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When is breast reconstruction surgery performed?

Dr. William L. Owens, MD
Vascular Surgeon

The most common scenario in which breast reconstruction is performed is following mastectomy surgery for breast cancer. This can be done either in a delayed fashion, where months or even years later a reconstruction of a breast mound is performed at the site of the flattened surface after a mastectomy. This can be challenging for the reconstructive surgeon and thus the patient, though, as skin and other tissue must be recruited from other parts of the body and attempts made to match the size and shape of the other breast. In most circumstances, the reconstruction is done immediately, at the same time that the mastectomy is performed. In these cases, when all the breast tissue is removed for the mastectomy, the breast surgeon leaves most of the skin envelope, and many times also the nipple and areola, in place, and the plastic surgeon then fills the envelope thus created.

In the United States, 80% of the time this filling is done with implant material, and in 20% of cases tissues from other parts of the body are mobilized and used to fill the space. This reconstruction is sometimes done when mastectomy is performed without cancer present, such as if a woman carries the BRCA gene mutation and she chooses to have the breasts removed for prevention, or if one breast has cancer and is being removed and the patient desires the other breast be removed for prevention (a so called prophylactic mastectomy). In some patients who have had lumpectomy and radiation for breast cancer, the breast is left unacceptably deformed after healing. In these cases, reconstruction can be performed to create a more acceptable breast shape.

Finally, newer lumpectomy techniques are using reconstructive methods at the time of lumpectomy to leave an acceptably shaped breast. These are called oncoplastic techniques. Federal law has mandated that all insurance providers, including Medicare and Medicaid, must cover breast reconstruction when it is being done in the setting of breast cancer. 

Breast reconstruction surgery is performed after the diagnosis of breast cancer and cancer operation.

Dr. Stuart A. Linder, MD
Plastic Surgeon

Breast reconstruction surgery can be performed concurrently with the mastectomy, staged, or delayed. Patients undergoing a mastectomy without radiation therapy may be a candidate for immediate implant reconstruction at the same surgical setting. Those requiring radiation to the chest may consider staging with a tissue expander or delaying the reconstruction with tissue transfer or flap surgeries several months later (TRAM flap, Latissimus Dorsi myocutaneous flap, etc.). This discussion should be made in advance with both the medical oncologist, and plastic surgeon.

Breast reconstruction surgery can be performed either at time of the mastectomy or delayed until a time after the mastectomy. Learn more from Dr. Mark Sisco on behalf of NorthShore University HealthSystem about breast recontruction surgery.

Dr. Homayoun N. Sasson, MD
Plastic & Reconstructive Surgeon

The timing of breast reconstruction following cancer surgery varies according to the stage and progression of the cancer, preferences of the woman and the surgeon and other treatments that might be necessary. Following are options for timing of breast reconstruction surgery:

  • Immediate breast reconstruction is done at the same time as cancer resection, often requiring further revisional surgeries for better symmetry. 
  • Delayed breast reconstruction is usually done when interim treatments are indicated, such as adjuvant chemo, radiation or hormonal therapies.
  • Delayed-immediate breast reconstruction is done at the same time as cancer surgery, but further definitive reconstruction is delayed until completion of interim treatments.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.