1. Types of breast reconstruction
There are 3 main types of breast reconstruction:
- Reconstruction using only a breast implant
- Reconstruction using your own tissue (a tissue flap)
- Reconstruction using a combination of tissue and an implant
A number of options may be available to you. However, one type of operation may be the most suitable depending on your shape and build, general health, your expectations and whether you’re having or have had treatment to the breast.
Read about breast reconstruction options including LD flap and DIEP flap.
Reconstruction using an implant
Implant breast reconstruction involves restoring the shape and volume of the breast using a breast implant. Breasts reconstructed in this way tend to be close to a natural breast shape, but are firmer and move less naturally than those using your own tissue. This can mean it’s more difficult to get a natural shape when one breast, rather than both, is being reconstructed.
The reconstructed breast will not droop with age and may look higher than the other breast, particularly as you get older. If you lose or gain weight, this will affect the natural breast but not the reconstructed breast, causing a difference in shape and size. At some point you may need more surgery to the reconstructed breast, or to the other breast, for a better match.
Implant reconstruction is often recommended for women with small and firm breasts, as it avoids the need for more extensive surgery using tissue from another part of the body.
With any type of reconstruction there is a risk of infection or other problems. If this happens with implant reconstruction, the implant may need to be removed.
There is no set lifespan for a breast implant but it will usually need to be replaced at some point and further surgery will be required at this stage.
Breast reconstruction - implants and LD flap
This film shows techniques that use a breast implant and those that use your body tissue to reconstruct the breast – including the LD flap where tissue is taken from your back.
Immediate reconstruction using an implant
If the breast cancer can be removed without taking away too much skin (skin-sparing ) and the remaining breast is not too large and doesn’t have a significant droop, an implant may be inserted under or in front of the chest muscle (see image 1). Inserting the implant under the chest muscle helps to keep the implant in the right place and hide its outline. A mesh or an acellular dermal matrix (ADM) can also be used to cover the implant. Talk to your surgeon about the best options for you.
For women with larger breasts, implant reconstruction may be possible using a dermal sling.
Using a breast implant alone is the simplest type of reconstruction operation and the recovery time is usually quicker than for other types of reconstruction. It’s most often done at the same time as the mastectomy (immediate).
The other option is to have an implant called a permanent tissue expander inserted at the same time as the mastectomy. This is an implant that is gradually expanded or ‘inflated’ over time. See Delayed reconstruction using an implant for more information.
For some women a temporary tissue expander implant is used and then expanded over time. It is then replaced with a permanent silicone implant. This might be referred to as a two-stage procedure.
If you need radiotherapy, surgeons may be able to insert a tissue expander or implant immediately after a mastectomy to create and preserve a space. The expander will not be inflated until the radiotherapy has finished. This can help to reduce the extent of any hard scar tissue (capsular contracture).
Delayed reconstruction using an implant
A permanent or temporary tissue expander is first placed behind the chest muscle, usually through the mastectomy scar. This helps keep the implant in the right place and hides its outline. Several weeks later, when the scars have healed, a surgeon or nurse gradually inflates the implant with saline (salt water) through a small port. The saline solution is injected into the port just under the skin. This is located either in the expander (see image 3) so that the solution can be injected directly or is connected to the expander by a short tube (see image 4).
This procedure is done during outpatient appointments, usually every one or two weeks, to slowly stretch the muscle and overlying skin. The number of appointments needed varies from person to person.
When expander implants are being filled, you’ll feel a stretching sensation and tightness within the breast reconstruction. It can be uncomfortable for a day or two after each inflating, but it shouldn’t be painful. The expander is generally inflated until the new breast is slightly larger than the other breast and then left for a few weeks so the skin stretches.
If a temporary expander is used, a further small operation will be needed to remove the expander and port, and replace it with a permanent implant, which will be your final breast shape.
If a permanent expander implant has been used, the port can be taken out under local anaesthetic, leaving the expander implant in place.
Implant reconstruction with tissue expansion can be particularly useful if you don’t have enough skin left on your chest to comfortably cover and support an implant, especially if you’re having delayed reconstruction.
