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.

About the Delay Phenomonon in Natural Tissue Breast Reconstruction

We know from many years of experiments and studies that if part of a blood supply to a certain area is cut off, the blood vessels that remain will become larger and more robust in order to continue to supply blood to that tissue. This is called the delay phenomenon.

When we think about this concept as it relates to the DIEP, the tissue that we harvest from the abdomen is dependent upon the blood vessel harvested with it. Thus, the amount of tissue we are able to harvest and use for reconstruction is limited by the amount of tissue that that one blood vessel can supply. The bigger that blood vessel is, the more tissue it can support.

In applying the delay phenomenon to the DIEP flap, a surgical delay is done prior to the reconstructive surgery. We select and identify the blood vessel that we want to use and train it to supply the tissue by removing the other blood vessels from the surrounding areas. This forces the remaining vessel to grow and perfuse the surrounding tissue where blood supply has been diminished. The entirety of the tissue perfused by this enlarged blood vessel can now be harvested and used for reconstruction, whereas before we would have been limited to the smaller amount of tissue that the original blood vessel could supply.

This means that patients who would not have had enough abdominal tissue to reconstruct their breasts can now be candidates for DIEP flap reconstruction. We have found the surgical delay to be an extremely useful and powerful adjunct to routine flap procedures.


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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