When Should You Undergo Your Breast Reconstruction?

Breast reconstruction

Timing is everything when it comes to your breast reconstruction surgery. It can be completed at the same time as mastectomy, delayed, or performed as a hybrid surgery. The option you choose depends on your personal situation and your own thoughts and feelings about breast reconstruction. For more information about undergoing a breast reconstruction in Houston, contact Dr. Linville to set up a personal consultation.

Immediate Reconstruction

This is when reconstruction is done at the same time as mastectomy surgery. Immediately after the breast tissue is removed your surgeon, they will reconstruct the breast — with tissue from another part of the body, with an implant, or both. Nearly all of the work is done during one operation. The breast cancer surgery and plastic surgery teams work together to get this job done.

In some cases, your surgeon may recommend waiting until you are done with chemotherapy or radiation therapy treatments before starting reconstruction. Sometimes, a surgeon may agree to do a partial reconstruction immediately, then finish the reconstruction after the chemotherapy and/or radiation therapy is finished.

If you elect to have a prophylactic mastectomy (to reduce high risk of breast cancer) reconstruction is always done immediately.

Delayed Reconstruction

This is when reconstruction is done after mastectomy or lumpectomy surgery, as well as after radiation therapy, chemotherapy, or targeted therapies are completed. If given after reconstruction surgery, radiation therapy in particular and sometimes chemotherapy can cause the reconstructed breast to lose volume or change color, texture, or appearance. Cancers that are larger than 5 centimeters and that have spread to the lymph nodes are more likely to need radiation therapy after mastectomy or lumpectomy surgery. A reconstructed breast may also interfere with radiation therapy reaching the area affected by cancer, although this can vary by person.

If your surgeon advises you to wait until after radiation and chemotherapy are finished before having reconstruction surgery, you may wait 6 to 12 months. You may also choose to undergo breast reconstruction years later. Reasons for waiting include not feeling physically, emotionally, or mentally ready to have the surgery sooner, or changing your mind down the road about your initial decision to “go flat” or wear prosthesis.

Staged Approach (Delayed-Immediate Reconstruction)

This involves some reconstructive surgery during mastectomy or lumpectomy and more reconstructive surgery after any additional treatments. In a staged approach, also called delayed-immediate reconstruction, a tissue expander or ordinary breast implant is inserted under the chest muscle and preserved breast skin after the breast is removed. Temporarily placing an expander or implant preserves the shape of the breast and breast skin during the upcoming radiation treatments. It also allows for the final benefit of a skin-sparing mastectomy technique. A tissue expander is a balloon-type device that stretches the skin to create a “pocket” for the reconstructed breast under the skin. Once radiation is complete and tissues have recovered (which takes about 4-6 months) the expander/implant that was used to maintain the shape of the breast is removed and replaced with a flap from the proper donor site, which is decided upon in consultation with your surgeon.

Cancer Stages that Influence the Timing of your Reconstruction

Stage I & II: In general, women diagnosed these earlier stages of breast cancers, who choose mastectomy based on a biopsy, are less likely to need radiation or other treatments after mastectomy. They are often good candidates for immediate reconstruction.

Stage III & IV: Women in these later stages of cancer almost always need radiation or other treatments after mastectomy. In these cases, delayed reconstruction is recommended. However, in certain cases your doctor may be open to other options. For example, if you have chemotherapy as your first treatment to shrink the breast cancer, you may become eligible for immediate flap reconstruction or staged reconstruction.

If you want to try staged reconstruction, which is a relatively new procedure, you will need to locate an expert who has been trained in that specific practice. Likewise, you will need to discuss all your options with your oncologist to find out what is best for your particular situation and where you might find the resources to make it happen.

Breast Reconstruction in Houston

Dr. Linville believes that a plastic surgeon is an artist, a problem solver, and must think outside the box. He is trained extensively in aesthetic surgery of the face, breasts, and body including advanced breast reconstruction techniques including microsurgery and perforator flap reconstruction methods. For more questions about receiving a breast reconstruction in Houston, contact Dr. Linville at 713-678-0019 today.