Breast reconstruction following mastectomy

Your consultant may suggest breast reconstruction surgery if you have had your breast removed due to breast cancer (a mastectomy). Your breast reconstruction may be performed straight after your mastectomy (immediate reconstruction), or several months or years later (delayed reconstruction).

You may also decide to have breast reconstruction surgery after risk-reducing surgery (a double mastectomy to reduce your risk of getting breast cancer).

Breast reconstruction surgery may be performed on one or both breasts and may involve a single, or several, procedures.

Deciding whether to have breast reconstruction surgery after a mastectomy is a very personal decision that only you can make. It may help to talk to friends, family, and health professionals, and to ensure you are fully informed of the risks and benefits of surgery before making a decision.

At your first consultation, you will be seen by a consultant breast surgeon, a doctor specialising in performing breast surgery. Your consultant will ask you about your medical history and general health and examine your breasts. They may discuss your reasons for wanting to have a breast reconstruction and any pros and cons of the surgery. They will explain the different types of breast reconstruction surgery and discuss which option may be best for you.

Why is this first consultation so important?

At Circle Health Group, your first appointment is very important as it’s where you get to meet your consultant, the doctor who will be responsible for your care.

Your first consultation is also where we get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have. It is important to us that you are as well-informed and comfortable as possible during your time with us, so please feel free to talk to your consultant about anything that is on your mind. It may help to write your questions down before your appointment.

At the end of your appointment, your consultant will decide if breast reconstruction is a good option for you, based on your general health, medical history, and previous breast surgery.

Your consultant will tell you everything you need to do to prepare for your surgery. If there’s anything you’re not sure about, or if you have any questions about how to prepare for your surgery, speak to your consultant or call the hospital for advice. Being well-prepared for your surgery will help to ease any anxiety you may have, as well as allow your surgery and recovery to go more smoothly.

Before your surgery, tell your consultant about any medical conditions or allergies you have and any medication, including over-the-counter medicines you are taking.

Your consultant may tell you to stop taking some medications like blood thinners before your operation. This is to reduce the risk of bleeding during and after your surgery.

You will not be able to eat or drink anything from midnight on the day of your operation.

What lifestyle changes can I make before my surgery?

Being in the best possible health before your surgery will help to reduce the risk of complications and speed up your recovery.

To make sure you are as healthy as possible before your surgery:

• Eat a healthy, balanced diet with plenty of fruit, vegetables, lean proteins, and whole grains
• If you smoke, try to stop at least eight weeks before your surgery
• Avoid alcohol for a few days before and after your surgery. Alcohol thins the blood and can increase the risk of bleeding
• Take regular exercise

Breast reconstruction can be done in one of 3 ways.

• Using implants (silicone or saline) to replace all or some of your breast tissue
• Using tissue taken from another part of your body (flap reconstruction)
• Using a combination of your own tissue and an implant

Your consultant will aim to match your natural, or remaining breast as closely as possible, though it may not look exactly the same.

After your breast reconstruction surgery, you may choose to have further surgery to:

• create a new nipple (nipple reconstruction)
• change the shape of your other breast to match your reconstructed breast more closely

What are the different types of breast reconstruction surgery?

There are 5 different types of breast reconstruction surgery. The type most suitable for you depends on several factors, including your shape and build, general health, and personal preference.

DIEP flap surgery

The DIEP flap procedure is a type of breast reconstruction surgery that allows for faster recovery and less post-operative pain. It is often done at the same time as your mastectomy, removing the need for further surgery.

DIEP flap surgery is normally performed in 2 or 3 stages a few months apart. This allows your consultant to complete the reconstruction process and get the best cosmetic result.

What is DIEP flap surgery?

A DIEP flap (deep inferior epigastric perforator) is a type of breast reconstruction surgery in which skin and fat, along with their blood vessels, are taken from the lower abdomen and used to reconstruct your breast. This type of surgery is known as a muscle-preserving procedure, as your consultant does not remove any of your abdominal muscles during the surgery. This results in less pain, a faster recovery, and does not result in any abdominal muscle weakness.

What happens during DIEP flap surgery?

Your consultant makes an incision (cut) along your bikini line and removes a flap of skin, fat, and blood vessels. The fat and skin are shaped into a natural-looking breast and sewn into place. The blood vessels that supply the tissue of your new breast are matched to blood vessels in your chest and reattached under a microscope. The procedure takes about 5-8 hours.

