Breast Reconstruction (cont.)
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Timing of breast reconstruction - Immediate versus delayed
Immediate breast reconstruction is reconstruction that is performed at the same time as the mastectomy. Delayed breast reconstruction is reconstruction that is performed weeks, months, or years after the mastectomy.
Surgeons differ in their opinions about when breast reconstruction should be performed. Some prefer to do it immediately after mastectomy, while others advise to delay breast reconstruction. If radiation therapy needs to be administered after mastectomy, then breast reconstruction is generally delayed until the skin in the treated area has healed. Excellent results can usually be achieved by either immediate breast reconstruction or delayed breast reconstruction.
The advantages of immediate reconstruction are that it avoids additional operation and general anesthesia at a later date, reconstruction is easier as the tissues are not damaged by scarring, and the breast skin retains the size and shape of the original breast.
The advantage of delayed reconstruction is that the woman has more time to consider the alternatives. After a mastectomy, many women choose a procedure recommended by the plastic surgeon and are more confident about the selection of the type of reconstruction. Additionally, these patients have no risk of a wound healing complication as a result of their reconstruction, which could potentially delay the initiation of chemotherapy.
Women who choose immediate reconstruction have to make the decision at a time of great stress, but, for some women, the idea of having the breast tissue reconstructed immediately after mastectomy relieves much of the stress associated with mastectomy. Women who delay reconstruction may go through two periods of emotional readjustment: the first period is adjusting to the loss of a breast and the second readjustment involves accepting the reconstructed breast as their own.
Some types of reconstruction can be completed in a single procedure, whereas other types may require 2 or more operations to complete the reconstructive process.
Marga Massey, MD
Leigh A Neumayer, MD, MS, FACS
Galen Poole, MD, FACS
Mary L Windle, PharmD
Lee P Shulman, MD
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