Synopsis
Choose reconstruction timing by combining cancer treatment, operative fitness, tissue quality and the person's priorities, then explain what the selected sequence means for recovery and later surgery.
- Discuss reconstruction before mastectomy. NICE offers immediate reconstruction, including when radiotherapy may be needed, unless comorbidity rules out reconstructive surgery; possible radiotherapy therefore changes counselling and planning rather than automatically excluding the option.
- Immediate reconstruction takes place with mastectomy; delayed reconstruction follows in a separate operation. A staged implant pathway may itself require several operations, so immediate does not mean that the whole reconstructive process finishes at one attendance.
- A person may choose an external prosthesis or a flat chest without reconstruction. Explain the available choices and record an informed preference, including whether they want to revisit reconstruction after treatment or recovery.
Investigation priorities
Confirm the oncological operation and likely adjuvant-treatment requirements before agreeing reconstruction timing.
Management branches
A fit 51-year-old needs mastectomy and may require postoperative radiotherapy; she strongly wishes to avoid an interval without a breast mound.
- Her assessment shows acceptable operative fitness and a suitable abdominal donor site. The team offers immediate reconstruction as NICE advises, while explaining why radiotherapy remains possible. The reconstructive surgeon compares flap, implant and delayed options, including wound complications, altered sensation and further surgery.
- She chooses immediate autologous reconstruction after discussing the longer initial operation and the possibility of treatment-related changes to the result. The teams document how final pathology and wound recovery will inform the radiotherapy plan; no promise is made that the reconstruction prevents its need.