Delayed Breast Reconstruction
What Will My Experience Be Like With Delayed Breast Reconstruction?
If you are ready for delayed reconstruction, you have already completed the important step of treating your breast cancer.
This treatment may have involved chemotherapy and radiation as well as surgery. Many of my breast surgery patients who have undergone delayed breast reconstruction tell me that the surgery helps to allow them to put the cancer behind them and feel like they are truly a cancer survivor.
DELAYED BREAST RECONSTRUCTION WITH TISSUE EXPANDERS AND IMPLANTS
For most patients who are referred to me for delayed reconstruction after mastectomy, it is possible to carry out the entire reconstructive sequence in a series of outpatient surgeries, with relatively quick recovery.
My first step when I assess the patient for delayed reconstruction is to evaluate the skin in the area of the mastectomy.
If there has not been radiation to the area and the skin and fat underneath are of good quality, I will typically recommend starting with a tissue expander. If the skin of the area seems thin or if there has been radiation, I will start with a preliminary fat transfer to the area, as this significantly improves the quality of the skin. Sometimes I prepare the skin with an external stretching device, which improves the amount of fat that I can transfer.
When I place the tissue expander I will typically carry out a fat transfer to the area, whether or not there has been a previous fat transfer to prepare the area. The recovery from the surgery where I place the tissue expander is generally quite easy.
There are some surgeons who categorically reject tissue-expander and implant-based reconstructions if there has been radiation after a mastectomy, but I have found these procedures to be suitable in some patients.
Each patient must be assessed individually. As I mentioned earlier on this section, flap reconstructions often have significant negative consequences on body mechanics that should not be ignored.
We typically start tissue expansion three weeks after placement of the expander.
The patient usually comes in weekly until we have brought the breast to the proper size.
The remaining steps of reconstruction are the same as I have described for immediate reconstruction.
DELAYED RECONSTRUCTION WITH A FLAP FROM THE BACK AND THE ABDOMEN
When flaps are used for delayed reconstruction, the surgeon will open the previous mastectomy incision and lift up the skin to create a space for the flap. The details of the flap operations are the same as I have described in the section about immediate flap reconstruction.
When tissue expanders are used for delayed reconstruction, the procedure is an outpatient surgery with a relatively easy recovery. This is not the case with flap reconstruction. The patient will need to spend several days in the hospital and it will take quite some time to return to comfort in the back and abdomen. There is also the possibility of long-term functional issues.
Learn More About Delayed Breast Reconstruction
As an experienced breast surgeon, Dr. John Q. Cook has performed many delayed breast reconstruction procedures. During a private consultation, he can review the details of the treatment and answer any questions you may have.