Breast reconstruction

Your options and priorities

Reconstruction may use an implant, your own tissue, or a combination. An external breast prosthesis or a flat chest without reconstruction may suit some people. These choices have different scars, recovery demands and long-term implications.

The aim is a breast shape that works for you, rather than an exact recreation of the original breast. Sensation, symmetry and appearance can remain different. More than one operation may be needed.

Timing and consultation

Reconstruction may begin at the time of mastectomy (immediate reconstruction) or at a later stage (delayed reconstruction). Cancer treatment takes priority. Radiotherapy, chemotherapy, previous operations and wound-healing risks may influence the options and sequence.

Consultation includes your cancer treatment plan, previous scars, medicines, nicotine exposure, general health and available donor tissue. Planning should be coordinated with the breast and oncology teams. Ask which options are suitable and available in your circumstances; the timing and treating team depend on the reconstruction proposed.

Implant and tissue reconstruction

Implant reconstruction may involve a tissue expander before a definitive implant. It avoids a larger tissue donor operation but carries implant-related risks and may require future revision or replacement. Radiotherapy can affect the reconstructed breast and complication risk.

Tissue reconstruction transfers skin and fat, sometimes with muscle, from another part of the body. A pedicled flap keeps its blood supply attached; a free flap requires microsurgical connection of blood vessels. The appropriate technique depends on anatomy, previous surgery and the treatment setting. A particular flap should not be assumed to be suitable or available before assessment.

Later procedures may address symmetry, contour or the nipple and areola. Fat grafting may be considered for selected contour problems, but is not a substitute for every form of reconstruction.

Hospital care and recovery

Major reconstruction generally involves general anaesthesia and hospital care. Admission, monitoring and recovery differ substantially between implant and tissue procedures. Drains, dressings and activity restrictions depend on the operation.

Arrange practical support at home. Return to driving, work and exercise depends on wounds, discomfort, the donor area and any ongoing cancer treatment. Follow the specific advice of your treating team rather than a general timetable.

Scars, risks and limitations

Scars remain on the breast or chest and, with tissue reconstruction, at the donor site. Changes in sensation, asymmetry and further surgery are possible. Reconstruction does not restore normal breast sensation reliably or remove the need for recommended cancer follow-up.

Risks include bleeding, infection, fluid collections, delayed healing, tissue loss, pain, blood clots and anaesthetic complications. Implant reconstruction adds risks such as capsular contracture, rupture, exposure and implant loss. Tissue reconstruction adds donor-site problems and partial or complete flap loss; urgent further surgery may be needed if circulation is compromised.

Report fever, spreading redness, increasing swelling, worsening pain or wound changes promptly. Follow any specific flap-monitoring instructions. Chest pain, breathlessness or collapse requires urgent assessment; call 000 in an emergency.

Frequently asked questions

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