I understand the decision making process that you have undergone to get to this point and repect your decision. However, I would suggest reconsidering a one-stage immediate reconstruction.
Rarely does this produce a result that rivals a two or three stage breast reconstruction. In addition dermal grafts, such as Alloderm, need to incorporate into the the skin flaps.
If this doesn’t occur, which is a known complication, the graft and implant will have to be remove and reconstruction will have to start over.
Immediate reconstruction can be performed using the abdominal tissue, called a deep inferior epigastric [artery] perforator flap (DIEP).
This is a more complicated reconstruction but gives the benefit of using your own tissue, which feels better and will also give you a tummy tuck at the same time.
You might what to find a surgeon in your area who specializes in this procedure. (Christopher L. Hess, MD, Fairfax Plastic Surgeon)
I agree with many of the central concepts written by the surgeons above. Breast reconstruction with implants following prophylactic mastectomy is usually a straight forward procedure with few complications, however, problems may arise that may not be readily apparent during surgery or even in the days to months following surgery.
Specifically, you could potentially have skin loss from the prophylactic mastectomy or significant capsular contraction. If you are a good candidate for an abdominoplasty, that tissue that would be discarded may ideal for breast reconstruction is there is a problem with your implant reconstruction. Don’t have a concurrent breast reconstruction with implants and abdominoplasty. You are burning a bridge that may be your next best option. Wait a year. After a year, you’ll know (for the most part) if you are happy with your breasts and can proceed with an abdominoplasty if you wish – and do so knowing you’re doing the safest thing. (David L. Kaufman, MD, Folsom Plastic Surgeon)
I am assuming you are getting bilateral prophylactic mastectomies. While it is possible to do the breast reconstruction with tummy tuck simultaneously, you should have your surgeons assess the risk of the procedures. From a healing point of view, the incisions and undermining necessary might reduce blood flow to certain areas of the breast and abdomen such that healing may be a factor.
Total blood loss from combined procedures may also reduce oxygen-carrying capacity and thus hinder healing and may also place you at risk for needing blood transfusions you might ordinarily not need. In addition, tension placed on the abdomen often will change the position of the inframammary fold that is critical in assessing position of the implants. Finally, while bilateral silicone implants for bilateral prophylactic mastectomy reconstruction is a sound option, there may be a significant risk of hardening or intolerance to the implants that might make autologous reconstruction a better long-term solution in case of implant failure.
Your plastic surgeon should factor this into his/her decision about reconstructive options. Think carefully about choices so you and your surgeon do not get painted into a corner. (Robin T.W. Yuan, MD, Beverly Hills Plastic Surgeon)
Prophylactic Mastectomy and Tummy Tuck Combination
It makes a lot of sense to combine the prophylactic mastectomy and tummy tuck procedures at the same time. Typically I would perform this surgery simultaneous while your mastectomy is being performed by a separate surgeon. This dramatically decreases the operative time, plus you also recover from both procedures at the same time. (Larry S. Nichter, MD, MS, FACS, Orange County Plastic Surgeon)
Based on our experience with bilateral prophylactic mastectomies with immediate reconstruction, I seldom recommend one stage reconstruction – even though it sounds so appealing – because it is associated with frequent need of revisions and it is most applicable for quite small breasts. I certainly would recommend that the nipples and areolas be reconstructed later.
If done together with the breast mound reconstructions, the nipples can end up misplaced and they cannot be moved. So you could have the abdominoplasty together with the nipple reconstructions; the idea is to have shorter anesthesia time.
This suggestion assumes that you are not having “nipple sparing” mastectomies, which are occasionally indicated in women who have no sagging. (George J. Beraka, MD (retired), Manhattan Plastic Surgeon)
No one likes the one stage breast reconstruction – nipple areolar reconstruction should be performed at a separate sitting. Breast reconstruction can be performed many different ways
a) implants with alloderm – added risks.
b) implants with lattissimus dorsi muscle flaps is another option with great results.
The muscle is harvested through very smal incisions on the back and the results are the most natural that I have witnessed. As for the tummy tuck – try to limit any elective surgical procedure to less than 4 hours. (Robert M. Freund, MD, New York Plastic Surgeon)