Introduction：Famous American movie star Angelina Jolie in order to reduce the risk of breast cancer, pre-excision of both mammary glands and then breast augmentation news triggered the attention of the people of the country, for which the Beijing Youth Daily reporter interviewed the Peking University Third Hospital Plastic and Reconstructive Surgery Department plastic surgery expert Li Bibi, asked him to explain in detail for readers and its related to the breast reconstruction technology. The famous American movie star Angelina Jolie had her both mammary glands removed in advance and then breast augmentation in order to reduce the risk of breast cancer, so she asked him to explain the breast reconstruction technology in detail. ◆Replay ◆ On May 14, Angelina Jolie, a famous American movie star, wrote an article in The New York Times that she had both breasts removed preventively because she carries the BRCA1 mutation gene. In the article, Jolie mentioned that because she has a family history of ovarian cancer (her mother died of ovarian cancer in 2007), her doctor gave her a genetic test, which showed positive results for BRCA1, according to which the risk of her developing breast cancer was 87% and the probability of her developing ovarian cancer was 50%. On February 2, in what is called a “Nipple Delay” procedure, Julie had the ducts behind her nipples surgically removed, and then additional blood flow was created to the ducts to preserve her nipples. Two weeks later, the breast tissue was removed and then filled in with temporary padding in an eight-hour operation, and nine weeks later, the final surgery was completed as the breasts were filled with implants to reshape them. Julie says her chances of developing breast cancer in the future dropped to 5 percent. “The kids won’t see anything that makes them uncomfortable. They’ll see a small scar, and that’s all there is. Other than it, everything is the same old mommy, she’s exactly the same as she used to be. Personally, I don’t feel like I’ve lost any of my femininity and I don’t feel like the strong choices I’ve made have diminished my femininity in any way.” Julie said. In addition to the shocking reports of Jolie’s surgery in recent days, it has also piqued the public’s curiosity about breast reconstruction surgery. How much of a scar does cutting out the breast and putting in a prosthesis leave? Can beauty really be gained in a surgery to prevent breast cancer? Although the details of Julie’s surgery were limited in what she said in the media, there was still enough bandwagon to bring our attention to a surgery that can improve our own handicaps and increase our sense of well-being and self-confidence in life. Question 1: Why did Julie’s surgery start with nipple preservation? Libby: The prophylactic mastectomy that Julie had, which removed virtually all of the glandular tissue, was thorough enough in terms of reducing tumor risk. Preserving the nipple areola helps with subsequent breast reconstruction and is very beneficial in maximizing the natural, intact appearance of the breast. Question 2: Why was it necessary to complete her breast reconstruction in three steps? Is it possible to place an implant to complete the reconstruction at the same time as the mastectomy? Libby: Prophylactic mastectomy can usually be accomplished by placing an implant at the same time as the mastectomy. There are a couple of possible scenarios for a step-by-step approach. One is that in order to ensure the safety of the nipple areola, the excised breast tissue, including the tissue immediately below the nipple areola, is pathologically examined to confirm that there is no tumor development so that it can be retained, which takes at least a week. At the same time, due to the large amount of tissue removed under the nipple areola, it takes some time to confirm that the blood supply to the nipple areola has not been compromised before reconstruction can take place. Therefore, the step-by-step procedure has time to both wait for the pathologic results and to allow a recovery period for the nipple areola. Secondly, it is hoped that the reconstructed breast will be a little fuller than the original. We have had many cases of reconstruction after simple mastectomy, where the implant could have been placed directly, but the patient thought that since it had already been removed, it would be better to place a slightly larger implant. However, the skin may look tighter, which may affect the result. Therefore, an expander can be put in first to occupy the space, and after a period of time, water can be injected into the expander, which can support the space a little bit more, and the tissues of the outer envelope can be loosened a little bit, so as to put in a bigger implant, which will make the appearance more voluptuous than the original one. Thirdly, it is safer to correct the appearance of the original breasts, such as sagging or asymmetry, before placing the implants. Because Julie has had 3 children, there may be some degree of breast sagging, which is a guess. Question 3: Is there a difference between breast reconstruction after breast cancer surgery and Julie’s preventive mastectomy reconstructive surgery? Libby: There are still some differences. Because the scope of mastectomy for breast cancer surgery is generally larger, more tissue will be removed, and even part of the skin may be removed, and the nipple areola may not be preserved, and these situations will make reconstruction difficult. Also unilateral breast reconstruction seeks complete symmetry with the opposite breast, which is difficult. However, prophylactically, only the gland is excised, the skin and subcutaneous fat and nipple areola are preserved, the amount of tissue covered is relatively large, and the reconstruction conditions are certainly much better than after breast cancer surgery, and the reconstruction only makes up for the lack of glandular volume, which is a little easier. In addition, it is easiest to achieve symmetry with prosthesis reconstruction after this bilateral prophylactic excision. Considering the ease of reconstruction and the outcome of the reconstruction, Julie’s decision was a visionary one. This is because it is better to wait for the disease to appear before excising and reconstructing than to excise now, while reconstruction is more likely to achieve beautiful results. But it takes courage. Question 4: How safe is prosthetic reconstruction? As Julie said, “no loss of femininity”? Libby: The implants used in breast reconstruction are exactly the same as those used in cosmetic surgery for breast augmentation. Every year, nearly 300,000 people in the United States to do breast augmentation, China is nearly 100,000, which is already a generally recognized safe and effective surgery. Breast implants have been proven to be the safest material for filling breasts after 50 years of practice and repeated research. It is possible to replace the gland with an implant to achieve the effect of a real one. However, subject to individual tissue conditions, such as the thickness and laxity of the overlying tissues (skin and subcutaneous fat), as well as the size of the implant to be used, and many other factors, not everyone will be able to achieve the best results in terms of appearance, texture, and mobility in terms of absolute naturalness. Question 5: Julie says that her children will not see anything that makes them uncomfortable, only a small scar, is that true? How small is the scar? Libby: We have done several prophylactic mastectomies, which is a 4-5 centimeter incision through the edge of the areola, up to half the length of the circumference, to remove the gland and put in the implant. This leaves a fine linear scar that is not very visible. The surgery can also be performed through a 4-5 cm incision in the inframammary fold, again leaving only a narrow linear scar.