QUESTION: I would like to know whether a baseline mammogram is recommended after skin-sparing mastectomy with TRAM reconstruction (one year later)
ANSWER: In general, mammography of a reconstructed breast is not necessary unless your doctors think that you are at significant risk of having a problem again in the area where the breast used to be. Women who had a large breast cancer (over 5 cm or 2 inches), had significant lymph node involvement (four or more nodes involved), or had tumor in the skin are considered at increased risk for tumor recurrence in the area of the breast. In those situations, you and your doctors will want to watch the area closely at three-month intervals by physical exam.
Because it's tough to feel the back of the chest wall where the back of the breast used to "live," and confusing lumps can occur after TRAM reconstruction (called "fat necrosis"—balled-up clumps of dead fat cells), it's helpful to find another way to ALSO evaluate the area. Mammography can be useful in this role, able to detect a possible recurrence in the original breast-area tissues at risk, and it can help distinguish fat necrosis from something more worrisome. MRI scanning can also be useful in certain women. If your cancer didn't have those high-risk features, then you probably don't need mammography. Work with your doctor to get the best guidance for you.
—Marisa Weiss, M.D.