Is It Best to Have Reconstruction Right After a Mastectomy or Delay It a While?
Doctor Answers 10
When to consider immediate breast reconstruction
There is a definite trend toward immediate breast reconstruction, and in ideal circumstances it may be done using "direct to implant" technique, with no tissue expander. Several things have to align for this to be done: teamwork between the mastectomy surgeon and the plastic surgeon; skin-sparing mastectomy technique; use of an acellular matrix such as Alloderm; and no prior radiation treatment to that breast.
Breast reconstruction, nipple reconstruction, breast cancer, DCIS, mastectomy, TUG flap, DIEP flap, Latissimus flap
One of the most important referrals your breast surgeon can make is to a Board Certified Plastic Surgeon with experience in breast reconstruction. This week I have done a case very similar to yours.n Radiation treatment always changes the tissue on that side. The skin and tissue overall is somewhat tighter and firmer than the tissue that has not been radiated. OUr goal is always to provide new health tissue to these areas. The abdomen is a good source for flaps such s the DIEP flap. You can also have TUG flaps, SGAP flaps, and Bilateral latissimus flaps. Also all of these results can be improved with fat grafting.
Arguments could be made for both approaches. I recommend you follow the approach your surgeon is familiar and comfortable with. The same surgery can have two different surgeons follow slightly different approaches, and achieve the same outcome. Thus, discuss this with a surgeon you trust and believe is a good fit for you.
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I am sorry that you are having another episode of breast cancer that requires surgery. Usually it is easier to perform the reconstruction at the same time as the mastectomy.
Immediate reconstruction will give you the best result
Immediate vs Delayed Mastectomy Reconstruction
Given that you stated you previously had breast cancer surgery, I am assuming you've already undergone a lumpectomy and radiation therapy. I am also assuming that now you will need a completion mastectomy. In most cases, immediate reconstruction does yield superior cosmetic results. But delayed reconstruction still remains a good alternative. Given that you have likely undergone radiation therapy, I will generally recommend autologous (using your own tissue) reconstruction with a DIEP, SIEA, or TRAM flap procedure. If you do not have enough excess skin and fat in your lower belly, then the latissimus flap is also a good option. Please visit with a board certiifed ASPS member surgeon in your area to learn more about your options.
Immediate or delayed breast reconstruction
As a rule, it is best to have the reconstruction at the same time as the mastectomy (immediate reconstruction). Broadly speaking, you will get a better cosmetic result because more of the skin will be spared and there are psychological benefits in not having a period without your breast.
However, when radiotherapy is planned, it may damage the reconstruction and so there is an argument to delay it, although it is not written in stone. Also, having an immediate reconstruction can be a major undertaking and the potential for wound healing problems postoperatively could delay further treatments (radio or chemotherapy), so some patients are better suited to a delayed reconstruction.
Like most things, it is best if you have a discussion with your doctors and weigh up the pros and cons for you. There is often not a right or wrong answer.
Good luck. Jonathan Staiano.
it is not clear if you have a recurrence in the same breast or another breast cancer in the opposite breast.
What was done the first tome, lumpectomy? Radiation? these are important issues in the decision making for breast reconstruction.
If it is the opposite breast, what needs to be done skin sparing mastectomy, type of cancer? expected plan for further treatment/
these are important issues for the decision making.
your plastic surgeon, general surgeon and oncolodgist should talk together to dedcide what needs to be done, then a decision is made along with your input to do immediate or delayed reconsteruction. and the type of reconstruction.
Immediate reconstruction after mastectomy is almost always best.
You probably have had radiation, and with the scarring that you describe I would recommend flap reconstruction using your own abdominal skin and fat.
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