These questions are for your plastic surgeon and relate to breast reconstruction only. These questions are not about breast cancer generally or risks of recurrence, or breast cancer treatments, other than how some may impact timing or results of the reconstruction.
Implant based reconstruction:
- Tissue expanders v. direct to implant (DTI)
- DTI:
- Am I a candidate for DTI? Why or why not?
- Do you do DTI?
- What size can I be after DTI?
- How often is revision surgery needed after DTI?
- Reconstruction using tissue expanders: Tissue expanders are slowly filled to expand the skin and then a second surgery replaces the expander with a permanent implant
- Are the expanders placed at the same time as the mastectomy?
- How long is the tissue expander process?
- How many fills will I need?
- What size can I be?
- How much do you put in each time there is a fill?
- When can the exchange surgery be scheduled after the fills are complete?
- Are revision surgeries necessary?
- DTI:
- Over the muscle or under the muscle implants.
- Over is considered a more modern approach to breast reconstruction. Under often results in animation deformity and is a more difficult recovery.
- Over the muscle can cause rippling that is visible to the eye, but type of implant used can impact rippling.
- NOTE: Some surgeons only do one or the other.
- Where will the incision(s) be?
- What type of implant do you recommend?
- What is the effect of radiation on implant based reconstruction.
- What complications can develop with implant based reconstruction? Capsular contracture, breast implant illness and breast implant associated anaplastic large cell lymphoma should be discussed.
- How long will I stay in the hospital for each surgery?
Autologous reconstruction (flap reconstruction using your own tissue)
- Am I a candidate for a flap reconstruction? If, not why not?
- What type of flap do you perform? If you don’t do this type of surgery, can you refer me to someone who does?
- Is it performed at the same time as the mastectomy?
- Do I need tissue expanders?
- Do I do the flap reconstruction before or after radiation?
- How long is the surgery?
- How long is the recovery time?
- Where will the incisions be?
- What complications can develop?
- How long is the hospital stay after surgery?
Hybrid reconstruction
- Combining flap procedure with an implant
- Is this an option if I have enough tissue to get the breast size I want from my own tissue?
Aesthetic Flat Closure
- Can I achieve an aesthetically pleasing result without reconstruction?
- What will my scar look like?
- If I choose to go flat, can I have reconstruction later?
Nipple sparing
- Am I a candidate for nipple sparing surgery?
- What complications can develop?
- Can I change the position, shape or size of my nipples?
Non-Nipple Sparing
- Is nipple reconstruction an option?
- How is it done?
- Do you recommend it?
- How often does it fail?
- 3D nipple and areola tattooing.
- When can it be done?
SMX v. DMX
- Can I achieve symmetry if I choose SMX?
- How and when will that happen?
Sensation after mastectomy?
- Will I lose all sensation?
- Do you do nerve re-sensation surgery? If not, why? If yes, explain the process. Is it covered by insurance?
Reconstruction after Lumpectomy: Lumpectomy can result in breast deformity and you should consult with a plastic surgeon about achieving an aesthetically pleasing result that many include surgery on the non-cancerous breast.
Other questions to ask regardless of the type of reconstruction:
General questions:
- How long is the surgery?
- What is the recovery time?
- What can be done at the same time as mastectomy?
- What complications can develop?
- Can I see photos of your work?
- What about fat grafting? Do you recommend fat grafting? If yes, when and if no, why not?
- How does the coordination with the oncological surgeon work? Who do I call if there is an issue post-surgery?
Recovery:
- What kind of drains will I have?
- What are the post-surgery restrictions?
- What kind of bra should I wear post-surgery and for how long?
- Do I need to sleep on my back?
- When can I shower post surgery?
- What about after surgery care and mobility exercises?
- What can I do to prepare for surgery?
- What do I need to look out for post surgery? When should I contact you and how?