Skin is very elastic and has a surprising ability to stretch but tissue expansion may not be suitable for women who have had radiotherapy treatment. This is because radiotherapy reduces the elasticity and quality of the skin.
Acellular dermal matrix (ADM) and dermal sling
These products are used to support breast implants. They are attached to the chest muscle to create a pocket that holds the implant in place, like an internal bra. They help to create a natural droop, shape and contour.
ADMs are made from animal tissue (usually pig or cow skin) and look and feel like very thin leather. They are processed and preserved so they can safely be left in the body. Meshes are manmade (synthetic) supports.
If you don’t want your surgeon to use products made from animal skin, talk to them about possible alternatives.
An ADM or mesh is most suitable for women with small or medium sized breasts. ADMs are not available in every hospital. You can ask your surgeon if it’s suitable for you and talk to them about any possible risks or complications with this type of reconstruction.
For women with larger breasts, their own tissue (from the lower half of the breast) can be used to support the implant. This is known as a dermal sling.
It’s not suitable for everyone and your surgeon can tell you if it is an option for you.
What scarring should I expect?
Scars will vary following reconstruction surgery using implants, but will often be horizontal across the newly formed breast (see image 2 and image 5). With immediate reconstructions the implant may be placed through an incision around the areola (the darker area of skin around the nipple). You can ask your surgeon about the position and length of the scar before the surgery takes place.
What are implants made from?
Breast implants have an outer shell made from silicone elastomer (similar to rubber). The shell is filled with silicone gel or saline. The surface of implants is usually textured, although some are smooth.
Silicone gel
Most implants used for reconstruction surgery contain silicone gel and the result tends to look more natural than with saline implants. The gel can be firm and feel more jelly-like or may be softer and feel more fluid-like depending on the type of implant used. Implants shaped like a teardrop are commonly used because they mimic the natural shape of a breast.
Saline
Saline (salt water) is an alternative to silicone gel. The outer shell of the implant is still made of silicone. These implants contain a liquid rather than a gel so they are more likely to wrinkle under the skin and can sometimes leak. Any leaks are absorbed by the body and are not harmful, but as the saline leaks out, the breast gradually gets smaller and in time the implant has to be replaced. Saline implants are also heavier, which may restrict the size that can be used. For these reasons this type of implant is not commonly used.
Expander implants
These use both silicone gel and saline. The outer shell is made of silicone with an inflatable inner chamber. Saline is injected in to the inner chamber to expand it. It’s used in both immediate and delayed reconstructions.
Are silicone implants safe?
Experts regularly examine evidence for the safety of silicone gel implants. Implants used in Europe should adhere to specific safety standards and surgeons in the UK continue to recommend them to women considering breast reconstruction surgery.
Modern silicone gel implants are expected to last at least 10 to 15 years, and are unlikely to need replacing.
Once inserted, implants are very difficult to damage. You can continue with all your normal activities including travelling by plane and taking part in sports.
Breast implants and lymphoma
Some women with breast implants have been found to have a rare type of cancer called breast implant associated anaplastic large cell lymphoma (BIA-ALCL). It has been diagnosed in women with and without breast cancer who have implants for breast reconstruction or breast enlargement.
It’s not known if the implants are the cause, but there may be a link, particularly to implants with a textured surface.
The most common symptom for BIA-ALCL is a seroma (a collection of fluid) that forms between the breast implant and the capsule at least six months after the breast implant surgery. Most cases have happened years after surgery.
If you develop a seroma, a breast lump or a swelling around your implant more than six months after having the breast implant (regardless of how many years later), tell someone in your specialist team such as your surgeon or breast care nurse or your GP.
Breast and Cosmetic Implant Registry (BCIR)
Since October 2016, anyone who has had breast reconstruction using a tissue expander or breast implant in England has been asked for their permission to have this recorded on a national registry. This is so that details of patients can be easily found if implants ever need to be recalled or removed. Since January 2019 this is now automatically recorded. Talk to your specialist if you would like to know more about this.
