Delayed Reconstruction possible with Skin Sparing Mast.?

[raman]

I am 37-year old female trying to conceive a first child when I was diagnosed with DCIS in June, via a biopsy for < 1cm subareolar lump and post-biospy MRI.

(Post-biospy mammography, ultrasound were negative, and the pre-biopsy monitoring of unilateral serous discharge with various needle biopsies, etc. for two years, and initial MRI two years ago all negative.)

I was recommended to have a mastectomy because of my continuing wishes for future pregnancy (hence to be sure, other tests were performed, such as bone scinti, liver ultrasounds and Chest X-rays). I was declared a candidate for skin-sparing mastectomy.

Ideally I would like to have a immediate reconstruction using abdominal tissue, such as a free TRAM or perhaps DIEP, and would like to avoid expander implants. Realistically because of the abdominal trauma I would suppose it might be better to settle for a delayed reconstruction until after finishing childbearing.

So, my questions are:
1) is it physiologically possible to have a skin sparing mast. with no immediate recon. and then just leave the excess skin hanging there for a few years until ready for the abdominal tissue reconstruction?

2) would reconstruction results be better for a delayed recon. with abdominal transplant (regardless of ultimate type of mastectomy), or for immediate recon with transplant from another area, such as the gluteal flap?

Thank you in advance for your opinion.

[CCF-RN,MSN-JS]

Dear raman, In answer to your questions; 1)While technically it is possible to have skin sparing without immediate reconstruction, it is not recommended, even discouraged.  Some reasons for this are; the end cosmetic result could be in jeopardy, and the interim care could be problematic in terms of cleaning, prosthesis fitting etc. 2) Delayed reconstruction could have just as good a result as immediate reconstruction.

A discussion with a well experienced plastic surgeon who can speak to many of the details of the various reconstructions, what might work in terms of your anatomy, as well as what their results have been would be an important step in terms of making your decision.

[surgeon]

Those are all good questions to ask a plastic surgeon, which I'm not. But, having seen many patients have various forms of mastectomy, and various reconstruction techniques with various timing, I can say with a high degree of confidence that reconstruction can be done at any time, and the results have nothing to do with timing. In my opinion, in fact, there's much to be said for delayed reconstruction. Furthermore, with TRAM reconstruction, skin sparing is much less of an issue. Having had DCIS right under the nipple, I'd want to be sure the entire nipple and plenty of skin around it was removed.....