Ask the Doctor- Can you help me schedule a consultation?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question:  I am 35 years old, my BMI is 29. I have a pathogenic mutation of the ATM gene and strong family history of breast cancer (mom dx in 2016 at age 68 and also has the ATM mutation, two deceased maternal aunts dx in their late 30s). In January 2017 I underwent diagnostic mammogram and ultrasound, then MRI, and then an MRI-guided core needle biopsy of a 4.6×1.4 cm linear nonmass enhancement. Pathology revealed sclerosing adenosis, benign changes, and flat epithelial atypia.

Because of the atypia I am scheduled for an extensional biopsy on February 16, 2017, to remove more tissue and hopefully rule out cancer. I am trying to stay ahead of the curve and I am interested in pursuing what I hope will be a prophylactic mastectomy with immediate flap-type reconstruction, but understand planning and timing will depend on the outcome of the pathology from my next procedure.

I spoke with my doctor about prophylactic mastectomy and reconstruction (my doctor is a surgical oncologist and will be performing my upcoming extensional biopsy) and asked which plastic surgeon she recommended on their team for flap-type reconstruction. She told me that she would perform the mastectomy, that I would be flat for a while, and that the plastic surgeon she recommended would perform reconstruction during a second surgery at a later date because “that’s just how he does it.”

I heard about your center on a DIEP support group on Facebook, and your surgeons are so highly recommended and are in-network with my insurance. I have learned a lot about the procedures in the support group, and I would like a second opinion from your doctors as I know that immediate reconstruction is possible in a lot of situations. I live near Winston-Salem, North Carolina, and I am willing and able to travel to be in the hands of an experienced team. A Monday morning appointment for a consultation would be ideal because of the travel involved, and either location would be fine, but I am flexible. Can you please help me schedule a consultation? I feel uncomfortable asking my doctor/surgeon for a referral at this time.

Answer: Thanks for your question. I’m sorry you are having to go through this, but we will help you any way we can.

The only common reason to NOT do immediate flap reconstruction at the time of mastectomy is if we know or suspect that you will need post-operative radiation, because that can severely damage a new flap. The most common reasons for giving radiation are a cancerous tumor over 5 centimeters in size, or a positive axillary lymph node.

Hopefully, you will end up not having cancer at all, and neither of these situations will apply to you. We do immediate flap reconstruction very routinely, sometimes several times a week, and I suspect there is a very good chance you could have it done that way.

We work with several truly cutting-edge breast surgeons, and we would be happy to arrange for you to see both of us on the same day. If you wish, we will have one of our PA’s (Kim and Audrey) or Nurse Practitioner (Lindsey) contact you to get additional information, and help make arrangements.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

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