The Decision of “When” in Breast Reconstruction

Timing can be everything when it comes to optimal breast reconstruction. Our patients have every available option in choosing services with Dr. Levine.

Breast reconstruction can be done immediately after a mastectomy during the same operative session or within 2 weeks in a separate operative session or can be delayed until months, if not years, later. The decision of “when” is highly personal with factors to consider with your treating physicians. The following are reasons why women may elect to reconstruct their breast(s) at the same time as mastectomy (immediate breast reconstruction) or postpone to a later time (delayed breast reconstruction.) or facilitate a combination of the two (staged-immediate).

Immediate – Breast reconstruction is done at the same time as mastectomy with one of our expert breast surgeons.
Staged-immediate – Breast reconstruction is done separately, generally within two weeks of mastectomy.
Delayed – Breast reconstruction is done at ANY time after mastectomy or partial mastectomy or following prior reconstructive efforts, i.e. failed breast implants.
Surgical Delay with DIEP or SIEA flap: We are using a surgical delay procedure to increase the reliability and the amount of tissue that we can harvest from the abdomen with either a DIEP or SIEA flap procedure. After doing this short outpatient procedure approximately one week prior to the definitive breast reconstruction, the patient will experience a quicker operation with less recovery time and less pain postoperatively.

The Delay Phenomenon

The Delay phenomenon takes 3-4 days to occur. The delay phenomenon causes enlargement of the selected artery and vein. This effect on the blood vessels is permanent. Therefore the breast flap transfer can be done anytime after 4 days. The blood flow in an artery is proportional to the radius to the 4th power. For example, if the artery increases in size from 1mm to 2mm, the blood flow is 16 times more.

Patients that may need radiation therapy after mastectomy can have the delay procedure at the time of the mastectomy to avoid an extra trip to the OR.
The Delay has been used successfully for decades in plastic surgery. The well-known concept involves selecting an appropriate blood vessel to supply the donor region. Around one week prior to flap harvest and transfer, other blood vessels supplying the donor are transected surgically. Over the next few several days the preserved, preselected blood vessel undergoes significant enlargement. This creates several advantages:

1. The growth of the ideal blood vessel will allow it to perfuse more territory.
2. The growth of the ideal blood vessel makes for a much quicker easier dissection.
3. The easier dissection allows for faster operation and quicker recovery.
4. The improved perfusion will increase the volume of the flap, and improve the perfusion of the tissue. This will reduce the risk of fat necrosis.
5. The preselection of the blood vessel allows us to choose almost any vessel in the abdomen, which can allow us to choose a vessel that will result in the best cosmetic abdominal scar.
6. More patients will be able to use their abdomen for autologous breast reconstruction


I wanted you to know how grateful I am for the use of your lab coat to cry on that one day in my hospital room. As much as I appreciate professionalism in my doctors, I value you more human nature’s willingness to be compassionate and understanding. Thank you for your arms of kindness and car that day. The days before me seem so much brighter than they have in the past years. Belssings! Jeannine

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