Table 1.

Timing of breast reconstruction: Immediate versus delayed.

TIMINGDEFINITIONIDEAL CANDIDATEADVANTAGESDISADVANTAGES
ImmediateReconstructive procedure is started during the same operation as the mastectomy or lumpectomy
  • Healthy

  • Low-grade cancer

  • Less likely to require postsurgical radiotherapy

  • In more advanced or unknown breast cancer stages, part of the breast reconstruction can start immediately

  • Preservation of native skin and possibly nipple

  • Fewer procedures

  • Considerable psychological benefit (avoids breast deformity)

  • Longer surgery

  • Longer recovery

  • Unknown tumour biology with variability in the need for postoperative adjuvant therapy

DelayedReconstructive procedure occurs months to years after mastectomy or lumpectomy
  • Cannot tolerate a longer surgical procedure and recovery

  • Requires radiotherapy postoperatively

  • Multiple important risk factors (smoking, diabetes, vascular disease, etc)

  • Increased time to make reconstructive decisions

  • Decisions can be based on final tumour pathology

  • More time to prepare for recovery

  • Need for multiple operations

  • More complicated operations (owing to missing skin envelope and possibly nipple)

  • Psychological effects of breast deformity until reconstruction is performed