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Nervous About Breast Reconstruction with Mastectomy

Breast reconstruction timing is one of the key questions that you should discuss with a team. That team should consist of your plastic surgeon, your general surgeon and your oncologist. In my Bay area practice I have performed immediate and delayed breast reconstructions, tailoring each treatment for the patient. In my experience with implant reconstructions, pedicled TRAMS and microsurgical breast reconstruction including free TRAMs, DIEPS, SIEA and SGAP flaps you can achieve an equivalent reconstructive outcome regardless of the timing. The biggest consideration for possibly waiting for breast reconstruction is the oncologic nature of the breast cancer. If the general surgeon is relatively certain that the cancer can be completely resected at the time of the mastectomy then immediate breast reconstruction might be a good option. If there is consideration of chemotherapy or radiation you will get better results by waiting until after those treatments are complete.

Clinical Context

Reconstruction after mastectomy is different from scheduling a cosmetic procedure. Your plastic surgeon, general surgeon, and oncologist work together to decide timing based on your specific cancer and treatment plan. Immediate reconstruction is done during the same surgery as the mastectomy, while delayed reconstruction happens after cancer treatments like chemotherapy or radiation are finished. Either approach can use the same surgical techniques. The right choice depends on your individual diagnosis, so this decision is best made together with your full care team.

Answered by Dr. Steven Williams, President Emeritus of ASPS

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