Immediate vs. delayed reconstruction

Breast reconstruction surgery can happen:

• Immediately after mastectomy, during the same operation
• Months or years after mastectomy (delayed reconstruction)

Plastic surgeons can also use a combination of timing, starting the process immediately after mastectomy and finishing later.

In some cases, breast reconstruction is an option during or after lumpectomy.

Your care team will help you decide whether immediate or delayed breast reconstruction is right for you. Your choice may depend on your cancer treatment plan and personal preferences.

Mastectomy and immediate reconstruction

In immediate breast reconstruction, surgeons perform mastectomy and reconstruction in one operation.

After your breast surgeon removes the breast tissue, your plastic surgeon reconstructs your breast or breasts using:

• Tissue from another part of your body
• A breast implant
• In some cases, both tissue and an implant

You may be able to have immediate reconstruction if:

• Your treatment plan does not affect the cosmetic outcome.
  • For example, radiation therapy on a reconstructed breast can interfere with wound healing. If radiation therapy is part of your treatment plan, your surgeon may recommend delaying reconstruction surgery until after your body has had time to recover from radiation.
• You do not smoke. Smoking can affect wound healing. Your doctor may recommend quitting smoking before having reconstruction surgery.
• You do not have another health condition, such as diabetes, that could delay wound healing.

Benefits of immediate reconstruction

• In some cases, immediate reconstruction avoids multiple procedures.
• You will wake up from mastectomy surgery with a breast shape. For some people, this may help reduce some anxiety about losing a breast.

Risks of immediate reconstruction

• Compared with mastectomy alone, mastectomy with immediate reconstruction requires a longer surgery.
• Mastectomy with immediate reconstruction takes longer to heal and has a higher risk of complications than mastectomy with delayed reconstruction.

Mastectomy and delayed reconstruction

Delayed reconstruction can start months or even years after your first breast cancer surgery.

Here are some reasons you and your doctor may decide to delay reconstruction:

• Your treatment plan includes radiation therapy to the chest after cancer-removing surgery. Radiation may:
  • Cause the tissue to shrink
  • Cause the skin to change color
  • Change the feel and look of the tissue
  • Delay healing
  • Cause scarring around an implant
• Your treatment plan includes chemotherapy. Your oncologist may recommend focusing on your cancer treatments before having reconstruction.
• You want more time to think about your options.
• You prefer to make one decision at a time.
• You prefer to recover from one surgery before having another.
• You have risk factors for complications.
• You have other things going on in your life (for example, you have young children or an elderly parent to care for, a busy job, or other health concerns).

Lumpectomy with immediate or delayed reconstruction

Reconstruction can also be performed during or after lumpectomy if you and your doctor decide this is a good option. This is sometimes called oncoplastic lumpectomy.

Learn more on the Lumpectomy and Reconstruction after lumpectomy pages.

Talking with your care team

Talk with your breast surgeon and your plastic surgeon about whether immediate or delayed reconstruction, or a combination of these, may be right for you. Ask your surgeons to explain the risks and benefits of each option.

It is important to know that even with immediate breast reconstruction, there may be reasons to have follow-up procedures later, including:

• Secondary breast reconstruction procedures, such as surgery to add volume or to create balance with the opposite breast
• Nipple reconstruction and/or 3D nipple tattooing if your nipple has to be removed during mastectomy

Many factors can affect whether you have immediate or delayed reconstruction, including the type of procedure you want to have and your overall health. Take time to make the best decision for you.