Mastectomy with delayed breast reconstruction

In a mastectomy with delayed breast reconstruction, you have 2 or more surgeries. In the first operation the tissue is removed (the mastectomy) and the reconstruction occurs later.

You may be able to keep your breast skin after the first surgery, depending on the type of reconstruction. However, it is usually not possible to keep your nipple, unless you have a nipple-sparing mastectomy.

Your surgeon can discuss the options with you.

Timing of delayed reconstruction

After your mastectomy surgery, you may have to wait between a few months and a few years for your reconstruction surgery.

The time between operations may be affected by:

• the treatments recommended for you after surgery, such as radiotherapy and chemotherapy
• whether you plan to have your surgery in the public or private system as wait times are different 
• whether you choose reconstruction with an implant or using tissue from your own body
• your personal health and recovery after cancer treatment.

Reconstruction after neoadjuvant therapy 

Some people are given drug treatments for breast cancer before surgery. This is called neoadjuvant therapy. Within 4 weeks of finishing neoadjuvant treatment, you will have breast surgery. Your treating team will discuss options for surgery and reconstruction (if needed) with you.

Advantages of delayed breast reconstruction

The advantages of delayed breast reconstruction after mastectomy include:

• You have more time between your diagnosis, surgery or other treatments and reconstruction to think about and discuss your options.
• Your body has had time to recover after treatment - such as surgery, chemotherapy or radiotherapy - before further surgery.
• You have more time to prepare for surgery, so you may recover more quickly.
• You may be able to choose when to have the procedure so it fits your schedule.
• You have time to organise finances and any support you may need.

Disadvantages of delayed breast reconstruction

The disadvantages of delayed breast reconstruction after mastectomy include:

• You may have to wait longer than you would like for breast reconstruction.
• You will have more time with no breast tissue (without a reconstructed breast mound). However, you may choose to wear a prosthesis for symmetry or two prostheses if you have had a double mastectomy.
• You may need more surgery after the reconstruction to make the breast look as good as possible.
• Tissue can be affected by radiotherapy, which can cause problems with wound healing.

If you are having radiotherapy 

Radiotherapy can be before or after breast reconstruction.

If you have radiotherapy before reconstruction, your tissue needs time to heal first. It makes radiotherapy easier, but surgery on the tissue is more difficult.

Radiotherapy after reconstruction with a breast implant can increase the risk of scar tissue forming.

Radiotherapy after reconstruction using your own tissue can make the breast tissue feel firmer or change the size and shape of the breast. 

Your radiation oncologist and plastic surgeon will discuss the best time and the risks and benefits of both options.

Read about Radiotherapy.

If you are having genetic testing

Your genetic testing result may influence decisions around breast surgery. Your treating team will talk to you about the options and timing if you are considering having both breasts removed ('bilateral mastectomy') and reconstructed.

Read about Genetic testing.

‘Goldilocks’ mastectomy

People who don't want or cannot have a breast reconstruction may be suitable for a ‘Goldilocks’ procedure. It is called ‘Goldilocks’ because it is between flat closure and a reconstruction.

This surgery happens after a mastectomy. The fatty tissue and skin that remain are formed into a breast mound.

This option may be more common or suitable for:

• people with larger and heavier breasts
• people with other health conditions (‘comorbidities’) who are not suitable for immediate reconstruction.

The procedure may also be a middle step between the mastectomy and a full breast reconstruction, if desired.