CONSIDERATIONS IN IMMEDIATE AND DELAYED RECONSTRUCTION OF BREASTS

Immediate reconstruction refers to reconstruction that takes place in the same surgical setting as the mastectomy. Delayed reconstruction is performed after the mastectomy heals. There can be many reasons why reconstruction is delayed. In general, immediate reconstructions have the best cosmetic result, but not all reconstructions can be done immediately. The differences in immediate and delayed reconstruction are outlined here to help you understand the potential difference in appearance.

During the mastectomy the nipple and areola are almost always removed (although nipple sparing mastectomy is a rare exception).  And depending on tumor location or size, more skin may need to be removed for your cancer surgeon to perform the mastectomy correctly. Consider the illustration below. The blue markings outline the nipple and areola lost with a skin sparing mastectomy. The entire mastectomy is performed through this incision, leaving an envelope of skin that helps to shape and support the immediate reconstruction.

 

The space left behind by the loss of the breast, nipple and skin is filled by the flap. This leaves an area of flap skin island where the nipple and areola used to be. This is illustrated in the figure below.

The nipple areola reconstruction is performed on this skin island at a later date (except in the case of TUG flap nipple areola reconstruction). The size of the skin island in immediate reconstruction varies depending on several factors including tumor size, previous surgical scars, or a history of radiation. 

In the rare case of nipple sparing mastectomy, a skin island can be avoided.