What you can expect

Breast reconstruction begins with placement of a breast implant or tissue expander, either at the time of your mastectomy (immediate reconstruction) or during a later procedure (delayed reconstruction). Breast reconstruction often requires multiple operations, even if you choose immediate reconstruction.

Breast implants

A breast implant is a round or teardrop-shaped silicone shell filled with salt water (saline) or silicone gel. Once restricted because of safety concerns, silicone gel implants are now considered safe.

A plastic surgeon places the implant either behind or in front of the muscle in your chest (pectoral muscle). Implants that are put in front of the muscle are held in place using a special tissue called acellular dermal matrix. Over time, your body replaces this tissue with collagen.

Some women are able to have the permanent breast implant placed at the time of the mastectomy (direct-to-implant reconstruction). However, many women require a two-stage process, using a tissue expander before the permanent implant is placed.

Tissue expanders

Tissue expansion is a process that stretches your remaining chest skin and soft tissues to make room for the breast implant. Your surgeon places a balloonlike tissue expander under or over your pectoral muscle at the time of your mastectomy. Over the next few months, through a small valve under your skin, your doctor or nurse uses a needle to inject saline into the valve, filling the balloon in stages.

This gradual process allows the skin to stretch over time. You'll go to your doctor every week or two to have the saline injected. You may experience some discomfort or pressure as the implant expands.

A newer type of tissue expander uses carbon dioxide. This remote-controlled expander releases the gas from an internal reservoir. Compared with the expansion using saline, the gradual expansion using carbon dioxide may decrease the amount of discomfort you feel.

After the tissue is adequately expanded, your surgeon performs a second surgery to remove the tissue expander and replace it with a permanent implant, which is placed in the same place as the tissue expander.

Recovery

You may be tired and sore for several weeks after surgery. Your doctor will prescribe medication to help control your pain.

Getting back to normal activities may take six weeks or longer. Take it easy during this period.

Your doctor will let you know of restrictions to your activities, such as avoiding overhead lifting or strenuous physical activities. Don't be surprised if it seems to take a long time to bounce back from surgery — it may take as long as a year or two to feel completely healed.

Generally, you'll follow up with your plastic surgeon on a yearly basis to monitor your reconstructed breast after the reconstruction is complete. Make an appointment sooner than that, however, if you have any concerns about your reconstruction.

Nipple reconstruction

Breast reconstruction may also entail reconstruction of your nipple, if you choose, including tattooing to define the dark area of skin surrounding your nipple (areola).

Future breast cancer screening

If you've had only one breast reconstructed, you'll need to have screening mammography done regularly on your other breast. Mammography isn't necessary on breasts that have been reconstructed.

You may opt to perform breast self-exams on your natural breast and the skin and surrounding area of your reconstructed breast. This may help you become familiar with the changes to your breast after surgery so that you can be alert to any new changes and report those to your doctor.