Reconstruction using your own tissue (tissue flap)
A commonly used reconstruction technique uses flaps of your own tissue (with or without an implant), including the skin, fat and sometimes a muscle. This can be taken from your back or lower abdomen, or from the inner thigh or buttock. This is then reshaped to form the new breast. Because the skin used is taken from another area of the body, it may be a slightly different shade or texture to the rest of the breast.
This method is particularly suitable for women with moderate- to large-sized breasts that have a natural droop.
Tissue flap reconstruction is commonly used in delayed reconstruction, particularly if radiotherapy has been given. Flaps without implants may also be used for immediate reconstruction.
You may need to have an ultrasound or CT scan (a scan that uses x-rays to take detailed pictures across the body) before your flap reconstruction to look at the blood supply to the tissue which will be used to create your new breast.
Reconstruction using your own tissue involves a longer operation and more recovery time than an implant-only reconstruction. But you will be less likely to need further surgery in the future than with reconstruction using implants alone. A reconstructed breast using tissue instead of an implant may also provide a better match with your other breast in the long term. This is because tissue is affected by gravity, ageing and weight change more naturally.
There are 2 ways reconstruction with a tissue flap may be done:
- Pedicled flap – the flap remains attached at one end to its blood vessels which means the blood supply to the muscle doesn’t need to be cut
- Free flap – the flap is completely detached from the body along with its blood vessels and reattached by microsurgery in the position of the reconstructed breast
There are different types of tissue flap reconstruction (see below) and surgeons are developing new ways of improving the cosmetic result. Your surgeon will advise on the best option for you.
2. LD flap, DIEP flap and other breast reconstruction options
LD (latissimus dorsi) flap – back flap
This procedure uses the latissimus dorsi muscle – a large muscle that lies in the back just below the shoulder blade. The skin, fat and muscle are removed from the back (see image 6) but the blood vessels of the flap remain attached to the body at the end nearest the armpit (known as a pedicled flap).
The flap is then turned and carefully tunnelled under the skin below the armpit and is brought round to the front of the body to lie on the chest wall and form the new breast (or part of the breast if being used in breast-conserving surgery) (see image 7). Some of the skin on the flap is used to form the new skin of the reconstructed breast while the muscle and the fat are used to form the volume of the breast. It’s usually necessary to use an implant under the flap after a mastectomy to help create a breast that’s a similar size to the other one.
An is sometimes used, particularly in a delayed reconstruction, and the expansion process starts when the tissue flap has healed, usually 2 or 3 weeks after surgery.
The scar on the back is usually horizontal and hidden along the bra line, or it can be diagonal. The scar on the breast will vary depending on your shape, the size of your breast and whether you have the reconstruction done at the same time as your mastectomy or at a later date.
After fully recovering from an LD flap reconstruction, some women will notice weakness in the shoulder during everyday activities. Possible weakness will be an important consideration if you’re very active, for example if you regularly swim, climb, row, play tennis or golf. So consider this when deciding which method of reconstruction is best for you.
DIEP (deep inferior epigastric perforator) flap
A DIEP reconstruction uses a free flap of skin and fat, but no muscle, to form the new breast shape. The flap is taken from the lower abdomen and uses the skin and fat between the belly button (umbilicus) and the groin along with the artery and veins (see image 8). It is called DIEP because deep blood vessels called the deep inferior epigastric perforators are used.
The free flap is transferred to the chest and shaped into a breast while the artery and veins are connected to blood vessels in the armpit or chest wall using a specialised technique called microvascular surgery. Rarely, if the flap of tissue doesn’t have a good blood supply it will die and the reconstruction will fail.
The advantage of this type of reconstruction is that no muscle has to be removed so the strength of the abdomen is not affected. This means there is very little chance of developing a hernia (a bulge or protrusion where the wall of the abdomen has been weakened). If you do develop a hernia it can be repaired with an operation.
The DIEP flap is major surgery involving a long and complex operation, and you will need to be in good overall health to go through it. Ideally you should be a non-smoker, have no existing scars on your abdomen and have enough fatty tissue in your lower abdominal area.
If you’re very overweight you may be advised to lose weight before being offered this type of surgery. This is to reduce your risk of complications from the anaesthetic and the surgery.
