Options and considerations in the timing of breast reconstruction after mastectomy

Timing of breast reconstruction after mastectomy is determined primarily by patient factors and the need for postmastectomy radiation therapy. If the risk of needing postmastectomy radiation is low, then immediate reconstruction produces the optimal aesthetic result. If the risk of needing postmastectomy radiation is high, then delayed reconstruction is preferable to optimize both radiation delivery and aesthetic outcome. For patients with an increased risk of needing postmastectomy radiation, "delayed-immediate" reconstruction, which involves placing a tissue expander at the time of mastectomy and awaiting pathology results to determine the need for radiation and guide reconstruction scheduling, is a viable approach. Thorough and informed physician counseling about the pros and cons of these options is critical for all women undergoing mastectomy.