Separate the cancer operation from the reconstruction decision
A risk-reducing or therapeutic mastectomy plan should define the breast surgeon's oncologic goals and the plastic surgeon's reconstruction goals. Ask whether skin-sparing or nipple-sparing surgery is appropriate, where scars will be placed, how tissue viability is assessed, and what circumstances could change the plan during surgery.
Immediate reconstruction, delayed reconstruction, or no reconstruction are all legitimate paths. The correct choice depends on cancer treatment, radiation likelihood, anatomy, health, recovery capacity, and personal priorities—not on pressure to decide quickly.
Implant and autologous choices
FDA-approved breast implants are saline-filled or silicone gel-filled and are not lifetime devices. Reconstruction may involve a tissue expander followed by an implant, or direct-to-implant placement in selected patients. Complications can include infection, pain, capsular contracture, rupture, asymmetry, changes in sensation, implant removal, and additional operations.
Autologous reconstruction uses a person's own tissue. A DIEP flap uses lower-abdominal skin and fat while aiming to preserve abdominal muscle, but it is microsurgery with longer operative and recovery demands. Ask about flap loss, abdominal weakness or bulge, scars, monitoring, donor-site care, and the surgeon's outcomes.
- Compare implant location, mesh use, shell texture, shape, size, manufacturer labeling, and surveillance.
- Ask whether radiation is likely and how it changes implant or flap timing.
- Expect that fat grafting, symmetry work, scar revision, nipple reconstruction, or implant exchange may be separate procedures.
Nerve preservation, sensation, and sexual function
Mastectomy commonly changes or eliminates breast and nipple sensation. Nerve-identification, preservation, grafting, or reinnervation techniques are evolving, and availability and evidence vary. A targeted second opinion can clarify what a surgeon actually performs, how outcomes are measured, and whether a technique changes oncologic margins or operative risk.
Loss of sensation can affect safety, body image, arousal, and intimacy. Counseling should include realistic sensory expectations, protection from heat or pressure injury, sexual-health support, and a plan for persistent neuropathic pain or numbness.