Preventive double mastectomy with reconstruction

The mastectomy removes breast tissue because a person has an elevated future risk, while reconstruction addresses the breast shape after removal. Reconstruction may use an implant, the person's own tissue, or a staged approach. Immediate reconstruction happens during the same operation; delayed reconstruction is planned after healing or other treatment.

The result is not the same as a natural breast: sensation, scars, firmness and symmetry can change. Preventive surgery lowers risk but cannot remove every breast or chest tissue cell. If cancer has already been found, the sequence may be different and may include chemotherapy before surgery or other treatment.

Meet the breast surgeon and reconstructive surgeon before deciding. Review your individual risk, whether the nipple and skin can safely be preserved, reconstruction methods, possible revisions, drains, movement restrictions and how treatment could affect the result. Bring a list of medicines and discuss smoking, diabetes, previous operations and any plans for pregnancy.

Plan for wound care, sleep, transport, clothing, time away from work and help with daily tasks. Ask how follow-up will check healing and how arm exercises can reduce stiffness. Lymphoedema symptoms should be reported early and may be helped by specialist therapy.

Contact the surgical team promptly for fever, spreading redness, increasing drainage, wound separation, sudden breast swelling, worsening pain or a change in skin colour. Seek emergency help for severe shortness of breath, chest pain or fainting. New arm swelling, heaviness or tightness also warrants assessment.

Ask: Which reconstruction method suits my health and goals? Can it be done at the same operation? What happens if healing is delayed? How will this affect sensation, exercise, imaging and future procedures?