Keeping options open for patients with anticipated postmastectomy chest wall irradiation: Immediate tissue expansion followed by reconstruction of choice

Since this method of breast reconstruction was first presented in 20004 (Fig. 1), it has become the technique of choice at Northwestern Memorial Hospital. In general, our results have been favorable enough that we continue to use it 8 years later. We feel that our approach incorporates almost all of the benefits of both immediate and delayed breast reconstruction, and gives patients the necessary time to make informed decisions about their final reconstruction. Moreover, this approach does not limit patients to a specific type of reconstruction and, as such, is more flexible than other recently published two-stage reconstruction techniques.37,38 In summary, we feel that immediate placement of a tissue expander in the setting of anticipated postmastectomy radiation therapy, followed by delayed reconstruction, has three major advantages over other techniques: It maintains the psychological and cosmetic benefits of immediate reconstruction. It allows reconstruction to be structured so the cosmetic effects of adjuvant postoperative radiation therapy are minimized, thereby protecting the final aesthetic result from radiation-related complications, which can be resolved in revision/completion procedures. A better informed decision about final breast reconstruction is made possible by the experience of having a breast prosthesis, and by delaying the final decision to an unhurried time after the completion of the cancer therapies, allowing full focus on the reconstructive options.