Flap reconstruction is generally not suitable for people with diabetes.
There will be scarring on the breast, which is usually oval, and on the abdomen – usually below the bikini line stretching from hip to hip. The belly button (umbilicus) is repositioned during this type of surgery, leaving a circular scar around it (see image 9).
If you have a skin-sparing mastectomy, there may also be a circular scar around where your nipple was.
Breast reconstruction - DIEP flap
This film shows the DIEP flap technique, which is tissue taken from the abdomen but without taking any muscle
TRAM (transverse rectus abdominis muscle) flap
This technique uses the large muscle that runs from the lower ribs to the pelvic bone in the groin. It is called a TRAM flap because the rectus abdominis muscle (large tummy muscle) is used and because the skin is taken from across your tummy (transversely) (see image 10).
TRAM flaps can be free (see image 10) or pedicled (see image 11).
A free flap is the most common type of flap used. The flap is completely detached and then reattached. A pedicled flap is where the flap remains attached at one end to the original anchoring point and the original blood supply.
In a free flap the muscle, fat and skin are removed completely from the abdomen and the surgeon shapes a breast from this tissue. The blood vessels that supply the flap are reconnected to blood vessels in the region of the reconstructed breast using microvascular surgery, either under the armpit or behind the breastbone.
In a pedicled flap, the rectus abdominis muscle, along with its overlying fat and skin and blood supply, is tunnelled under the skin of the abdomen and chest and brought out over the area where the new breast is to be made. Usually there’s enough fat in the flap to make the new breast the same size as the other one without the need for an implant.
If the flap of tissue isn’t getting a good blood supply following the procedure it will die and the reconstruction will fail. This is rare but if it does happen further surgery will be needed to remove the flap and, if possible, perform the reconstruction again at a later date.
Both types of TRAM flap operation may weaken the abdominal wall, which you might notice afterwards when lifting or during sport. During the operation the surgeon will put a ‘mesh’ into the abdomen to help strengthen the muscles and to try to avoid a hernia (a bulge or protrusion where the wall of the abdomen has been weakened). If you do develop a hernia it can be repaired with a fairly simple operation.
The free flap TRAM is sometimes a longer and more complex procedure, with a greater risk of complications than the pedicled flap, so a longer recovery time is usually needed.
You will need to be in good overall health to have either type of TRAM flap procedure. You’ll need to be a non-smoker, have no existing scars on your abdomen (caesarean scars don’t always mean you can’t have this procedure) and have enough fat in the lower abdominal area.
If you’re very overweight you may be advised to lose weight before being offered this type of surgery. This is to reduce your risk of complications from the anaesthetic and the surgery.
Flap reconstruction is generally not suitable for people with diabetes.
Both types of TRAM flap leave a scar across the width of the abdomen, from hip to hip, usually just below the bikini line. The scar on the reconstructed breast will be circular or oval and vary in size from person to person. The belly button (umbilicus) is repositioned during this type of surgery, leaving a circular scar around it (see image 12).
If you have a skin-sparing mastectomy, there may also be a circular scar around where your nipple was.
Breast reconstruction - TRAM flap
A TRAM flap takes skin, tissue and muscle from the abdomen to create the reconstruction.
SIEA (super inferior epigastric artery flap)
This is similar to the DIEP flap as it uses only skin and fat from the lower abdomen and no muscle, but the vessels taken are superficial (nearer the surface) rather than the deep vessels used in the DIEP flap.
The blood supply might not always be sufficient to have this procedure. The operation, complications and recovery time are similar to a DIEP flap.
A SIEA flap (shown in this video after the DIEP flap)
A SIEA flap uses skin and tissue taken from the abdomen, without taking any muscle. A DIEP flap uses a similar technique.
Other free flap reconstructions
There are some other reconstruction techniques using flaps from other areas of the body. The following types of free flap reconstruction use tissue from the buttocks or thighs.
These techniques are mainly used when other types of reconstruction aren’t suitable. They may be appropriate for women who are too slim for tissue to be taken from their abdomen or who have scarring from previous surgery to their abdominal or back area. Only a few surgeons in the UK offer these techniques and you may need to travel to another centre if you need this type of surgery.
