Now or Later? Post-Mastectomy Breast Reconstruction Surgeon Shares Her Thoughts
27 Feb 2017
This week we eagerly welcome Dr. Natalie Ngan as a guest writer. She shares her thoughts about immediate versus delayed breast reconstruction. A Fellow of the Royal Australasian College of Surgeons (FRACS) since May 2010, Dr. Ngan is specially trained as a breast reconstruction surgeon and has the ability to perform reconstruction with autologous tissue (with or without microsurgery), as well as with tissue expansion and implant-based reconstruction.
Immediate or Delayed Reconstruction: It’s Your Choice
Choosing to have breast reconstruction is a very personal decision. The timing of reconstruction may be immediate, which means that it takes place at the time of mastectomy. Conversely, delayed reconstruction occurs at a variable time after the mastectomy.
The choice to have an immediate breast reconstruction may not solely be in the hands of the patient. Your oncology doctors may recommend waiting until you have completely recovered from surgery and chemotherapy/radiotherapy.
Some Benefits of Immediate Breast Reconstruction
If you are offered immediate reconstruction, there are proven benefits to this.
- Psychological benefits to those women who do not want to wake up from surgery with a mastectomy defect,
- Preservation of the breast skin pocket to improve the overall cosmetic/aesthetic result,
- Smaller scars than if a mastectomy alone is performed.
Insights on Delayed Reconstruction
It is interesting to note that for those women who choose to have delayed reconstruction, their satisfaction with their result can be higher on average than those who have had immediate reconstruction.
This is most likely due to the fact that these women have had some time living with a mastectomy defect. They are therefore comparing life without a breast with one that now has had a reconstruction. For the woman who has decided to have immediate reconstruction, they are comparing their native breast with the reconstructed one.
In the setting of delayed reconstruction, the option for the method of reconstruction may be affected. If radiotherapy is part of a women’s breast cancer journey, the option of an implant-based reconstruction is less predictable and has higher risks of complications associated. When delayed reconstruction is embarked upon following radiotherapy, autologous (using your own tissue) reconstruction will most likely be recommended.
The reasons for women choosing to delay reconstruction are often multifactorial. For many women, the diagnosis of breast cancer can be so overwhelming that they may choose to have a mastectomy alone, and not proceed with reconstruction. For some women, once their cancer treatments are finished and they have recovered physically, they may then feel strong enough to embark on reconstruction to help make a complete emotional recovery.
Further Reasons Some Women Delay Indefinitely
For most families, women are the central, and paramount to the daily workings of the family. Some perceive there to be a longer, more complex recovery associated with breast reconstruction compared with mastectomy alone. This perception can put some women off having immediate breast reconstruction, as she feels she must put her family first.
Another reason for delaying reconstruction can be that the woman “feels that she is being vain” for wanting to have a breast reconstruction. This can be in the older woman who has a supportive husband and feels that perhaps she does not “need” a reconstruction.
For many women, the lack of knowledge that reconstruction is an option to them is the reason that many do not have a breast reconstruction.
The psychological and physical benefits of breast reconstruction to those women who choose to proceed with this have been proven and are well known. The effects of breast reconstruction can benefit not only the woman, but also her spouse, children and others in her community.
All women are entitled to have the right to choose – a discussion about the options of breast reconstruction should be offered to all women who require mastectomy.
You can read more about Dr. Ngan, her training, and her practice here.