Immediate vs. Delayed Reconstruction

There are many factors that go into the decision regarding the timing of breast reconstruction. Sometimes women prefer to proceed with a mastectomy and other needed cancer treatment, leaving the question of possible reconstruction for later. Sometimes there are clear medical reasons why a delay is preferable, and sometimes women strongly prefer a single major surgery and awakening with a “new” breast.

As breast reconstruction has become increasingly common, there have been more studies to determine the best and safest practice in a range of situations. Two recent studies have provided information about instances in which delayed reconstruction is safer and have been reassuring about chemotherapy, either pre or post surgery, not causing additional complications.

One study from Dr. Rodney Pommier and colleagues at the Oregon Health and Sciences University found that complications after radiation occurred in 44% of women who had immediate reconstruction and only 7% of women who did not (and who, presumably, had reconstruction later or not at all). Dr. Pommier suggests that sentinel node biopsies prior to mastectomy surgery will often identify those women who will likely need post-operative radiation therapy, and further discussion can then include the higher risk of complications from this course. At BIDMC, women who anticipate radiation therapy are often counseled to delay reconstruction until later.
The other study from UCSF found that women who had chemotherapy, either pre or post surgery, were no more likely to have surgical complications than women who did not receive chemotherapy. Thirty-one percent of women studied had a complication that required a second surgery, but the incidence was the same among women who had chemotherapy and those who did not.
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All of this supports the need to have thoughtful discussions with your doctors as you consider your surgical options. No single course is best for all women, but we are increasingly able to individualize recommendations and understand the best choices for women making these difficult decisions.



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