Breast Reconstruction Surgery

April 10, 2025

This page was reviewed under our medical and editorial policy by Antoine Carre, M.D., M.P.H., assistant clinical professor, Division of Plastic Surgery, Department of Surgery, and assistant clinical professor; and Susan Yost, Ph.D., staff scientist, Department of Medical Oncology & Therapeutics Research, City of Hope^® Cancer Center Duarte

After a mastectomy, patients have the decision to either undergo breast reconstruction or remain flat-chested. This choice is deeply personal and influenced by various factors, including medical conditions, personal preferences and treatment plans.

Breast reconstruction surgery may be performed immediately after a mastectomy or at a later time. Breast reconstruction is a process that requires multiple procedures to achieve the desired result.

Understanding the types of surgeries and their timing helps patients and their families make informed decisions.

When Is Breast Reconstruction Done?

Immediate breast reconstruction is performed on the same day of the mastectomy, while delayed reconstruction is done at a later time, separate from the mastectomy. The choice to have an immediate or delayed reconstruction is based on various factors, including the type of reconstruction, choices of neoadjuvant or adjuvant treatments, individual risk factors and the patient’s choice.

Immediate reconstruction: This approach involves reconstructive surgery with implants or tissue flaps at the same time as the mastectomy.

Delayed reconstruction: In some cases, reconstructive surgery is postponed until the initial breast cancer treatment is complete. Delayed reconstruction allows patients to focus on cancer treatment first and make decisions about reconstruction later when they might feel less overwhelmed.

Delayed-immediate reconstruction: For some patients who desire breast reconstruction, the breast tissue may not be in a place to receive implants or tissue flaps right away during mastectomy. Tissue expanders, which are like empty implants that can be slowly inflated, are an option. An expander is placed in the breast right after mastectomy during the same operation to help prepare the tissue for later implant or tissue flap surgery. This approach is preferred over the delayed procedure, as it usually yields better cosmetic results by preserving the breast footprint.

Factors influencing the timing of reconstruction include the following.

Type of cancer treatment: If breast cancer radiation therapy is required, immediate reconstruction might not be recommended. Radiation may affect healing and the final appearance of the reconstructed breast.

Health conditions: Conditions like obesity, diabetes, smoking and blood circulation problems may impact the healing process. Surgeons often recommend quitting smoking at least two months before surgery to improve healing outcomes.

Personal preference: Some patients prefer to avoid additional surgeries or may need more time to make decisions about reconstruction. Others might want to minimize the time without a breast by opting for immediate reconstruction. Additionally, some patients may want to increase their original breast size.

Risk factors: Patients with certain health issues or those who are actively smoking might be advised to delay or even avoid reconstruction to reduce the risk of complications.

Types of Breast Reconstruction After Mastectomy

There are various surgical methods for breast reconstruction after a mastectomy, each tailored to meet individual needs and preferences. The main types of reconstruction include implant-based surgery in the pre-pectoral plane and flap or autologous tissue surgery. Additionally, there are procedures to improve symmetry of the opposite breast, and reconstruction of the nipple and areola.

Implant Surgery

Implant surgery involves using breast implants to reconstruct the breast after a mastectomy. In the United States, most implants have a silicone outer shell filled with either silicone gel or saline (sterile salt water). Saline implants aren’t usually recommended for reconstruction because they lack structural integrity and may lead to a suboptimal result. Silicone gel implants, particularly the highly cohesive implants, are designed to mimic natural breast tissue.

Flap or Autologous Surgery

Flap or autologous surgery reconstructs the breast using tissue from other parts of the patient’s body, such as the abdomen, thighs or buttocks. These tissue flaps provide a more natural look and feel than implants, and the tissue changes with the patient’s weight fluctuations. Unlike implants, which may rupture or cause other side effects, tissue flaps do not need to be replaced. Flaps from the back (latissimus dorsi) usually need to be combined with implants to achieve the desired breast volume. For that reason, they aren’t a truly autologous reconstruction and carry all the same long-term risks as implant surgery.

Surgery to Alter Opposite Breast

Patients who have a single mastectomy may find that reshaping the opposite breast may help make the breasts more similar. The care team may recommend symmetrizing surgery to create a balanced appearance between the reconstructed breast and the natural breast, helping the breasts to match. Techniques include reducing or enlarging the breast size and/or surgically lifting the breast. These steps help ensure both breasts look symmetrical, enhancing the overall aesthetic outcome.

Restoring Sensation

After mastectomy, the patient may lose feeling on the skin, including the ability to sense temperature changes and pain.

This may be different if the patient has a nipple-sparing mastectomy. During a mastectomy, sometimes it’s safe to preserve the nipple area complex. If the surgical oncologist decides it’s safe to keep the patient’s nipple and areola, the patient should discuss ways to re-innervate the area with her surgeon. Nerves are cut while removing tissue, which may lead to less sensation in the chest area. With the help of a special microscope, the surgeon may be able to find the cut nerves and use a microsurgical technique to reconstruct the cut nerves and improve the chances of recovering some sensation.

