Breast reconstruction surgery

Published by Bupa's Health Information Team, July 2010.

This factsheet is for women who are planning to have breast reconstruction surgery, or who would like information about it.

Breast reconstruction surgery is done to help regain the original shape and appearance of breast(s) after complete or partial breast removal (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 immediately after having a complete or partial breast removal (mastectomy), or at a later date.

The main ways of making a new breast shape include:

• removing all the breast tissue and a significant amount of skin and inserting an implant to gradually stretch the remaining skin
• removing just the breast tissue, but leaving the skin, and inserting an implant
• restoring the shape using tissue from another part of your body (usually from the abdomen or back, but sometimes from the 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 restore your breast shape and appearance. This may include:

• restoring your breast shape and size
• restoring your nipple if it was removed during a mastectomy
• having further treatment to restore the area of dark tissue
• surrounding the nipple (areola) and to change the size of your natural breast so that both breasts are similar in shape

This factsheet gives information about the initial operation done to restore the shape and size of the breast.

What are the alternatives to surgery?

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

Preparing for your operation

Your surgeon will explain how to prepare for your operation. 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.

You may be asked to bring in a soft, supportive bra without under-wiring to wear after surgery. Your surgeon will advise you about the most suitable type of bra beforehand.

Breast reconstruction surgery usually requires a hospital stay of three to five days. The length of your stay will depend on the extent of your surgery and how you feel afterwards.

Breast reconstruction surgery is done under general anaesthesia. This means you will be asleep during the operation.

You will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However some anaesthetists allow occasional sips of water until two hours beforehand.

At the hospital your nurse may check your heart rate and blood pressure, and test your urine.

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 may be asked to do by signing a consent form.

Your surgeon will measure your unaffected breast and assess its shape and the position of the nipple. Your surgeon may mark the position of the surgical cuts on your operated breast. Photographs may be taken, so that the results of surgery can be compared with your original appearance and you may have a mammogram (X-ray of your breasts).

What happens during breast reconstruction surgery

Your surgeon will use a combination of methods to get the most acceptable result. Depending on the method used, your operation can take from one to eight hours.

Implant-based reconstruction

Usually a silicone breast implant is used. This is placed directly under the breast surface or beneath the muscle in the breast. An implant is ideal if the breast skin and nipple are preserved during mastectomy. If some of the breast skin was removed in the earlier operation, tissue expanders may be used to stretch the skin over your breast area before an implant is inserted at a later date.

Tissue flap reconstruction

Tissue is taken from other parts of your body and used to reconstruct your breast. There are two main types of tissue flaps used for breast reconstruction.

• Latissimus dorsi flap reconstruction - the skin, fat and muscle from your back is repositioned to the breast area while keeping its connection to the blood supply under the armpit. An implant is sometimes needed beneath the flap.
• Abdominal flap reconstruction - the skin, fat and muscle from your abdomen is removed and transplanted to the chest area. It can either be moved with its blood supply intact (a pedicled flap) or a free flap can be done where the original blood supply is disconnected and reconnected to blood vessels in the chest or armpit using microsurgery.

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

Fine plastic tubes may be left in your breast for up to 48 hours afterwards. These allow blood and fluids to drain into a bag or bottle.

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 drip in your arm to keep you hydrated and you may be given painkillers and antibiotics.

When you feel ready, you can begin to drink and eat, starting with clear fluids.

You may have a catheter (a fine tube) to drain urine from your bladder into a bag. This will usually be removed when you are ready to get out of bed and walk around.

Your surgeon will visit you to assess your progress and answer any questions you may have about the operation.

Your nurse will give you advice about getting out of bed, bathing and diet. A physiotherapist (a health professional who specialises in movement and mobility) will usually visit you before you go home and guide you through exercises that are designed to help your recovery.

You will go home with bandaging in place and you will be given a date for a follow-up appointment.

Dissolvable stitches usually disappear in seven to 10 days. Non-dissolvable stitches are removed seven to 14 days after surgery.

Recovering from breast reconstruction surgery

At home, you will tire easily to begin with, so it's important to take it easy and eat a balanced diet.

You may be asked to wear a support bra for four to six weeks after the operation. This helps to stop the weight of the breasts pulling on the healing wounds. Your breasts will feel sore and you will have swelling for a few weeks. Using extra pillows when sleeping can help reduce the swelling around your breasts.

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.

After having a breast reconstruction, there is a risk of infection. An infected wound can take longer to heal and may result in a more noticeable scar. Contact your breast care nurse, consultant or GP if you have any of these symptoms:

• increasing pain
• a high temperature
• your wound looks red, inflamed or starts to weep

At your follow-up appointment, your surgeon will give advice about when you can resume your usual activities and return to work.

Follow your surgeon's advice about driving. You shouldn't drive until you are confident that you could perform an emergency stop without discomfort.

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

What are the risks?

Breast reconstruction surgery is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

Side-effects are the unwanted but mostly temporary effects of a successful treatment, for example feeling sick as a result of the general anaesthetic.

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 area of the body from which tissue is taken, but they usually fade over time

Complications

Complications are when problems occur during or after the operation. Most women having breast reconstruction aren't affected. 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 (deep vein thrombosis, DVT).

Complications specific to breast reconstruction surgery are uncommon but can include:

• infection - antibiotics can help treat an infection
• bleeding under your skin (haematoma) - this may require surgery to stop the bleeding and drain the area
• change in skin and nipple sensation - this can be permanent
• unusual red or raised scars (keloids) - these can take years to improve
• an unevenness in size and shape - your reconstructed breast may look different to your natural breast
• loss of part, or even all, of the breast tissue - changes in blood supply can cause the new breast tissue to die
• build up of scar tissue around the implant (capsular contracture ) - this may cause a firm, painful swelling and require surgery
• build up of fluid around the implant (seroma) - this may require surgery

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

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

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

For sources and links to further information, see Resources.