Immediate vs Delayed Reconstruction

Procedures

Immediate vs Delayed Reconstruction

About Immediate vs Delayed Reconstruction
Immediate Reconstruction: Mastectomy with DIEP Flap(s)
Stage 1
  1. Mastectomy is performed with DIEP flap(s) at the same time.
  2. Surgery is known as the “tummy tuck” reconstruction.
  3. Involves removing just skin and fat from the abdomen and transplanting to one or both breasts, AKA “Free Flap”.
    • Surgery is on average 4 hours long for bilateral and about 3 hours for unilateral, including mastectomy time as well.
    • Inpatient surgery with a 2-3 night stay in the hospital.
    • Drains stay 10 days on average. One to two in the abdomen and one in each breast.
    • 4-6 week recovery total (most patients are back to work after 2-3 weeks).
Stage 2
  1. Performed no sooner than 3-4 months after stage 1. You can delay the stage 2 surgery as long as needed or would like.
  2. This surgery is to “fine-tune” and beautify.
  3. It can involve lowering of the abdomen scar, increasing/decreasing/lifting the breast, creating a nipple if desired, liposuction for fat grafting to the breast, adding an implant if desired, etc.
  4. At this surgery is when you can have hysterectomy or any other additional surgery combination that might be needed.
    • Outpatient surgery (go home the same day or first thing the next morning).
    • Sometimes there is one drain in the abdomen. Drain stays about 7 days on average.
    • 2-3 week recovery.
Pros to DIEP flap reconstruction
  • Natural reconstruction using your own tissue and not having a foreign object in your body, such as an implant.
  • No need for future reconstruction.
  • Low complication rate.
  • Cosmetic enhancement to the abdomen, similar to having a tummy tuck.
Cons to DIEP flap reconstruction
  • 1-2 week longer recovery with a 3-night stay in the hospital.
  • Multiple sites on the body to recover from, such as the abdomen and breast.
Immediate Reconstruction: Mastectomy with TDAP Flap(s)
Stage 1
  1. Mastectomy is performed with TDAP flap(s) at the same time.
  2. Involves removing just skin and fat from the flank area and rotating it to one or both breasts, AKA “Rotational Flap”.
    • Surgery is on average 4-5 hours long for bilateral and about 3-4 hours for unilateral.
    • Outpatient surgery.
    • Drains stay 10 days on average. One in each breast.
    • 2-3 week recovery with patients returning to work around 2 weeks.
Stage 2
  1. Performed no sooner than 3 months after the first surgery. You can delay the stage 2 surgery as long as needed or would like.
  2. This surgery is to “fine-tune” and beautify.
  3. It can involve scar revision of the donor site (back area), increasing/decreasing/lifting the breast, creating a nipple if desired, liposuction for fat grafting to the breast, adding an implant if desired, etc.
  4. At this surgery is when you can have hysterectomy or any other additional surgery combination that might be needed.
    • Outpatient surgery (go home the same day).
    • Most patients don’t have to have a drain.
    • 2-week recovery with patients returning to work after 1 week.
Pros to TDAP flap reconstruction
  • Natural results using your own tissue.
  • Once both surgeries are complete no need for future surgeries.
  • Low complication rate.
Cons to TDAP flap reconstruction
  • Slightly more of a recovery than implant reconstruction.
  • Healing from 2 areas on the body.
Immediate Reconstruction: Mastectomy with PAP Flap(s)
Stage 1
  1. Mastectomy is performed with PAP flap(s) at the same time.
  2. Involves removing just skin and fat from the inner thigh and transplanting to one or both breasts, AKA “Free Flap”.
    • Surgery is on average 4-6 hours long for bilateral and about 3-4 hours for unilateral.
    • Inpatient surgery with a 2-3 night stay in the hospital.
    • Drains stay 10 days on average. One drain in each thigh and one in each breast.
    • 4-6 week recovery total. Patients are back to work around 3 weeks.
Stage 2
  1. Performed no sooner than 3-4 months after your first surgery. You can delay the stage 2 surgery as long as needed or would like.
  2. This surgery is to “fine-tune” and beautify.
  3. It can involve scar revision of the donor site, increasing/decreasing/lifting the breast, creating a nipple if desired, liposuction for fat grafting to the breast, adding an implant if desired, etc.
  4. At this surgery is when you can have hysterectomy or any other additional surgery combination that might be needed.
    • Outpatient surgery (go home the same day or stay one night if you are out of town).
    • No drains.
    • 2-3 week recovery. Patients return to work around 1 week.
Pros to PAP flap reconstruction
  • Natural results using your own tissue.
  • Cosmetic enhancement of thighs.
  • No need for future surgeries.
  • Low complication rate.
Cons to PAP flap reconstruction
  • Longer recovery.
  • Healing to 2 areas on the body.
Immediate Reconstruction: Mastectomy with Implants
Stage 1
    1. Mastectomy is performed and at the same time a temporary tissue expander is placed. When radiation is a possibility, we use a tissue expander at the time of the mastectomy.
      • Surgery is about 3-4 hours long total including the mastectomy.
      • Outpatient surgery. Patients can stay overnight if need/want.
      • 3-4 week recovery, patients return to work around 2 weeks.
      • One drain per breast. The drain stays about 10-14 days.
      • 1 week till the first expansion is done if a tissue expander was placed.
      • Complete expansion takes about 2-3 weeks.
      • If radiation is needed the patient will start once the tissue expansion is complete, which is about 6 weeks after surgery.
Stage 2
  1. Performed about 3-4 months after the first surgery.
  2. If the patient needed radiation, then this surgery is done 3-6 months after the last treatment.
  3. The tissue expander is removed and a permanent silicone implant is placed.
  4. Sometimes fat grafting is performed at this surgery. (Liposuction of fat from one area of the body and injected into breast to help with shape)
    • Outpatient surgery.
    • 2-3 week recovery with patients returning to work after 1 week.
    • No drains.
    • 8 weeks no excising chest.
Pros to implant reconstruction
  • Faster recovery.
  • Only one area of the body to heal.
Cons to implant reconstruction
  • Higher complication rate which includes capsular contraction, infection, body rejection of implants, etc.
  • Need for future surgery due to implants having to be replaced every 10 years.
Immediate Reconstruction: Lumpectomy with Oncoplastic Surgery
Stage 1
    1. A lumpectomy is performed with oncoplastic surgery at the same time.
    2. Surgery is when a lumpectomy is required, which will leave the breast distorted. The remaining tissue is sculpted to realign the nipple and areola and restore a natural appearance to the breast shape. The opposite breast will also be modified to create symmetry.
    3. With most lumpectomies, patients have to have radiation.
      • Surgery is on average 2-3 hours long.
      • Outpatient surgery.
      • Depending on the patient, drain(s) may be used. Usually removed at 7-10 days.
      • 2-week recovery with patients returning to work after 1 week.
Stage 2

