1. After your operation
Dressings
When you wake up, you’ll have dressings on your reconstructed breast or breasts. If you had surgery using your own tissue, you’ll also have dressings on the area the tissue was taken from.
Stitches
You may have dissolvable stitches, or you may have non-dissolvable stitches that will need to be removed usually 7 to 10 days after surgery. You may also have paper stitches (steristrips) that need to be removed.
Drains
Fluid can build in the areas you had surgery. You may have wound drains inserted during the operation. These are tubes that drain blood and fluid from the wound into a bottle or small bag.
Monitoring the blood supply
If you have reconstruction using your own tissue, your reconstructed breast will be monitored closely. This is to make sure the area has a good blood supply and there’s no swelling.
It’s important to keep your reconstructed breast warm in the first 24 to 48 hours after your operation. This helps improve blood flow. You may be given padding or a special blanket to help with this.
Pain and discomfort
You’ll be given pain relief after your operation.
There are many types of pain relief and different ways of giving it.
Recovery time
Your recovery time will depend on the type of reconstruction you’ve had and your general health and fitness.
Most people can walk to the toilet a few hours after an implant reconstruction operation. You can usually go home the next day.
If you’ve had reconstruction using your own tissue, your treatment team will tell you when they expect you to be out of bed and walking around. You may need to stay in hospital for several days.
Bras and underwear after surgery
Your breast care nurse or surgeon will usually tell you what type of support bra you’ll need to wear after your surgery.
It’s a good idea to have at least 2 support bras so you can wear 1 while you wash the other.
You’ll usually be advised to wear a bra during the day and night in the weeks after surgery.
2. Possible problems soon after breast reconstruction
Tissue failure (after flap reconstruction)
With all flap reconstructions, there’s a small risk the flap does not have a good enough blood supply. This can cause part or all of the flap to fail.
Your treatment team will monitor the reconstruction closely in the days straight after your operation. If they’re concerned, you may need another operation to try to assess the blood supply.
If the blood supply is not good enough, the surgeon will need to remove the affected tissue.
If you lose part or all of your reconstruction, your surgeon will talk to you about possible options for further reconstruction in the future.
Other problems
Other possible problems soon after breast reconstruction include:
- Bruising and bleeding
- Wound infection
- Delayed wound healing
- Build-up of fluid
Read more about these in our After breast cancer surgery guide.
3. Longer-term problems after reconstruction
Capsular contracture (after implant reconstruction)
After implant reconstruction, a thin layer of scar tissue builds up around the implant to form a capsule. This is part of the healing process.
In most cases this capsule stays soft, but sometimes it can toughen and tighten around the implant. This can make the breast feel hard and may distort the shape of the breast. Some people also have pain.
When this happens, it’s called capsular contracture.
Capsular contracture may be more common in people who have had radiotherapy, infections or are smokers.
It may happen less often in people who have textured implants or an ADM surgical mesh.
Mild cases often do not need treatment.
If the breast feels hard and looks misshapen, or you have pain, you may need to have the implant and capsule removed. It may be replaced with another implant, or your surgeon may discuss other reconstruction options.
Damaged or leaking implants
Some people worry about damaging their implant if they’re doing activities such as sports.
Implants do not get damaged easily. Modern implant linings are strong, and the silicone gel is firm, which makes the risk of leaks and tears small.
Occasionally silicone gel may leak into the breast, forming a lump. If you can feel a lump or a scan shows an implant is damaged, you may need to have the implant removed and replaced.
Tell your GP, surgeon or breast care nurse if you notice any change in the shape of your reconstructed breast, or if it becomes misshapen, uncomfortable or swollen.
Rippling (after implant reconstruction)
Implants can sometimes crease. This can cause wrinkling or rippling which you may notice in any part of the breast.
This is often more common in people who are slim or who have had their implant placed in front of the chest muscle.
If you have rippling, your surgeon may suggest injecting fat from another part of your body into the area on the breast to improve the appearance.
Bulges or hernias (after flap reconstruction)
After some tissue flap reconstructions, there’s a small risk of a bulge or hernia in the area 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 the area tissue was taken from, such as your abdomen. You’ll usually need an operation to repair a hernia.
The risk of a hernia is much lower if the tissue flap does not include a muscle.
Loss of sensation or altered sensation
Loss of sensitivity in the reconstructed breast can be difficult to come to terms with. You may also have loss of sensation in the area where a tissue flap was taken.
You may have nerve pain and altered sensation while your reconstruction is healing.
This may improve over time, but for some people the sensation will not return.
Fat necrosis and mastectomy flap necrosis
A lump can form if an area of fatty tissue in the reconstructed breast is damaged or if the blood supply is poor. It can also happen in the area where a tissue flap was taken.
The medical name for this is fat necrosis.
Sometimes a wound does not heal after reconstruction and areas of the skin can change colour, sometimes a dark red or even black. This may differ depending on skin tone. This can cause a scab to form or the scar to reopen. This is known as flap necrosis. It happens if the blood supply to the skin is not good enough.
A small area of flap necrosis will often heal on its own. If it’s larger, you may need surgery to remove the area of dead tissue.
Scars
Scar tissue is produced naturally by the body during healing.
Sometimes the body can produce too much collagen, causing scars that are more raised than usual. These are called hypertrophic scars and can take several years to settle.
Some people develop keloid scarring. This is similar to a hypertrophic scar but continues to grow and can cover normal tissue even after it has healed. Keloid scars can be painful, tender and itchy.
If you’re concerned about your scars, let your breast care nurse, surgeon or GP know.
4. Getting used to your reconstructed breast
Adjusting to how your reconstructed breast looks and feels can take time.
It can take several months for your reconstructed breast to heal and settle and for your scars to fade.
It’s important you’re satisfied with the final look and feel.
If you’re unhappy with the size or shape of the reconstructed breast or your other breast, let your breast care nurse or surgeon know. They can talk to you about possible options.
You may want to have further surgery to the reconstructed breast or to your other breast to give you a better match and symmetry.
It’s not unusual to need several surgical procedures before your breast reconstruction is complete, including nipple reconstruction or tattooing and surgery to the other breast.
5. Mammograms after breast reconstruction
You will not have mammograms on the reconstructed breast after a mastectomy. This is because there is no breast tissue to be scanned.
You’ll be offered regular mammograms on your remaining breast.
You’ll also be offered mammograms if you had breast reconstruction after breast-conserving surgery. This is to check any remaining breast tissue.
If you’ve had an implant in your other breast to match the reconstructed breast for symmetry, tell the radiographer. They may need to use a different technique to take 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 should explain the technique and why they think it’s suitable for you.
6. Checking for changes after surgery
Whatever type of surgery you have, be aware of any changes to the breast, chest or surrounding area afterwards.
This is important even if you’re having follow-up appointments or regular mammograms.
Things to look out for 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
- Redness or a rash on the skin or scar line of your reconstructed breast
