Reconstruction timing
Timing should follow the cancer-treatment plan.
Immediate reconstruction is not automatically better than delayed reconstruction. Delayed reconstruction is not evidence that care was incomplete.
The most appropriate timing depends on the anticipated cancer treatment, surgical risk, anatomy, available techniques and patient priorities.
Potential reasons to consider immediate reconstruction
- Preservation of more breast skin
- Reconstruction begins during the mastectomy operation
- Avoidance of a period without a breast mound
- Potentially fewer major operations in selected patients
- Psychological preference for immediate restoration of breast contour
Potential reasons to delay reconstruction
- Radiotherapy is expected
- The cancer-treatment sequence remains uncertain
- The patient has medical conditions that increase surgical risk
- A longer combined operation is not appropriate
- The patient wants more time to consider options
- The preferred reconstruction is not currently feasible
- Additional cancer treatment should not be placed at risk
Why radiotherapy matters
Radiotherapy can change skin elasticity, blood supply and soft-tissue quality. It can also increase the risk of capsular contracture and implant-related problems.
Autologous reconstruction may also be affected by radiation, although the pattern of complications differs from implant reconstruction.
The reconstructive surgeon and radiation oncologist should ideally be involved before mastectomy when post-mastectomy radiotherapy is a realistic possibility.
Can the timing change after surgery?
Yes.
Final pathology may show findings that were not known before surgery. A recommendation for radiotherapy or additional systemic treatment can therefore change the reconstructive pathway.
Patients should ask in advance how the team would respond if the final treatment plan changes.