As with all types of flap reconstruction, these techniques are generally not suitable for women who have diabetes, are heavy smokers or are very overweight.
SGAP (super gluteal artery perforator) flap and IGAP (inferior gluteal artery perforator) flap
SGAP and IGAP use only fat and skin taken from the upper or lower buttock to create a new breast (see image 13 and image 14). This involves microvascular surgery, which is the process of joining blood vessels together. Where tissue has been removed from the buttocks, there will be a scar and an indentation.
TMG (transverse myocutaneous gracilis) flap or TUG (transverse upper gracilis) flap
The tissue removed in this procedure is taken from the upper inner thigh and consists of skin, fat and a small strip of muscle (see image 15).
The procedure may be suitable for women with small- or medium-sized breasts. The inner thigh fat feels soft and is therefore similar in texture to the breast fat. Microvascular surgery is needed to join the blood vessels.
The scar is placed in the fold of the groin and runs to the fold of the buttock area – you will also have a scar on the breast where the flap is placed (see image 16). You can discuss with your surgeon how the scar will look. You may have to wear bandages or lycra shorts to reduce the risk of swelling, bruising and fluid collection for some weeks following surgery.
Breast reconstruction - other techniques
This film shows the SGAP and IGAP, TMG and TUG techniques.
Tissue failure
With all flap methods of reconstruction, there’s a risk that the flap, or part of the flap, will fail if it doesn’t have a good enough blood supply. This is rare, but if it happens you may need another operation to remove the affected tissue. Your surgeon will then talk to you about your options for further reconstruction.
3. Comparing breast reconstruction options
View a chart comparing different types of breast reconstruction side-by-side (PDF)
You can also find the chart in our booklet Breast reconstruction, which can be ordered or downloaded from the website.
4. Reconstruction with breast-conserving surgery
Breast-conserving surgery is usually referred to as wide local excision or lumpectomy, and is the removal of the cancer with a margin (border) of normal breast tissue around it.
Oncoplastic surgery techniques can be used during or after breast-conserving surgery. The aim of this type of surgery is to remove the cancer and maintain the shape and symmetry of the breast if there’s likely to be a noticeable indentation after surgery.
There are two ways of trying to maintain shape and replace the volume of the tissue lost from removing the cancer.
Volume can be replaced by moving some of the remaining breast tissue around to shape the breast and fill out the area where the cancer has been removed. This surgical procedure is sometimes called a therapeutic mammoplasty. This usually reduces the size of the affected breast so if this technique is used, you are likely to be offered surgery to your other breast to reduce its volume and restore symmetry.
Lost volume in the breast can also be replaced with tissue from elsewhere, usually from your back (called a latissimus dorsi flap).
LICAP (lateral intercostal artery perforator) flap or TAP (thoracodorsal artery perforator) flap
A newer way of replacing lost volume is to use skin and fat from the side of the chest, under the arm (see image 17). This is called a LICAP or TAP flap. These types of reconstruction can be used when breast cancer has been removed from the outer part of the breast, and scarring will vary (see image 18). Because it doesn’t use muscle it does not affect the arm or chest movement.
If you are having radiotherapy after any of these procedures, your surgeon can advise you further.
5. Possible problems following breast reconstruction surgery
Immediate problems
Bleeding
Sometimes there can be bleeding within the reconstruction. If this happens, it will usually be within 24 hours after the operation. This may mean another operation is needed to stop the bleeding.
Infection
If you have a raised temperature or notice any redness, excess swelling or heat in the breast or where tissue has been removed, tell your specialist team or GP straight away as these might be signs of an infection. Treating an infection is easiest and most effective if caught early. Occasionally an infection develops around an implant that doesn’t respond to treatment with antibiotics. In this case, the implant might have to be removed to allow the infection to settle completely.
Bruising
Bruising to the breast, and where any tissue has been removed, is common after your breast reconstruction and usually goes away after a few weeks.
Build-up of fluid or blood
Any drainage tubes put into your wounds during surgery are usually removed a few days after the operation.
