Breast reconstruction
Breast reconstruction is a personalized procedure that aims to restore the shape, volume, and balance of the breasts. It is considered after a mastectomy, after a previous surgery, or to regain shape and volume, and it can be done with or without implants.
This page covers breast reconstruction with implants and without implants, depending on the technique defined for each case.
What it involves
Depending on each case, reconstruction can be done with your own breast gland, with fat transfer, with implants, or with a combination of these techniques. The choice depends on the surgery you had, the treatments you received, your anatomy, and the tissue available.
After a mastectomy, reconstruction with implants is usually done in stages: often a tissue expander is placed first to stretch the skin little by little, and it is later exchanged for the implant. Fat transfer takes fat from another area of your body by liposuction and places it in the breast to add volume or improve the contour.
It can be done in the same surgery as the mastectomy or later on. The timing is coordinated with the team treating your cancer.
Who it is for
It is mainly intended for women who have had a breast, or part of one, removed because of breast cancer. The clinic also considers it after a previous breast surgery or to regain shape and volume. It helps to have your health under control and realistic expectations. Your evaluation confirms whether you are a candidate.
- After a mastectomy, in the same surgery or later on.
- After a previous breast surgery.
- To regain the shape and volume of the breasts.
- Good general health, with no conditions that impair healing, and realistic expectations.
- Smoking and some treatments, such as radiation therapy, influence the technique and the timing of the surgery.
What to know beforehand
Length of surgery
It depends on the technique and on whether one or both breasts are treated. Surgery with implants usually takes 1 to 2 hours, and more complex reconstructions can take several hours, depending on each case. Your evaluation gives an estimate for your surgery.
Type of anesthesia
General anesthesia is the usual choice. Some minor complementary procedures can be done with local anesthesia. The choice is made for each case at the evaluation, according to your health and the technique that is defined.
Hospital stay and recovery
It depends on the technique and the extent. Surgeries with implants are usually outpatient or require one night in the hospital; when the reconstruction is more extensive or is done together with the mastectomy, the stay can be several days. The breasts will be swollen, tight, and tender, especially during the first two weeks, and the swelling can last about six.
Daily routine and desk work are usually resumed 1 to 4 weeks later, depending on the technique and the type of work. Exercise and physical effort are generally resumed after 6 to 8 weeks, depending on each case. If the reconstruction is done in stages, each surgery has its own recovery.
Aftercare
Your medical team gives you the exact instructions for your case. These are the usual ones:
- Wear the support bra for as long as your surgeon indicates; it can be several weeks to a few months.
- If you have drains, care for them as you are shown until they are removed.
- Walk several times a day from the start to help the circulation in your legs.
- Do not lift heavy objects or strain your arms and chest until your surgeon clears you.
- Do not smoke or use nicotine: it affects circulation and slows healing.
- Seek care right away for severe pain, sudden changes in breast shape or volume, chest pain, or trouble breathing.
- Keep your follow-up visits with your surgeon and the checkups indicated by the team treating your cancer.
Expected results
The shape of the breast is visible from the start, but it changes as the swelling goes down and the tissues settle, which takes several weeks to a few months. The result is often reached in stages, and touch-up procedures or surgery on the other breast may be needed to improve symmetry.
A reconstructed breast does not regain normal sensation and will not be identical to the other one. The scars are permanent: they improve over time, but they do not disappear. Implants do not necessarily last a lifetime and may need to be replaced. Weight changes and the passage of time also alter the result.
Frequently asked questions
What are the risks of breast reconstruction?
Like any surgery, it carries risks: bleeding, infection, fluid buildup, slow or unfavorable scarring, blood clots, changes in sensation, and asymmetry. With implants there can be capsular contracture, which is a hardening of the tissue around them, displacement or rupture, and, very rarely, a lymphoma associated with implants. With fat transfer, part of the fat can be reabsorbed or form cysts. Some complications require another surgery.
When can reconstruction be done after a mastectomy?
It can be done in the same surgery in which the breast is removed, known as immediate reconstruction, or later on, as delayed reconstruction. Treatments such as chemotherapy or radiation therapy influence the timing and the technique. The plastic surgeon does not make that decision alone: it is coordinated with the team treating your cancer, and your case is reviewed at the evaluation.
Is it done in a single surgery?
Often it is not. Reconstruction is usually planned in stages: for example, a tissue expander that is later exchanged for the implant, or several sessions when fat transfer is used. Later on there may be touch-ups to adjust the shape, or surgery on the other breast to improve symmetry. The number of stages depends on the technique and is explained at your evaluation.
Does a reconstructed breast feel the same as before?
Not entirely. Reconstruction restores shape and volume, but it does not bring back the normal sensation of the breast, and it may feel different to the touch. Over time some sensation in the skin may return. It is also not possible to make it exactly like the other breast, although the difference can be reduced with touch-ups. It is worth discussing these expectations before surgery.
What determines whether it is done with or without implants?
The surgery you had, whether you have received or will receive radiation therapy, the size and shape of the other breast, your build, and your preferences. Fat transfer requires enough fat in another area, is usually used to add contour or correct partial defects, and may need several sessions. Your evaluation defines the technique or combination indicated for you.
Does it also apply if I have not had a mastectomy?
Yes. Reconstruction after a mastectomy is the most common meaning of the term, but the procedure is also considered after a previous breast surgery or to regain shape and volume. In those cases the plan, with or without implants, depends on what needs to be corrected and is defined at the evaluation, with your medical history and your previous surgeries.
This information is general and does not replace a medical assessment. The timing, technique and recovery for your case are defined in consultation with the surgeon.
Let us talk about your case
Every body needs a personal assessment. Tell us what you are considering and we will review the options that suit you best.