Delayed Breast Reconstruction

(Secondary Breast Reconstruction)

For a variety of reasons some women have mastectomy surgery without immediate breast reconstruction. Once everything has healed following mastectomy, and often when the adjuvant treatment for the cancer (chemotherapy, radiotherapy or herceptin) has finished, we can undertake delayed reconstruction of the breast. This is usually months but can be years after mastectomy. It is performed when you feel ready to take this next step.

The main advantages of delayed breast reconstruction are that the patient has already completed their cancer treatment and the operation is smaller to the extent that it is not combined with a mastectomy and removal of axillary lymph nodes. It, however, means that the patient has to live without one or both breasts for a period of time. It also involves a 2^nd operation and having to deal with the effects of previous radiotherapy and surgery on the chest wall and axilla.

There are different ways to reconstruct the breast. They include implant-based techniques, the use of your own tissues or a combination of both. The method chosen together with your surgeon will be based on several factors such as your personal preference, body shape, available tissue, appearance of the opposite breast and your general health and lifestyle. It is also heavily influenced by what other cancer treatment you needed for your breast cancer especially radiotherapy.

(For specific techniques see the “Methods of Breast Reconstruction”).

As in any plastic surgery, there are benefits, risks and the final results are not guaranteed: The realistic goal of delayed breast reconstructive surgery is to improve the appearance, improve the symmetry and not the perfect replacement of the breast. Nipple reconstruction is performed as a local anaesthetic procedure 3 – 6 months after the breast mound reconstruction.

To view the before and after photos of surgery as shown in Professor Malata’s publications on delayed breast reconstruction please click below

• An algorithmic approach to abdominal flap breast reconstruction in patients with pre-existing scars results from a single surgeon’s experience;

• Methods of Breast Reconstruction – Photos of Immediate & Delayed Techniques;

• Early experience with an anatomical soft cohesive silicone gel prosthesis in cosmetic and reconstructive breast implant surgery

• Previous multiple abdominal surgeries - A valid contraindication to abdominal free flap breast reconstruction

Advantages of delayed breast reconstruction

• The cancer treatment is complete

• staggers the surgeries: hence individual recovery times shorter

• no theoretical risk of masking recurrence

• possibly stronger to withstand a large operation than immediately after chemotherapy

Disadvantages of delayed breast reconstruction

• Psychological morbidity of the mastectomy deformity

• multiple operations, hospitalizations, time off work & away from family

• Need for new skin to replace what was removed at mastectomy

• Unfavourable effects of radiotherapy on the tissues and blood vessels

• More challenging to obtain the same quality results

• More difficult to achieve excellent cosmesis

• More expensive in the long run