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:
- Total mastectomy - This is the treatment of choice for most surgeons, as it removes both the nipple and breast tissue. Today, this procedure is usually performed as a skin-sparing mastectomy.
- Subcutaneous mastectomy - Removes the breast tissue but spares the nipple. Surgeons are concerned about leaving the nipple because of the possibility of leaving cancerous tissue in the ducts that run through the nipple.
- Areolar-sparing mastectomy - This is a new technique that we have recently been using. It offers a compromise between the above two procedures. The nipple is removed, leaving the areolar skin, which is converted into a nipple. The areola is recreated with a tattoo.
Because all or most of the skin and muscle are retained following a prophylactic mastectomy, there is no need to bring in extra skin by means of a flap. The muscle is strengthened with an acellular dermal graft (Alloderm, Surgimend or Neoform). 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.
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 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
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