Breast Reconstruction Timing: Immediate vs Delayed Reconstruction
By: Dr. Minas Chrysopoulo
With so much to think about after a breast cancer diagnosis, many patients facing mastectomy do not fully understand how the timing of breast reconstruction influences how the reconstructed breasts will ultimately look.
Breast reconstruction can be performed at the same time as the mastectomy ("immediate reconstruction") or a while after mastectomy ("delayed reconstruction"). When the mastectomy and reconstruction are performed at the same time, a skin-sparing mastectomy can usually be performed which saves the majority of the natural breast skin envelope. Only the actual breast tissue under the skin is removed. The reconstruction then "fills" this empty skin envelope. In some cases nipple-sparing mastectomy can be performed. This preserves the nipple and areola as well as the breast skin.
Whether the reconstructive process is started at the time of the mastectomy ("immediate") or some time after ("delayed'), it important for patients to realize that in most cases, further surgery is required to complete the reconstructive process.
Skin-sparing (or nipple-sparing) mastectomy and immediate breast reconstruction produce the most "natural" results with the least scarring. Skin-sparing mastectomy and immediate reconstruction is therefore preferred whenever possible and should be the goal for breast cancer patients with early disease (stage I or II).
Delayed reconstruction unfortunately leaves more scarring (typically) and the final breast is less likely to look like the breasts Mother Nature provided. Common reasons to delay reconstruction include advanced breast cancer (stage III or IV), inflammatory breast cancer, the plan for radiation therapy after mastectomy, and lack of access to a reconstructive surgeon. While immediate breast reconstruction can still be performed if radiation is planned, many plastic surgeons prefer to delay reconstruction until some time after radiation has been completed to decrease the risk of complications.
The difference in scarring between immediate and delayed breast reconstruction can be seen in these breast reconstruction before and after photos.
Ultimately the priority must always be "life before breast" - obviously the breast cancer treatment comes first in terms of priority. However, all other things being equal, there will sometimes be a choice to be made between having the reconstruction performed with the mastectomy or some time after the mastectomy.
Whenever possible, I encourage women to consider immediate reconstruction for the best cosmetic results.