, and plastic surgeons should consider before suggesting a prophylactic mastectomy for a patient including heredity, the breast cancer gene (BRCA1 and BRCA2), previous diagnoses, and more. It must also be explained to patients that advances in mammography techniques have made it easier to track potential cancers without removing the entire breast.
Choosing a preventative unilateral or bilateral mastectomy is a difficult choice for any woman. According to the chapter written by Dr. Elliott, the “plastic surgeon must limit his or her role to the very accurate description of the patient’s options after mastectomy and, equally important, a full and complete discussion of the recovery phase and the expected result.”
Oftentimes, prophylactic mastectomy patients are shown before and after pictures of women who have had breast cancer and undergone mastectomy and breast reconstruction surgery. It’s important that patients are given information specific to their particular procedure, regardless of the similarities between their procedures and another patient’s.
It’s rare that women with no risk factors are interested in prophylactic mastectomies with reconstructions. Some patients are motivated by fear. However a lack of risk factors in patients seeking prophylactic mastectomies probably means that they should not be considered for surgery.
Though controversial among some doctors and patients, there are benefits to preventative mastectomy and breast reconstruction. In the chapter, Dr. Elliott concludes, “With the variety of techniques available for breast reconstruction, intelligent management of the overlying skin, and gradual formation of the breast mass itself, patients can be increasingly assured of complete or near complete breast tissue removal and safe, predictable, uncomplicated breast reconstruction.”
To read the chapter, click here (link to PDF). Other articles written and used by Dr. Franklyn Elliott can be found on his articles page. You can also connect with him on Facebook and Twitter for the latest in plastic and reconstructive surgery news.
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