Should I Have a Bilateral Mastectomy Instead of Lumpectomy and Radiation?

This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers a special two-part question.

Q: Do you know of surgeons in northwest Ohio who can do natural breast reconstruction? I was diagnosed with DCIS and had a lumpectomy done and now am considering a bilateral mastectomy instead of radiation. I was a AA cup size and don’t have much breast tissue left, so I feel like I could use the reconstruction, which is why I am considering the mastectomy.

A: Thank you for your question. I’m sorry I don’t know anyone in that area. Based on your situation you are asking a very good question!

If you have little breast tissue remaining after your lumpectomy then if you went through radiation the breast may develop more abnormal shape. When that occurs, it is difficult to fix that breast because of the radiation effects. If you instead remove the remaining breast tissue you could rebuild the breast to the size you wanted based on how much of your own tissue you have to use. Also you would not need radiation. Remember that implants after radiation are more likely to have complications than without radiation. 

Q: If the DCIS is in one breast, would a double mastectomy make sense, so I could even out the “new” size I choose? Also, do you have information on recurrence rates if I try a nipple-sparing or skin sparing mastectomy?  Is that wise at all?

A: Questions regarding recurrence rates are best answered by the surgeon who performs the mastectomy. We work closely with them as a team and perform the reconstruction immediately after the mastectomy. I’ll be glad to forward your question to the expert. In general, recurrence rates should be the same or lower for mastectomy vs.  lumpectomy and radiation. Skin and nipple sparing mastectomy should be the same as well. For your situation we would get the cancer specialists we work with to give us their opinion before we could give you specific recommendations.

We do have patients choose to do what you mentioned frequently, for the same reasons. Preventive mastectomies are done to reduce the chances of getting breast cancer. If someone is high risk, then they  might decide to reduce the risk of DCIS on the other side. When someone has enough donor tissue we try to give them the best result possible based on each person’s expectations. If you had a bilateral mastectomy we would try to make the new breasts fuller and uplifted as long as there was enough donor tissue to work with. I hope this answers your questions. Let me know.

Dr. James Craigie

Center for Natural Breast Reconstruction

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

What Is My Best Reconstructive Surgery Option After Lumpectomy and Radiation?

Sometimes, the answers we need are found in unexpected places. Our team is happy to share our information…wherever we go!

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I had a lumpectomy on my right breast in 2007. My oncologist has given me the green light to plan reconstructive surgery. I’m hoping to have some sort of reconstructive surgery to balance both breasts. I’m 69 years old. The odd part of this request is that a close friend of mine sat next to Dr. Kline on a flight from Louisville to Charleston!

A: It was a pleasure talking with your friend on the plane, she seemed extremely nice, and immediately mentioned you when she learned what I do for a living.

There are potentially several reconstructive routes one can go after lumpectomy with radiation, depending on your present situation and your goals. As you probably know, your chances of successfully tolerating a breast implant in the radiated breast, while not zero, are much diminished due to the radiation.

If it’s OK with you, I’d like to have our nurse Chris or P.A. Kim call you, and get a few more details about your situation. After that, we can chat by phone, and I’ll give you my honest opinion about which potential interventions might be best for you.

Dr. Richard M. Kline, Jr.

Center for Natural Breast Reconstruction

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

I Found Lumps After Reconstruction Surgery–Could I Possibly Have Breast Cancer Again?

Ask the DoctorThis week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I had breast reconstruction surgery 5 years ago.

Upon my 5-year check up, three lumps were found on my left breast. I had an ultrasound, then an MRI. I just received a call from my general physician informing me that I need a biopsy done due to fat necrosis on my left breast. Meanwhile, I have found many more lumps on both breasts. I’m waiting for my plastic surgeon to return from vacation to schedule a biopsy. I’m extremely nervous. Could I possibly have breast cancer again? Why do they need to do a biopsy? 

A: Although I don’t know what type of mastectomy or reconstruction you had, at least microscopic amounts of breast tissue are left after any mastectomy, so it’s still theoretically possible to develop  cancer. This is very unlikely in most cases, however. If you just had lumpectomy with radiation, it’s much more common. Fat necrosis after reconstruction with your own tissue is pretty common, but it’s unusual to have it show up after five years. If you had radiation after your reconstruction, however, that could help explain the late changes you note.

 Dr. Richard M. Kline, Jr

Center for Natural Breast Reconstruction

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