Immediate vs. Delayed Reconstruction: Making the Choice
19 Mar 2016
The timing of a woman’s breast reconstruction procedure may seem like a minor detail when compared to many of the other choices they have to make during their diagnosis and treatment. However, making the final decision on timing is often a challenge, and for good reason. There are several factors that women must consider when deciding on reconstruction timing.
At the end of the day, if the woman is given a green light from her physician, she will ultimately have to choose whether to start reconstruction immediately (called “immediate breast reconstruction”) or delay until after her treatments and potentially even after time for emotional recovery (called “delayed breast reconstruction”). These two options exist, regardless of whether she chooses implants or autologous reconstruction. When deciding between the two, women and their doctors take into account a number of factors, including each woman’s medical condition, lifestyle and preference, and their need for any additional therapies.
Immediate Breast Reconstruction
The plastic surgeon starts immediate breast reconstruction at the time of the mastectomy surgery. Once the cancerous breast tissue is removed, a plastic surgeon reconstructs a new breast with an implant or tissue from another part of the body or inserts a tissue expander, in the case of immediate two-stage reconstruction. The woman then awakes from her breast surgery with either a new breast or the start of one. However, even in single stage immediate breast reconstruction, additional surgeries may be required later to adjust the appearance of the reconstructed breast. Women undergoing a prophylactic mastectomy, a mastectomy that decreases the risk of developing breast cancer, almost always have the choice of opting for immediate reconstruction.
One of the advantages of immediate reconstruction lies with the fact that two surgical procedures are performed at once. This prevents women from needing a second major surgery after their mastectomy and prevents them from dealing with general anesthesia twice. It can also reduce medical costs.
Immediate reconstruction often results in improved appearance of the reconstructed breast. This is because the breast skin is better preserved in the shape and size of the original breast and is often void of severe scarring that may alter the appearance. Fewer surgeries means less scarring.
Another major advantage of immediate reconstruction may be the decreased risk of emotional and social difficulties for women who feel a close attachment to having breasts (many readers might find it strange to word it this way, but different women have different levels comfort with contemplating life, even temporarily, without their breasts). Since women wake up from their mastectomy with a fully reconstructed breast, they are less likely to experience the emotional challenge of feeling like they have lost their womanhood or sense of self. which is a common feeling that many women struggle with post-mastectomy.
Finally, immediate reconstruction is not associated with any increase in the rate of local cancer recurrence. Nor does it affect the ability to detect cancer recurrence. Furthermore, women who undergo immediate reconstruction can receive other cancer treatments without any significant delays. However, receiving treatment following immediate reconstruction can affect the appearance of the reconstructed breast.
While there are many advantages to immediate breast reconstruction, it is, unfortunately, not without its disadvantages. Even though immediate reconstruction results in fewer surgical procedures, it often requires initially a longer hospitalization and recovery time than just having a simple mastectomy. This can result in higher short-term costs even though long-term medical costs are normally lower.
Additionally, women getting immediate reconstruction have less time to decide which type of breast reconstruction they want or even to process how the different types of reconstruction will impact their lifestyles. Receiving a mastectomy is often time-sensitive for women who have already developed breast cancer, so the decision-making process revolving around reconstruction type is shorter. This fact can make the process more stressful for those who are not already familiar with the types of breast reconstruction available.
Lastly, immediate reconstruction may make it more difficult for doctors to detect any skin problems following a mastectomy. Although there is normally no significant delay in receiving additional treatments after a mastectomy, any complications that arise from the reconstruction surgery can delay chemotherapy treatments. Chemotherapy prevents the body from properly healing itself, so it’s important that the breasts have fully healed before treatment can begin.
Delayed Breast Reconstruction
Delayed breast reconstruction is done some time after a mastectomy during a separate procedure. It is most often performed within six to 12 months after a mastectomy, once women have completed any additional treatment requirements. However, women can get delayed breast reconstruction many years after their mastectomy. Similar to immediate reconstruction, minor procedures may be required after the main reconstruction procedure to adjust the appearance of the reconstructed breast.
Since delayed breast reconstruction can be done at virtually any time, women have plenty of time to consider their reconstruction options and whether they want reconstruction at all. Women can fully discuss the best procedures for them with their plastic surgeon to ensure that they are happy with the results.
Delayed breast reconstruction allows women to safely complete additional therapies and treatments without risking damage to the reconstructed breast or the surgery site. Certain therapies, particularly radiation therapy, are known for altering the appearance of reconstructed breasts. Some therapies have also been linked to various problems at the reconstruction site. By getting delayed breast reconstruction, these risks are diminished. Beyond that, delayed reconstruction allows for faster healing times following a mastectomy and prevents any treatment delays.
There is normally more scarring associated with delayed breast reconstruction, because two procedures are done at separate times. Although the scarring is not normally excessive, scarring from the mastectomy can affect the appearance of the reconstructed breast and make certain reconstruction types more difficult to perform. Unfortunately, the breast skin left after a mastectomy normally shrinks down and the original size and shape of the breast is lost. It may take more time and more operations to prepare the skin and muscles for desired shape and size.
Another disadvantage is the additional surgery and increased total recovery time associated with delayed reconstruction. The initial mastectomy may require shorter hospital stays and recovery time. However, in the long-run, women getting delayed reconstruction are in the hospital longer and have longer total recovery times. Furthermore, the separated hospital visits may increase medical costs.
Lastly, women who opt for delayed reconstruction have a higher risk of experiencing emotional stress relating to the loss of one or both breasts. This may make the process of healing and moving forward more difficult. It is not unusual for a woman post-mastectomy and pre-reconstructive surgery to struggle with a variety of negative thoughts and feelings, though reconstructive surgery should also not be seen as a cure or complete prevention of this challenge. With or without breast reconstruction, a woman’s body undergoes significant changes during breast cancer treatment, and it’s not unusual to need help dealing with these changes. It’s important to know your options when you begin to feel overwhelmed, such as by joining a support group or seeking the help of a counselor or psychologist.
How Do I Make the Choice?
As we briefly discussed at the beginning of this article, deciding between immediate and delayed breast reconstruction relies on several factors. There is no single best option for all women. Just a few of the factors that women and their surgeons must consider during this process include:
- Personal preference
- Smoking habits
- Therapy schedule
- Current medications
- Level of physical activity
- Cancer stage
Make sure you clearly discuss all of your options and preferences with your physician and surgeon prior to your mastectomy to ensure you choose the best timing option for you.
To read more on deciding on breast reconstruction timing, take a look at the discussion on this