Mastectomy During Pregnancy & Beyond
Undergoing a mastectomy during pregnancy—often due to pregnancy-associated breast cancer (PABC)—is possible and can be safely managed with a multidisciplinary team.
1. Is Surgery Safe During Pregnancy?
- Mastectomy can be performed in any trimester and does not pose significant fetal risks :contentReference[oaicite:1]{index=1}.
- General anesthesia crosses the placenta but has not been shown to cause birth defects, and fetal monitoring is maintained :contentReference[oaicite:2]{index=2}.
2. Immediate Reconstruction?
Some centers offer immediate reconstruction using tissue expanders during pregnancy. A cohort of pregnant patients (mean ~16 weeks) showed no major fetal or obstetric complications :contentReference[oaicite:3]{index=3}.
- Pros: Helps reduce emotional impact and improve aesthetics.
- Cons: Longer surgery time; data are still limited and autologous flap methods are not recommended due to operative risk :contentReference[oaicite:4]{index=4}.
3. Alternatives & Timing
- Breast-conserving surgery is possible, but postoperative radiotherapy must be postponed until after delivery :contentReference[oaicite:5]{index=5}.
- Radiation and targeted hormonal treatments (e.g., tamoxifen, trastuzumab) are avoided until postpartum :contentReference[oaicite:6]{index=6}.
4. Chemotherapy During Pregnancy
- Chemotherapy (particularly anthracyclines) is generally safe in the second and third trimesters but contraindicated in the first trimester and near delivery :contentReference[oaicite:7]{index=7}.
5. Pregnancy Outcomes & Recovery
- Infants are typically born at term and healthy, with normal birth weights :contentReference[oaicite:8]{index=8}.
- Pregnancy does not clearly worsen cancer outcomes compared to non-pregnant patients when managed properly :contentReference[oaicite:9]{index=9}.
6. Fertility & Breastfeeding After Treatment
- Women can conceive after breast cancer treatment once hormonal therapy (e.g., tamoxifen) is complete—usually 2+ years later :contentReference[oaicite:10]{index=10}.
- Breastfeeding is possible on the unaffected side after unilateral mastectomy; double mastectomy precludes breastfeeding but many choose formula without issue :contentReference[oaicite:11]{index=11}.
💡 Key Takeaways
- Mastectomy (and sometimes immediate reconstruction) during pregnancy is both feasible and safe under experienced care.
- Multidisciplinary planning ensures balancing fetal safety with cancer control.
- Postpone radiation, targeted therapy, and endocrine treatments until after delivery.
- Future pregnancy and breastfeeding potential are real for many—discuss fertility preservation and postpartum planning early.
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