Breast reconstruction

Breast reconstruction is surgery to create a new breast shape.

It may be done after surgery to remove your whole breast (mastectomy) or part of the breast (breast-conserving surgery).

A new breast shape can be created using:

1. A breast implant
2. Your own tissue from another part of the body
3. A combination of an implant and your own tissue

Your treatment team will explain the benefits and limitations of the options suitable for you.

Breast reconstruction tries to create a breast shape that looks as natural as possible and matches the breast on the other side in size, shape and position.

It can involve several operations over time to give you the best cosmetic outcome.

The first operation is to create the breast shape. You may need more operations to the reconstructed breast to improve the appearance or to the other breast to improve symmetry.

Even with the best outcome, there will be differences between the remaining breast and the reconstructed one.

Where both breasts are being reconstructed, the aim is to recreate breasts that match and are in proportion to your body shape.

You may have reconstruction:

• At the same time as a mastectomy or breast-conserving surgery (immediate reconstruction)
• Months or years later (delayed reconstruction)

Immediate reconstruction

Reconstruction at the same time as breast cancer surgery is known as immediate breast reconstruction. 

Your breast surgeon may discuss a skin-sparing or nipple-sparing mastectomy. This is removal of the breast tissue and sometimes the nipple area without removing the overlying skin of the breast.

Your breast surgeon will discuss which type of operation is appropriate for you.

Benefits of immediate reconstruction

• You’ll have a breast shape straight away, which may help you feel more confident with your appearance after surgery
• If the skin of the breast and the nipple are preserved, the cosmetic results can be better than with a delayed reconstruction
• There may be less scarring than with a delayed reconstruction

Limitations of immediate reconstruction

• Your operation and recovery will be longer than having a mastectomy without reconstruction
• If you develop complications after surgery that slow down wound healing, such as an infection, this may occasionally delay any additional treatments such as chemotherapy or radiotherapy
• If you’re having radiotherapy after surgery, it can sometimes affect the appearance of immediate reconstruction, which may mean you need more surgery in the future

Delayed reconstruction

You can have a reconstruction months or even years after your breast surgery. This is called delayed reconstruction.

During this time you may adjust to your mastectomy and feel that you no longer want to go through further reconstruction surgery. It’s OK to change your mind.

Benefits of delayed reconstruction

• You will have completed most or all of your breast cancer treatment before you have reconstruction
• You’ll have more time to consider your options and make a decision about the type of reconstruction you would like
• If you have pre-existing medical conditions, having a delayed reconstruction may allow these to be managed so the operation can be done safely

Limitations of delayed reconstruction

• You’ll be flat after your mastectomy and may want to wear a breast prothesis for symmetry until you have your reconstruction. This could be many months or years
• The cosmetic appearance of delayed reconstruction may not be as good as having an immediate reconstruction
• There may be more scarring with delayed reconstruction
• You will not be able to keep your nipple
• If you have had previous radiotherapy, this may limit your options for delayed reconstruction
• While delayed reconstruction is available on the NHS, in some areas there may be a long wait

Most women who have a mastectomy, and some who have breast-conserving surgery, can have either immediate or delayed breast reconstruction.

National guidance says the choice of immediate breast reconstruction should be discussed with anyone having a mastectomy. This includes people who may need radiotherapy or have had it previously. However, a delayed reconstruction may be a better option for some people.

All suitable breast reconstruction options should be offered and discussed, even if they’re not available at your local hospital.

If you’re having radiotherapy

If it’s likely you’ll need radiotherapy, this may affect the options for and timing of breast reconstruction.

Radiotherapy can increase the risk of scar tissue forming around an implant. It can also affect a reconstruction that uses your own tissue, making the breast feel firmer, reducing its size and possibly altering its shape.

If you’re likely to have radiotherapy, your treatment team may talk through suitable options for breast reconstruction in your individual case.  

If you’re having genetic testing

Your options for breast reconstruction may be different if you’re having genetic testing or being considered for genetic testing.

Your treatment team can talk through your surgery options and the timing of your surgery if you’re considering having both breasts removed and reconstructed.

Breast reconstruction and men

Reconstruction is not commonly offered to men who have a mastectomy for breast cancer. But you can talk to your treatment team to find out what options are suitable to improve the appearance and evenness of the chest after surgery.

Smoking and vaping

Smoking significantly increases the risk of developing complications from surgery and may affect your options for reconstruction.

Your breast care nurse or surgeon is likely to advise you to stop smoking before and after your operation to reduce this risk. You may also be advised not to vape or use other products that contain nicotine.

If reconstruction is not an option

Some people are advised not to have breast reconstruction.

This may be because of the type or stage of their breast cancer, or because they have other medical conditions that increase the risk of complications after surgery.

Your BMI (body mass index) may also affect your options for breast reconstruction. Having a high BMI increases the risk of complications after surgery.

