Ask the Doctor-Should the same physician do the mastectomy and the reconstruction?


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

Question: Should the same physician do the mastectomy as does the reconstruction? Your thoughts?? I am undergoing chemo, will have bilateral mastectomy, radiation then reconstruction?

Answer: Generally speaking, the mastectomy should be done by a general surgeon, and the reconstruction should be done by a plastic surgeon. Often, the mastectomy and stage I of the reconstruction can be done at the same time, but not always. It is done this way for several reasons:

1) It would be difficult for one surgeon to stay up-to-date and proficient at both breast cancer management and breast reconstruction

2) There may be subtle unwanted bias when doing the mastectomy (i.e., extent of tissue removal) if the surgeon knows he also has to do the reconstruction

3) It is more fatiguing for one surgeon to do both procedures, and this could have undesirable consequences.

If you know that you are going to have radiation, then most likely the plastic surgeon will either do nothing, or place a tissue expander at the time of surgery. If you are going to attempt permanent implant reconstruction, the plastic surgeon may try to place the permanent implant before the initiation of radiation, or may leave the inflated tissue expander in place until after you have healed from radiation (usually about 6 months).

If you are planning to have natural tissue reconstruction, the expanders can be removed and flap transfers done after healing from radiation. Natural tissue reconstruction is usually not done at the same time as the reconstruction if radiation is planned, as the radiation can severely damage the transferred tissue.

Hope this helps, please let us know if we can answer any more questions.


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