Timing of Reconstruction
Once you have decided to have a breast reconstruction procedure and have determined which type of reconstructive procedure will best meet your needs, one of the first choices you have to make is whether to undergo immediate or delayed reconstruction. Immediate breast reconstruction is performed during the same operation as the mastectomy, whereas delayed breast reconstruction involves only performing the mastectomy at the first operation and after the patient has fully recovered. Any additional necessary treatment having been completed, a second operation is performed to reconstruct the breast. This may be weeks, months or even years after the mastectomy.
Factors determining the suitability of immediate or delayed reconstruction are:

+ Patient's stage ofbreast cancer
+ Patient's medical condition
+ Patient's preference and lifestyle
+ If additional therapies (such as radiation and chemotherapy) are needed to treat the breast cance

The shape and size of the scars after a mastectomy will vary between immediate and delayed reconstruction. For immediate reconstruction, it is often possible to perform nipple or skin-sparing mastectomy which will result in either a circular scar around the nipple and areola or a relatively small straight line scar. However, for delayed reconstruction, more skin is removed at the time of mastectomy leaving a long scar across the chest wall.
There are advantages and disadvantages associated with both options:

Immediate Reconstruction Advantages :

♦ Better aesthetic results
♦ Smaller breast scars
♦ Possibly fewer surgeries
♦ One anaesthetic and recovery period
♦ Decreased risk of emotional and social difficulties

Immediate Reconstruction Disadvantages :

♦ Longer anaesthetic and recovery time
♦ Harder to detect mastectomy skin problems
♦ Increased risk of infection
♦ Distortion of reconstructed breast if radiotherapy is required.

Delayed Reconstruction Advantages

♦ Staggered surgery resulting in easier and shorter recovery after each procedure
♦ Patients have more time to consider breast reconstruction options
♦ Additional cancer therapy after mastectomy (such as radiation) does not cause problems at the reconstruction site

Delayed Reconstruction Disadvantages :

♦ Longer breast scars
♦ Less optimal aesthetic results
♦ Requires additional surgery and recovery time
♦ Multiple hospitalisations