Breast Reconstruction

Timing of Breast Reconstruction Surgery

Once a woman has decided that she wants to have a breast reconstruction procedure and has determined which type of reconstructive procedure will best meet her needs, the next step is to decide on the best time to have the procedure. This decision should always be made in conjunction with the entire breast management team, because such factors as the need for radiation or chemotherapy may affect the timing of reconstructive breast surgery. Breast reconstructions performed at the time of a mastectomy are called “immediate,” while those performed at a later date are called “delayed”. Each approach to the timing of breast reconstruction surgery has advantages and disadvantages.

IMMEDIATE BREAST RECONSTRUCTION

Immediate reconstruction with natural tissue allows a woman to wake up following a mastectomy with a reconstructed breast. For women who are candidates for skin-sparing mastectomy or nipple-sparing mastectomy, an immediate breast reconstruction generally offers the best possible aesthetic results. Immediate reconstruction preserves the greatest quantity of a woman’s own breast skin and also minimizes scarring on the breast. In addition, immediate reconstruction will reduce the number of surgical procedures needed to treat a woman’s breast and reconstruct it, and reduce the total amount of time required for recovery and recuperation.

Although recent studies have shown that breast reconstruction surgery generally does not, delay further cancer treatment (including chemotherapy and hormone therapy), your breast cancer surgeon or oncologist may recommend that reconstruction not be performed at the time of mastectomy.

If your postoperative treatment plan includes radiation therapy, Dr. Greenspun will generally recommend that perforator flap reconstruction be delayed until several months after radiation therapy is completed.

If you have recently been diagnosed with breast cancer, our staff can help arrange prompt consultation with one the breast oncologic surgeons with whom Dr. Greenspun works. If necessary, plans can be made for you to consult with medical and radiation oncologists who, together with Dr. Greenspun and your breast surgeon, will develop a comprehensive cancer treatment plan for you. For women who have recently been diagnosed with breast cancer, we can help make arrangements for you to undergo treatment and reconstruction within a relatively short time. If you are traveling from out of town, our office staff can set up an itinerary that will allow you to arrive in New York City or Connecticut, consult with the physicians of your breast management team and undergo surgery within just a few days.

DELAYED BREAST RECONSTRUCTION

Some women choose to delay breast reconstruction; their reasons for doing so are diverse. Sometimes it’s at the recommendation of the breast surgeon or oncologist. Others wish to get out of the hospital as quickly as possible after mastectomy and opt to undergo a reconstruction at a more convenient time. Still others initially decide not to have reconstruction, but later decide they want to have a breast restored. And some women, not fully informed about their options for breast reconstruction prior to mastectomy, sadly, learn about reconstructive options only later.

In most cases, successful breast reconstruction can take place even after a delay of many months or even years.

Delayed reconstruction can also be done if a woman’s desires to revise a previous reconstruction using a new reconstructive procedure. Women who are dissatisfied with an implant reconstruction, for example, may decide to have their implants removed and replaced with their body’s own tissue. Women who are not satisfied with a previous natural tissue or implant reconstruction may elect to undergo a reconstruction well after the original procedure.

Because perforator flaps, such as the DIEP and GAP flaps, are performed on a regular basis at only a small number of specialized centers around the world, some women may choose to be treated for their breast cancer close to home and, later, travel to one of these centers for state-of-the-art breast reconstruction. Although a delayed reconstruction does involve a second anesthetic procedure, modern anesthesia techniques are extremely safe. The risk of the second procedure should be balanced against the somewhat longer surgery time of an immediate reconstruction.

Our staff can help plan an itinerary for patients traveling from out of town who wish to have a consultation and, on the same visit, undergo delayed reconstruction surgery in New York City or Connecticut.

» Find out more about the timeline for breast reconstruction surgery