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Types of mastectomies and reconstructions possibly offered, basically :
Nipple-sparing mastectomy - this can be offered to smaller breasted women. The incision is across the fold beneath the breast and typically does not show.
Nipple-grafting mastectomy - this can be offered to women with larger or droopy, loose skinned, breasts. The nipple is preserved, thinned, and grafted on by a plastic surgeon, as is done in a breast reduction with incisions and scars like those of a reduction or of a lift.
Skin sparing mastectomy - this is done when the disease is too close to or involves the nipple or areola. This is usually done through a horizontal incision and the nipple is included with the specimen.
Implant based reconstructions - after the mastectomy, a plastic surgeon can replace the desired amount of missing breast tissue with either a smaller permanent implant (silicone gummy gel or saline) or a temporary expander that can be expanded in the office to the desired size. Often this involves grafting a human dermis leathery product over the implant or expander at the time of the mastectomy to control its position and increase the thickness of the tissue covering it. If an expander is placed, this will be replaced with a permanent implant 3 or more months later as a short outpatient surgery, often along with the grafting of fat over the implants that is aspirated from the abdomen and flanks. All implants will eventually fail and will likely need replacing via another short outpatient surgery.
Tissue-based reconstructions - this is when the missing tissue is replaced, either immediately or after tissue expansion, with tissue taken from the abdomen, buttocks, flanks or thighs. This is a longer operation with more risks and requires several days in the hospital. This avoids the need to replace the implant, if none are used.
So...PROs and CONs
Lumpectomy and radiation
+ Preserves nipple sensation the best.
+ Preserves the most of a breast
+ Avoids bigger and more surgery.
- Slightly higher recurrence rate.
- Requires every 6 to 12 months mammography and or ultrasound/MRI
- Can make mammography less comfortable.
- May cause indentation and or nipple position issues at one year, not seen initially.
+/- Mastectomy remains an option if not satisfied, comfortable, or there is a local recurrence of cancer.
Mastectomy
+ Avoid the gauntlet of all future regular breast imaging/mammography.
+ Slightly lower local recurrence rate.
+ Best chance for symmetry if done bilaterally, with or without reconstruction.
+ Reserves your body's total radiation dosing for when and if it's ever needed to treat end-stage disease and pain.
- Nipple and breast sensation loss or decrease.
- Somewhat bigger surgery with more risk, although now 50% of mastectomies are done as outpatients nationwide.
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