However, a collection of fluid (seroma) or blood (haematoma) may continue to build up around the wound sites. These will normally be reabsorbed naturally over time, but larger amounts may need to be drawn off (aspirated) with a needle and syringe by your surgeon or breast care nurse. This is usually a painless procedure as the area is likely to be numb. Sometimes a seroma will refill so it may need to be drawn off several times over a few weeks before it goes away completely.
If you have an implant, the doctor or nurse may use ultrasound (high frequency sound waves that produce an image) to help guide them. This procedure can be done as an outpatient so you will not have to stay in hospital.
Pain and discomfort
You are likely to have some pain or discomfort after surgery. After your operation you will be given pain relief to make you more comfortable.
You may continue to feel sore and stiff for several weeks after surgery. This should gradually improve and you can carry on taking pain relief. Your wound may also itch as it heals. This is natural but try not to scratch it.
Pain can occur in the scar, chest wall and upper arm, the area where the tissue was taken for a flap reconstruction, and your shoulder can feel uncomfortable. Some people also have phantom breast pain (pain that feels like it’s coming from the breast although the breast tissue has been removed and reconstructed). These can all be the result of injury or damage to the nerves, and may settle with time.
With an abdominal flap operation you will probably feel uncomfortable when you bend over or straighten up, cough or sneeze for a few weeks after surgery. Take things gently and support your wound with your hands and a small cushion or rolled up towel if you need to.
If you’re experiencing pain around your scar areas that doesn’t improve with time or pain relief, talk to your specialist team.
Longer-term problems
Capsular contracture
In the first year or so after an implant operation, tough fibrous tissue builds up around the implant to form a ‘capsule’. This happens because the body sees the implant as a foreign object and wants to isolate it. In most cases this capsule stays soft and supple but sometimes it tightens around the implant, making the breast feel hard and sometimes painful. This is known as capsular contracture.
Radiotherapy can cause capsular contracture. For this reason, reconstruction using an implant alone may not be recommended for women having radiotherapy.
Capsular contracture is now less common than it used to be. This might be because many implants have a textured outer surface that reduces the amount of scar tissue that forms around the implant.
Leakage and rupture
If silicone implants wear out, the silicone gel may leak into the fibrous capsule. Occasionally silicone gel may get into the breast, forming a lump. If this can be felt or a scan shows a ruptured implant, the implant may have to be removed and replaced. Modern casings are strong and the risk of leaks and rupture is small. If you notice any deflation of your reconstructed breast, or if it becomes misshapen, uncomfortable or swollen, tell your surgeon or breast care nurse.
Creasing and wrinkling
There can be noticeable skin creasing or wrinkling over the implant. It’s most common in people who are slim and have saline implants. It’s usually less obvious when you’re wearing a bra. If it becomes very noticeable the implant may need to be replaced.
Abdominal hernia
There is a small risk after some flap reconstructions that a hernia can develop in the area where the tissue was taken from. A hernia happens when part of an internal organ (often a small piece of the intestine) bulges through a weak area in a muscle. Hernias can be painful and can cause a noticeable bulge in your abdomen. Usually an operation is needed to repair them.
Unevenness
It will take several months for your new breast to settle down and for scars to fade. Only then can you judge whether you are satisfied with the look and feel of your new breast and how well it matches your other breast. If you’re unhappy with the size or shape of the breast or the positioning of the nipple there are things that can be done. You can discuss your options with your surgeon or breast care nurse.
Loss of sensitivity
For many women the loss of sensitivity of the reconstructed breast can be difficult to come to terms with. You may also experience loss of sensation in the area where the flap has been taken. Some women experience nerve pain and altered sensation while their reconstruction is healing. This may improve over time, but for some people the sensation won’t return.
Fat necrosis
Sometimes a lump can form if an area of the fatty tissue in the reconstructed breast is damaged or if the blood supply is poor. It can also happen in the area where the flap of tissue has been taken. The lump can feel firm, but is likely to soften over time. This is called fat necrosis (necrosis is a medical term used to describe damaged or dead tissue).
