Ideally, breast reconstruction is performed at the same time as mastectomy, but sometimes that isn’t always possible. Some women are undecided about reconstruction at the time of their mastectomy, while others prefer to forego any further surgery, but change their minds months or years later, and then decide to pursue delayed reconstruction. In some cases, oncologists may recommend that certain individuals, especially those with underlying health conditions that may delay healing, postpone reconstruction.
Immediate planning for delayed breast reconstruction
If your oncologist recommends a mastectomy to treat invasive breast cancer, you may or may not also need radiation therapy after the surgery, depending on the stage of your tumor and lymph node involvement. Unfortunately, it isn't always clear if radiation therapy will be needed until post-mastectomy pathology results are available. Under these circumstances, many surgeons advise against immediate breast reconstruction if there is a possibility you may need radiation treatments.
If you have your heart set on immediate reconstruction with a breast implant or a flap of your own tissue, delaying your reconstruction can be a hard pill to swallow, because you will wake up with a flat chest and miss out on the advantages of immediate breast reconstruction. Delayed-immediate reconstruction is a unique approach to this issue. It recognizes the potential need for radiation therapy and also provides the aesthetic advantages of immediate reconstruction. As soon as the breast tissue is removed, a tissue expander is positioned under the chest muscle, and fully inflated to preserve your breast shape and skin for later reconstruction. After your mastectomy, if it turns out that you don’t need radiation after all, you can proceed with reconstruction, exchanging the expander for an implant or swapping it for an autologous tissue flap of your own skin, fat and/or muscle.
If you do need radiation therapy, the tissue expander can be deflated and left in place, and then later reinflated when your radiation is completed. (Deflating the expanders also addresses the concern that immediate reconstruction may interfere with the delivery of radiation.) Several months later, you can proceed with tissue flap reconstruction—implants aren’t generally advised after radiation because of the high potential for complications.