Delayed Breast Reconstruction After Mastectomy

  • Cicero Urban
  • Flavia Kuroda
  • Mario Rietjens


Although immediate breast reconstruction after mastectomy is oncologically safe for most patients, its use remains low worldwide. In addition, there are many disparities in its availability which are related to race, sociodemographic factors, and financial and cultural barriers. Then, delayed breast reconstruction remains an option for many patients. There are some surgical procedures that have minor risks, and many of them can be performed in day-surgery, like expanders and definitive implants. However, in irradiated patients it is necessary to do breast reconstruction with autologous flaps. So, the aim of this chapter was to cover the indications, preoperative evaluation, operative techniques, and complications related to delayed breast reconstruction.


Breast reconstruction Tissue expansion device Breast implantation Breast prosthesis implantation Breast reconstruction Plastic surgery Esthetic surgery Cosmetic surgery Medical oncology Clinical oncology Mastectomy Mammectomy 


  1. 1.
    Petit JY, Le MG, Mouriesse H et al (1994) Can breast reconstruction with gel-filled silicone implants increase the risk of death and second primary cancer in patients treated by mastectomy for breast cancer? Plast Reconstr Surg 94:115–119CrossRefGoogle Scholar
  2. 2.
    Petit JY, Le MG, Rietjens M et al (1998) Does long-term exposure to gel-filled silicone implants increase the risk of relapse after breast cancer? Tumori 84:525–528CrossRefGoogle Scholar
  3. 3.
    Lee M, Reinerstein E, McClure E et al (2015) Surgeon motivations behind the timing of breast reconstruction in patients requiring postmastectomy radiation therapy. J Plast Reconstr Aesthet Surg 68:1536–1542CrossRefGoogle Scholar
  4. 4.
    Lardi AM, Myrick ME, Haug M et al (2013) The option of delayed reconstructive surgery following mastectomy for invasive breast cancer: why do so few patients embrace this offer? Eur J Surg Oncol 39:36–43CrossRefGoogle Scholar
  5. 5.
    Disa JJ, Mccarthy CM (2005) Breast reconstruction: a comparison of autogenous and prosthetic techniques. In: Advances in surgery, vol 39. Mosby, New York, pp 97–119Google Scholar
  6. 6.
    Hvilsom GB, Hölmich LR, Steding-Jessen M (2011) Delayed breast implant reconstruction: a 10-year prospective study. J Plast Reconstr Aesthet Surg 64:1466–1474CrossRefGoogle Scholar
  7. 7.
    Berbers J, van Bardwijk A, Houben R et al (2014) ‘Reconstruction: before or after postmastectomy radiotherapy?’ A systematic review of the literature. Eur J Cancer 50:2752–2762CrossRefGoogle Scholar
  8. 8.
    Alderman AK, Wilkins E, Kim M et al (2002) Complications in post-mastectomy breast reconstruction: two year results of the Michigan breast reconstruction outcome study. Plast Reconstr Surg 109:2265–2274CrossRefGoogle Scholar
  9. 9.
    Bezuhly M, Wang Y, Williams JG, Sigurdson LF (2015) Timing of postmastectomy reconstruction does not impair breast cancer-specific survival: a population-based study. Clin Breast Cancer 15:519–526CrossRefGoogle Scholar
  10. 10.
    Beasley ME (2006) In: Spear SL (ed) Delayed two-stage expander/implant reconstruction. Surgery of the breast: principles and art. Lippincott, Williams and Wilkins, Philadelphia, p 489Google Scholar
  11. 11.
    Halsted WS (1907) The results of radical operations for the cure on carcinoma of the breast. Ann Surg 46:1CrossRefGoogle Scholar
  12. 12.
    Alderman AK, Hawley ST, Morrow M et al (2011) Receipt of delayed breast reconstruction after mastectomy: do women revisit the decision? Ann Surg Oncol 18:1748–1756CrossRefGoogle Scholar
  13. 13.
    Chawla A, Kachnic L, Taghian A et al (2002) Radiotherapy and breast reconstruction: complications and cosmesis with TRAM versus tissue expander/implant. Int J Radiat Oncol Biol Phys 54(2):520–526CrossRefGoogle Scholar
