How long must I wait for breast reconstruction after a mastectomy?
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