Women who have undergone a mastectomy often consider having a breast reconstruction, but depending upon the medical needs of the patient, it may be necessary to delay the procedure. A delayed or “staged” reconstruction occurs after any further cancer treatment is complete or when the patient’s health allows for the procedure. An immediate reconstruction, or “direct to implant” takes place directly after the breast has been removed in a mastectomy. Some women were unaware that this was an option prior to the mastectomy. The amount of breast tissue removed can vary, and in some cases, the nipple and some breast tissue is left, whereas in other cases, the entire breast must be removed.
Delayed Breast Reconstruction
In some cases, the patient cannot have an immediate breast reconstruction due to the need for further treatment or other health issue, although most women are candidates for this option. It is okay to wait to have your breasts restored. For some women, they prefer to wait and find out more about their options before a decision. Some may decide to wear a prosthesis, but soon discover that they are unhappy with this solution. A delayed breast reconstruction can be performed in various ways, including the use of your own natural tissue or with implants, or a combination of both.
Cancer Treatments After a Mastectomy May Delay Breast Reconstruction
Some cancer treatments must continue after surgery. Radiation or chemotherapy can impact the size, shape and appearance of a reconstructed breast. Radiation is known to be a problem, and to lead to the possibility of negative changes on a reconstructed breast, and your surgeon and breast cancer doctor may advise you to wait until radiation or chemotherapy treatments are completed.
While you are recovering from the mastectomy and undergoing your treatments, preparing for your reconstruction can begin, with a tissue expander or implant inserted to preserve the skin on the breast. Once the tissues have recovered from radiation treatment, either the tissue expander or implant is removed and replaced with the tissue flap. This procedure is often called a delayed-immediate procedure.
What Option is Right for Me?
To come to a decision about what to do, it requires working closely with the surgeon performing the mastectomy, your plastic surgeon, your oncologist, and any other professionals involved in your care. Working together, with all of the data about your condition and future treatment needs, the right decision can be made. Your options include:
- Single-Stage Breast Reconstruction: This procedure spares the nipple and areola, and is performed in a single operation. An implant is placed directly after the mastectomy operation.
- Staged Breast Reconstruction: This procedure involves several surgeries. With an implant, there are at least two surgeries, and for natural tissue (flap reconstruction), two or three stages are required. The entire process is completed in varying lengths of time, from about three months to a year in total.
- Direct to Implant Breast Reconstruction: This is a one-step approach in which a single-stage reconstruction is performed directly following the mastectomy.
- Immediate Breast Reconstruction: This type of breast reconstruction also occurs directly after the mastectomy, with an implant (saline or silicone), or performed with the use of your own natural tissue moved from an appropriate area of your body, then used to rebuild the breast.
- Delayed Breast Reconstruction: A delayed reconstruction may be necessary due to the breast cancer stage, your medical condition, the need for radiation or chemotherapy after the mastectomy, or your own personal preference.
Advantages of Immediate Breast Reconstruction
For women who can have an immediate reconstruction, it brings many benefits, including:
- Fewer surgeries and inherent risks
- Reduced emotional and personal difficulties due to breast loss
- Does not affect further cancer development
The Advantages of Delayed Breast Reconstruction
For women who must have a delayed reconstruction, or have chosen to do so, there are benefits, including:
- No problems associated with radiation or other cancer treatment
- Provides more time for a woman to make a decision about breast reconstruction
Talk to a Premier Breast Reconstruction Surgeon
You deserve to have guidance you can trust. If you are concerned about what to do after a planned mastectomy, or have already had a breast or breasts removed and are ready to talk about your breast reconstruction options, we invite you to speak with Dr. Prichard for guidance, and to understand all of your options, what they entail, and what to expect.