6. Lipomodelling
This is a procedure used to improve the appearance of dents or a change in the outline of the breast that are sometimes noticeable after breast-conserving surgery. It may also be used after breast reconstruction, for example increasing the size of the breast, adjusting its shape or helping to hide visible implant ripples or wrinkles.
The technique uses fat taken by liposuction from one part of the body (usually the abdomen, hips or inner thigh), which is injected into the breast. It will be done under a general anaesthetic and may need to be repeated several times to achieve the correct shape. You will usually have some small scars where fat has been removed. Your surgeon and breast care nurse will explain what to expect after surgery, such as bruising and pain in the area where the fat is taken, and fat necrosis (where breast tissue has been damaged or has died, causing a hard lump).
7. Nipple reconstruction
Occasionally your own nipple can be preserved safely, but a mastectomy usually involves removing the whole breast including the nipple and areola. It’s possible to have the nipple reconstructed and this may be done at the same time as the breast surgery.
But it’s more commonly done a few months after the reconstruction to give the new breast time to settle into its permanent position and to make sure you’re happy with the symmetry of your breasts. The nipple reconstruction can be done under a local anaesthetic if carried out after the breast reconstruction.
A reconstructed nipple can improve the appearance of your new breast, but it won’t feel the same as a natural nipple. It has none of the nerves that allow it to become erect or flatten in response to touch or temperature, and it has no sensation.
There are several ways of reconstructing a nipple, so you may want to discuss different options with your surgeon. The skin of the new breast is usually used to make the nipple. This involves folding the skin to create a nipple shape. Sometimes part of the nipple from the other breast can be used. However good the initial result, the reconstructed nipple may flatten over time.
For the nipple and areola area to look as realistic as possible, the skin needs to match the shade of the natural nipple and areola. A reasonable match can usually be achieved by colouring the skin using micropigmentation, which is similar to tattooing.
This is usually done several weeks later once the surgery has had time to settle. The procedure takes about 30 minutes and may require local anaesthetic. Sometimes it needs to be repeated to give a better result. The colour will fade over time but should last for a few years.
Giving your new breast a nipple can be another stage in creating a breast that looks as natural as possible. On the other hand, you may choose not to have nipple reconstruction or you may decide to use stick-on nipples. These can be custom-made, sometimes by the hospital, to match your natural nipple and areola, or they can be bought ready-made.
8. Surgery to your other breast
Surgeons try to create a new breast that matches your natural breast as far as possible. If it is difficult to get the size, shape or position that matches your natural breast, you may want to discuss the option of having an operation on your other breast to improve symmetry.
This may mean making the remaining breast a little smaller or larger, lifting it or moving the nipple. These procedures will all leave some permanent scarring, which will fade with time.
Any surgery to the natural breast may be done in a separate operation to give the reconstructed breast time to settle. If you have your reconstruction done privately it is worth checking that any surgery to your other breast is covered under your insurance plan; if it isn’t you may have to pay extra.
Breast reduction
Sometimes it may be necessary to remove tissue and skin from the natural breast in order to make it smaller and more in balance with the reconstructed breast. The nipple and areola usually need moving to be more central on the breast.
Breast reduction usually leaves some scarring around the nipple and areola, down the central part of the breast and along its underside. This isn’t noticeable when wearing a bra, and will usually fade over time. There may be less feeling and sensation in the breast and nipple, and you may not be able to breastfeed in the future.
Breast enlargement (augmentation)
Sometimes the reconstructed breast is larger than your natural breast, especially if you’ve had an implant. You can have an implant placed either under the breast tissue or behind the chest wall muscle of your natural breast to make both breasts more balanced. Scarring is usually in the fold beneath the breast or around the areola.
The feeling in the nipple and skin can change after breast enlargement and you may find the nipple is less or more sensitive for a few months after the operation.
When implants are used and there’s also remaining breast tissue, mammograms (breast x-rays) can still be done (see Mammograms after breast reconstruction further down).
Breast enlargement does not usually prevent you from breastfeeding in the future.
