Once the decision has been made to have a mastectomy, patients need to decide whether they plan to remove just the affected breast or both breasts. This decision is a very personal one, with many factors to be considered. Your oncologist will review your risk of recurrence related to your specific diagnosis and treatment modalities. They will help guide you in your decision and discuss the probabilities of developing a cancer on the unaffected breast in the future.
Patients also need to consider the emotional factor of removing both breasts. Some women feel that they will worry about developing cancer on the remaining breast if it is not removed, while others want to preserve their appearance. Choosing to have a one-sided or unilateral mastectomy at the time of diagnosis does not prevent you from having the other breast removed at a later date. Again, reconstruction is an elective process, which usually has no firm time frames.
A third factor to consider is the anatomy of the unaffected breast. Your plastic surgeon will address these issues in your consult and guide you toward your reconstructive goals, whether it is unilateral or bilateral mastectomy. For very large breasted women, sometimes a breast reduction to the unaffected breast to match the reconstructed side is a great option. A breast lift or mastopexy, may be required to match a more moderately sized breast. For smaller breasted women, an implant may be used to augment the natural breast and provide symmetry for the reconstructed side.
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