Breast Reconstruction Specialist Weighs in on Timing of Reconstruction
06 Mar 2017
Today we happily welcome Dr. Thomas Lam, a Fellow of the Royal Australasian College of Surgeons and a breast reconstruction specialist. In this post, he offers a few key insights on choosing between immediate and delayed reconstruction. Dr. Lam recently published a great study on women’s breast reconstruction preferences, and so we’re sure you’ll appreciate his expertise!
Increasingly around the world and especially in the US, all women who are diagnosed with breast cancer for the first time and require a mastectomy will be informed of the possibility of breast reconstruction. Either the breast surgeon or a plastic surgeon will discuss with you in details what that involves. At the end of the consultation, you should ask yourself three questions: 1. Do I want breast reconstruction? 2. If yes, which type (ie implant or flap or a combination)? And 3. When?
This post focuses on the last question of timing: immediate (IBR) or delayed breast reconstruction (DBR).
Pros and Cons of Immediate Breast Reconstruction
Theoretically, the advantages of IBR are that you save one general anaesthetic/operation as well as the time in waiting for a DBR where you are missing your breast. The wound is fresh and ready for reconstruction and you wake up from the mastectomy with the reconstruction, albeit partial if a tissue expander is used, without having to go through the trauma of not having a breast.
However, the downside of IBR is that should there be surgical complications arising from the reconstructive surgery, adjuvant cancer treatments such as chemotherapy or radiotherapy might be delayed. In addition, if a flap is performed at the time of mastectomy and you are subsequently judged to require radiotherapy, irradiating the flap might result in inferior aesthetic results. For tissue expanders, they tend to be high within a totally submuscular pocket until removed and replaced by an eventual breast implant after completion of tissue expansion. This step is commonly bypassed more recently where a nipple-sparing mastectomy is performed and an implant is used, but the surgical revision rate might be higher.
Pros and Cons of Delayed Breast Reconstruction
On the other hand, DBR has the advantages of the mastectomy wound healing without any ‘cross-over’ problems and as such, no potential delay in any necessary adjuvant cancer treatments.
The surgical time is shorter and you recover quickly from the mastectomy. For tissue expanders, they do not require total muscle coverage and are thus more accurately placed in the infra-mammary crease, and so you experience less discomfort. The disadvantages with DBR are that you will have to wear an external prosthesis or go without for some time after mastectomy. You will then require another general anaesthetic / operation and the extra time off work or away from the family. The mastectomy wound would have healed and the resultant scarring may need to be revised.
Special Considerations and Final Thoughts
Practically, you should check with your surgeon if it is likely that you will require post-mastectomy radiotherapy. If you don’t, then all the options are available to you and you can make a decision after discussing with your surgeon and family having considered your cancer status, work, family and financial situation to come to an individualised decision. However, should post-mastectomy radiotherapy is required, DBR with a flap from the abdomen will provide the best aesthetic result. If circumstances are such that you choose an implant-based IBR, the tissue expander should probably be inserted immediately as the skin might be too tight to expand after radiotherapy.
Finally, if you are not in a position or state of mind to make a decision on breast reconstruction when you just want to focus on your cancer treatment, be reassured that you can always come back to revisit the issue anytime down the track and you haven’t lost anything. Never be pressured into breast reconstruction unless you are ready.
Thanks, Dr. Lam, for this useful information! Dr. Lam also joined us recently on our Boob Tube program to discuss the details and risks of breast reconstruction. Check it out: The Secret Life of Breast Reconstruction. Dr. Lam practices at the Department of Plastic & Reconstructive Surgery, Westmead Hospital, Westmead, New South Wales, Australia. You can find more information about him here.
Dr. Lam also developed Breconda (Breast Reconstruction Decision Aid), to help women explore their breast reconstruction options. Check it out! All you need to register for it is your name and email address.