Prophylactic Mastectomy yes or no?

[alucasrn]

I have been classified as very high risk for getting breast cancer (42%) Have had 2 tumors biopsied and found to be fibroadenomas.  Do not want to take Tamoxifen for the next 5 years.I have been followed closely for the past 2 years with mammograms and MRI's every 6 months. The stress has gotten to me and my oncologist and surgical oncologist
are now recommending a prophylactic bilateral mastectomy. (actually they told me they were just waiting for me to process it all and decide on the mastectomy myself) My question is, "What type of mastectomy produces the best natural looking outcome? Of course, I would love to have a nipple sparing. From what I have researched skin sparing is not an option b/c  I am obese and have very large and sagging size 44DD breasts. What type would best suit me?

[japdip]

I would think Bilat. Mod. Radical but that would be at the discretion of the Oncologists & Surgeon. Keep in mind that this does not mean that you are "home free" as far as breast cancer is concerned but it certainly reduces your overall risk considerably. Reconstruction is another factor that you need to investigate before making this decision ... the type, or whether to have recon. at all. I would give this some very serious thought and go over all the pros and cons before you decide. There is also the possibility that you may never develop breast cancer even though you say your risk is high. I would get at least two opinions from Surgeons and a consult with a Plastic Surgeon as well.   Regards .....

[SueYoung55]

You may want to look up Dr. Dellacroce in New Orleans, just type in his name and do a search, you'll find his website. There is also a Dr. Allen. And a Dr. Craigie. Search DIEP reconstruction and you'll find out lots about it. I personally would use someone who's done thousands of these instead of someone who's done a couple hundred because it's such a specialty. Ahh, and there are photos of their work online. You would be interested in the different types of surgery they do.

I would also suggest a  bilateral modified mastectomy. I've seen women who have not had cancer get DIEP reconstructive surgery done and you would never know and the bonus of this is they use your own stomach skin and fat to create your breasts. So in fact you get a tummy tuck with it.

It's a big surgery and I had it after cancer so you can definetly see my scars as I only had one breast at the time of reconstruction. This is microsurgery and they leave your muscles intact but move your own tissue and reconnect the blood supply. I travelled to New Orleans for mine from Florida and would do it again in a heartbeat! Well worth the plane ticket to get the BEST in my opinion. Three great teams out there, one in New York, one in South Carolina and two in New Orleans (one of them has offices in all 3 states). Please understand that the plastic surgeons you choose to speak with will ONLY recommend their specialty. Not all do DIEP. It really is a specialty.

A lot of women decide to go flattop and not have reconstruction at all. Some have one step implants and some get expanders, tram flap, lattisimus flap... lots to choose from. Research research research!

Be aware that obesity may limit your choices some and you may want to consider losing some of the weight before surgery should you choose that route. It will also improve your outcome and your risk overall.

Best wishes with whatever you choose!

[katarina777]

This is a difficult decision to make. When japdip and Sue Young55 recommend mod. radical mastectomy, doesn't that include taking the lymph nodes under the arm? Is that part of preventative surgery?

As for Alucasm, you do need to know that this surgery is major, and it does not always come out the way you wanted it to. (At least I have heard many, too may, women say this who had bc, and I do not know if you are in a different category.)

It also matters how old you are, and it really is a very personal decision. For myself, I would not reconsider reconstructive surgery anymore. I walk around with one breast and sometimes I wish I had no breasts to bother with. But I do not find, or feel that the side where I had the mastectomy, (mod. radical) is the least bit ugly at all.

Then there is always the possibility of poor wound healing, and other problems.

I have a lot of empathy for you having to make this decision. Best, Katrin