Breast Reconstruction

Breast reconstruction rebuilds the shape of the breast after it has been removed for cancer. It restores appearance and the ability to wear ordinary clothes and a normal bra, and it does not treat the cancer or change how likely it is to return.

There are two broad routes. An implant reconstruction places a silicone implant behind the chest muscle or under the skin, sometimes after a tissue expander has been used for a few months to stretch the skin. A flap reconstruction uses your own skin, fat and sometimes muscle, taken from the lower abdomen or the back, and moved to the chest.

It can be done at the same operation as the mastectomy, called immediate reconstruction, or months to years later once chemotherapy and radiotherapy are behind you. Your surgeon and your oncologist decide the timing together, since planned radiotherapy affects both the choice and the result. Nipple reconstruction and tattooing, where you want them, are a small separate step at the end.

You are asleep under a general anaesthetic. An implant-based reconstruction adds about one to two hours to the mastectomy. A flap reconstruction from the abdomen takes four to eight hours, because the tissue has to be raised with its blood vessels and the abdomen closed afterwards.

Your surgeon marks you standing up the morning of surgery. In an implant reconstruction a pocket is made and the implant or expander placed in it. In a flap reconstruction the tissue is shaped into a breast mound and its artery and vein are joined to vessels near the breastbone or armpit under a microscope.

You wake with drains, a support bra and, after a flap, a scar across the lower abdomen. Nurses check the flap's colour and warmth every hour for the first day or two. You are helped out of bed the next morning.

Expect three to five nights in hospital after an implant reconstruction and five to seven after a flap. Drains stay in for one to two weeks and are usually removed at a clinic visit. Pain is worst in the first week and controlled with tablets after the first few days.

No lifting above a couple of kilos and no driving for four to six weeks. Desk work is realistic at four to six weeks and heavier work at eight to twelve. After an abdominal flap the tummy feels tight when you stand straight for the first fortnight and core exercise waits three months.

The reconstructed breast will not look final for six to twelve months as swelling settles and scars fade, and it will feel numb, since sensation rarely returns fully. Symmetry often needs a small adjustment operation later, and your surgeon will plan that when things have settled.