Stages of Breast Reconstruction
Timing of Breast Reconstruction
Breast reconstruction can usually be performed at the time of the mastectomy (i.e. immediate breast reconstruction) without jeopardizing oncologic outcomes or interfering with cancer surveillance. Many women report a significant psychological and emotional benefit to waking up from breast cancer surgery with a newly reconstructed breast(s) already in place. Additionally, the appearance of the reconstructed breast is generally better when more breast skin and the nipple can be preserved, and reconstruction is carried out during the same surgery. Immediate breast reconstruction also usually requires fewer surgeries overall. For these reasons, national trends indicate that more women are undergoing breast reconstruction at the time of mastectomy.
Breast reconstruction can also be performed months or years after a mastectomy (i.e. delayed reconstruction). Reconstruction is sometimes deferred due to medical reasons or personal preferences. Even if a decision is made to delay reconstruction, women with a new diagnosis of breast cancer are encouraged to seek a consultation with a plastic surgeon to better understand their options.
Some mastectomies are able to preserve the nipple, but in other cases it is removed with the breast tissue. When it is resected, a nipple can be recreated on the reconstructed breast, usually at a later surgery. The two most common methods of reconstruction are rearrangement of local flaps of skin and nipple sharing. In the first method, skin at the center of the breast is elevated and sewn to itself in a shape that resembles a nipple. Nipple sharing transfers a portion of the opposite nipple to the desired site on the reconstructed breast.
Areolar tattooing can be done months after nipple creation to color the nipple and surrounding skin. 3D tattooing is a non-surgical alternative to nipple reconstruction that can create a lifelike appearance of a nipple and areola but one that is flat.