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Breast reconstruction surgery

Key points

  • Breast reconstruction surgery can restore your breasts if you have them removed in a mastectomy.
  • There are two main types of breast reconstruction - implants and flap operations.
  • You may need to have more than one operation.
  • It usually takes several weeks to make a full recovery from breast reconstruction surgery, but this will vary.

Breast reconstruction surgery is an operation to restore the shape and appearance of your breasts after having complete or partial breast removal surgery (mastectomy).

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About breast reconstruction surgery

Breast reconstruction surgery can be done at the same time as a complete or partial breast removal (in the same operation). Alternatively, you can have the procedure at a later date.

There are a number of different ways your surgeon can make a new breast shape. However, most fall into two main types of surgery.

  • Implants. Your surgeon may remove just your breast tissue, but leave your skin. He or she will then insert an implant. This is usually made of silicone.
  • Flaps. During flap reconstruction, your surgeon will take tissue from other parts of your body to create your new breast. This may be from your abdomen (tummy) or back, or your buttocks or thighs.

Your surgeon may use a combination of these types of surgery to restore the shape of your breast. He or she may also inject your own fat cells during a breast reconstruction operation, in what is called lipomodelling. This can help to make your breast smoother or enlarge your breast.

You may need to have more than one operation to get the best breast shape and appearance. You may also need further treatment to uplift or reduce your other breast so that they match as well as possible.

Before surgery you will have the opportunity to discuss the different types of breast reconstruction operations with various specialists. They will explain all the options so you can make a decision on what option is best for you. It's important to understand that the timing of the operation may also depend on other treatment you may be having, such as chemotherapy. Ask your surgeon for more information.

What are the alternatives to breast reconstruction surgery?

Alternatives to breast reconstruction surgery include wearing a lightweight foam bra insert or a soft plastic (silicone) false breast inside your bra.

Preparing for breast reconstruction surgery

Your surgeon will explain how to prepare for your breast reconstruction surgery. For example, if you smoke, you will be asked to stop. Smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

You may need to stay in hospital for around four days but this will depend on the type of operation you have. Breast reconstruction surgery will be done under general anaesthesia. This means you will be asleep during the operation. You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon or anaesthetist’s advice.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen. You can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead. You will be asked to sign a consent form.

Your surgeon will measure your breasts, and look at their shape and the position of your nipple. He or she may make some marks on your breast using a special pen. Your surgeon may also take photographs so that the results of your surgery can be compared with your original appearance.

What happens during breast reconstruction surgery?

The time breast reconstruction takes will depend on the method your surgeon uses. It may be anything between one and 10 hours. You may be able to have a breast reconstruction in just one operation, or your surgeon may do it in stages. This will depend on a number of things, such as the size of your breast and whether or not your nipple was removed. Ask your surgeon for more information.

Implant-based reconstruction

If your skin is saved when your breast is removed, you may be able to have an implant. Your surgeon will place the implant under your chest muscle, under your skin.

If your surgeon removed skin from your breast when you had it removed, you may have an expandable implant (an expander) inserted under your muscle. Your surgeon will then gradually inflate it with salt water (saline), which will gently stretch the skin and muscle over your breast area. The expander can be replaced with an implant at a later date.

Tissue flap reconstruction

In this type of operation, your surgeon will take tissue from another part of your body and use this to reconstruct your breast. There are a number of different tissue flap reconstruction operations. The type of operation you have will depend on a number of factors, such as your body shape. Ask your surgeon to explain the options available to you. There are three main types of tissue flaps.

  • Latissimus dorsi flap reconstruction. In this operation, your surgeon will take tissue from your back, including the latissimus dorsi muscle that lies below your shoulder and behind your armpit.
  • Transverse rectus abdominis myocutaneous (TRAM) flap reconstruction. Your surgeon will take tissue from your abdomen. This will consist of a portion of transverse rectus abdominis muscle and skin and fat from your lower abdomen, along with the veins and arteries. Your surgeon may leave the veins and arteries intact in what's called a pedicle flap technique. Alternatively he or she will join the ones in the flap to those in your chest to restore its blood supply.
  • Deep inferior epigastric perforator (DIEP) flap reconstruction. In this operation, your surgeon will take skin and fat from your abdomen, along with its blood supply but leave the muscle behind. As with some TRAM flap techniques, a DIEP involves microsurgery to restore the blood supply to the flap.

Your surgeon will explain the differences between these and other types of procedure.

When your breast reconstruction is complete, your surgeon will close the cuts with stitches, which may be dissolvable. He or she will wrap your breasts in a special supportive dressing.

Lipomodelling

Lipomodelling can be done on its own or as part of another operation to reconstruct your breast. Your surgeon will use a syringe to take some fat from your abdomen, side or outer thigh. The fat cells will be prepared and then your surgeon will inject them into your breast to smooth the shape or enlarge your breast. You may need to have a number of injections in separate visits.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

You may have a catheter to drain urine from your bladder into a bag. This will usually be removed when you’re ready to get out of bed and walk around. You may also have fine tubes called drains running out from the wound. These drain fluid into another bag and are usually removed after a few days. However, you may go home with the drains still in place.

On the first day, you may have to wear special pads, attached to a pump, on your lower legs. The pump inflates the pads and encourages healthy blood flow in your legs and helps to prevent deep vein thrombosis (DVT). You may also need to wear compression stockings on your legs for the same reasons.

A physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) will guide you through exercises designed to help your recovery.

Your nurse will give you some advice about caring for your surgical wound before you go home. You may be given a date for a follow-up appointment.

You will need to arrange for someone to take you home.

The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure, they should usually disappear in about two weeks. If you have non-dissolvable stitches, ask your surgeon when you will have these taken out.

Recovering from breast reconstruction surgery

It usually takes several weeks to make a full recovery from breast reconstruction surgery, but this depends on the type of surgery you have. It can also vary between individuals, so it’s important to follow your surgeon’s advice.

Ask your surgeon for advice about wearing a bra after your operation. It might be better not to wear one at first or you may need to wear a support bra.

Your breasts will feel sore and you will have swelling for a few months. If your surgeon moved tissue from your back or abdomen during your operation, these wounds may be uncomfortable. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

At your follow-up appointment, your surgeon will give you advice about when you can go back to your usual activities and return to work. It’s best not to drive for at least a few weeks but follow your surgeon’s advice.

It may take several months before your reconstructed breast settles into its new shape.

What are the risks?

As with every procedure, there are some risks associated with breast reconstruction surgery. We haven’t included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

Side-effects of breast reconstruction surgery include:

  • soreness, swelling and bruising – this can last up to a month
  • scars – you will have permanent scars on your breast and other areas that your surgeon took tissue from but these will fade

Complications

Complications are when problems occur during or after the operation. Complications of breast reconstruction surgery can include:

  • an infection
  • bleeding under your skin (haematoma), which may require further surgery to stop the bleeding and drain the area
  • a change in sensation both in your breast and the site where your surgeon took tissue from in flap operations – this can be permanent
  • an unevenness in size and shape – your reconstructed breast may look different to your natural breast
  • loss of part or all of your reconstruction – transplanted tissue may die, and complications with implants can lead to implant loss
  • build-up of scar tissue around an implant (capsular contracture)
  • build-up of fluid around the implant or where your surgeon removed tissue (seroma)

It's possible that you may not be completely satisfied with your appearance after the operation.

Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, June 2014.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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