When Is Breast Reconstruction Done?

You can have breast reconstruction surgery at the same time as mastectomy or lumpectomy or you can have reconstruction weeks, months, or years after breast cancer surgery.

Breast reconstruction done at the same time as breast cancer surgery is called immediate reconstruction. Breast reconstruction done after mastectomy or lumpectomy is called delayed reconstruction.

Talking with a plastic surgeon who specializes in breast reconstruction before you have breast cancer surgery can help you decide when to have breast reconstruction, as well as which type of reconstruction is best for your situation.

The timing of breast reconstruction depends on a number of factors, including:

Whether you’re scheduled to receive radiation after breast cancer surgery. Radiation therapy can cause wound healing problems or infections in reconstructed breasts. It also may change the appearance or texture of the breast. For these reasons, some doctors may recommend having reconstruction after radiation. Still, making this decision includes other factors, including the type of reconstruction you’re having.

If you’ve decided whether breast reconstruction is right for you. You may prefer to make one treatment decision at a time. By taking your time to talk with your doctor and other members of your healthcare team, you can learn about all of your surgical options.

Whether you’ve been diagnosed with other health conditions, such as high blood pressure or heart disease. These conditions are known to increase the risk of complications during surgery, such as heart failure. In some cases, your doctor may recommend against breast reconstruction or may recommend that you make a complete recovery from breast cancer surgery and have the condition under control before you have reconstruction.

After the surgeon removes the breast during mastectomy, the plastic surgeon reconstructs the breast with tissue from your body (flap or autologous reconstruction), an implant, or both. In many cases, nearly all the work is done during one operation and you wake up with a reconstructed breast (or breasts, if you had a double mastectomy). During immediate reconstruction, the breast cancer surgery teams and plastic surgery teams coordinate with each other.

In some cases, your plastic surgeon may recommend placing a tissue expander in the area where the breast was and then doing the final reconstruction at a later stage. The tissue expander is filled with liquid or air over time to create a space that will hold either a breast implant or the tissue flap that recreates the breast. Once you’re ready to have breast reconstruction surgery, your surgeon exchanges the expander for a permanent implant or tissue flap.

Immediate reconstruction after a lumpectomy (sometimes called oncoplastic lumpectomy) can involve filling in dents and divots caused by the lumpectomy, moving your nipple to be symmetrical with your other breast, and more. If you want to have reconstruction that takes place at the same time as the lumpectomy, you’ll need to find a plastic surgeon who can work together with your breast surgeon, or a breast surgeon who is experienced in oncoplastic techniques. 

Advantages:

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  You have no time without a breast (or breasts) because you wake up from breast cancer surgery with this area reconstructed.

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  You likely have fewer surgeries.

Disadvantages

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  Your surgery time is longer and the recovery time is longer.

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  You’ll have a higher risk of surgical complications, such as infection, than mastectomy or lumpectomy alone.

If radiation is part of your treatment plan or you’re not sure what type of reconstruction you want after lumpectomy or mastectomy — or if you want reconstruction at all — then delayed reconstruction is likely the best option for you.

Most plastic surgeons recommend that reconstruction wait until after the full course of radiation is completed and the skin has completely healed, in many cases about six months after radiation treatment is finished. If you’re not ready to have the surgery or change your mind about having no reconstruction, you can have reconstruction many months or years after breast cancer surgery.

Advantages:

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  Waiting may reduce your risk of complications following surgery, particularly if you’ve received radiation to the area.

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  You have more time to consider your reconstruction options.

Disadvantages:

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  You have to live for a period of time without a breast, if you’ve had mastectomy.

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  If you’ve had lumpectomy, your breasts may look different from each other or your nipples may not be symmetrical until you’ve had reconstruction surgery.

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  You’ll need to have another surgery and recovery.

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  The nipple and areola usually can’t be kept during mastectomy if reconstruction isn’t done at the same time as mastectomy.