Immediate breast reconstruction and delayed breast reconstruction are the two main methods of breast reconstruction after breast cancer surgery. There are significant differences between the two in terms of operation time, surgical process, patient experience and prognosis. This article will systematically explain the definitions, indications, surgical methods, advantages and disadvantages, and clinical selection strategies of the two, aiming to provide a reference for clinicians and patients.
I. Definition of concepts
Immediate Breast Reconstruction (IBR) refers to breast reconstruction surgery performed at the same time or within a short period of time after breast tumor removal surgery (such as mastectomy). Usually both are completed within the same surgical cycle to reduce the number of surgeries for patients.
Delayed Breast Reconstruction (DBR) is a breast reconstruction performed at a certain stage after breast cancer surgery (usually several months or years later), after the patient has recovered and completed adjuvant treatment (such as radiotherapy and chemotherapy).
2. Indications and Selection Principles
Immediate reconstruction is suitable for patients with early breast cancer, with a small tumor area, who do not need immediate postoperative radiotherapy, who are in good physical condition, have high expectations for aesthetic reconstruction, and are not at risk of serious complications. It can be given priority.
Delayed reconstruction is suitable for patients with large or multiple tumors who need postoperative radiotherapy or chemotherapy. Because radiotherapy may affect the reconstruction effect, delayed reconstruction can avoid damage to the reconstructed tissue by postoperative radiotherapy. In addition, delayed reconstruction is also suitable for patients who are not suitable for reconstruction at the beginning of the operation due to physical condition or other factors.
3. Surgical Method
Immediate breast reconstruction usually involves implantation of a prosthesis (silicone or saline) or reconstruction with autologous tissue (such as the rectus abdominis myocutaneous flap or deep inferior epigastric perforator flap). During the surgical procedure, the surgeon begins the shaping and implantation process after the mastectomy is completed.
Delayed breast reconstruction is usually divided into two stages: first, the patient resumes normal life after mastectomy, and after adjuvant treatment, autologous tissue or prosthesis is implanted according to the patient's physical condition and needs. This method allows more flexibility in choosing a suitable reconstruction plan and more time for preoperative preparation.
4. Comparison of advantages and disadvantages
Number of surgeries and length of hospital stay
Immediate reconstruction usually only requires one operation to complete breast removal and reconstruction, reducing the patient's overall number of surgeries and hospitalization time, and reducing the psychological and financial burden. Delayed reconstruction requires at least two operations, a long time span, and the patient needs to undergo multiple hospitalizations and recovery.
Aesthetic Effect
Immediate reconstruction can keep the breast skin and contour intact during the operation, making the appearance more natural after reconstruction and having less psychological impact on the patient after the operation. Delayed reconstruction requires additional soft tissue expansion or flap transfer during reconstruction due to atrophy of the breast skin and tissue, and the appearance may be slightly inferior.
Effects of radiotherapy
Immediate reconstruction is greatly affected by postoperative radiotherapy, which may cause capsular contracture and tissue sclerosis, affecting the final effect. Delayed reconstruction is performed after the end of radiotherapy, which reduces the negative impact of radiotherapy on the reconstructed tissue and has a relatively low incidence of postoperative complications.
Risk of complications
Immediate reconstruction is complicated and time-consuming, and some patients are at risk of infection and prosthesis exposure. Delayed reconstruction is a staged surgery, so wound recovery can be observed in the first stage and the risk of infection can be reduced. However, due to the increase in the number of surgeries, the overall probability of complications may also increase.
Psychosocial impact
Immediate reconstruction can help patients complete breast reconstruction while undergoing mastectomy, reduce loss of body image and psychological trauma, and help with postoperative recovery. Although delayed reconstruction prolongs the reconstruction period, it also gives patients more time to adapt to the condition and make decisions, and is suitable for patients who are not mentally prepared.
5. Clinical Research and Data Support
Several clinical studies have shown that patients who underwent immediate reconstruction had higher quality of life scores than those who underwent delayed reconstruction, especially in terms of self-image and emotional regulation. However, in patients who required radiotherapy, delayed reconstruction had better success rates and long-term aesthetic effects. Different studies emphasize the importance of individualized treatment, and it is recommended to consider the patient's tumor stage, adjuvant treatment plan, and personal needs in a comprehensive manner.
6. Impact of surgical technology progress on both
With the development of minimally invasive technology, autologous tissue reconstruction technology and tissue engineering, the safety and effectiveness of immediate reconstruction have continued to improve. The improvement of tissue expanders and the optimization of prosthesis surface design have reduced the incidence of complications. In delayed reconstruction, the selection of autologous tissue and vascular anastomosis technology have been continuously improved, which has also significantly improved the success rate and aesthetics of transplantation.
VII. Patient consultation and decision support
For breast cancer patients, medical staff need to provide comprehensive preoperative consultation, explain the pros and cons of immediate and delayed breast reconstruction, surgical risks and expected results, and encourage patients to make choices that suit their needs based on their physical condition, treatment plan and personal wishes. Cooperation with a multidisciplinary team (breast surgery, plastic surgery, and oncology) is the key to ensuring treatment effectiveness and patient satisfaction.
Beauty Encyclopedia Tips:
Immediate breast reconstruction and delayed breast reconstruction have their own characteristics. The appropriate plan should be selected based on the patient's specific situation. Early clarification of the treatment plan and reasonable arrangement of the timing of surgery are of great significance to improving the effect of breast reconstruction and the patient's quality of life. Full communication between doctors and patients is the basis for achieving personalized breast reconstruction.