Reconstruction can be done in the same procedure, immediately following breast removal. For some patients, immediate reconstruction is not recommended or available. Therefore a delayed reconstruction is performed in a second procedure, anytime later on.
There is also a third option called delayed-immediate reconstruction which balances the benefits and constraints of both immediate and delayed reconstruction. It provides an improved aesthetic and psychological outcome, compared with delayed reconstruction but does not impede radiation delivery, if indicated postoperatively.
DELAYed-immediate breast reconstruction
At the time of mastectomy, a tissue expander is inserted under skin and chest muscle to maintain the overlying skin envelope. After a couple of months, it is replaced by either a flap or an implant.
If staging and pathology assessment of cancer within the removed breast tissue indicate no need for additional radiation therapy, patients proceed to the second stage. During the second stage, they undergo definitive breast reconstruction, either with a flap or silicone implant. In cases where additional radiation therapy is needed, the tissue expander preserves the skin envelope during treatment. Patients are monitored during radiation, in cases where the overlying skin becomes too thin, the tissue expander can be temporarily deflated. Partial deflation reduces the stress exerted on the overlying skin. After radiation therapy is concluded and tissues healed, a second stage, during which expander is replaced, most commonly with a flap, is performed.
IMMEDIATE (PRIMARY) Breast reconstruction
The main shape of the breast or the breast mound is reconstructed in the same operation as the mastectomy. It is done either with a flap, implant or combination of both. One of the options in this category is also a single-stage reconstruction. This is the only technique that alleviates the need for additional procedures, as nipple-sparing mastectomy (nipple and areola are preserved) following immediate reconstruction with an implant is performed.
DELAYED (SECONDAry) reconstruction
Delayed reconstruction is done in cases where the patient has had no breast reconstruction after previously failed breast reconstruction or is dissatisfied with her current breast reconstruction result.
Secondary or delayed reconstruction is done using the same techniques as primary but without the possibility of immediate implant placement. This is not possible due to insufficient soft tissue quantity in the breast area.
The decision about the timing of reconstruction is complex, and we approach it in a multidisciplinary fashion. It is essential for the doctors to consider the patient’s wishes, the need for postoperative radiotherapy, the extent of the disease as well as other medical conditions when deciding about the optimal treatment plan.