Delayed vs Immediate Reconstruction

September 13th, 2023

Immediate Breast Reconstruction

In many cases, breast reconstruction can be started or is done at the time of mastectomy. This is called immediate reconstruction. This form of reconstruction is done in all women having a prophylactic mastectomy to prevent breast cancer. This will involve the placement of an implant or tissue expander after the mastectomy or the transfer of some of your own tissue to the breast. It also requires coordination between the general surgeon and the reconstructive surgeon. The instances in which reconstruction cannot be done at the time of mastectomy often relate to the need for chemotherapy and/or radiation therapy after mastectomy. There are many benefits to immediate reconstruction including:

  • Possibly fewer surgeries and lower cost
  • Psychological benefit
  • Better cosmetic result

Delayed Breast Reconstruction

In cases where cancer is more advanced and additional treatments like radiation and chemotherapy are necessary, it is recommended to wait before having reconstruction. This is called delayed reconstruction. Chemotherapy can cause problems with healing after large reconstructions, but more importantly, radiation can have some very negative effects on breast reconstruction. There is a strong association between problems and complications in implant reconstructions and radiation therapy. In addition, radiation can make reconstructions made of your own tissue smaller and more firm and unshapely. Women with larger tumors and tumors in their lymph nodes are more likely to need radiation therapy and most reconstructive surgeons would recommend waiting six months to a year before having reconstructive surgery. There are benefits to delayed reconstruction as well:

  • More time to consider reconstructive options
  • Additional therapies do not interfere with the reconstructive site

Many factors are taken into consideration including the stage of cancer, the health of the patient, and personal preference before recommendations are made regarding the timing of breast reconstruction. It’s important that your entire team of doctors — breast surgeon, plastic surgeon, radiation oncologist, medical oncologist, and other caregivers — meet as a group and discuss your unique situation. Ideally, this group should meet before you make your decision about mastectomy or lumpectomy because the type of breast surgery you have can affect the reconstruction outcome. Because each breast cancer is unique, each reconstruction surgery and its timing are unique. Together, you and your team can decide on an approach that is best for you.

Getting a breast cancer diagnosis is extremely stressful and very scary. Making decisions about mastectomy or lumpectomy and other treatments is extremely emotional, and making even more decisions about the type of reconstruction to have and the timing only compounds the level of anxiety. Remember to pause and give yourself time to think things through and weigh all of the options. Be sure to do your research and seek multiple opinions before deciding on your team, and take time to think of things long-term. Your reconstructive results will matter greatly in the future, even though the stress of cancer may not make it seem so right now.

Questions to Ask Your Surgeon

  1. Am I a candidate for immediate reconstruction? If not, why?
  2. What are the risks associated with immediate vs. delayed reconstruction?
  3. How will my results differ with immediate vs. delayed reconstruction?
  4. How long will I be in the hospital?
  5. What will my recovery be like and what are my limitations?
  6. If I need delayed reconstruction, how long will I have to wait?

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