Q: I have had a bilateral mastectomy. I am interested in seeing what it looks like when women are able to use body tissue to recreate breast tissue. I do not want implants. I live in a small, underserved community, and I am meeting with a plastics doctor on Feb 3. My friend spoke to you about her situation, and she gave me rave reviews on her experience. I am unsure if you take my insurance, so it may not be possible to get surgery with your doctors. I am scared to death because I have a nasty genetic mutation, PALB2. I not only had that but breast cancer with one node affected (sentinel). I would like to have possible reconstruction; however, I was told I didn't have enough tummy fat a year ago, but maybe after COVID-19 isolation following bilateral mastectomy, chemo and radiation?   A: We see many patients that have been told by other doctors that they don’t have enough “natural” tissue to have natural tissue breast reconstruction. Almost every one of those patients does have enough tissue. Even before COVID! The reason is that not all plastic surgeons specialize in natural tissue reconstruction and may not be familiar with the possibilities and or limitations. Many more surgeons feel comfortable using implants. If you think you have any extra fatty tissue anywhere, you can have natural tissue reconstruction and have a proportional result. When you have your consult in February, find out what type of breast reconstruction is the surgeon’s preferred technique. If they tell you that you are not a candidate for natural tissue and they don’t do that surgery, you can seek another surgeon who has experience. I would be glad to do a virtual consult with you at a convenient time and review your situation and give you my opinion. Just let me know. We have photos of results on our website, and if you are having difficulty looking at them online, my office manager can help.   Dr. James Craigie CNBR