Breast Reconstruction
Surgery to rebuild a breast after mastectomy
Quick Facts
- Type: Reconstructive surgery
- Main methods: Implants or own tissue (flap)
- Timing: Immediate or delayed
- Common after: Mastectomy for breast cancer
Overview
Breast reconstruction is surgery to rebuild the shape and look of a breast after some or all of it has been removed, most often as part of breast cancer treatment or risk-reducing surgery. The goal is to restore a natural breast shape and help a person feel more comfortable and confident, though a reconstructed breast will not look or feel exactly the same as the original.
Reconstruction is an option, not a requirement, and some people choose not to have it. It can be done at the same time as the breast is removed (immediate reconstruction) or months to years later (delayed reconstruction). There are several techniques, and the best choice depends on body type, cancer treatment, overall health, and personal preferences. Reconstruction is usually carried out by a plastic surgeon working alongside the breast surgical team.
Types of Reconstruction
There are two main approaches, sometimes used in combination:
- Implant-based reconstruction: A breast implant filled with saline or silicone is placed to recreate the breast shape. This is often done in stages, sometimes using a temporary tissue expander first to stretch the skin.
- Flap (autologous) reconstruction: Tissue, including skin, fat, and sometimes muscle, is taken from another part of the body such as the abdomen or back and used to build a new breast mound. This uses the person's own tissue.
Additional steps, such as reconstructing the nipple or creating a nipple tattoo, and surgery to match the other breast, may follow later.
Who Considers It
Breast reconstruction is most often considered by people who:
- Are having or have had a mastectomy for breast cancer
- Are having risk-reducing breast removal due to high inherited risk
- Have had a lumpectomy that significantly changed the breast shape
Whether reconstruction is suitable, and which method fits best, depends on factors such as body shape, smoking status, other health conditions, and whether radiation therapy is planned, since radiation can affect healing and results. It is a personal choice, and people can take time to decide.
The Procedure and Timing
Reconstruction can be planned around cancer treatment:
- Immediate reconstruction: Begun during the same operation as the mastectomy, so the person wakes with a breast mound already started.
- Delayed reconstruction: Done weeks, months, or years later, which can be preferred when radiation or other treatments come first.
Many reconstructions involve more than one operation over several months. The surgical team explains the number of stages, expected scars, and how the timing fits with chemotherapy or radiation.
Recovery
Recovery depends on the type of surgery and whether it was combined with other procedures.
- Hospital stay: Flap reconstruction usually needs a longer stay than implant-based surgery.
- Healing time: It can take several weeks to return to normal activities and longer to fully recover, especially with flap surgery that has a second surgical site.
- Drains and follow-up: Temporary drains, wound care, and follow-up visits are common.
- Sensation and appearance: The reconstructed breast often has reduced sensation, and final shape settles over months.
Following the surgeon's activity and wound-care instructions supports good healing.
Risks and Considerations
As with any surgery, breast reconstruction carries risks that should be weighed with the surgical team.
- Bleeding, infection, or problems with wound healing
- Implant-related issues such as hardening of scar tissue, rupture, or the need for future replacement
- For flap procedures, partial or rarely complete loss of the transferred tissue, and a scar at the donor site
- Differences in size, shape, or symmetry that may need further surgery
- Effects of radiation on the final result
Discussing expectations openly helps in choosing the option that best matches a person's goals.
When to Contact Your Surgeon
After surgery, contact your surgical team promptly if you notice:
- Increasing redness, warmth, swelling, or drainage from a wound
- Fever or feeling generally unwell
- A reconstructed area that becomes pale, dusky, cold, or unusually painful (important with flap surgery)
- Sudden change in the shape or firmness of a reconstructed breast
These can signal infection or a problem with blood supply that needs timely attention. Keep all scheduled follow-up appointments.
Frequently Asked Questions
What are the main types of breast reconstruction?
The two main types are implant-based reconstruction, which uses a saline or silicone implant, and flap reconstruction, which uses the person's own skin, fat, and sometimes muscle from another part of the body. Some people have a combination of both.
When can breast reconstruction be done?
It can be done immediately, during the same surgery as the mastectomy, or delayed until months or years later. Delayed reconstruction is sometimes preferred when radiation or other treatments are planned first.
Is breast reconstruction required after mastectomy?
No. Reconstruction is a personal choice, and some people decide not to have it or to use an external breast form instead. The decision depends on individual preferences, health, and cancer treatment.
How long is recovery after breast reconstruction?
Recovery varies by technique. Implant procedures generally have a shorter recovery, while flap surgery involves a longer hospital stay and healing time because there is a second surgical site. Full recovery can take several weeks or more.
What should prompt me to call my surgeon after reconstruction?
Contact your surgeon if you have spreading redness, warmth, drainage, fever, or a reconstructed area that becomes pale, cold, or very painful. These may indicate infection or a blood supply problem that needs prompt care.
References
- American Cancer Society. Breast Reconstruction Surgery.
- National Cancer Institute (NCI). Breast Reconstruction After Mastectomy.
- Mayo Clinic. Breast reconstruction.
- MedlinePlus, U.S. National Library of Medicine. Breast reconstruction.