What are the benefits of DIEP flap surgery?

The primary advantage of DIEP flap surgery is that only skin and fat from the abdomen are used to reconstruct the breast, leaving the abdominal muscles intact. This preserves the strength of your abdominal muscles and reduces the risk of an abdominal hernia caused by weakened muscles. A further advantage is that the blood supply to the skin and fat is improved when compared with a pedicled TRAM flap, meaning your recovery is quicker. You can expect to spend around three to five days in hospital after DIEP flap breast reconstruction surgery.

Another advantage of the DIEP flap method is that no synthetic material or implants are used, making it safer with fewer long-term side-effects. Your breast may also feel and look more natural than with implant surgery. Women who undergo this form of reconstruction also enjoy the added benefit of a flatter abdomen, with results that mimic a “tummy tuck” procedure.

How safe is DIEP flap surgery?

DIEP flap surgery is a relatively safe procedure, but like all types of surgery, there is a small risk of complications.

Possible complications of DIEP flap surgery include:

• Abdominal hernia — the intestine can bulge through the abdominal wall after surgery
• Lumps — scar tissue may form lumps in the reconstructed breast that may need to be removed
• Necrosis — if the flap doesn’t get enough blood supply, the tissue can die and turn black. This requires further surgery

How long does it take to recover?

It normally takes around six to eight weeks before you can resume normal activities after DIEP flap surgery.

DIEP flap with lymph node transfer

Lymphoedema is a common side effect of breast cancer surgery and occurs when fluid builds up in the body’s tissues.

Lymph node transfer surgery is a relatively new and significant option for the management of lymphoedema.

What is DIEP flap with lymph node transfer?

If lymph nodes are removed from under the arm as part of breast cancer surgery, the normal drainage of lymph may be affected and this may cause the arm to swell, sometimes permanently. Lymph nodes with a blood supply can be transferred from spare lymph nodes in the groin. This can dramatically improve or cure the arm lymphoedema without causing swelling of the leg where the spare nodes are harvested from.

What happens during DIEP flap with lymph node transfer surgery?

Vascular lymph node transfer can be done at the same time as DIEP breast reconstruction or as a separate procedure. If done at the same time as DIEP breast reconstruction, the lymph nodes are taken along with the DIEP flap, so that they receive their blood supply through the flap itself. If the lymph nodes are used in isolation, then they are taken with a supplying artery and vein which is connected to blood vessels in the chest area.

During DIEP flap with lymph node transfer surgery, an area of skin and fat is removed from your abdomen along with the blood vessels that supply the area. The lymph nodes are carefully removed, ensuring they remain attached to the blood vessels supplying the DIEP flap. The tissue is then removed, and the blood vessels are reattached under your arm. The abdomen is closed in the same way as a tummy tuck. Your consultant then makes an incision under your arm to make a pocket for your new lymph nodes. The breast flap is then attached to its new blood supply and a new breast is created.

The procedure adds very little to a standard DIEP flap procedure time. If it is performed in isolation, then it is a 3-4 hour procedure with several days in hospital.

How safe is DIEP flap with lymph node transfer surgery?

Complications from DIEP flap with lymph node transfer surgery are rare, and there are normally minimal side effects from harvesting the nodes. Most importantly, there is no risk of lower limb lymphoedema.

Whilst this is a relatively new procedure and few units in the world are offering this, we have performed this technique on 30 patients to date and they have all seen an improvement in their symptoms with minimal side effects. In a questionnaire, all patients experienced a significant improvement in their quality of life, function and symptoms and say that they would recommend the procedure to a friend.

Possible complications of DIEP flap with lymph node transfer surgery include:

• Scarring
• Swelling and bruising — normally settles within a few weeks
• Infection
• Haematoma — bleeding under the skin
• Seroma / lymphocele — fluid build-up under the skin
• Fat necrosis — reduced blood supply causes a hardening of the skin
• Change in sensation around the scar such as numbness or oversensitivity
• Flap failure — the flap tissue may die due to lack of blood supply requiring further surgery

How long does it take to recover?

On average, you can expect to return to work after around 8-12 weeks. You can normally drive after 2 weeks and start gentle exercise after 4 weeks.

