How do medical experts determine if a woman is a candidate for breast reconstruction surgery?

Dr. Benny Tan is a board certified plastic surgeon specializing in breast reconstruction and revisions at Banner MD Anderson Cancer Center.

Question: How do medical experts determine if a woman is a candidate for breast reconstruction surgery?

Answer: The primary goal of breast cancer treatment – to eliminate the cancer – must always be given top priority before reconstruction is considered. While most healthy women are candidates for reconstruction after mastectomy, certain health issues can influence the timing and type of reconstruction available to a patient.

Smokers are not good candidates for immediate reconstruction, which is done in the same operating room after mastectomy. Nicotine affects blood flow and can increase the risk of complications like skin necrosis, infections, wound healing issues, and post-operative concerns such as pneumonia. These patients are often offered reconstruction at a later date with the advice that quitting smoking in the meantime will greatly lower their risk of complications after surgery.

Obese patients have a higher incidence of complications during breast reconstruction, including blood clots, infections, fluid collection at the operating site, and would healing issues. These patients may also have limited reconstruction options. Before reconstruction, obese patients are advised to reduce their weight to a healthier level to improve their outcomes.

Diabetic patients at higher risk for wound complications after surgery need their glucose levels under control prior to reconstruction. Consulting with a primary care physician or endocrinologist before undergoing reconstruction to manage glucose levels is strongly encouraged.

Other medical issues may influence a patient’s timing for reconstruction, particularly those that require steroid treatments because steroids decrease the body’s ability to fight infection and adversely affect wound healing.

Reconstruction is a major surgery that can require multiple stages over a period of months, so a patient’s emotional state is always considered. The patient must be psychologically prepared to handle the reconstruction and understand that complications may delay future procedures or treatments. These concerns should be discussed with the patient’s cancer care team to determine the best approach for her situation.