For many women, potentially needing post-mastectomy radiation can affect the ability to have immediate breast reconstruction. Mastectomy patients who are diagnosed with invasive breast tumors often don’t know whether they need radiation until after their mastectomy; that’s because the extent of lymph node involvement and clear-cut staging of the tumor really can’t be done until the mastectomy is performed.
Breast cancer experts often advise women to delay having breast reconstruction if there is a possibility that adjuvant (after surgery) radiation will be needed. It can be a very disappointing turn of events for women who were hoping to have immediate breast reconstruction along with their mastectomy—they’ll not only wake up from mastectomy without breasts, but they miss out on the cosmetic benefits of having immediate breast reconstruction. They also have to endure additional surgery and recovery if they choose to have delayed breast reconstruction at some later time.
One approach to this issue is delayed-immediate breast reconstruction. It’s not exactly traditional immediate reconstruction or delayed reconstruction. Rather, it’s a hybrid of the two. During this procedure, after the breast tissue has been removed, a tissue expander is placed in a pocket under the pectoral muscle. The expander is then fully inflated; this preserves the remaining breast skin and breast shape for later reconstruction.
If it turns out that radiation isn’t needed after all, the expander can be swapped out for a full-size breast implant or a flap of the woman's own healthy tissue. If radiation is required, the expander can be deflated (so there is no chance that it might interfere with delivery of the radiation) but left in place. A few months after radiation treatments have been completed, the expander can be replaced with a natural tissue flap. (Breast implants aren't the best option for reconstruction after radiation, due to the significant potential for complications Radiated tissue is usually a poor combination with breast implants, and even though a natural tissue flap is a better option for most women, the radiated reconstructed breast may take on a different shape and feel than the opposite reconstructed breast.