TRAM flap procedure

The TRAM flap procedure uses your own abdominal tissue to reconstruct your breast.

What is TRAM flap surgery?

TRAM (transverse rectus abdominis myocutaneous) flap surgery is a procedure where the cancerous breast is removed, and a section of your abdominal tissue, including skin, fat, and muscle, is transplanted onto the breast site.

What are the benefits of TRAM flap surgery?

This procedure uses your own tissue rather than foreign implants, which is safer and reduces the risk of complications. It also has the added benefits of an abdominoplasty (tummy tuck), leaving you with a flatter tummy after your surgery.

TRAM flap surgery is similar to a DIEP flap breast reconstruction but involves removing a portion of the rectus abdominis muscle (the six-pack) whereas the DIEP flap removes only skin and fat, leaving the muscle intact.

What happens during TRAM flap surgery?

An oval section of skin, fat, and muscle is taken from the lower half of the abdomen and slid up through a tunnel under the skin to the breast area. Blood vessels usually remain attached, and the tissue is shaped into a natural-looking breast and sewn into place. If blood vessels have been cut, the surgeon reattaches them to blood vessels in the chest area using a microscope. TRAM flap surgery takes about four to six hours.

How safe is TRAM flap surgery?

TRAM flap surgery is relatively safe, but as with any operation, there is a small risk of complications.

Potential complications of TRAM flap surgery include:

• Abdominal wall weakness
• Abdominal hernia
• Tissue flap necrosis — death of flap tissue due to lack of blood supply that can be corrected with surgery
• Fat necrosis — areas of fatty tissue moved to the breast can die due to lack of blood supply. Fat necrosis can be corrected with surgery

How long does it take to recover?

You will need to spend about five days in hospital after your TRAM flap procedure. Recovery normally takes between six and eight weeks.

Breast reconstruction with latissimus dorsi flap

Breast reconstruction with latissimus dorsi flap uses skin, fatty tissue, and muscle from your back, just below your shoulder blade.

What is breast reconstruction with latissimus dorsi flap?

Your consultant will recreate a breast shape using the latissimus dorsi muscle from the side of your back, usually with an implant and tissue expanders, to increase breast size. It may not be suitable for you if you don’t want to have implants.

What kind of breast implant should I choose?

All implants are made of an outer layer (shell) of silicone or polyurethane. They can be filled with silicone or saline. Softer silicone and saline implants have a softer, more natural feel but are more prone to kinking or rippling. More cohesive silicone implants give a firmer feel, hold their shape better, and are less prone to kinking or rippling. If you do not have enough skin or you have already had your mastectomy, your surgeon may need to use a tissue expander. A tissue expander is an empty breast implant that is placed under the skin. It is filled with air or fluid over around 6 to 8 weeks to “stretch” your skin and make room for your implant.

Is silicone safe?

There is no evidence to suggest that women with silicone breast implants have a higher risk of developing diseases such as breast cancer and arthritis. There is a reported link between having an implant and a rare type of cancer called anaplastic large-cell lymphoma (ALCL) but the increase in risk is small and ALCL in this area is not as serious as it is when it happens elsewhere in your body.

What are the benefits of latissimus dorsi flap surgery?

Breast reconstruction with a latissimus dorsi flap normally results in you regaining your breast shape.

Are there alternatives to breast reconstruction with latissimus dorsi flap?

Using padded bras or bra inserts can give the appearance of a breast shape when you are wearing clothes. Sometimes, it may be possible to have a reconstruction using only an implant, or to use tissue from another area of your body, such as your lower abdomen, buttocks, inner thigh, or side.

What happens during latissimus dorsi flap surgery?

The operation is performed under general anaesthetic and usually takes around 4 to 6 hours. Your surgeon will make an elliptical (oval) cut on your back, usually along the natural creases of your skin. They will lift the latissimus dorsi muscle along with a small patch of skin that will replace the areola (the darker area around your nipple) and nipple. They will keep the blood supply to the muscle and move it around to the front of your chest to supply your new breast. If you need an implant, your surgeon will create a pocket under the muscle to place the implant in.

How soon will I recover?

