Breast reconstruction can be done at different times, depending on what
works best for you.
Immediate Breast Reconstruction
As soon as the breast is removed by the breast cancer surgeon, the plastic
surgeon reconstructs the breast either with tissue from another location
on your body or with an implant (and sometimes both). The surgery is coordinated
between your surgeon and a plastic reconstructive surgeon. Studies have
shown that this is a safe approach and may result in a better cosmetic result.
Delayed Breast Reconstruction
The reconstructive surgery is performed sometime after the mastectomy,
and any additional therapies that are given including chemotherapy, radiation,
or targeted therapies. Radiation therapy in particular is known to cause
undesirable changes to a reconstructed breast. Some stage II and all stage
III breast cancers are likely to need radiation therapy after mastectomy.
Therefore, some surgeons advise patients to wait until after chemotherapy
and radiation are finished before having reconstruction. This means reconstruction
might be done 6 to 12 months after mastectomy.
In some cases, doctors aren't sure if a woman will need chemotherapy
or radiation until after the cancer and some lymph nodes are removed and
analyzed. It can take up to a week for this analysis to be done. In these
cases, a tissue expander is inserted under the chest muscle after the
breast is removed, thus holding open the mastectomy space until definitive
reconstruction can be performed once chemotherapy and/or radiation are
completed. The breast reconstruction is usually completed about 4 to 6
months after radiation.