Breast Reconstruction: Q&A

Ask a Question

Nervous About Breast Reconstruction with Mastectomy

My oncologist has recommended I have a mastectomy - I was diagnosed with breast cancer - and I'm going to have the surgery. He told me I could have reconstructive surgery on the breast at the same time--but I'm nervous about that. It just seems that the breast should be given time to heal and make sure that everything is ok first--but my doctor doesn't seem to think that's an issue. Is it ok to have reconstruction at the same time as mastectomy--or are there advantages to waiting?

Tags:

nervous options

Comment on this

38 Doctor Answers | Asked by NancyM in Rutherford, NJ

Doctor Answers (38)
Community Comments (0)

Is it ok to do immediate breast reconstruction after mastectomy?

As the breast reconstruction has become more and more successful the immediate reconstruction has become very popular. Today the majority of patients have immediate reconstruction at the time of their mastectomy. The benefits certainly out-weigh the slight increased risk.

Immediate breast reconstruction is usually preferred

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... more

Many variables to answer that question

Immediate breast reconstruction is an option for the majority of women getting a mastectomy. Keep in mind though, that breast reconstruction (even when considered immediate), often requires multiple steps to get it as symmetrical and aesthetically pleasing as possible. Delayed reconstruction is an option, but the skin envelope often contracts, which may require bringing in tissue in the form of an abdominal or latissimus flap. Good Luck!

Discuss Breast Reconstruction issues with your surgeon

Your unique situation would clearly require a consultation. Breast reconstruction involves a variety of techniques and methods which are too detailed to discuss in this format. Important information to acquire during a consultation involves a long history to document: family history, future risk, methods/approaches/incisions for cancer removal (biopsy, lumpectomy, partial/total mastectomy), management of the opposite breast (enlargement, reduction, or lift), previous surgical procedures... more

Otto Joseph Placik, MD

32 reviews

Chicago Plastic Surgeon

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... more

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Different options in breast reconstruction

Breast reconstruction can be immediate (at the same time as the mastectomy) or delayed (after a few weeks to months). The decision as to which one is better for a particular patient depends on a lot of factors one of them is surgeon preference. In my practice I now rarely perform immediate reconstructions because I have a strong feeling that the wound has to settle down first, the disease has to be cured and the patient ready to embark on a long journey which is the reconstruction, starting... more

Immediate breast reconstruction has advantages

Debbie, Breast reconstruction is a personal decision and should be discussed thoroughly with your plastic surgeon. He/she can help you decide the timing and which procedure is best for you. All things being equal, I feel immediate breast reconstruction has several advantages vs. delayed including one less surgery, combined recovery with mastectomy, greater psychological benefit and tissue which is more supple, allowing for a better cosmetic result. Whether you use an expander/implant or your... more

Mastectomy and immediate breast reconstruction yields the most aesthetic results

If you are diagnosed with breast cancer and a mastectomy (removal of all of the breast tissue) is recommended, you will always be a candidate for breast reconstruction. Breast reconstruction is in fact your right, by law! Immediate breast reconstruction refers to reconstruction of the breast form at the same time. The advantage of this is that you will only need to undergo one major surgery, and the shape of the breast is maintained. Immediate reconstruction often... more

Immediate breast reconstruction preferred

When an option, immediate breast reconstruction is generally preferred over delayed reconstruction. You are already under anesthesia, so it spares you from one additional surgery, and since everything is open already, the surgery can be quicker as well. If your surgeon feels like you are a good candidate for it, then I generally recommend it.

Timing of breast reconstruction

There are advantages to both ways, and certain times when waiting is the only answer. A reconstruction performed during the same surgery as the mastectomy is known as an "immediate breast reconstruction" whereas having it later is known as a "delayed breast reconstruction." A diagnosis of breast cancer is a very emotional and intense event in ones life. Having to make a decision about reconstruction during this hectic time often seems overwhelming. One of the main goals... more

David Bogue, MD

6 reviews

Boca Raton Plastic Surgeon

www.drbogue.com

Timing of Immediate vs. Delayed Breast Reconstruction

The decision to perform immediate vs. delayed reconstruction depends on one important factor: whether or not you will have postoperative radiation therapy. If you are considering a implant reconstruction, the rate of capsular contracture after radiation may be much higher than without radiation. Autologous reconstruction fares better with radiation overall. If radiation is planned, some surgeons prefer to irradiate the breast and then have the option to perform autologous reconstruction... more

Breast Reconstruction Timing

Breast reconstruction timing is one of the key questions that you should discuss with a team. That team should consist of your plastic surgeon, your general surgeon and your oncologist. In my San Francisco area practice I have performed immediate and delayed breast reconstructions, tailoring each treatment for the patient. In my experience with implant reconstructions, pedicled TRAMS and microsurgical breast reconstruction including free TRAMs, DIEPS, SIEA and SGAP flaps you can achieve an... more

Advantages of immediate reconstruction

Having been instrumental as a founding member of a breast clinic in a major urban hospital treating breast cancer with a multidisciplinary approach I have a few points to make. First of all, the fact that your oncologist, and hopefully your general surgeon, has offered immediate reconstruction as a possibility is a step forward. Many doctors, especially in the "old days," wouldn't allow any reconstruction, thus condeming a lot of patients to many months, if not years, of emotional... more

