User:Paj204/sandbox

Timing
Breast reconstruction can be performed either immediately following the mastectomy or as a separate procedure at a later date, known as immediate reconstruction and delayed reconstruction, respectively. The decision of when breast reconstruction will take place is patient-specific and based on many different factors. Breast reconstruction is a large undertaking that usually takes multiple operations. Sometimes these follow-up surgeries are spread out over weeks or months.

Immediate reconstruction
Breast reconstruction is termed "immediate" when it takes place during the same procedure as the mastectomy. Because of this, one of its inherent advantages is the potential for a single-stage procedure. This also means that the cost of immediate reconstruction is often far less. Additionally, immediate reconstruction often has a better cosmetic result because of the preservation of anatomic landmarks and skin. With regards to psychosocial outcomes, opinions on timing have shifted in favor of immediate reconstruction. Originally, delayed reconstruction was believed to provide patients with time to psychologically adjust to the mastectomy and its effects on body image. However, this opinion is no longer widely held. Compared to delayed procedures, immediate reconstruction can have a more positive psychological impact on patients and their self-esteem, most likely due to the post-operative breast more closely resembling the natural breast compared to the defect left by mastectomy alone.

Delayed reconstruction
Delayed breast reconstruction is considered more challenging than immediate reconstruction. Frequently not just breast volume, but also skin surface area needs to be restored. Many patients undergoing delayed breast reconstruction have been previously treated with radiation or have had a reconstruction failure with immediate breast reconstruction. In nearly all cases of delayed breast reconstruction tissue must be borrowed from another part of the body to make the new breast. Patients expected to receive radiation therapy as part of their adjuvant treatment are also commonly considered for delayed autologous reconstruction due to significantly higher complication rates with tissue expander-implant techniques in those patients. Waiting for six months to a year following may decrease the risk of complications, but this risk will always be higher in patients who have received radiation therapy. As with many other surgeries, patients with significant medical comorbidities (e.g., high blood pressure, obesity, diabetes) and smokers are higher-risk candidates. Surgeons may choose to perform delayed reconstruction to decrease this risk.

The primary part of the procedure can often be carried out immediately following the mastectomy. There is little evidence available from randomised studies to favour immediate or delayed reconstruction. The infection rate may be higher with immediate reconstruction (done at the same time as mastectomy), but there are psychologic and financial benefits to having a single primary reconstruction.

If an implant is used, the individual runs the same risks and complications as those who use them for breast augmentation but has higher rates of capsular contracture (tightening or hardening of the scar tissue around the implant) and revisional surgeries.