Flap surgery to restore sensation after an autologous reconstruction: This procedure may result in more sensation than implant reconstruction if it’s a delayed reconstruction and most of the abdominal skin is used to reconstruct the breast (with the mastectomy skin flap removed). In this case, the surgeon may try to preserve a sensory nerve within the new tissue flap. The nerve in the flap may be connected to a nerve in the chest wall using interposed nerve grafting, which may help the reconstructed breast regain feeling. Studies have shown that this technique may improve sensation in the reconstructed breast.

Researchers are looking for more ways to restore sensation in the reconstructed breast to improve patients’ quality of life postmastectomy.

Before having breast reconstruction, patients should discuss loss of breast sensation with their care team.

Nipple Tattoos and Areola Reconstruction

After a skin-sparing mastectomy, the nipple is typically removed. However, nipple-sparing options may be an option for some patients. For those undergoing breast reconstruction after skin-sparing mastectomy, the plastic surgeon may recreate the nipple and areola through surgery, tattooing or a combination of both. This final reconstruction phase aims to match the new breast to the original, focusing on size, shape, position, color, texture and projection.

The procedure is usually performed three to four months after the initial reconstruction to allow proper healing. Tissue for the nipple and areola may be taken from the reconstructed breast or another body part. Nipple tattooing may be used alone or to add color, creating a 3D look even without tissue reconstruction.

Deciding on Breast Reconstruction

Recovery

Recovery from breast reconstruction surgery varies depending on the type of procedure performed. Most patients begin to feel better within weeks and are able to resume normal activities in a few months. It is essential to discuss specific expectations with the cancer care team.

Implant surgery recovery: Typically, patients feel tired and sore for about one to two weeks. Recovery from implant surgery is generally quicker than flap surgery, with most women returning to their usual activities within six to eight weeks.

Flap surgery recovery: This procedure involves two surgical sites (the breast and the donor area), leading to a longer recovery period. Patients might experience soreness and fatigue for a few weeks, with full recovery extending up to two months.

Most patients go home within a few days after surgery. They might be discharged with one or more drains to remove excess fluid from the surgical site. The care team will teach patients how to manage these drains at home, and they will be removed once fluid collection decreases.

Doctors prescribe medications to help manage pain and discomfort during the initial recovery phase.

For the first four to six weeks, patients should avoid overhead lifting, strenuous sports and certain sexual activities. Following the doctor’s instructions regarding wound and drain care and wearing support garments is crucial.

Bruising and swelling may take up to eight weeks to subside. Complete tissue healing and scar fading may take one to two years, though scars will not disappear entirely.

Complications

Like any surgery, breast reconstruction carries certain risks and potential complications. Although many of these complications are uncommon, it is important to be aware of them. Discuss possible complications with the surgeon for a list that’s tailored to the patient’s procedure, body type, age and previous and future treatments.

Immediate risks and complications may include:

• Anesthesia issues, from mild (sore throat, nausea) to serious (breathing problems or life-threatening reactions)
• Blood clots
• Pain
• Bleeding
• Swelling
• Buildup of fluid in the breast or donor site (which may be seroma)
• Slow-healing wounds
• Fatigue
• Infections affecting the donor site
• Infections affecting the surgical site

Long-term risks and complications may include:

• Tissue death (necrosis) of all or part of a tissue flap or the area around it
• Nipple and breast sensation changes
• Loss of muscle strength, abdominal bulging or skin dimples at the donor site
• Movement, leakage, rupture or rippling of the implant
• Visibly uneven breasts
• Lymphedema

A common issue involves scar tissue forming around the breast implant, called capsular contraction. As it tightens, capsular contraction may cause the breast to feel stiff or look distorted. Treatment may involve surgery to remove the scar tissue or replace the implant.

Smoking may delay healing and increase the likelihood of wound complications. This may lead to more noticeable scars and longer recovery times.

Breast Reconstruction at City of Hope

The breast reconstruction program at City of Hope provides patients with access to leading-edge surgical options and comprehensive support. The world-class surgical team specializes in advanced techniques such as nipple-sparing and skin-sparing mastectomies, promoting optimal cosmetic outcomes while preserving as much natural tissue as possible.

City of Hope’s expertise extends to various lymphatic reconstruction and bypass techniques, reducing the risk of lymphedema. The team routinely performs breast reinnervation, which aims to restore sensation to the reconstructed breast, enhancing patients’ overall quality of life.

In addition to surgical excellence, City of Hope also offers robust supportive care and long-term follow-up programs. Patients benefit from assistance with managing side effects related to cancer treatment, access to community support programs for both patients and caregivers, and resources to help them return to work and daily life.