A healthy living blog from Marshfield Clinic Health System

Breast reconstruction: Is timing important?

The American Society of Plastic Surgeons notes only 19 percent of women understand timing of their breast cancer treatment and timing of their decision to undergo reconstruction greatly impacts options and results. In this article, Plastic Surgeon Dr. Kathleen M. Meyer, addresses common questions about timing of breast reconstruction surgery.

When should I see a plastic surgeon about breast reconstruction?

Three women in a park

Breast reconstruction, for women electing to receive it, often begins at the time of mastectomy.

You can see a plastic surgeon about reconstruction any time you consider treatment that includes possible surgery to remove a breast and also after you have begun or even completed treatment for breast disease. Some options are best with cooperation between the surgeon who removes the breast and the surgeon who begins reconstruction at the time of breast removal.

When does breast reconstruction normally start?

Breast reconstruction, for women electing to receive it, often begins at the time of mastectomy. Each woman considers her options before surgery, and the cancer surgeon and reconstructive surgeon coordinate plans for treatment. In appropriate patients, two main choices are using their own tissue for reconstruction, or using implants. For implants, the surgeon will place tissue expanders at the time of breast removal to begin a two-stage reconstruction. Rarely can a permanent implant be placed at the time of the mastectomy.

If I have my mastectomy first and heal from that, can I still have reconstruction?

Yes. And options are tailored to different factors, such as whether you had radiation therapy, how much skin was saved, your desire to use your own tissue, whether you have enough tissue to transfer, or are using implants to take the place of missing breast tissue. Your surgeon can help you decide.

Can I still start breast reconstruction at the time of mastectomy if I have a high likelihood of needing radiation therapy after surgery?

This is controversial. Some reconstructive surgeons will place a tissue expander at the time of initial mastectomy and others will not. Recent experience with tissue expanders suggests some patients may still have successful staged reconstruction with implants, compared to data from years ago before tissue matrices were available. There is still a higher complication rate for implant reconstruction when radiation treatment is needed, but it’s no longer completely out of the question. Your surgeon can help you with this decision.

Why can’t you just put a permanent implant in at the time of mastectomy?

Skin of the breast after mastectomy is delicate and has very limited circulation, which improves over time. Stressing it with too large of an implant risks almost certain failure and loss of skin. Placing a tissue expander allows judgment about how much fluid to add.

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