You can choose to have immediate or delayed breast reconstruction following a mastectomy. The surgeries can be done immediately and together, but other factors may determine when they are performed.
If you’ve been advised by your doctor to have a mastectomy, you may be wondering about breast reconstruction. Reconstructive surgery can be performed at the same time as your mastectomy surgery. This procedure is called immediate reconstruction.
The decision to do both surgeries at once is influenced by many factors. You’ll need to involve your breast cancer surgeon, oncology treatment team, and plastic surgeon to decide whether this is an appropriate option for you.
You will be under general anesthesia during your mastectomy and immediate reconstruction.
Your breast surgeon will usually make an oval-shaped incision over the nipple area. In some people with certain early breast cancers, the nipple can be preserved on the breast. This is done by making an elliptical incision around the nipple or areolar.
From the incision, your surgeon will remove all of the breast tissue of that breast. They may also remove some or all
The plastic surgeon will then
Prosthetic reconstruction
This type of reconstruction uses
Immediate reconstruction with implants or prosthetics may be performed in several ways. The technique may depend on:
- the plastic surgeon’s preference and experience
- the condition of your tissue
- the kind of breast cancer you may have
At the time of mastectomy, some plastic surgeons will lift the pectoralis muscle, located immediately behind the breast, and place the implant behind the extra layer of tissue.
Others will place the implant immediately behind the skin. Some surgeons will also use an artificial skin layer within the empty breast pocket to give additional protection and support.
Some points to keep in mind about implants include:
- Implant surgery is easier and takes less time than other reconstruction procedures.
- Recovery time with implants is shorter than with tissue flap reconstruction.
- There are no other surgical sites on the body to heal.
- No implant will last forever. Your implant will likely need to be replaced.
- Silicone implants will need monitoring with MRIs every few years to detect rupture.
- Your body may have problems with the implants, such as infection, scarring, and implant rupture.
- Future mammograms may be harder to perform with implants.
Tissue flap reconstruction
Some people might prefer to have the more natural feeling of their own tissue in their reconstructed breast.
Additionally, if you have had or will likely have radiation therapy, implants are more likely to cause complications. Your surgeon will then likely recommend
This type of reconstruction uses tissue from various parts of your body, including your abdomen, back, thighs, or buttocks, to rebuild your breast shape. The types of flap procedures include:
| Flap procedure | Uses tissue from |
|---|---|
| transverse rectus abdominis muscle (TRAM) flap | abdomen |
| deep inferior epigastric perforator (DIEP) flap | abdomen |
| latissimus dorsi flap | upper back |
| gluteal artery perforator (GAP) flaps | buttocks |
| transverse upper gracilis (TUG) flaps | inner thigh |
The most common autologous type of reconstruction is the DIEP flap. TRAM and latissimus dorsi flaps are not commonly used.
Consider the following when thinking about this type of reconstruction:
- Tissue flaps generally look and feel more natural than implants.
- They behave more like the rest of your body. For instance, their size can fluctuate with the rest of your body as you gain or lose weight.
- You will less likely need to replace tissues as you would need to replace implants.
- Surgery generally takes longer than implant surgery, with a longer recovery time.
- The procedure is more technically difficult for the surgeon, and the tissue can fail to take.
- It will leave multiple surgical site scars because multiple areas of your body will be operated on.
- Some people may experience muscle weakness or damage at the tissue donor site.
Immediately after surgery
The duration of these surgeries (per breast) can take anywhere from 2 to 3 hours for a mastectomy with immediate implant reconstruction or 6 to 12 hours for mastectomy and reconstruction with your own tissue.
After the reconstruction is complete, your breast surgeon will attach temporary drainage tubes within the surgical cavity and exit at your side. This is to make sure that any excess fluid has a place to go during healing. Your chest will be wrapped with a bandage.
