Breast Reconstruction After Mastectomy: Options and Timing

Neoadjuvant chemotherapy should be started before referral in two situations: triple-negative breast cancer, and locally advanced disease, meaning a tumour over 5 cm, ulceration, peau d'orange skin change, satellite nodules, or bulky or supraclavicular nodes. In locally advanced disease, surgery follows after around four to four and a half months of chemotherapy. In genuinely advanced or metastatic disease, treatment is systemic only, chemotherapy or hormone therapy, with no surgery. For anything in between, it is always better to discuss the specific case jointly before deciding independently whether and when to start treatment.

No, a BRCA1 and BRCA2 test should be done first. Indications for testing are all triple-negative breast cancer, a strong first-degree family history (a sister, mother, or maternal or paternal aunt with breast cancer), and any history of male breast cancer in the family, which alone is enough to warrant testing. If the BRCA test comes back positive, mastectomy of the affected breast should be combined with prophylactic mastectomy of the opposite side. If BRCA testing isn't available locally, it can be arranged through Dr. Jain's centre.

There is no single definitive treatment; breast cancer, like all solid tumours, requires multimodal treatment. Chemotherapy alone, radiotherapy alone, or hormone therapy alone cannot cure it. Surgery has to be part of the treatment plan for a cure, combined with hormone therapy, chemotherapy or radiation as indicated, though surgery alone is occasionally sufficient in very select cases.

It's mandatory, and Dr. Jain considers it roughly 95% of overall cancer management. Physical rehabilitation covers arm exercises and lifelong protection of the affected arm, no rings, blood pressure cuffs or needles on that side. Psychological rehabilitation matters just as much, since patients carry real emotional weight after a cancer diagnosis, and in some settings social rehabilitation is needed too, since patients can lose their jobs, or in some communities face marital breakdown, because of the diagnosis.

Prognosis is improving steadily. Five-year survival is around 97-98% for stage one, 90-95% for stage two, 80-85% for stage three, and even stage four disease has a 25-30% five-year survival rate. Triple-negative and locally advanced cases carry a higher recurrence risk specifically, so they need especially stringent follow-up to catch any recurrence early enough to treat.

Either is reasonable. Immediate reconstruction, under the same anaesthesia as the mastectomy, spares a second procedure but adds four to five hours to surgery and lengthens recovery; delayed reconstruction after all other treatment is complete is the alternative. The choice is the patient's.

A latissimus dorsi flap combined with an implant for smaller reconstructions, a TRAM or DIEP free flap using abdominal tissue for larger ones, and a direct saline or silicone implant where a skin-sparing mastectomy is feasible.