Breast cancer after DIEP reconstruction?


Question from Cindy: Hi, my question is about DIEP reconstruction. I had mastectomy and tissue expander put in 4 years ago, then had infection 3 months later and had the implant removed, then had a Becker implant put in, and now have capsular contracture. My plastic surgeon is recommending DIEP, but my worry is that if I do this, what happens if I get breast cancer in other breast? Thank you.
Answers - Joseph Serletti For patients who have capsular contracture with implant reconstruction, an excellent alternative is to use the patient's own tissue. The most common site that we go to for that is the abdomen, and the most common way we perform that is as a DIEP flap. The abdomen can only be used once. In a situation where we are only reconstructing one breast, we typically harvest all of the lower abdominal tissue and then use what we need to match the opposite breast. When we reconstruct both breasts, we divide the lower abdominal tissue in half and use each half for breast mound reconstruction. In either setting, the abdominal tissue can only be harvested once. So, if the patient is only going to have one side reconstructed, she would need to have some other means of reconstruction should she get cancer in the opposite breast. The most common next alternative site would be the buttock.
Jennifer Sabol, M.D., F.A.C.S. I think in patients such as yourself, it may be reasonable to ask your surgeon to estimate what the risks to the opposite breast are. Often, patients assume that they are much higher than when is truly predicted. Most patients who have a cancer have an expected .5 to 1 percent risk per year to the opposite breast. Obviously, the younger you are at diagnosis, the more years you have at risk. The patients with the highest risk to the opposite breast are those with the BRCA mutation, where the risk may be as high as 60 percent by the age of 70. In that situation, patients would often consider the prophylactic mastectomy on the contralateral side at the time of revising their reconstruction with a TRAM flap.

On Wednesday, May 16, 2007, the Ask-the-Expert Online Conference was called Reconstruction UpdatesJoseph Serletti, M.D. and moderator Jennifer Sabol, M.D. answered your questions about breast reconstruction.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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