Immediate vs Delayed vs Delayed-Immediate reconstruction

Immediate reconstruction means having a mastectomy (with or without preservation of the nipple) and a reconstruction in the same operation. This does mean having a longer operation and staying in hospital for up to a week, as well as a longer recovery period. However there are definite physical and psychological benefits of having an immediate reconstruction. Women need not be flat chested at any point of their breast cancer journey and the long-term psychological benefits have been shown to be significant.

A delayed reconstruction is performed separately some time after the mastectomy. In many cases this is dictated by the type and timing of treatments such as chemotherapy and radiotherapy to ensure the best outcome for the woman from her cancer treatment. Some women may also choose to separate their cancer journey from their reconstructive one. A standard mastectomy is carried out and no immediate reconstruction is performed. Women choose to be ‘flat’ or use an external prosthesis in a bra and see a plastic surgeon for reconstruction at a later date. A delayed reconstruction can be performed at any point after the original surgery, however if you undergo radiotherapy most plastic surgeons will ask that you wait 8 to 12 months before undergoing reconstruction. The only safe option after radiotherapy will be using autologous tissue and the benefits of this approach are also highly significant.

A further subgroup of patients are women who are at high risk of requiring radiotherapy after mastectomy who want to preserve options for reconstruction. In these cases, a delayed-immediate approach is utilized. An implant or expander is selected for immediate reconstruction following mastectomy allowing women to carry on with adjuvant treatment as required. After 8 to 12 months a definitive reconstruction is performed which would usually utilise autologous tissue.

The sequence of breast reconstruction can be complex and the options available may not always be same for every patient. Many factors play a crucial role in breast reconstruction such as breast size, suitability for nipple preservation, the availability of tissue from other areas as well as the interaction of other health issues with the effects of cancer treatment.

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