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?
Nervous About Breast Reconstruction with Mastectomy
Doctor Answers 40
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 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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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,
- adjuvant treatment protocols (radiation or chemotherapy), etc.
There are many issues to discuss:
- Will your reconstruction be done at the same time as the mastectomy or at a later date?
- Are you in good enough health to undergo a combined procedure?
- Do you smoke?
- Do you want your own tissue (stomach/back/buttock) or an implant or a combination of both?
- Can your body provide sufficient tissue for reconstruction?
- In regards to the opposite breast, you may want to reduce the large breast or enlarge the small breast. A breast lift may also be in order. Reduction and or lifts can be completed using a variety of techniques depending on the amount to be corrected and the degree of asymmetry. Areolae can be made smaller.
As you can see, this is not an issue which can be discussed over the internet. Depending on the results of this discussion with your surgeons, the answer may become clear.
In the past, delay was recommended to ensure adequacy of cancer removal as well as assessment of the quality of the remaining skin.
However, the vast majority of patients seek immediate reconstruction for its psychological beneifts which should not be discounted. Several studies have dispelled earlier concerns about delaying diagnosis of recurrence and have shown that immediate reconstruction does not effect cancer survival.
I hope this helps!
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!
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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 yields the most aesthetic (cosmetic) results.
On the other hand, if you are unable or not yet ready to consider reconstruction at the time of cancer surgery, a delayed reconstruction can be done. Delayed refers to waiting a period of time before your breast is reconstructed. There is no time limit to when this can be done (i.e. weeks to 30 years or more later!), and it also is covered by insurance.
The main difference between immediate and delayed reconstruction is that the shape of the breast has been lost, and the remaining skin of the breast has likely contracted. Reconstruction therefore is slightly more complicated, and the skin of the chest will either need to be stretched out to accommodate an implant, or removed if a "flap" (tissue from the body) is used.
Don't be nervous about breast reconstruction! Reconstruction is usually viewed as a positive, even a FUN experience, and is the "light at the end of the tunnel" for many breast cancer survivors.
Be sure to visit a Board Certified Plastic Surgeon with a great deal of experience in breast reconstruction, and ask to speak to other women just like you for your reference. Before and after photographs will also give you a good idea about what you can expect with surgery.
Best of luck to you!
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.
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.
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 with the breast mound and followed by the nipple and areola reconstruction.
Both options are medically appropriate but they need to be discussed at length with the reconstructive surgeon to find out which way is best for each patient.
Immediate breast reconstruction has advantages
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 own tissue (TRAM flap) depends on what your plastic surgeon recommends.
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 of your consultation with your Plastic Surgeon is to clarify this process and work with you to explain your options and come up with a plan.
An immediate reconstruction is a safe and reliable way to reconstruct a breast. Regardless of the technique used to reconstruct the breast, it invariably results in one less operation and general anesthetic. If an implant based reconstruction is planned, a larger amount of expansion can be performed in an immediate setting because the skin has not had a chance to contract down. Thus, many times, a substantial breast mound can be reconstructed prior to waking up. This leads to less expansions afterwords in the office and a quicker time to complete the reconstruction.
Delaying a reconstruction is not a "bad" option at all, but more of a personal decision. There are times when a delayed reconstruction is the only option due to prior radiation or uncertain extent of the cancer. Still, some patients prefer the "wait and see" approach.
Making these decisions is often helped by asking others who have gone through breast cancer and reconstruction before you. Most hospitals have support groups of breast cancer survivors which can be immensely helpful. Also, plastic surgical resources from the American Society of Plastic Surgeons can also helps you understand what your options are and help you in your discussions with your plastic surgeon.
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.
The decision is also based on your preference. However, many patients feel very happy to see that they have a new breast after they awaken from anesthesia. There is a sense of closure that is psychologically healthy.