Breast Reconstruction After Mastectomy

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What to expect after breast reconstruction surgery

It’s important to have an idea of what to expect after breast reconstruction surgery, including the possible risks and side effects. The time it takes you to recover from surgery will vary depending on the type of reconstruction you have. Most women begin to feel better in a couple of weeks and can return to normal activities in a couple of months. Talk to your doctor about what you can expect. Be sure you understand how to take care of your surgery sites and how to follow up with your breast care, including regular mammograms.

Possible risks during and after reconstruction surgery

There are certain risks from any type of surgery, and breast reconstruction may pose certain unique problems for some women. Even though many of these are not common, it’s important to have an idea of the possible risks and side effects.

Some of the risks during or soon after surgery include:

  • Problems with the anesthesia
  • Bleeding
  • Blood clots
  • Fluid build-up in the breast or the donor site, with swelling and pain
  • Infection at the surgery site(s)
  • Wound healing problems
  • Extreme tiredness (fatigue)

Problems that can occur later on include:

  • Tissue death (necrosis)of all or part of a tissue flap, skin, or fat
  • Loss of or changes in nipple and breast sensation
  • Problems at the donor site, such as loss of muscle strength
  • The need for more surgery to fix problems that come up
  • Changes in the arm on the same side as the reconstructed breast
  • Problems with a breast implant, such as movement, leakage, rupture, or scar tissue formation (capsular contracture)
  • Uneven breasts

Risks of infection

Infection can happen with any surgery, most often in the first 2 weeks after surgery. If an implant has been placed, it might have to be removed until the infection clears. A new implant can be put in later. If you have a tissue flap, surgery may be needed to clean the wound.

Risks of capsular contracture

The most common problem with breast implants is capsular contracture. A scar (or capsule) can form around the soft implant. As it tightens, it can start to squeeze the implant, making the breast feel very hard. Capsular contracture can be treated. Sometimes surgery can remove the scar tissue, or the implant can be removed or replaced.

Additional risks for smokers

Using tobacco narrows blood vessels and reduces the supply of nutrients and oxygen to tissues. As with any surgery, smoking can delay healing. This can cause more noticeable scars and a longer recovery time. Sometimes these problems are bad enough that a second operation is needed to fix them. You may be asked to quit smoking a few weeks or months before surgery to reduce these risks. This can be hard to do, so ask your doctor for help.

Recovering after reconstruction surgery

You’re likely to feel tired and sore for a week or 2 after implant surgery, and longer after flap procedures (which will leave you with 2 surgical wounds). Your doctor will give you medicines to help control pain and other discomfort.

Depending on the type of surgery you have, you will most likely be able to go home from the hospital within a few days. You may be discharged with one or more drains in place. A drain is a small tube that’s put in the wound to remove extra fluid from the surgery site while it heals. In most cases, fluid drains into a little hollow ball that you’ll learn how to empty before you leave the hospital. Follow your doctor’s instructions on wound and drain care. Also be sure to ask what kind of support garments you should wear. If you have any concerns or questions, ask your doctor or nurse.

Getting back to normal

You should be up and around in about 6 to 8 weeks. If implants are used without flaps, your recovery time may be shorter. Some things to keep in mind:

  • Reconstruction does not restore normal feeling to your breast, but some feeling may return over a period of years.
  • It may take up to about 8 weeks for bruising and swelling to go away. Try to be patient as you wait to see the final result.
  • It may take as long as 1 to 2 years for tissues to heal and scars to fade, but the scars never go away completely.
  • Ask when you can go back to wearing regular bras. Talk with your surgeon about the type of bra to wear – sometimes it will depend on the type of surgery you had. After you heal, underwires and lace might feel uncomfortable if they press on scars or rub your skin.
  • Follow your surgeon’s advice on when to begin stretching exercises and normal activities, because it’s different with different types of reconstruction. As a basic rule, you’ll want to avoid overhead lifting, strenuous sports, and some sexual activities for 4 to 6 weeks after reconstruction. Check with your surgeon for specific guidance.
  • Women who have reconstruction months or years after a mastectomy may go through a period of emotional adjustment once they’ve had their breast reconstructed. Just as it takes time to get used to the loss of a breast, it takes time to start thinking of the reconstructed breast as your own. Talking with other women who have had breast reconstruction might be helpful. Talking with a mental health professional might also help you sort out anxiety and other distressing feelings.
  • Silicone gel implants may open up or leak inside the breast without causing symptoms. Surgeons usually recommend getting regular magnetic resonance imaging (MRI) of implants to make sure they aren’t leaking. (This isn’t needed with saline implants.) You’ll likely have your first MRI 1 to 3 years after your implant surgery and every 2 years from then on, although it may vary by implant. Your insurance might not cover this. Be sure to talk to your doctor about long-term follow-up.
  • Call your doctor right away if you notice any new skin changes, swelling, lumps, pain, or fluid from the breast, armpit, or flap donor site, or if you have other symptoms that concern you.

For more information on coping after cancer, see After Diagnosis: A Guide for Patients and Families and Sexuality for the Woman With Cancer.

Talk to your doctors about mammograms

Women who have had a mastectomy to treat breast cancer generally do not need routine screening mammograms on the affected side (although they still need them on the other breast). There isn’t enough tissue remaining after a mastectomy to do a mammogram. Cancer can come back in the skin or chest wall on that side, but if this happens it’s more likely to be found on a physical exam.

Women who have had a skin-sparing mastectomy still need follow-up mammograms. In this surgery, the woman keeps her nipple and the tissue just under the skin. Often, an implant is put under the skin. This surgery leaves behind enough breast tissue to require routine screening mammograms in these women.

It’s possible for women with reconstructed breasts to get mammograms, but experts agree that women who have breast reconstruction after a mastectomy don’t need routine mammograms. Still, if an area of concern is found during a physical exam, a diagnostic mammogram may be done. (Ultrasound or MRI may also be used to look at the area closely.)

If you have a breast implant and you need a mammogram, be sure to get it done at a facility with technologists trained in moving the implant to get the best possible images of the rest of the breast. Pictures can sometimes be impaired by implants, more so by silicone than saline-filled. Be sure your technologist knows about your implant before starting the mammogram.

If you’re not sure what type of mastectomy you had or whether you need to get mammograms, ask your doctors about this.

Last Medical Review: 12/05/2014
Last Revised: 09/13/2016