The immediate approach of creating a breast mound at the same time as the mastectomy has the advantage of being less psychologically disruptive ("mourning" for the lost breast). Immediate reconstruction is appropriate for women with small cancers and without spread to axillary lymph nodes who wish to avoid an extra operation but realize that under certain circumstances or if spread is likely there may be a slightly higher risk of healing problems. But if the tumor is large, immediate reconstruction usually is not performed. The primary goal is always curing the cancer. Breast reconstruction is always a secondary goal.
The delayed approach has certain advantages. It allows the surgical wound to heal completely, so the reconstruction does not compound possible post-mastectomy healing problems. The surgical specimen and axillary lymph nodes are evaluated by a pathologist, allowing both patient and physician to make the most appropriate decisions about the various options for reconstruction.
Reconstruction is also generally delayed if radiation therapy and chemotherapy are undertaken immediately after surgery. Both can cause low blood counts and impaired immunity, increasing the risk of infection, compromised wound healing and other complications. Reconstruction is usually delayed for four to six weeks after radiation therapy is completed and two to three months after chemotherapy ends.
