Breast reconstruction surgery

Breast reconstruction surgery is an operation to help regain the original shape and appearance of your breast or breasts after having complete breast removal surgery (mastectomy). Occasionally, it’s also done after partial breast removal.

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), or at a later date.

The main ways your surgeon can make a new breast shape include:

• removing all your breast tissue and a significant amount of your skin and inserting an expandable implant (called an expander) to gradually stretch your remaining skin
• removing just your breast tissue, but leaving your skin, and inserting an implant
• restoring the shape of your breast using tissue from another part of your body – usually from your abdomen (tummy) or back, but sometimes from your buttocks or thighs
• restoring the shape using a combination of your own tissue and an implant

You may need to have more than one operation to get the best breast shape and appearance. For example, you may need further treatment to restore your nipple or to exchange an expandable implant for a permanent implant. You may also need further treatment to uplift or reduce your other breast to get the best symmetry.

What are the alternatives to breast reconstruction surgery?

You don't have to have breast reconstruction; you may decide to wear a lightweight foam bra insert or a soft plastic (silicone) false breast inside your bra. This will closely match the size and shape of your other breast.

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, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

Breast reconstruction surgery usually requires a hospital stay of three to seven days and it’s done under general anaesthesia. This means you will be asleep during the operation.

If you’re having a general anaesthetic, 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, and 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, which you will be asked to do by signing a consent form.

Your surgeon will measure your unaffected breast and assess its shape and the position of your nipple. Your surgeon may mark the position of surgical cuts he or she will make on your other breast that is to be operated on. 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?

Depending on the method your surgeon will use, your operation can take from two to 10 hours.

Implant-based reconstruction

An implant is an option if your breast skin is preserved during breast removal surgery. Your surgeon will place the implant under your skin. There are several different techniques that your surgeon may use to protect the implant from complications associated with the scar from breast removal surgery. Your surgeon will discuss these options with you.

If some of your breast skin needs to be removed or has been removed previously in your earlier breast removal operation, your surgeon may insert a tissue expander under your muscle. This will gradually stretch the skin and muscle over your breast area. You can then have the expander replaced with an implant at a later date.

Tissue flap reconstruction

In this 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 types of tissue flap reconstruction operations. The type you have will depend on factors such as your body shape, whether you have breast reconstruction surgery at the same time as breast removal surgery and your personal preferences – ask your surgeon to explain the options that are available to you. The two main types of tissue flaps are:

• latissimus dorsi flap reconstruction – tissue is taken from the latissimus dorsi which is one of your back muscles that lies below your shoulder and behind your armpit
• abdominal flap reconstruction – tissue is taken from around your abdomen

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

When your breast reconstruction is complete, your surgeon will close the cuts with stitches (which may be dissolvable) and your breasts will be wrapped in a special supportive dressing.

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 running out from the wound. These drain fluid into another bag and are usually removed after two to five days – you may go home with the drains still in place.

On the first day, you may have to wear special pads, attached to an intermittent compression 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 be wearing compression stockings on your legs to help maintain circulation – you may need to wear these for up to 10 days.

Your nurse will give you advice about getting out of bed, bathing and diet. A physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) will visit you to 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 drive you home. Try and have a friend or relative stay with you for the first 24 hours.

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. Non-dissolvable stitches will be removed seven to 10 days after your operation.

Recovering from breast reconstruction surgery

It can take several weeks to make a full recovery from breast reconstruction surgery, but this depends on the type of surgery you have and also varies 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 initially or you may need to wear a support bra. This will depend on the type of operation you have had.

Your breasts will feel sore and you will have swelling for a few weeks. If you have had tissue moved from your back or abdomen, 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 resume your usual activities and return to work.

It’s best not to drive for a few weeks but follow your surgeon's advice about driving.

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 have not 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
• scarring – you will have permanent scars both on your breast and on any other area of your body from which your surgeon takes tissue, but they usually fade over time

Complications

Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (DVT).

Complications specific to breast reconstruction surgery include:

• an infection – you may need to take antibiotics to treat it
• bleeding under your skin (haematoma) – you may need to have further surgery to stop the bleeding and drain the area
• change in your skin and nipple sensation – this can be permanent
• an unevenness in size and shape – your reconstructed breast may look different to your natural breast
• loss of part, or even all, of your reconstruction – changes in blood supply can cause the transplanted tissue to die, and complications with an implant can lead to implant loss
• build up of scar tissue around the implant (capsular contracture ) – this may cause a firm, painful breast and you may need further surgery to correct it
• build up of fluid around the implant or in other parts of the body where your surgeon removed tissue (seroma) – you may need to have a procedure in an outpatient clinic to treat this

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

Produced by Rachael Mayfield-Blake, Bupa Heath Information Team, July 2012.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.