Best Time for Breast Surgery - Before or After Menstrual Cycle?

First of all, it is absolutely true that any kind of elective surgery can be safely performed during any phase of the menstrual cycle. In fact, often the psychological stress or pre-operative "butterflies" can often send a woman into her cycle prematurely--all surgeons who have been operating more than a few years have seen this, since absolute predictability is impossible!

But, as physicians, we also understand that the female body undergoes significant and profound physiologic changes with each menstrual cycle in order to prepare for the possibility for fertilization of an ovum and resultant pregnancy. These changes affect the uterus primarily, but also the breasts, and to lesser degrees, the rest of the woman's body. Just ask a dozen women or so--they'll tell you! Obviously, some women notice these effects more than others, and surgeons who operate on lots of women start to notice these effects as well.

Of course, since women choose their surgical dates on the basis of personal schedule, work requirements, time off requests, help at home, children's schedules, spousal or partner availability, etc., we operate on women at all phases of their menstrual cycle, and we do it safely and effectively. So that should put to rest the "urban legend" that is is "unsafe" or that there is potentially serious risk of bleeding if operations are performed during a menstrual cycle.

BUT . . .

It would be equally incorrect to state that there is NO identifiable difference in women at various phases of their cycle. Many surgeons, myself included, have operated on enough women to be aware of these differences, and I recommend, all things being equal, that if possible, a woman schedules her surgery a week AFTER her period rather than the week BEFORE. At least with breast surgery, and perhaps with other operative areas as well, there is less bleeding, more easy coagulability, and less "boggy" tissues in the operating room, as well as less bacteria in the breast ducts, less tenderness, bruising, and swelling post-op, and as a result of these factors, perhaps less likelihood of capsular contracture. I would cheerfully admit that this is not a statistically significant, double-blinded, peer-reviewed scientific fact, but something that has become clearly evident to me in over 25 years of breast surgery in thousands of patients.

So, if possible, why not? And if not possible, I know to be just a little bit more cautious, and a tiny bit longer on the vessel coagulation, and a smidgen more restrictive on my patient activity recommendations. That's the art that goes along with the science, or perhaps the experience that goes along with the skill!

Breast Augmentation During Menstrual Period - It doesn't make much of a difference.

Breast Surgery is one of the most common procedures I do, especially Breast Augmentation. Over more than a 25 yrs I have often operated on women during their menstrual period and  I have not found it to be a problem .

It is not an uncommon to do breast surgery including augmentation during a menstrual cycle.  My experience even in women as "regular as a clock" with surgery scheduled between periods often start the day before, day of or within a few days after surgery or contrarily can be late. Menstrual cycles can become irregular at times of stress, from surgery and anesthesia. It should not be a problem.

Hi Dina, Theoretically, it might be best to have it after your menses, but practically I did not notice any diffference in postop pain, healing  or other issues. Due to the stress of surgery I had a few patients who experienced menstrual bleeding right after surgery which did not coicide with their regular schedule.

I personally have never tried to time the surgery based on a patients menstrual cycle. Sometimes a womans breasts will become slightly larger during certain phases of the menstrual cycle and this will continue to occur after the surgery.

I have found a an individual's breast symptom history to be the best guide to timing surgery. Fortunately most patients do not have much variation in symptoms with menstruation and timing is independent. However, for individuals with highly sensitive breasts, it would be wise from a symptom perspective to time the augmentation when it is least discomfort. Risks of physical surgical complications from menstrual cycle changes are not documented.

Hi Dina24,

Thank you for your question.  Since the breasts usually swell right before and during the menstrual cycle, I usually try to avoid surgery the week before the patient's period will begin.  However, some patients report that their breast size does not change much just prior to and during their period, so there is no need in these patients to plan around their period.  Other patients notice significant size changes in their breasts during their period and are naturally concerned that the increased size of their breasts could throw off the surgeon's intra-operative assessment of the breast size, whether it is breast reduction or breast augmentation. So if your breast size changes during your period, then I would try to schedule your surgery for the week after.  Agree with previous comments that occasionally the stress of surgery seems to bring periods on early; so not uncommon for patient expecting period the following week to come in for surgery and has her period.  This is not a problem and is handled very tactfully, with no embarrassment for the patient.  Hope this helps.

Tracy M. Pfeifer, MD, MS

 

My vote is after the cycle ends. Less swelling occurs. Great question for all to read our responses. Thanks for asking it. 

I never really noted whether or not there was an increased risk for surgery with the menstrual cycle and I have not seen any studies suggesting any.

Dear dina84,

I would not worry about planning the timing of your breast surgery around your menstrual cycle. All things being equal, there are subtle advantages to having surgery in the postmenstrual period, but the differences are very small and the menstrual cycle can be irregular especially around the time of surgery.

Warmest wishes,

Larry Fan, MD

People can have breast surgery anytime during the menstrual cycle although patients frequently have more discomfort in the premenstrual time.