Breast reconstruction

This is a tough question to answer in such a small space. I often spend 30 minutes to 1 hour with new patients regarding this very question. First, you want to know what type of tumor it is, how big, whether they suspect lymph node involvement, what type of post-op therapy you will need. All these are important questions.

If you are an appropriate candidate to have an immediate reconstruction, then I would strongly recommend it. It is much easier to reconstruct the breast when you know what the mastectomy specimen looks like in terms of size and shape, as well as the skin flaps that are left after the mastectomy. Of course, options for reconstruction are numerous including DIEP flaps, TRAM flaps, tissue expander/implant, to name a few.

There are many factors to consider when deciding whether or not to have immediate breast reconstruction.  Immediate breast reconstruction is when the reconstruction is done at the time of mastectomy; in other words, there is no delay. 

The reconstruction can be done using your own tissue or using a tissue expander.  If you have a tissue expander, a 2nd procedure is needed to remove the expander and put in the implant.  Many patients also have reconstruction of the nipple.  Even though you are not sure what you want to do right now, I strongly urge you to have a consultation with a plastic surgeon to discuss your options and then you can decide what is best for you. 

There are emotional issues as well as physicial issues.  Whether or not you need radiation after the mastectomy is one thing your plastic surgeon will consider when discussing your options with you.  In general, if you are healthy and do not need radiation after the mastectomy, plastic surgeons prefer to perform immediate reconstruction.  This is because immediate reconstruction generally leads to an enhanced aesthetic result compared to delayed reconstruction.  Your thoughts about allowing the breast to heal are very insightful.  When the skin heals however, a lot of scar tissue forms around it and the tissues become "tight".  While the area is healed, this tightness of the tissues actually makes the reconstruction more challenging, although it can still be done. 

Look for a breast surgeon who routinely works with a plastic surgeon.  These two people then have a lot of experience working together and it will be simple for you and your  team to decide what is best for you.

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