In general, all women undergoing a mastectomy are candidates for immediate or delayed breast reconstruction. Whether tissue has been damaged by radiation therapy or aging, and is not sufficiently healthy to withstand surgery. The patient is usually educated and counseled in breast reconstructive possibilities prior to mastectomy, so that she can make the decision for or against reconstruction before going into surgery. If chemotherapy is part of the treatment protocol, the surgeon may recommend delayed reconstruction. Any type of surgery carries some risk.
Patients differ in their anatomy and their ability to heal.
A TRAM flap involves removing an area of fat, skin, and muscle from the abdomen and stitching it in place to the mastectomy wound. Drains are put in place, and recovery time is longer due to the additional surgery, but the care afterward is the same as for mastectomy alone. Delayed reconstruction, as second surgery, requires more than an hour, and drains are not routinely inserted. The recovery is much quicker than it is after immediate reconstruction because the mastectomy wound has already healed.