CONSIDERATIONS IN IMMEDIATE AND DELAYED RECONSTRUCTION

During an immediate reconstruction (a breast reconstruction performed during the same anesthetic as the mastectomy) all or most of the skin of the breast can be saved – something commonly known as a skin sparing mastectomy. The skin envelope that is spared leaves a supporting structure for the new breast that helps the microsurgeon shape the reconstruction into a more natural appearance. Unfortunately, skin sparing cannot be done in a delayed reconstruction. Sometimes implants or expanders are used to preserve some of the breast skin, with limited success.

Since soft tissues have contracted and scarred down by the time a delayed reconstruction is performed, another strategy must be used to sculpt the breast into a more natural appearance - skin from the flap is used to replace skin that was removed by the mastectomy. What results is an island of skin on the reconstructed breast, making the scar larger than the one present after skin sparing mastectomy and immediate reconstruction. The scar cannot be the size of the areola, but the trade off with the larger scar is a more natural shaped breast.

Take for example the figure below, that shows the need for a larger skin island in a patient that has had a mastectomy. There is no3-dimensional supporting envelope for the reconstruction.

Below, the skin from the abdominal flap is used to help create the supporting structure of the new breast. The scar therefore appears larger. And, the shape is more difficult to sculpt.

For the most part, reconstructions will have a skin island, some of which or all of which is later used to recreate the nipple areola complex. In TUG flap reconstruction, the nipple areola complex can in some cases be made immediately, giving the illusion that there is no skin island.

During a microsurgical consultation you can see photos of immediate and delayed reconstructions. These photos will be able to give you more insight into the procedures outlined here and what to expect in terms of appearance after the reconstruction.