Robin T.W. Yuan, MD

4 reviews

Beverly Hills Plastic Surgeon

Immediate vs. Delayed Breast Reconstruction: No "Wrong" Answers - Heed Your Instincts

It is certainly overwhelming to be presented not only with the diagnosis of breast cancer, but also the variety of possible treatments that follow from the breast cancer diagnosis, including possible chemotherapy or radiation therapy. The thought of reconstructive breast surgery may seem like one additional complicating factor to consider. There are excellent reasons to consider immediate breast reconstruction, which is initiated at the time of the mastectomy. Your plastic surgeon works... more

It is always okay to wait for reconstruction

The only time you lose an opportunity for your best result is when you could have had a "skin sparing mastectomy" with an immediate reconstruction using your own tissues such as from the lower abdomen. I these cases, less breast skin is removed and the crease under the breast is preserved and the tissue removed is replaced with new tissue. This is the Cadilac of breast reconstruction but can't always be offered for a wide variety of reasons. Otherwise, all reconstructions can be done on a... more

Think of breast reconstruction as a process started with mastectomy

In the majority of patients, I believe there is an advantage to having the reconstructive process started with the mastectomy. If my wife were in your shoes, that is what I would suggest. Think of breast reconstruction as a process, that may take several stages to complete. Many times, these subsequent stages can be realtively minor and done as an outpatient procedure. If you are sure you will want breast reconstruction, then it is more efficient (less surgeries, anesthesia, time out of life... more

Timing of breast reconstruction

Thank you for the excellent question! Hope that these help you in your decision! The first thing to consider once you have decided that breast reconstruction is the right thing for you is the timing. It could be done immediate (at the same time as your mastectomy or delayed (at anytime after your mastectomy has been completed). The second thing to consider is what type of reconstruction (implant-based vs. flap-based vs. fat transfer). Usually, immediate... more

Nervous is normal

Breast reconstruction at the time of mastectomy is a normal procedure in many places. The tissues are fresh which allow more accurate placement and there are documented psychological benefits to waking up with breast reconstruction completed. There is no right or wrong answer but its important that you to get all the facts. Talk to your doctors.

Immediate breast reconstruction produces the best results

If you are a candidate for immediate breast reconstruction, the results are usually superior to delayed reconstructions for several reasons. 1. your plastic surgeon and general surgeon can work together and plan out your mastectomy incisions to produce the best results 2. much more of your own native skin can be saved and recruited for use in your breast reconstruction (skin envelope shrinks and tightens during the healing process and you have less of your native breast skin to use for in... more

Perry Liu, MD

Beverly Hills Plastic Surgeon

www.perryliumd.com

Immediate breast reconstruction

Immediate breast reconstruction is an option for many women undergoing mastectomy. There are advantages and disadvantages of immediate (versus delayed) reconstruction. In general, breast reconstruction is performed in one of two ways-either using tissue expanders and implants or flap techniques. In choosing a plastic surgeon for breast reconstruction, it is important to inquire as to both techniques (and select a surgeon who is familiar with both methods of breast... more

Is Immediate Breast Reconstruction a Good Idea?

There are now laws requiring oncologic surgeons to inform you about the possibility of having breast reconstruction because, frankly, many women weren't told of these options. This is an important advance because it allows for planning and discussion of the option of immediate breast reconstruction or delayed breast reconstruction reconstruction, or no breast reconstruction after Mastectomy surgery. This is important because there are advantages to immediate breast... more

Immediate breast reconstruction

I can understand that you are nervous about breast reconstruction after mastectomy. I know there are a lot of things to worry about before any surgery. There are several options for breast reconstruction. Most commonly, breast can be reconstructed with implants or autologous (your own) tissue. The timing for breast reconstruction can be Immediate (done at the time of mastectomy) or delayed (done some time after mastectomy). Although immediate breast... more

Timing of reconstruction after mastectomy

There is actually quite a debate among plastic surgeons about the timing of reconstruction, and it depends on several factors. The concern is exactly the one you pointed out: since the surgeon's job is to get rid of the cancer, they want to be thorough which may mean thin skin flaps that might not heal well. If there is an implant underneath then the reconstruction could be compromised. However, if there is a team appraoch then it makes a lot of sense since you save an additional... more

Immediate Reconstruction is a Safe Option

Immediate reconstruction following mastectomy usually yields the best results. Reconstruction after mastectomy must be covered by insurance thanks to the only health care mandate that is federal law (1998 federal law). In addition to the cosmetic results, there are psychological benefits to a patient not having to experience the chest wall deformity following mastectomy. There are implant-based and autologous (tissue only) reconstructive options. Delayed reconstruction... more

Immediate breast reconsutruction is safe

I admire your intuition about questioning the safety of immediate breast reconstruction- this same question has been debated for a long time- the prevailing opinion is that it is safe and reasonable to do immediate breast reconstruction at the time of mastectomy. Outcomes are excellent.

