Immediate Reconstruction

At the same time as mastectomy surgery, this is called immediate 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). Nearly all of the work is done during one operation, and you wake up with a rebuilt breast (or breasts). When immediate free flaps are performed, generally two plastic surgeons and a breast oncologic surgeon is involved. This includes the removal of the breast with free flap placement to reconstruct the breast at the same time.

Free flap procedures require an additional “second stage” surgery to optimize breast and donor site aesthetics and for possible nipple reconstruction when required.

  • IMMEDIATE IMPLANT Based: Direct to implant
  • Free flaps at time of mastectomy
  • Second Stage SUrgery After Free Flap Reconstruction :2-3 months post-reconstruction

Delayed Reconstruction

After mastectomy or lumpectomy surgery, as well as after radiation therapy, chemotherapy, or targeted therapies that are given. This is called delayed reconstruction. Treatments such as radiation therapy and sometimes chemotherapy given after surgery can cause the reconstructed breast to lose volume and change color, texture, and appearance. Radiation therapy in particular is known to cause undesirable changes to an implant reconstruction. Some surgeons advise patients to wait until after radiation and chemotherapy are finished before having breast reconstruction. This means reconstruction might be done 6 to 12 months after mastectomy or lumpectomy.

When breasts are reconstructed in a delayed setting then tissue expanders are usually placed followed by implants or free flap reconstruction.

    • Tissue expander placement PRIOR to implants
    • Filled to appropriate size in clinic status post mastectomy weeks 2-6
    • Exchange expanders for permanent implants 2-3 months post expander placement
    • Tissue expander placement PRIOR to Free Flap
    • Filled to appropriate size in clinic status post mastectomy weeks 2-6
    • Second Stage SUrgery After Free Flap Reconstruction : 2-3 months post-reconstruction:
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Delayed-Immediate Reconstruction

As a staged approach, involving some reconstructive surgery during mastectomy or lumpectomy and more reconstructive surgery after any additional treatments. This is also called delayed-immediate reconstruction . In delayed-immediate reconstruction, a tissue expander is inserted under the chest muscle and preserved breast skin after the breast is removed. Temporarily placing an expander or implant will preserve the shape of the breast and breast skin during the upcoming radiation treatments and allow for the final benefit of a skin-sparing mastectomy technique. A tissue expander is a balloon-type device that stretches the skin to create a “pocket” for the reconstructed breast under the skin. Once radiation is complete and tissues have recovered (4-6 months), the expander/implant that was used to maintain the shape of the breast is removed and replaced with a flap from the proper donor site as decided upon in consultation with your surgeon.

Tissue expander

  • To IMPLANT based reconstruction
  • To AUTOLOGOUS based reconstruction
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