If you’re planning for a mastectomy, you likely have a lot on your mind. Maybe you know you’ll want implants for breast reconstruction, but you’re not sure when you should get them. Or maybe you’re not ready to make any decisions at this time, which is 100% okay.
You have options when it comes to breast reconstruction after a mastectomy. It can happen during the mastectomy procedure, or months or even years later. What makes sense for you will depend on health factors, your treatment plan and personal preferences. You may also prefer to keep your chest flat, and not have your breast reshaped after mastectomy. Your breast cancer care team can help guide you to the choices that are best for you.
So why might you want to choose immediate or delayed reconstruction with breast implants? Below, we answer common questions about the timing of breast reconstruction after a mastectomy.
What is breast reconstruction after mastectomy? A procedure to reshape your breast.
During a mastectomy, the surgeon removes all breast tissue, which may include the skin, nipple and areola. Breast reconstruction is the surgery that helps restore the shape of a breast after it’s been removed. Some people also choose to have the noncancerous breast removed and reconstructed at the same time for better symmetry.
Breast implants come in different sizes and shapes, and are either filled with saline (salt water) or silicone. You can also choose to rebuild your breast using tissue from another part of your body (like the stomach or back), which is called tissue-based reconstruction. Using a combination of an implant and your own tissue is another option.
As part of breast reconstruction, you can decide if you’d like to have the nipple and the areola (the dark part around it) recreated. This can be done with surgery or tattooing, or a combination of both, and can occur as early as 3-4 months after breast reconstruction surgery.
An overview of immediate vs. delayed breast reconstruction
The main difference between immediate and delayed breast reconstruction is timing. Immediate reconstruction starts during the same surgery as your mastectomy, while delayed reconstruction is done later. This can affect how long surgery takes and how many procedures you have.
Immediate breast reconstruction options: Starting the reconstruction process right away
Immediate breast reconstruction starts during the same surgery as the mastectomy. After removing the breast tissue, your plastic surgeon begins the breast reconstruction process based on the choices you made ahead of time. Immediate breast reconstruction increases the length of the mastectomy procedure, sometimes doubling how long it takes.
The following are types of immediate breast reconstruction after mastectomy. Your cancer care team can discuss which may be options for you.
Direct-to-implant breast reconstruction
This is when an implant is placed into the breast pocket created by the mastectomy. Typically, a biologic mesh (acellular dermal matrix) is placed over or around the implant to keep the implant in place and help with healing. Direct-to-implant breast reconstruction reduces the number of surgeries you need and may provide better cosmetic results. But additional surgery may be needed to make the breast mound look as good as possible.
This approach is not an option for most women. But you may be able to get implants right away if there’s enough tissue after the mastectomy to cover and support a breast implant. Your cancer care team can let you know if this may be an option based on the tumor location, the quality of skin left after the mastectomy, and your treatment plan.
Immediate breast with tissue expander placement
This is when a breast tissue expander, a device that looks like an empty breast implant, is placed right after the mastectomy procedure. The tissue expander is an adjustable temporary implant that can slowly stretch the skin and tissue on the chest, so there’s room for the permanent implant.
Most expanders are made of silicone and include a small valve or port that allows it to be gradually filled with sterile fluid. Typically, you’ll go in once a week to have your doctor fill the expander until there’s enough room for the implant beneath the skin. Tissue expanders can safely remain in place for 6 months or more.
When it’s a good time to continue the breast reconstruction process, the doctor will remove the expander before placing the implant. Additional surgery may be needed to make the breast mound look as good as possible.
This approach may be an option for you, even if your treatment plan includes radiation therapy or chemotherapy. It’s often chosen for its flexibility.
The delayed breast reconstruction option: Reconstruction at a later time
With delayed breast reconstruction, your chest is left flat or with minimal contouring after the mastectomy. The breast reconstruction happens during one or more additional procedures. It can be done as soon as you complete other cancer treatments, or you can choose to wait until the time is right for you – even if it’s years later. Delayed breast reconstruction is an option for almost everyone.
Delayed breast reconstruction with an implant is usually done as a staged breast reconstruction after mastectomy. The first step is surgery to place a breast tissue expander. As with immediate breast tissue expander placement (discussed above), you’ll typically have weekly visits to the doctor’s office to fill the tissue expander until there’s enough room for the implant under the skin. Then when you have surgery to reconstruct your breast, the surgeon will remove the tissue expander and place the implant. Additional surgery may be needed to make the breast mound look as good as possible.
Nipple and areola reconstruction is often a final step
If your nipple and areola were removed during surgery, you can choose to have them recreated to restore a more natural look. This is usually done as a final step in breast reconstruction.
Your surgeon can rebuild the nipple using skin from your breast and then add color through medical tattooing to recreate the areola. Some people choose tattooing alone, which can be very realistic and doesn’t require additional surgery. Others may prefer nipple prosthetics, which are removable and can be worn as needed.
Factors that affect the timing of implants after mastectomy
Your surgeon can discuss the timing that makes sense for you based on your treatment plan, health and personal preferences. The following factors may affect when you have breast reconstruction or implants after surgery.
- Radiation therapy – Radiation can make the skin tighter and more fragile, which increases the risk of complications like infection or hardening around the implant. Most doctors recommend delaying implants until radiation is finished for better healing and results. However, a tissue expander can be placed immediately after mastectomy so that you don’t have to be flat while having radiation.
- Chemotherapy – If you have reconstruction right away and then start chemo soon after, it can increase the chance of infections or slow down recovery. The type of chemotherapy may impact the timing of your surgery.
- Health factors – Smoking, being overweight and other medical conditions can affect the healing process. Your surgeon may recommend delayed reconstruction to allow your body to heal from the mastectomy before beginning reconstruction.
- Personal preferences – Some people aren’t emotionally ready to make decisions about reconstruction right away. It’s okay to take time to focus on healing and treatment first and consider reconstruction later when you feel more prepared.
Pros and cons of breast removal and reconstruction options with implants
There are reasons why people may choose one approach over another, and it’s important to keep in mind not all approaches may be options for you. Your breast cancer care team (including your plastic surgeon) can guide you to the approach that makes sense for you.
| Approach | Pros | Cons |
|---|---|---|
| Direct to implant | Fewer surgeries
Breast mound immediately after surgery |
Longer initial surgery and recovery
Less time to make decisions Not recommended before radiation therapy Not an option for all women |
| Immediate tissue expander placement | Breast mound immediately after surgery
May be an option before radiation therapy and other treatments More time to consider reconstruction options |
Breast mound is not the final size
One or more additional surgeries Weekly sessions to fill the expander before breast reconstruction |
| Delayed reconstruction with implant | May be a better option after radiation therapy and other treatments
More time to consider reconstruction options Breast reconstruction can be done months or even years later |
One or more additional surgeries
Weekly sessions to fill the expander before breast reconstruction Possibility of more scarring It may be emotionally difficult to have a flat chest |
The most common approach of breast reconstruction and implants after mastectomy is immediate reconstruction
According to the American Society of Plastic Surgeons, about one third of women have immediate reconstruction after their mastectomy. The number of women who have delayed reconstruction is unknown, but it’s likely fewer than those who have immediate reconstruction.
Talk to your care team about the best timing for breast reconstruction
Breast reconstruction is a deeply personal decision, and there are many factors to consider. It’s important to have open conversations with your care team about what matters to you. Together, your care team will help you explore your options and develop a plan that supports both your cancer treatment and your reconstruction goals, ensuring the best possible outcome for your health and well-being.