Breast Reconstruction: Questions to Ask at Your First Plastic Surgery Consult
At a checkup with my plastic surgeon a year after my mastectomy and breast reconstuction
Breast reconstruction after a mastectomy is way more complicated than you might think — there are many different factors to consider and a lot of options. Most of these options you’ve likely never even heard of, unless you’ve witnessed someone close to you experience this.
After learning that I’m BRCA1-positive in 2018 while I was going through ovarian cancer treatment, and therefore at high risk for breast cancer, in 2020 I started preparing to get a prophylactic double mastectomy. Part of this process involved having my initial consultation with a plastic surgeon.
When preparing for this appointment, I did a lot of research: I asked others who’d had breast reconstruction after a mastectomy what questions I should ask at my first plastic surgery appointment, and I also thought about my own concerns and what factors were important to me when it came to my reconstruction. I finally came up a long list of questions to bring to my initial plastic surgery consult, in order to get all the information I needed to make the best decision for me.
I created the list below based on the questions I asked my plastic surgeon at my first breast reconstruction consultation, slightly modified to make the questions more broadly applicable, as a guide for you to bring to your first plastic surgery consult. Don’t feel like you have to ask them all — you can pick and choose the ones that are personally relevant and important to you. And add any other questions to this list that you want answers to!
NOTE: These questions are based on my experience meeting with a plastic surgeon in preparation for a risk-reducing prophylactic double mastectomy. Some questions may not apply or may be different if you’re consulting with a plastic surgeon about breast reconstruction after breast cancer surgery. At the end of this list, I’ve included additional questions to consider if you’re getting breast reconstruction as part of your breast cancer treatment.
Questions to Ask at Your First Plastic Surgery Consult for Breast Reconstruction
Do you do DTI (direct-to-implant) reconstruction, or delayed reconstruction with expanders? Why? What are the benefits and potential drawbacks of each approach?
Which do you recommend and why: implants placed UTM (under-the-muscle) or OTM (over-the-muscle)? What are the pros and cons of each?
In implant reconstruction, what kinds of implants do you use? Silicone or saline, textured or not? And is there any cancer risk associated with this type?
Tell me about the use of cadaver skin (AlloDerm) in the breast reconstruction process. Are there any potential dangers or complications associated with this?
Besides implant-based reconstruction, could you explain the other options of autologous reconstruction (using tissue from your own body to reconstruct the breasts), such as DIEP flap, LAT flap, TUG flap, etc.? Which option — implant or autologous reconstruction — would you recommend for me and why? [Read more about the different types of flap surgery options in breast reconstruction here.]
Will this be a nipple-sparing mastectomy? Why or why not? If not nipple-sparing, what options are there to recreate my nipples — nipple reconstruction, nipple tattoos? Does your office do any of those procedures, and if not, are there providers who do that you could refer me to?
Can you explain any sensation loss I may experience in my chest after mastectomy and reconstruction?
Will I need/what can I expect re: follow-up revision surgery(ies) and fat grafting, etc.?
What can I expect re: the cosmetic outcome? Where will the scars be and what will those look like? Can I see photos of samples of your work?
If doing implant reconstruction, how do I/you/we decide what size to choose for the implants? What factors should I consider when making that decision?
Do implants ever flip or move around, and what do I do if/when this happens?
How long will I be in the hospital after my surgery?
How long will I have the post-op surgical drains (JP drains) in for?
How long will I have physical restrictions and limitations post-op with implant reconstruction? With autologous reconstruction?
What’s your rate of infection/complication?
[For prophylactic mastectomy and reconstruction] Ideally, is there a better or worse time of year to have this surgery? (e.g., should I not do it in the summer if I can avoid it due to hot temps and more physical/outdoor activities?)*
Could you tell me about the post-op pain management and what that will entail?
What are the subsequent appointments I’ll need to schedule with you before my surgery and what does that timeline look like? What are the next steps after I leave here today?
🖨️ DOWNLOAD THIS LIST OF QUESTIONS IN PRINTABLE FORMAT YOU CAN BRING TO YOUR DOCTOR’S OFFICE HERE
Additional questions to consider asking your plastic surgeon if you are having breast reconstruction due to breast cancer treatment, and if radiation is part of your treatment plan, would include questions about how radiation impacts breast reconstruction in terms of things like the timing of the reconstruction procedure(s), infection risk, and potential complications. Research suggests that radiation with implant reconstruction seems to result in more complications than radiation with autologous reconstruction, so you may want to ask your plastic surgeon more about this so you can weigh your options and make an informed decision. Read more about this topic in this article on BreastCancer.org, “How Does Radiation Affect Reconstruction Results?”
Another option some people may want to consider is choosing to not reconstruct their breasts, which is called aesthetic flat closure. If you are interested in learning more about this option, definitely ask your plastic surgeon about it. You can read more in this article about aesthetic flat closure on BreastCancer.org.
* I asked this question for a prophylactic double mastectomy and reconstruction, where there’s more flexibility around timing; for mastectomy and reconstruction during breast cancer treatment, the timing would likely be dictated by your treatment schedule, with less flexibility possible.
Have you had breast reconstruction? Was it after a prophylactic double mastectomy or during cancer treatment? What questions would you add to this list? Share them in the comments!
For more information about mastectomy and reconstruction, check out these additional resources:
“Mastectomy Must-Haves on a Budget” on my blog
“More Mastectomy Prep Tips” on my blog
“How to Prep Your Home for After Breast Surgery” on Everyday Health
“The Best Post-Mastectomy Bras From Under-the-Radar Brands You Might Not Know About — but Should” on Everyday Health