  14. 14.
    Cordeiro PG, Pusic AL, Disa JJ, McCormick B, VanZee K (2004) Irradiation after immediate tissue expander / implant breast reconstruction: outcomes, complications, esthetic results and satisfaction among 156 patients. Plast Reconstr Surg 113:877–891CrossRefGoogle Scholar
  15. 15.
    Berry T, Brooks S, Sydow N, Djohan R, Nutter B, Lyons J et al (2010) Complication rates of radiation on tissue expander and autologous tissue breast reconstruction. Ann Surg Oncol 17S3:202–210CrossRefGoogle Scholar
  16. 16.
    Momoh AO, Colakoglu S, de Baclam C et al (2012) Delayed autologous breast reconstruction after postmastectomy radiation therapy: is there an optimal time? Ann Plast Surg 69:14–18CrossRefGoogle Scholar
  17. 17.
    Clough KB, O’Donoghue JM, Fitoussi AD, Nos C, Falcou MC (2001) Prospective evaluation of late cosmetic results following breast reconstruction: I. implant Reconstruction. Plast Reconstr Surg 107:1702CrossRefGoogle Scholar
  18. 18.
    Cordeiro PG, McCarthy CM (2006) A single surgeon’s 12-year experience with tissue expander/implant breast reconstruction: part II. An analysis of long-term complications, esthetic outcomes, and patient satisfaction. Plast Reconstr Surg 118:832–839CrossRefGoogle Scholar
  19. 19.
    Mayo F, Vecino MG (2009) Esthetic remodeling of the healthy breast in breast reconstruction using expanders and implants. Aesthet Plast Surg 33:220–227. Scholar
  20. 20.
    Heden P, Jernbeck J, Hober M (2001) Breast augmentation with anatomical cohesive gel implants: the world’s largest current experience. Clin Plast Reconstr Surg 28:531CrossRefGoogle Scholar
  21. 21.
    Tebbetts JB (2002) Breast implant selection based on patient’s tissue characteristics and dynamics: the TEPID approach. Plast Reconstr Surg 190:1396CrossRefGoogle Scholar
  22. 22.
    Tebbets JB (2001) Dual-plane (DP) breast augmentation: optimizing implant–soft tissue relationships in a wide range of breast types. Plast Reconstr Surg 107:1255–1272CrossRefGoogle Scholar
  23. 23.
    Tebbetts JB (2002) A system for breast implant selection based on patient tissue characteristics and implant-soft tissue dynamics. Plast Reconstr Surg 109:1396–1409CrossRefGoogle Scholar
  24. 24.
    Pajkos A, Deva AK, Vickery K et al (2003) Detection of subclinical infection in significant breast implant capsules. Plast Reconstr Surg 111:1605–1611CrossRefGoogle Scholar
  25. 25.
    Spear SL, Onyewu C (2000) Staged breast reconstruction with saline-filled implants in the irradiated breast: recent trends and therapeutic implications. Plast Reconstr Surg 105:930CrossRefGoogle Scholar
  26. 26.
    Krueger EA, Wilkins EG, Strawderman M et al (2001) Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy. Int J Radiat Oncol Biol Phys 49:713CrossRefGoogle Scholar
  27. 27.
    McCarthy CM, Mehrara BJ, Riedel E et al (2008) Predicting complications following expander/implant breast reconstruction: an outcomes analysis based on preoperative clinical risk. Plast Reconstr Surg 121:1889–1892Google Scholar
  28. 28.
    Gart MS, Smetona JT, Hanwright PJ et al (2013) Autologous options for postmastectomy breast reconstruction: a comparison of outcomes based on the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 216:229–238CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Cicero Urban
    • 1
  • Flavia Kuroda
    • 2
  • Mario Rietjens
    • 3
  1. 1.Breast UnitOur Lady of Grace Hospital and Positivo University Medical SchoolCuritibaBrazil
  2. 2.Breast UnitHospital Nossa Senhora das GraçasCuritibaBrazil
  3. 3.Division of Plastic and Reconstructive SurgeryEuropean Institute of OncologyMilanItaly

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