Breast Reconstruction

Breast reconstruction is surgery to rebuild the shape of a breast after it has been partly or completely removed to treat cancer. Its purpose is to restore a natural-looking breast form and balance, which can be an important part of recovery and well-being for many people. Reconstruction can be performed at the same time as cancer surgery, an approach known as immediate reconstruction, or it can be carried out months or years later as delayed reconstruction, depending on the cancer treatment plan and personal preference. The choice of timing and method is highly individual, and reconstruction is always optional.

Before reconstruction, the surgeon discusses the available options and helps the person choose the approach that best fits their body, their cancer treatment, and their goals. Stopping smoking well in advance is strongly advised, because it significantly improves healing. General health is optimized beforehand, and the timing is planned carefully, since radiation therapy in particular can influence which method gives the best result.

There are two broad types of reconstruction.

Implant-based reconstruction uses a silicone or saline implant to recreate the breast shape, often beginning with a temporary tissue expander that is gradually filled to stretch the skin before the final implant is placed.

Flap, or autologous, reconstruction uses a person's own tissue — most commonly from the lower abdomen, and sometimes from the back or thigh — to form a new, natural breast.

Reconstruction is frequently completed in stages over several months, and a separate, smaller procedure can later recreate the nipple and areola if desired. The operation is performed under general anesthesia, and recovery time is generally longer for flap procedures than for implant-based ones.

As with any major surgery, risks include bleeding, infection, and problems with wound healing. Implant-based reconstruction carries specific risks such as implant rupture over time or the formation of tight scar tissue around the implant, known as capsular contracture, which can change the breast's shape or feel. Flap reconstruction involves an additional surgical site where the tissue is taken from, and in rare cases part or all of the transferred tissue may not survive. Some people need revision procedures to refine the result or to improve symmetry between the two breasts.

Reconstruction is usually a staged process that unfolds over several months, and the final appearance continues to settle over time. Follow-up appointments monitor healing, address any need for revision, and, for those with implants, include guidance on long-term monitoring. The reconstructed breast does not have normal sensation, and care continues alongside the regular follow-up for the underlying cancer.