Delayed vs. Immediate
The timing of breast reconstruction will depend on your circumstances and personal wishes. Some patients are able to have immediate reconstruction at the same time as mastectomy. Others delay reconstruction until after recovery from mastectomy and subsequent cancer treatments.
For the best cosmetic results, mastectomy patients who will undergo radiation and or chemotherapy are advised to delay reconstruction until their treatments have been completed.
If you plan on delayed reconstruction, it’s best to have a tissue expander put in place at the time of mastectomy to make room for a permanent implant or natural tissue (autologous) reconstruction. The tissue expander acts as a space-saver and prevents the skin from scarring down to the chest wall after radiation, which would otherwise complicate reconstruction. The expander will be filled with saline during the procedure, but the degree of expansion will be limited at the time of surgery by the amount of available skin left following mastectomy. Once the incisions from surgery heal, more saline can be inserted during a series of follow-up office visits, allowing your breasts to expand over time to the size you desire.
Ultimately, the tissue expanders will be exchanged for implants or natural tissue during reconstruction. Each patient’s situation is unique, and the timing of your delayed reconstruction will depend on your cancer treatment.
Some patients are candidates for one-step breast reconstruction in which they skip using tissue expanders and have natural tissue reconstruction or implants placed at the time of mastectomy. This option is typically reserved for women who will not need radiation treatment. For those who are eligible, it promises more simplicity and less disruption to daily life.