This surgery is only if needed. Some patients do not need this second surgery. Often with radiation, the tissue becomes damaged and shrinks. Should radiation change the breast and cause asymmetry, there are things we can do to help correct these changes.

  1. Performed no sooner than 4-6 months after the last radiation treatment. You can delay the stage 2 surgery as long as needed or would like.
  2. This surgery is to “fine-tune” and beautify.
  3. Can include scar revision, increasing/decreasing/lifting breast, creating a nipple if desired, liposuction for fat grafting to the breast, etc.
    • Outpatient surgery (go home the same day).
    • No drains.
    • 2-week recovery with patients returning to work after 1 week.
Delayed Reconstruction:
Via DIEP Flap(s)
Stage 1
    1. In this case, we know that the patient will need radiation, or there is a high chance for radiation.
    2. Mastectomy is performed with a temporary tissue expander is placed at the same time.
    3. The tissue expander is there to preserve the skin and take the brunt of the damage from the radiation.
      • Outpatient surgery. The patient, can go home the same day or stay overnight (known as a 23-hour observation stay).
      • One drain per breast. Stays about 10 days.
      • 2-3 week recovery on average. Patients return to work at about 2 weeks.
      • If you get a tissue expander, the first tissue expander fill is done about 1 week after surgery.
      • Takes about 3-4 weeks to complete the tissue expansion.
      • Patients wait till the tissue expansion is complete before starting radiation, which is about 6 weeks after surgery.
Stage 2
  1. Tissue expander(s) are removed and replaced with DIEP flap(s) (belly fat and tissue).
  2. Performed 2 months after the patient has completed radiation.
    • Surgery is on average 3-4 hours long for bilateral breast.
    • Inpatient surgery with a 3-4 night stay in the hospital.
    • Drains stay 10 days on average. One to two in the abdomen and one in each breast.
    • 4-6 week recovery with patients returning to work around 2 weeks.
Stage 3
  1. Performed no sooner than 3-4 months after the second surgery. You can delay this surgery as long as needed or would like.
  2. This surgery is to “fine-tune” and beautify.
  3. It can involve lowering of the abdomen scar, increasing/decreasing/lifting breast, creating a nipple if desired, liposuction for fat grafting to the breast, adding an implant if desired, etc.
    • Outpatient surgery (go home the same day).
    • Sometimes there is one drain in the abdomen. Drain stays about 7 days on average.
    • Drains stay 10 days on average. One to two in the abdomen and one in each breast.
    • 2-3 week recovery with patients returning to work around 1 week.

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The Staff and Surgeons at ReCenter took excellent care of me before, during, and after my diagnosis of breast cancer. They treated me and my husband like family. They put our hearts and minds at ease when choosing my surgery options and completed the procedure with skilled precision. Very grateful for ReCenter. 10/10 recommend

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I recently had a double mastectomy at ReCenter & can't speak highly enough on the level of care and compassion from the doctors, nurses, admissions & every employee at ReCenter. They genuinely make you feel comfortable from the time you walk in until you leave. Any questions or concerns I had were addressed & handled with the utmost of respect. Everything is top notch! I know I am in excellent hands with Dr. Bowie & Dr. Theunissen & recommended them highly!

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The entire hospital staff was so kind and helpful during my stay after my mastectomy. The nurses kept my pain under control and were very personable throughout my stay. My night nurses were my saving grace! Every concern that I had was heard and every question was answered. The room was very comfortable and did not feel like the regular hospital stay. I would recommend Recenter to anyone needing this type of care!

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Kaitlin C.

This facility treats you like family and always there to explain any concerns. When doctors (Dr. Bowie and Dr. Theunissen) call you personally to check on you and discuss concerns that you might have is wonderful. On day of surgery, everybody was helpful and friendly. I am a very anxious person but they knew what to do to help me relax.

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The facility is absolutely beautiful. The entire staff was friendly and very professional. I was so calm and at ease from the time that I walked in for pre-op until I was discharged from recovery. First class!

Katherine S.

Such a kind, warm, and knowledgeable staff. They helped to put any pre-surgery jitters at ease. Everyone tended to me well the entire time and were quick to respond to my vasovagal response when coming out of anesthesia. 10/10 recommend!

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