Potential postoperative complications of immediate reconstruction are similar to those of any mastectomy procedure. They can include:
- fatigue
- wound healing issues
- scar tissue
- infection
Because nerves are cut during the surgery, you may have numbness along the site of the incision.
Scar tissue may also build up around the site of your incision, which can cause pressure or pain. Most women lose the complete sensation of their chest wall skin after a mastectomy.
Infection and delayed wound healing sometimes happen after a mastectomy. You and your doctor should be on the lookout for signs of both.
Plan to be home after 2 to 3 days in the hospital after autologous reconstruction. Your doctor will prescribe pain medication during the healing process.
For some time, you may be instructed not to sleep on your side or stomach. Visible scarring on your breasts, even after reconstruction, is normal. Over time, the visibility of the scars will go down. Massage techniques and scar removal creams can decrease their appearance, as well.
You won’t need to be on bed rest once you are released from the hospital. The sooner you can get up and walk around, the better.
However, until the drains in your breast tissue are removed, you will be restricted from driving and other tasks that require the use of the upper body.
Driving under the influence of some pain medications, such as Vicodin, is also restricted.
There are no special dietary concerns, but you should focus on eating foods that are high in protein. Protein promotes cell growth and healing.
Your doctor will give you safe exercises to help you regain sensation and strength in your chest and upper body.
Like immediate reconstruction, delayed reconstruction involves either flap surgery or breast implants. Delayed reconstruction is more commonly chosen by those who need radiation or any other additional treatments for their cancer after the mastectomy has been completed.
Some people with breast cancer may also choose to have part of the reconstruction done immediately and the other part done after any other additional treatments are completed. This is known as delayed-immediate reconstruction.
Delayed reconstruction will begin 4 to 12 months after your mastectomy. The timing will depend on you reaching certain milestones in your cancer treatment and healing process.
If you are also receiving radiation therapy, a plastic surgeon will typically wait 1 to 2 years.
Research has found that women who have had mastectomies followed by immediate reconstruction reported a better quality of life than women who did not undergo breast reconstruction.
As you weigh your options, ask your surgeon for a professional recommendation before making any decisions. Every person and clinical situation is unique.
If you are not offered the option to discuss breast reconstruction, try to speak up. Ask your breast surgeon for a consultation to discuss if breast reconstruction is appropriate for you.
Here are some
- Am I a good candidate for breast reconstruction surgery?
- Would you recommend reconstruction surgery immediately after my mastectomy, or should I wait?
- How should I prepare for surgery?
- Will my new breasts look similar to my old breasts?
- How long is the recovery time?
- Will reconstructive surgery interfere with any of my other breast cancer treatments?
- If I choose to use implants for my reconstruction, will the implants ever need to be replaced? How long do they last?
- What kind of wound care will I need to do at home?
- Will I need a caregiver of some kind after surgery?
Many people are also not aware of their options or the fact that health insurance companies will pay for reconstructive surgeries after mastectomy.
Depending on health factors such as obesity, smoking, diabetes, and cardiovascular conditions, having these two surgeries as part of one procedure may not be recommended.
For example, people with inflammatory breast cancer usually need to wait until they finish additional treatment, such as radiation, before reconstruction can be performed.
Additionally, smoking is a well-known risk factor for slow healing after reconstructive surgery. If you smoke, your plastic surgeon will likely ask you to quit before they consider reconstructive surgery.
Any type of reconstruction can increase the risk of side effects from a mastectomy, but this is not dependent on whether the reconstruction happens immediately or later on.
It can be difficult to undergo a mastectomy, and the possibility of another surgery for reconstruction may seem even more daunting.
Recovering from a mastectomy and reconstructive surgery at once may be more uncomfortable in the short term. But in the long term, it may be less stressful and painful than multiple surgeries.
“If you have the opportunity to have reconstruction immediately after mastectomy, I would really think about doing it. Get it all done at the same time and save yourself from having more surgeries!”
— Josephine Lascurain, breast cancer survivor who began her reconstruction process 8 months after her mastectomy