How long must I wait for breast reconstruction after a mastectomy?Plastic Surgery Breast Cancer
I had a mastectomy last year. I am planning a delayed reconstruction. How long must I wait for breast reconstruction after a mastectomy? I understand that breast tissue expansion must be completed first - is this factored into the wait? How long does it take to complete breast tissue expansion before I can proceed with the implant surgery?
Thank you for the D2D enquiry. I hope that you have recovered well from your breast surgery and I am happy that you have decided on a delayed reconstruction. There are many benefits of breast reconstruction and you have certainly made the right choice.
The treatment options for reconstruction after a mastectomy can be broadly divided into autologous reconstruction (using your own tissue) or implant reconstruction. Autologous reconstruction using your own tissue is the gold standard for reconstruction in most patients. However, many patients also choose implant-based reconstruction due to the shorter surgery time and faster recovery. From your question, it seems that you are planning for tissue expansion and an implant-based reconstruction.
How long must I wait for breast reconstruction after a mastectomy ?
Whilst an immediate reconstruction would be the most ideal as the surgeon would be able to preserve as much of the native breast skin and in some cases, even the nipple; delayed reconstruction, if performed by an experienced surgeon has been shown to provide equivalent patient satisfaction and quality of life benefits.
In patients who are planning for breast reconstruction after a mastectomy, the timing would depend on whether you had to undergo chemotherapy or radiotherapy. In patients who do not require any chemotherapy or radiotherapy, a reconstruction can be done anytime i.e. it could be done 20 days or 20 years after the mastectomy. However, in patients who underwent mastectomy without reconstruction and would require chemotherapy, I would usually advise a minimum of 4 weeks after completion of chemotherapy, before consideration of reconstruction. Chemotherapy reduces the immunity of the patient and can lead to problems of wound healing and increased risk of surgical site related infections. In patients who need to undergo radiation therapy to the chest, I would recommend autologous (using your own tissue) reconstruction as there is a high risk of complications for implant-based reconstruction in this group of patients. It would also be more challenging to get a symmetrical aesthetic outcome and there is significant risk of capsular contractors and implant complications. Autologous reconstruction will usually only be performed after 6 months from the conclusion of the radiation therapy.
Tissue expansion and how long does it take ?
Tissue expansion is a procedure that enables the body to “grow” extra skin for reconstruction. This is done in cases where there is a shortage of skin. In this case, it is to provide extra skin to replace the skin that has been “lost” due to the contraction of the skin after mastectomy. This is one of the reasons why autologous immediate reconstruction is advantageous, as the neo-breast can be made with your own tissue during the mastectomy, saving the trouble of tissue expansion and multiple surgeries. Tissue expansion usually involves 2 or more operations. The initial operation of inserting a tissue expander takes about 1-2 hours, where a silicone balloon expander is placed in a pocket created beneath the skin overlying the chest. The expander will have a one-way valve that allows the surgeon to fill the expander with saline solution gradually over the next few weeks, once the initial incision has healed. Once the surgeon has checked that the incision has healed (usually after 3-4 weeks), the patient will come to the clinic every 3-4 days for injection of saline into the expander for tissue expansion. During each visit 20-40 mls of saline would be injected and the reason for the variation is that sometimes patients may feel pain if the skin is being stretched excessively. In such cases, less saline would be injected. Depending on the size of the contralateral normal breast, the amount of tissue expansion required, the tissue expansion may take few weeks to months. Once the desired expansion is achieved, the expander is left there for another 2 weeks, before it is removed and a permanent implant is then inserted during a second operation. The time required to complete a tissue expansion depends on the size of the expansion. As a rough estimate, it would take about 8-10 visits or approximately 30 days to complete a 300 cc tissue expansion.
Hope this answers your questions. Please click the link below if you need further information on breast reconstruction. Breast reconstruction is the most commonly researched topic in reconstructive surgery and the techniques for both autologous and implant-based reconstruction have evolved tremendously over the years. Speak to an experienced plastic surgeon in breast reconstruction if you have any further queries.
Dr. Terence Goh
Thank you for your question. There are a couple of factors to consider when deciding when to have your delayed breast reconstruction.
The first is whether you have finished your adjuvant therapies such as chemotherapy and radiation therapy. Elective surgery is usually postponed until 1 month after the completion of chemotherapy to allow the effects to wear off. If you do need or have had radiation therapy, implant reconstruction may not be the ideal choice for you in view of the increased risks.
Another factor to consider is why you delayed your reconstruction in the first place. Was it because you wanted to make sure you are free of cancer before you proceeded with the reconstruction? There is no evidence that breast reconstruction increases the risk of tumour recurrence or interferes with the detection of a recurrence, but I've had patients wait 5 years until they got the all clear before going ahead with the reconstruction.
There aren't many good reasons to delay a breast reconstruction, you actually get better results if done immediately. If the above factors don't apply to you then you can proceed with planning your reconstruction.
To answer your question about how long it takes to complete the expansion, everyone is different because everyone has different sized breasts. Every week fluid is injected to expand the skin, if you haven't has radiation the skin will be softer and more expandable and will be able to take more fluid. If your breasts are smaller, you can reach the desired volume faster.
Tissue expansion is only necessary for implant based reconstruction. If you are using your own tissue, skin will be transplanted with the flap to replace the skin taken during the mastectomy.
Hope this information helps.
Thank you for your question!
I hope you are recovering well from your mastectomy. There are basically 2 forms of breast reconstruction available to you: use of your own tissue (autologous reconstruction) or implant-based reconstruction.
I assume from your question that you are mainly looking at implant-based reconstruction. This is a good option provided that the original mastectomy did not require the removal of the pectoralis major muscle and you do not require radiotherapy to the breast. The success of implant-based reconstruction depends very much on the quality of the soft tissue envelope overlying the implant, ie. muscle and skin/fat.
To answer your question succinctly, there are 2 factors that would impact on your timing of delayed breast reconstruction: the need for adjuvant therapy (chemo-, hormonal and/or radiotherapy) as well as your health and wound status.
Personally, I would wait for the completion of any chemotherapy before placing an implant expander. A minimum of 3 weeks is my preference after cessation of chemotherapy to consider reconstruction. Chemotherapy results in poorer wound healing and can cause problems with both the implant and the expansion process.
Hormonal therapy on the other hand can be carried out concurrently. Implant expanders allow for a single stage reconstructive process without the need for a staged expander removal and implant insertion.
I hope this answers your question.
Dr. Samuel Ho
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