The timing of your breast reconstruction procedure may seem like a minor detail when compared to life-saving treatment options. However, whether you have immediate or delayed reconstruction could have a long-term impact on your peace of mind and satisfaction. Let’s look at the factors involved.
Assuming your physician gives you the green light, you will have to choose whether to start reconstruction at the time of your mastectomy (called “immediate breast reconstruction”) or delay until after treatment (called “delayed breast reconstruction”).
- your unique medical condition
- your lifestyle
- personal preferences
- any need for additional therapies
Let’s look at why you might choose either immediate or delayed breast reconstruction.
Immediate Breast Reconstruction
The plastic surgeon starts immediate breast reconstruction at the time of the mastectomy surgery. Once the breast surgeon removes the cancerous breast tissue, a plastic surgeon reconstructs a new breast mound. The plastic surgeon may use an implant or tissue from another part of the body. Alternatively, the surgeon may insert 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, she may later need additional surgeries to adjust the appearance of the reconstructed breast. If she has a tissue expander, she will eventually have another surgery to switch it with a permanent implant.
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.
- You accomplish two surgical procedures 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 looks better. This is because it is easier to preserve more of the breast skin and to prevent severe scarring that may alter the appearance. Moreover, fewer surgeries means less scarring.
- You wake up from surgery with breasts, or at least the start of breasts. It can be a huge roller-coaster of emotions to see your breast-less chest. Some women embrace this challenge, but others would rather avoid it.
One thing we don’t want to skip over is that immediate reconstruction is not associated with any increase in 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.
- Because you’re recovering from a “double procedure,” 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.
- There is less time to decide which type of breast reconstruction you want or even to process how the different types of reconstruction will impact your lifestyle. 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 (you may want to read a survivor’s advice for overcoming this challenge).
- Certain therapies, particularly radiation therapy, are known for altering the appearance of reconstructed breasts. If you need radiation after your reconstruction, expect changes in appearance.
Additionally, 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
In the case of delayed breast reconstruction, the woman opts to start reconstruction at a later date, not at the time of her mastectomy. Most women start six to 12 months after a mastectomy, once treatment ends. However, women can get delayed breast reconstruction many years after their mastectomy.
- You have plenty of time to consider your reconstruction options or even whether you want reconstruction at all (some choose to go flat after healing). Women can fully discuss the pros and cons of procedures with their plastic surgeon to ensure that they are happy with the results.
- Delayed breast reconstruction allows you to safely complete your cancer treatments without risking damage to the reconstructed breast or the surgery site.
- You will likely experience faster healing times from the mastectomy and prevent any treatment delays.
- It’s an additional surgery and means recovering from major breast surgery twice (not counting revision surgeries). Women getting delayed reconstruction are in the hospital longer altogether and have longer total recovery times. Furthermore, the separated hospital visits may increase medical costs.
- There is normally more scarring with delayed breast reconstruction, because two procedures are done at separate times. Scarring from the mastectomy can affect the appearance of the reconstructed breast and make certain reconstruction types more difficult to perform.
- 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 your desired shape and size.
- You wake up from a mastectomy without a breast. Some women experience more stress from this than others. If you have always put a high value on your womanly curves, the mirror could feel like torture for a time.
It’s important to note that it is not unusual for a woman post-mastectomy to struggle with a variety of negative thoughts and feelings. Reconstructive surgery will never be a cure or 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 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 breast surgeon. And don’t forget to ask this one important question of your breast surgeon.
If you found this article useful, you may want to check out Breast Reconstruction 101, where we keep all of our latest posts on breast reconstruction. Additionally, sign up for our free Breast Reconstruction Decisions e-course by joining our newsletter.