Primary versus Secondary Postmastectomy Reconstruction

Many patients who undergo a mastectomy desire breast reconstruction. The reconstructive surgeon must ensure that the patient has reasonable expectations and motives. While immediate breast reconstruction generally results in a more aesthetically pleasing breast, the primary consideration is treating the cancer. Immediate breast reconstruction has not been shown to affect the oncologic outcome; however, the reconstructive surgeon should confer with other treatment team members to obtain a clear understanding of the stage of cancer and any necessary adjuvant treatments. The likelihood of tumor recurrence, extent of excision required, and need for postoperative radiation, as well as psychosocial and financial considerations, may affect whether immediate or delayed reconstruction is appropriate.