If you’re advised not to have reconstruction or have delayed reconstruction due to your BMI, your breast or plastic surgeon should explain the reasons why. You can ask for a second opinion if you think this would be helpful.

Why have breast reconstruction? 

Women choose to have breast reconstruction for different reasons. 

You may want to restore your natural appearance after breast cancer surgery.

Surgery for breast cancer is likely to affect how you look and feel. Some women find it harder than others to come to terms with losing one or both of their breasts.

You may feel breast reconstruction is necessary to restore your confidence.

Some women may choose to have reconstruction as they think it will help them feel more confident in an intimate or sexual relationship, either now or in the future.

It's important you make a decision based on what's right for you.

Having breast reconstruction will not increase your risk of the breast cancer coming back (recurrence).

Limitations of reconstruction

Most women who have reconstruction are satisfied with the overall result.

However, not everyone’s experience is positive. Some women feel unsure about their new shape or self-conscious about their reconstructed breast or breasts.

It’s important to have realistic expectations of how a reconstructed breast will look and feel. You can talk to your surgeon or breast care nurse about what to expect.

Look and feel

A reconstructed breast will not feel, look or move exactly the same as your natural breast.

It will often be a slightly different size and shape.

Any differences should not be noticeable when you’re clothed, even in a bra or in swimwear. But when you’re undressed, the differences are more obvious.

You’ll be able to see your scars, although scarring should fade over time. You may also have scars on other parts of your body depending on the type of reconstruction.

Loss of sensation

There will be loss of sensation in the reconstructed breast and anywhere you have additional scars.

It’s common to have numbness or pins and needles in your reconstructed breast. This may improve over time but for many women the numbness can be permanent.

Loss of sensation can be difficult to come to terms with and can take time to adjust to. 

Differences to a natural breast

A natural breast will change over time and droop as you get older. Reconstructed breasts, especially those using implants, may not change in the same way.

Over time the differences between a natural and reconstructed breast may become more obvious, and you may need more surgery to improve symmetry.

Recovery and risk of complications

Recovery after breast reconstruction will take longer than if you have a mastectomy without reconstruction.

There’s also a higher risk of complications than if you have a mastectomy without reconstruction. Occasionally complications may delay further breast cancer treatment such as chemotherapy or radiotherapy.

Other limitations

You may need more hospital appointments and operations to get the desired cosmetic result.

If you need radiotherapy after your reconstruction, this can affect the appearance of your reconstructed breast.

Making a decision

Choosing whether to have breast reconstruction or when to have it is a complex and personal decision.

You may need more than 1 appointment with your treatment team before you feel confident deciding what’s best for you.

It’s important to take time to consider your options without feeling under pressure to decide.

Some women feel they need reconstruction to restore their confidence.

Others choose not to have reconstruction and prefer to wear an artificial breast form, called a prosthesis, inside their bra to restore their shape.

Some women choose not to have reconstruction and not to wear a prosthesis.

You may choose to delay your reconstruction, which can be an option if you do not want to decide straight away.

Even if you decide not to have reconstruction, you can still change your mind in future and have surgery months or years later. You may want to talk to your treatment team about what your options might be in future. 

There’s no right or wrong choice. It’s important to do what’s best for you.

Helping you decide

It can be helpful to talk to other women who have had breast reconstruction before making your decision.

Sometimes people find it helpful talking to women who have chosen not to have a reconstruction before making a decision.

We can put you in touch with someone who has and who hasn’t had a reconstruction through our Someone Like Me service.

Your breast care nurse or treatment team may also be able to arrange for you to speak to someone.

The charity Keeping Abreast offers information and support specifically about breast reconstruction.

Flat Friends offers support and information for women who have had a mastectomy without reconstruction.

Questions to ask your surgeon

Making decisions

• Which reconstruction would be best for me and why?
• What are the benefits, limitations and risks of this type of surgery?
• Am I suitable for immediate reconstruction?

Reconstruction and your other treatment

• Can reconstruction delay my other cancer treatments, like chemotherapy and radiotherapy?
• If I need radiotherapy will this affect my options for reconstruction?

Preparing for reconstruction

• Can you show me where the scars would be on my body and what they would look like?
• Can I keep my nipple? If not, what are my options to recreate a nipple in the future?
• Can you show me any photographs or images of your previous breast reconstructions?
• Can I see the type of implant I might have?
• Can I speak to someone who has had the same type of reconstruction?

Recovery

• How long would I have to stay in hospital?
• What drains or dressing may I have?
• What is the recovery time for this operation?
• How much pain is there likely to be?
• When would I be able to move about, exercise and drive?
• Would I need to wear a support bra or support underwear after the operation?

After reconstruction

• What will my breast look and feel like after surgery?
• Will I need any additional surgery or procedures after my reconstruction?