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If you’re preparing for a mastectomy, you may have questions about what comes next. Your surgical team will likely discuss breast reconstruction with you. This is the process of rebuilding the shape of the breast that’s being removed.
You may opt to go through this process right away (immediate reconstruction) or wait weeks, months, or even years (delayed reconstruction) after mastectomy.
Breast reconstruction after mastectomy occurs in stages to allow your body to recover and heal between each phase. While everyone’s timeline varies, most reconstructions take several medical appointments and more than one surgery. Your surgeon will explain that your breasts can be rebuilt with implants or tissue from your own body or both.
In this article, we’ll cover the main stages of breast reconstruction after mastectomy, including timing and surgical options. We’ll also discuss what the recovery period is like.
Immediate vs. Delayed ReconstructionWhen you have a mastectomy, there are several decisions to make. It’s up to you whether you want breast reconstruction after a mastectomy.
If you’re not interested in rebuilding the shape of your breasts, you may opt for a “flat closure,” which means the surgeon removes any extra skin and fat before closing the incision, leaving a completely flat chest. This is often referred to as “going flat.”
If you opt for reconstruction, you and your surgery team will work together to decide when to begin the process. It’s possible to begin reconstruction at the time of your mastectomy. However, some people choose to wait until they’re fully recovered from mastectomy surgery and later treatments like radiation therapy.
Radiation therapy after mastectomy can affect how the body heals and may raise the risk of problems after reconstruction. This can happen with both implant reconstruction and autologous reconstruction (reconstruction using your own tissue).
Because of this, your surgeon may recommend waiting to do reconstruction or choosing a method that works better with your cancer treatment plan. Your surgical and cancer care teams can help you decide the safest timing and option for you.
Before Mastectomy — Choose Your Reconstruction TypeYour reconstruction experience and recovery period will depend on which type of reconstruction you choose or need. The two main types are:
Implants are usually filled with silicone or saline. Autologous tissue comes from your own body, such as fat and other soft tissues from your abdomen, back, or thighs. Sometimes both implants and autologous tissue are used.
The recovery process is usually shorter for people who choose implant reconstruction. However, implants don’t last forever and may need to be replaced. The surgery and recovery period for autologous tissue is longer than for implants, but it often provides a more natural shape and feel.
Before your mastectomy, your surgeon will discuss your options with you and help you choose the right type of reconstruction for you. It’s common to feel overwhelmed or stressed by the decision. This is also a good time to contact your insurance company and hospital billing department to understand your coverage.
According to federal law, insurance companies that cover mastectomy surgeries must also cover reconstructive surgeries. The Women’s Health and Cancer Rights Act of 1998 (WHCRA) generally requires health plans that cover mastectomy to also cover breast reconstruction and treatment of complications.
Depending on your insurance plan, you may still have costs like copays, coinsurance, or deductibles. Some insurance companies require that you get a second opinion before they’ll provide coverage.
During Mastectomy — First Stage of ReconstructionThe first phase of reconstruction usually happens during mastectomy surgery. It’s possible to place an implant at this time.
In many cases, the surgeon will place a temporary device called a tissue expander into the breast area to prepare for a future implant. The tissue expander device is similar to an expandable balloon.
In the weeks after your mastectomy, your surgeon will see you for follow-up appointments that may be weekly or every two weeks to gradually add air or saline to the balloon to stretch out the skin.
After the tissue expander is in place, the surgeon will insert one or two drains to remove any fluid after surgery. Your surgeon will see you back in their office after one to two weeks to remove the drains.
For an autologous reconstruction, the surgeon will remove fat, skin, blood vessels, and sometimes muscle from another area of the body. Common sites include the abdomen (belly), back, thighs, or buttocks. This tissue is called a “flap.”
The surgeon may cut the tissue from the body and attach it to new blood vessels in the chest area with a highly specialized type of microscopic surgery. This is known as a free flap.
In other cases, the surgeon may move the tissue and attached blood vessels together. This is called a pedicled flap. There are several types of flaps available based on where the tissue is taken from.
In some cases, the surgeon may use both implants and autologous tissue to provide enough breast volume.
After an autologous reconstruction, you’ll likely stay in the hospital for three to five days. Expect to have drains in both the chest area and the part of the body where the tissue was taken. All of the drains are usually removed after one to two weeks.
After Mastectomy — Second Stage of ReconstructionIn the weeks after a mastectomy, your surgical team will recommend that you rest and heal. The recovery time after an autologous reconstruction is about four to six weeks. Fat and tissue are most commonly taken from the belly, so this area will need to heal as well.
Full recovery from an autologous reconstruction takes four to six months. Some people require another surgery to correct any scars or asymmetry. Fat grafting can be used to fill in areas that need more volume.
For an implant-based reconstruction, once the chest tissue has healed and the muscle has relaxed, you can move on to the next stage. If an expander was placed in your chest, the surgeon will perform surgery to remove the expander and replace it with an implant during the second stage of implant-based reconstruction.
This step usually occurs about two to six months after the tissue expander is placed. The recovery time after implant placement is about three to four weeks.
It’s common to experience numbness in the chest area after a mastectomy. Some feeling may return over time, but the same degree of feeling as you had before your surgeries may not return. Some amount of reduced feeling may be permanent.
It can take time to adjust to your new reality after a mastectomy and reconstruction. Remember that it’s common to experience sadness and anger as you heal.
Final Stage — Nipple and Areola ReconstructionOnce you’ve fully recovered from your reconstruction surgeries and the tissue in the breast area has stabilized, your surgeon will be able to reconstruct the nipple and areola if they were removed. This final step isn’t mandatory, but some people find it helps restore self-confidence. Your surgeon can reconstruct the nipple and areola with a tattoo or surgery.
Depending on the type of mastectomy, the surgeon may have performed a nipple-sparing mastectomy. In this case, the surgeon preserves the person’s own nipple and areola during surgery.
If you opt for a tattoo, your surgeon will refer you to a 3D tattoo artist who specializes in postmastectomy nipple tattoos. In this case, your skin is still flat to the touch, but it looks like there is a real nipple and areola.
For nipple reconstruction surgery, the surgeon uses small pieces of skin from the reconstructed breast area to form a nipple shape. Once the new nipple is healed, the surgeon can reconstruct the areola using tattoo ink or, in some cases, a skin graft from the abdomen or groin area at the time of nipple reconstruction. Other specialized techniques may use skin grafts from donor sites such as the inner thigh or labia minora.
As you recover from a mastectomy and reconstructive surgeries, you may benefit from starting physical therapy. A trained physical therapist can help with shoulder strength and range of motion after a mastectomy. They can also provide a strengthening program for any areas where muscle was taken for an autologous reconstruction.
Possible Reconstruction ComplicationsAs with any surgery, breast reconstruction comes with certain risks. It’s possible for the breasts to look different or asymmetrical. In these cases, if you feel uncomfortable with the appearance, the surgeon can perform another surgery to adjust your breasts’ size and shape.
Possible complications of implant-based reconstruction include:
Rarely, having implants can raise the risk of certain cancers, including squamous cell carcinoma, breast implant-associated anaplastic large cell lymphoma, and other lymphomas. These cancers are very rare.
Possible complications of an autologous reconstruction include:
Having an autologous reconstruction raises the risk of bleeding and blood clots more than an implant-based surgery. People who have diabetes, obesity, or a history of smoking may be at a higher risk of experiencing complications from either type of reconstruction.
On MyBCTeam, people share their experiences with breast cancer, get advice, and find support from others who understand.
Which type of breast reconstruction did you choose? What was the recovery process like for you? Let others know in the comments below.
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