Immediate vs Delayed Breast Reconstruction
Breast reconstruction does not increase the risk of breast cancer recurrence, impact prognosis or decrease survival.
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 any time after the mastectomy ("delayed reconstruction"). When the mastectomy and reconstruction are performed at the same time, a skin-sparing 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 many cases nipple-sparing mastectomy can be performed. This preserves the nipple and areola as well as the entire breast skin envelope. Nipple-sparing mastectomy is the latest evolution in mastectomy technique and provides the best cosmetic results without compromising cancer care.
Whether the reconstructive process is started at the same time as 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 and achieve the best results.
Immediate breast reconstruction is typically associated with the least amount of scarring and the best cosmetic results. Immediate reconstruction does not typically delay other components of breast cancer treatment like chemotherapy. Most breast cancer patients, especially those with early disease (stage 1 or 2) are candidates.
Delayed reconstruction usually leaves more scarring and the final breast is less likely to look like the breasts Mother Nature provided. Common medical reasons to delay reconstruction include advanced breast cancer (stage III or IV), inflammatory breast cancer, and the plan for radiation therapy after mastectomy. 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.
Several other factors can also influence breast reconstruction timing including the patient's overall health, patient preference and access to a reconstructive surgeon.
Whenever possible, immediate breast reconstruction should be considered to allow for the best final cosmetic results.
The difference in scarring between immediate and delayed breast reconstruction can be seen in these breast reconstruction before and after photos.
Learn more about your various breast reconstruction options here.