A breast reconstruction may be done at the same time as mastectomy (immediate breast reconstruction) or at some time later (delayed breast reconstruction).
An immediate breast reconstruction is done during the same operation as a mastectomy.
Benefits of an immediate reconstruction are:
- there is only one operation (although the surgery and recovery time is longer than for mastectomy alone)
- it may be possible to keep the skin, nipple and areola intact so that the look of the reconstructed breast is more natural.
Immediate breast reconstruction is also thought to lead to improved psychological, emotional and social outcomes, because the woman wakes from the mastectomy operation with a breast shape and does not experience the loss of a breast. Despite the immediate replacement of the breast, a woman may still grieve for the loss of a breast even after a breast reconstruction.
If a woman is having a breast reconstruction using tissue expanders (breast reconstruction using implants or LD flap), she may wake up from her operation with a flat chest.
"I don't think I could have coped as well if I hadn’t had an immediate reconstruction... I just know that when I had my operation and I woke up afterwards and I kind of looked under my gown and it just looked like I still had breasts."
A delayed breast reconstruction is done after a mastectomy. This may be months or even years later.
A benefit of delayed breast reconstruction is that the initial mastectomy surgery and recovery time are shorter. However, the final look of the reconstructed breast may not be as natural because the skin, nipple and areola will usually be removed at the time of mastectomy.
It may difficult to coordinate two surgeons to perform an immediate breast reconstruction in the public sector and a waiting list may be unavoidable. Women having breast reconstruction in a private hospital do not experience these difficulties. Regardless of whether there is a waiting list, other cancer treatments may affect the timing or outcome of a breast reconstruction. Some women may be advised to delay their reconstruction until after breast cancer treatment.
If you are advised not to have a breast reconstruction at the time of mastectomy and/or you decide not to have a breast reconstruction at all, delayed breast reconstruction is an option later down the track. In the meantime, you can choose to use an external breast prostheses.
"It's a very difficult thing to live without a breast. A lot of women do and do it successfully, I did for a long time… And it didn't worry me terribly, it just became second nature. But when my grandkids come to stay overnight, I'd always find myself wearing my bras to bed with the prosthesis in it in case I had to get up to them in the night. Or if they wanted to come and sleep in my bed or something, you know, I didn't want them to see that I had no breast."