Immediate or delayed breast reconstruction: the aspects of timing, a narrative review

Abstract

Objective: The objective of this study is to discuss the timing of immediate and delayed breast reconstruction. Background: The evolution of conservative mastectomy surgical techniques and the introduction of acellular dermal matrix (ADM) have paved the road for the increased popularity of immediate reconstruction, and this also includes use of autologous tissue. Immediate reconstruction holds several benefits, the most important being superior aesthetic outcomes and improved levels of psychosocial wellbeing post-mastectomy. Both immediate and delayed breast reconstruction has been found to be oncologically safe, although high-quality studies are still lacking. Potential delay in adjuvant treatment is a significant concern amongst medical and surgical oncologists, and in addition, a few studies have examined complications in cancer surgery and found negative association with the oncological outcome. Methods: Narrative literature review and presentation of the authors practice. Conclusions: Careful patient selection, especially in case of invasive breast cancer is very important. Absolute contraindications for immediate reconstruction include a diagnosis of locally advanced breast cancer or inflammatory breast cancer or active infection in the breast area. Relative contraindications to be carefully considered to keep the risk of complications at a minimum and thus the risk of delaying the adjuvant therapy is: smoking, high BMI, and comorbidities and need of postoperative radiation therapy. Delayed reconstruction should be considered for patients with pressing medical comorbidities, obesity, smoking, inflammatory breast cancer, and for patients distressed regarding their breast cancer diagnosis who are not ready to make treatment decisions. The authors prefer immediate reconstruction if feasible, but it should be remembered that delayed breast reconstruction has been found not to compromise patient-reported outcomes in the long-term. Therefore, the timing and technique of reconstruction should be decided on a case-by-case basis after a thorough discussion with the patient and preferably also in multidisciplinary meetings.