Breast uplift (mastopexy)
Breast uplift is an operation to raise, reshape and firm the breast, which reduces any natural drooping and improves the position of the nipple and areola. A strip of skin is taken from under the remaining breast or around the nipple to tighten and lift the skin over the breast.
You may have similar scarring to that found after breast reduction, but this can vary. There may be less feeling and sensation in the breast and nipple. You should still be able to breastfeed.
9. Recovering from breast reconstruction
Your operation will be carried out under general anaesthetic. The length of surgery depends on the type of procedure you are having, and recovery time will vary too. You can compare approximate timings on our breast reconstruction comparison chart.
After the operation
When you wake up you’ll have dressings on your newly reconstructed breast and, if you have had flap surgery, on the area where the flap has been removed.
After surgery, staff at the hospital will:
- Monitor you to make sure there is good blood supply to the flap
- Give you appropriate pain relief
- Encourage you to keep your new breast warm (for example using padding and soft blankets)
You may also:
- Have drainage tubes connected to your wounds
- Have a urinary catheter (a tube in your bladder to drain urine)
- Be given a course of antibiotics
If you experience any pain or discomfort, tell the staff looking after you.
Recovery time
Your recovery time will depend on the type of reconstruction you’ve had. After an implant operation you will probably be out of bed within a few hours and may be able to go home the next day. If you’ve had more extensive surgery it will take a little longer for you to be up and about, and you’ll stay in hospital for several days.
You may be given:
- Advice and information from a physiotherapist on breathing and performing everyday tasks (particularly if you’ve had abdominal surgery)
- Exercises to keep your arms and shoulders mobile
- Information about what sort of bra and other support garments are suitable to reduce discomfort, swelling and fluid collection
- Advice about how to look after your wounds and what activities you should avoid during the healing process
Your new breast
The newly reconstructed breast takes a while to settle and resemble a natural breast. It’s normal for it to be bruised and swollen for quite a while, and the wounds will take time to heal. If you are concerned about any part of your recovery talk to your specialist team.
Resuming normal activities
How long it takes to get back to your normal daily activities will depend on what type of surgery you have had. Gradually reintroducing them is generally the best way.
It’s best not to drive or do anything strenuous while your wounds are healing. When you want to start driving again, think about whether you would be comfortable enough to wear a seatbelt and be able to do an emergency stop.
Listen to your body and stop if you feel you may be over-exerting yourself. Check with your surgeon or breast care nurse if you’re not sure.
Returning to work
Whether and when to return to work is a personal decision that may take into account not only how you’re feeling physically and emotionally but also your financial position. By law, an employer must make reasonable adjustments to help you at work if you have breast cancer.
10. Being breast aware
It is important still to be breast aware after reconstruction surgery. Once your breast has settled down after surgery, get to know the way it looks and feels.
After any type of breast reconstruction you should look out for changes in the breast. These include:
- A change in appearance or shape
- A lump or lumpy area in the breast or armpit
- A change in skin texture or swelling in the upper arm
If you notice any changes in either of your breasts, tell a member of your specialist team or your GP. Having a breast reconstruction should not affect the ability of you or your surgeon to detect a recurrence of your cancer.
Having a breast reconstruction will not increase the chances of your cancer coming back.
Find out more about being breast aware.
Mammograms after breast reconstruction
You will still be offered regular mammograms on your natural remaining breast, and to check any remaining tissue in your reconstructed breast if only part of your breast tissue was removed.
If you’ve had an implant in your natural breast to match the reconstructed breast for size, tell the radiographer in advance so the Eklund technique can be used if appropriate. This takes an additional image of the breast during screening. It involves easing the breast tissue forward away from the implant so that it can be seen more clearly. The radiographer (someone trained to carry out x-rays and scans) should explain the technique and explain why they think it is suitable for you.
Bras after surgery
Sometimes you may be advised to wear a bra during both the day and night initially after your surgery.
Many women are concerned about finding comfortable and well-fitting bras following breast reconstruction. Initially after surgery your surgeon will advise what bra to wear depending on your type of reconstruction.
Our booklet Breast prostheses, bras and clothes after surgery provides practical information about bras and clothing for women who have had breast surgery.
