Is One-stage Breast Reconstruction Better Than Two-stage Reconstruction?

Fully 50% of my business is breast reconstruction, and I perform one stage breast reconstruction routinely. Of course, the patient must be healthy, the breasts are best if smaller than a D, although I have performed it with larger implants (>600cc) without increase in complication rates. Most importantly, performing it in one stage takes practice and time. In surgery, the patient must be brought up into a seated position to check if the breasts are even, and any asymmetries fixed on the... more

Options that I consider in determining if a patient is more suitable for a one vs. two stage breast reconstruction: 1.  Stage of Cancer:  if there is a potential for radiation, I always recommend delayed reconstruction or 2 stages with a tissue expander. 2.  Type of mastectomy:  if there is limited potential for skin involvement with cancer and your plastic surgeon trusts the ability of your breast surgeon to perform a good skin sparing mastectomy,  I... more

 It really depends on your surgeon.  In my opinion I prefer two stage reconstruction.  Simply stated it gives me two attempts to make the best reconstructed breast possible.

It would be nice to say that one technique is better than the other, but that's just not the case. Some surgeons prefer one stage to two and others like myself prefer a rwo stage but will ocassionally do a one stage reconstruction. Much of this depends upon the type of mastectomy you are having (skin sparing, lumpectomy, modified radical), the type of reconstruction you are having( tissue adding like flaps or available tissue like expanders and implants) and your anatomy to begin with... more

Dear Mary, This question is STILL hotly debated even among Plastic surgeons. All things being equal, Breasts can be created in several ways begining at the time of the mastectomy (ie IMMEDIATE vs. Delayed) : 1. a tissue expander is placed in, the matectomy incision is closed. Over the next 3-4 months depending on the patient's circumstances the expander is slowly filled creating enough breast skin. Then, in a second stage the expander is taken out and a breast implant is placed in. A... more

Breast reconstruction can be performed using autologous tissue( your own) versus non-autologous ( like a tissue expander and implant). The implant method will often require two stages. One to expand the chest skin and two to replace with an implant. A later stage is performed to reconstruct the nipple. For autologous reconstruction, this is usually a one stage procedure but sometimes secondary procedures are performed to adjust the shape and volume. But there are many variables that may... more