Breast reconstruction: a ray of hope in dealing with breast cancer

Breast reconstruction can help restore a woman's confidence and self-esteem during the battle against breast cancer. Immediate reconstruction, at the time of mastectomy, is preferred for ideal cosmetic outcomes. You have many options available and should definitely meet with a Plastic Surgeon well before your mastectomy is done. Good luck!

Carmen Kavali, MD

11 reviews

Atlanta Plastic Surgeon

Breast Reconstruction: Patient Choice

As opposed to the mastectomy, which is medically necessary to treat your breast cancer, breast reconstruction after mastectomy is the patient's choice. My job as a plastic surgeon is to discuss your reconstructive options and allow you to make the most educated decision possible. Unless there is a medical condition that prevents breast reconstruction or the cancer stage is too advanced, I prefer to help the patient understand their options, expected outcomes,... more

Immediate Breast Reconstruction is Reasonable

For most patients, immediate breast reconstruction, performed at the same time as mastectomy, is reasonable, safe and effective. There is definitely a psychological advantage to immediate reconstruction. Some of the reasons to delay reconstruction include medical problems such as diabetes, smoking, unclear pathology, a known need for radiation, or aggressive pathology that requires chemotherapy to be started as soon as possible. Other reasons to delay reconstruction include... more

Immediate reconstruction is a very sound option

Most women today consider immediate reconstruction after mastectomy as long as their cancer is relatively contained and treatable by surgery. There is no evidence that reconstruction will negatively effect your prognosis and in fact there is much evidence of the positive psychologic benefits. You should discuss all options with your general surgeon and oncologist who will refer you to a plastic surgeon if they feel you are an appropriate candidate.

Immediate breast reconstruction will give you the nicest result

If your general surgeon and your plastic surgeon agree that you can have immediate breast reconstruction after your mastectomy, you should do it. However, there can be issues of radiation treatment in some cases, which may preclude you from being able to get the reconstruction until later. There are many advantages to getting the reconstruction at the same time as the mastectomy, including the fact that the cosmetic result will be MUCH better than if your reconstruction is done later. When... more

Many good reasons why mastectomy and breast reconstruction are best combined

If your oncologist is comfortable that the reconstruction will not interfere with any treatment you may need to have after your surgery, than there are three excellent reasons to combine the reconstruction with the mastectomy. First, the mastectomy can be done through a skin sparing incision, which allows for an improved cosmetic result. Second, you can eliminate the need for another operation and additional anesthesia. Third, multiple studies have shown that women who can recover from... more

Breast Reconstruction with mastectomy a matter of timing

Breast reconstruction is a procedure that can be performed at the same time as the mastectomy or at a later date. There are many factors that go into making that decision including the spread of the cancer at the time of surgery necessitating the need for radiation and/or chemotherapy as well what the patient desires. If there are no plans for radiation therapy to the best of your surgeon's knowledge then the decision when to proceed with breast reconstruction lies completely with you. I... more

Immediate reconstruction is the gold standard

Immediate reconstruction following mastectomy is becoming the gold standard for the majority of the patients. A consultation with a board certified plastic surgeon is neccessary to get all the options explained in details.

It is best to have the mastectomy and the breast reconstruction together.

Hi. Your oncologist is right. For most women, it is completely safe, and the results are better, if the mastectomy and the breast reconstuction are done at the same time. In New York, 95% of our patients have immediate breast reconstruction.

There are advantages to both immediate and delayed breast reconstruction

There are advantages for immediate Breast Reconstruction and there are advantages to Delayed Breast Reconstruction. The ONLY argument in favor of Delayed Reconstruction is that it may be easier to spot a recurrent cancer ; You put it as " breast should be given time to heal and make sure that everything is ok first" . That is certainly a consideration. But is more so depending on which cancer you had and how extensive it is. On the other hand, depending on the reconstruction you... more

Immediate breast reconstruction is safe and acceptable

Hi, The priority of all doctors is to treat your breast cancer; reconstruction always is a secondary concern. That being said, in the vast majority of patients, immediate breast reconstruction not only is safe, but ultimately leads to better reconstructive results. For many patients. immediate reconstruction consists of tissue expander placement. This prevents the breast skin envelope from fully contracting and preserves the inframammary fold (fold below the breast) during subsequent... more

Either way is ok

This is a complex issue that has been bandied about fo over 20 years by my count. Both ways have pluses and minuses. My personal opinion that it is safer to do a delayed reconstruction, but others may disagree. Remember, ablation of the cancer is the first priority, and you want to get that done ASAP. There is no imperative to get the reconstruction. Some people forgo the reconstruction totally. Just be sure that you are not smoking, and have a heart to heart with everyone so you are... more

Immediate reconstruction looks better, but you can wait.

Hello, The results of immediate reconstruction are usually better than those of delayed reconstruction, but you can opt to wait if it seems "too much to bear" at this time. Starting reconstruction immediately allows the plastic surgeon to work with the general surgeon to limit the extent of tissue removal to only that which is needed to clear the cancer. The removal can also be done in a way that does not limit options for later reconstruction and placing even an empty expander... more