Prophylactic Mastectomy with Immediate Reconstruction

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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.

vertical scarNipple-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.

Minimally Invasive Breast Reconstruction

For women diagnosed with breast cancer, or advised by their surgeon to undergo a prophylactic mastectomy, revolutionary new procedures have become available that enable a patient to undergo a mastectomy with the possibility of preserving all the breast skin, the areola and even the nipple.
 
The adjustable implant is placed above the muscle and held in position with an absorbable mesh.
The injection port which attaches to the implant is placed beneath the skin.
Once healing is assured (usually 1-2 days) filling of the implant is done by injecting saline into the port. Filling is usually completed in several days. The injection port is removed under local anesthesia once the patient is satisfied with the results.
As the implants are placed above the muscle, there is less pain and no abnormal distortion of the implant by the muscle.
 
Dr. Becker, an internationally known plastic surgeon has pioneered this procedure. He is the inventor of the adjustable breast implant and has published over 30 articles and contributed chapters to plastic surgery text books. He serves as an instructor at national plastic surgery meetings, lectures internationally, and holds regular workshops around the world demonstrating his sought-after surgical techniques.

Patient with carcinoma of right breast

Patient with carcinoma of right breast

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Following bilateral nipple sparing mastectomy
with adjustable implants placed above the muscle
and absorbable mesh support

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Final result

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No abnormal implant movement

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.

Dr. Becker’s response to questions on realself.com

Click here for Dr. Becker’s response to questions on realself.com