You should be able to go home after 2 to 5 days and return to normal activities after around 4 to 6 weeks. Regular, gentle exercise can help speed up your recovery and allow you to return to normal activities as soon as possible. Always check with your consultant or healthcare team before starting any exercise programme. You must not drive for at least 3 weeks after your surgery. If you have an expandable implant, you will need to come back to the clinic regularly as your skin expands over the implant. Bear in mind that the shape of your reconstructed breast takes several weeks to settle, so it will be a while before you see the finished result.

Fat transfer for breast reconstruction

Fat transfer for breast reconstruction is used to add volume to your new breast.

What is fat transfer for breast reconstruction?

Fat transfer surgery involves extracting fat cells from your abdomen, thighs, buttocks, or areas where there is an excess, and re-injecting them into your breast.

What are the benefits of this procedure?

Fat transfer offers several major benefits, including the fact that it’s your own cells simply moved from one area to another, removing the risk of allergy or immune rejection. It also has the added benefits of rejuvenating the skin and bringing in a new, healthy blood supply.

What happens during a fat transfer procedure?

The procedure is performed under general or local anaesthetic, depending on the amount of fat required. The fat is harvested into syringes and cleansed to remove impurities before injecting it into the areas to be treated. Only a certain amount of fat can be injected into an area at one time to ensure the tissue is not over saturated. Some of this fat (approximately 30%) is expected to be reabsorbed by the body. Depending on the volume you are looking to achieve, several sessions may be required.

How safe is fat transfer procedure?

Fat transfer is a generally safe procedure, but there are some risks you need to be aware of. A major potential problem is changes on your mammogram, which can mimic cancer. As an extra precaution, fat is not directly injected into breast tissue, but into the subcutaneous fatty layer above the breast gland.

Your consultant will discuss all the possible risks and complications with you before the procedure. Before having your fat transfer, you must have a mammogram and ultrasound scan to screen for cancer and will need to have regular mammograms and ultrasound for several years afterwards.

Rare complications of fat transfer include:

• Fat necrosis
• Contour irregularities
• Infection

How long does it take to recover from fat transfer procedure?

You should be able to go home on the same day that you have your treatment, although this will depend on the extent of the procedure and your individual circumstances. Where possible, any scarring is usually hidden in the natural crease of your body. You will probably have some bruising, redness and/or swelling after the procedure, which should resolve after around a week. We advise that you avoid strenuous activity for a few weeks after your procedure.

Recovery from any type of surgery is different for everyone and depends on factors such as your age, general health, the type of surgery you had, and whether there were any complications during your surgery.

Your consultant will give you an estimated recovery timeline based on your individual circumstances.

As with all types of surgery, breast reconstruction surgery carries a small risk of complications. Your consultant will explain all the possible risks and complications before your surgery and answer any questions you may have about your procedure. Being as well-informed as possible about what to expect from your surgery will help put your mind at rest and allow you to make an informed decision, so please ask any questions you may have.

Possible complications of any surgery include:

• Pain
• Bleeding
• Scarring
• Blood clot in your leg (deep vein thrombosis)
• Blood clot in your lung (pulmonary embolism)
• Chest infection
• Infection of the surgical site (wound)

Specific complications of breast reconstruction surgery vary, depending on the type of surgery you have, but may include:

• Seroma / lymphocele — a buildup of fluid under your wound
• Haematoma — a buildup of blood under your wound
• Loss of the flap
• Skin necrosis — death of skin tissue due to lack of blood supply
• Unnatural movement or twitching of the reconstructed breast
• Difference in the shape and appearance of your breast
• Numbness or pain around your armpit or the inner part of your arm
• Permanent numbness around your scar
• Shoulder stiffness
• Arm weakness

Implant complications

• Developing a collection of fluid (seroma) in the pocket where the implant is
• Infection of the implant
• Capsule contracture, where scar tissue that your body naturally forms thickens and tightens around the implant
• Kinking and rippling
• Rupture of the implant
• Rotation of the implant

At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care, including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about breast reconstruction surgery, book your appointment online today or call a member of our team directly.

Content reviewed by Circle in-house team in January 2024. Next review due January 2027.

• About breast reconstruction Cancer Research UK
• Breast Reconstruction After Mastectomy National Cancer Institute
• Breast Reconstruction Macmillan Cancer Support
• Breast Reconstruction Options American Cancer Society