Prophylactic Mastectomy with Immediate Reconstruction
Prophylactic preventative mastectomy is the surgical procedure performed to remove one or both breasts in an effort to prevent or reduce the risk of developing breast cancer.
Three techniques are commonly used:
- Skin-sparing mastectomy – The glandular tissue is removed, leaving most of the skin intact
- Areolar-sparing mastectomy – The nipple is removed, leaving the areolar skin, which is converted into a nipple.
The areola is recreated with a tattoo.
- Nipple-sparing mastectomy – Removes the breast tissue but spares the nipple.
Nipple-sparing mastectomy – Vertical placement above the muscle.
There are several options available to patients undergoing prophylactic mastectomy and reconstruction.
One of the techniques that many patients do not know about is that of nipple sparing mastectomy, one stage reconstruction using an adjustable implant placed above the muscle.
The advantage of this technique is that it avoids the problems related to implant placement under the muscle such as abnormal breast movement when the muscle contracts and high riding implants due to the muscle tending to elevate the implant.
The adjustable implant enables the reconstruction to be done at the time of mastectomy without the need to replace a tissue expander with an implant
Dr Becker is a pioneer in this procedure having been the developer of the Becker adjustable gel implant and the Spectrum adjustable saline implant.
While a flap can be used to replace the volume of the breast, the implant developed by Dr. Becker (the Mentor Becker 50/50) is considered by many surgeons to be the ideal implant to reconstruct the breast following prophylactic mastectomy.
Dr. Becker’s response to questions on realself.com
The Mentor Becker 50/50 implant is a double-chambered implant with cohesive gel in the outer chamber and saline in the inner chamber. Saline can be added or removed from the implant by means of an injection dome. The implant can be placed under the muscle or above the muscle depending on the thickness skin flaps, in the same way that it is done for breast augmentation. Saline is added once the skin has sufficiently healed, and then over-expanded to improve the shape of the breast. The volume is then reduced, and the injection dome is removed through a tiny incision. In select cases where circulation to the skin is not comprised, a gel implant can be used to eliminate the need for delayed filling or expansion.
The scar at the areola becomes almost invisible; and there is no donor site scar that is seen with flap surgery.
The reconstruction surgery takes approximately one hour following the mastectomy.