Breast Cancer Reconstruction

Overview

Reconstruction after breast cancer surgery aims to restore shape and symmetry, and is planned alongside the cancer treatment rather than after it. It may be carried out at the same operation as the mastectomy (immediate) or later (delayed), and may use the body's own tissue, an implant, or both. Reconstruction does not treat the cancer and does not interfere with its treatment; the oncological plan comes first, and the reconstruction is fitted around it.

Common procedures

• Pedicled TRAM flap (pTRAM) — skin and fat from the lower abdomen, transferred on its own blood supply through the chest wall to rebuild the breast.
• Pedicled latissimus dorsi flap (pLD) — muscle, fat and skin from the back, rotated to the chest, often combined with an implant where more volume is needed.
• Breast implant reconstruction — reconstruction using a tissue expander followed by an implant, or a direct-to-implant approach where the skin envelope allows.
• Post-BCT reconstruction — correction of the contour defect, asymmetry and firmness that can follow breast-conserving therapy and radiotherapy.
• Autologous fat transfer — the patient's own fat, harvested by liposuction and grafted to refine contour, soften edges and correct small defects, usually over more than one session.
• Nipple reconstruction — rebuilding the nipple with local tissue, usually several months after the breast mound has settled.
• Areola tattooing — medical pigmentation to match the colour of the areola, as the final stage.

Consultation & planning

Planning takes account of the cancer operation proposed, whether radiotherapy is expected, body shape and previous abdominal or back surgery, smoking, other medical conditions, and what matters most to the patient — appearance in clothes, symmetry, avoiding further scars, or the shortest possible recovery. Reconstruction is usually a sequence of operations spread over months, and that timeline is set out in full before anything begins. Work proceeds in coordination with the breast surgeon and oncology team.

Recovery

Implant-based reconstruction typically involves a hospital stay of a few days and four to six weeks before normal activity. Flap reconstruction is a longer operation with a stay of several days to a week, drains for one to two weeks, and six to eight weeks before full activity, with abdominal or back discomfort depending on the donor site. Fat grafting, nipple reconstruction and tattooing are shorter staged procedures. Final shape settles over six to twelve months.

Risks & considerations

Risks include bleeding, infection, delayed wound healing, partial or complete loss of a flap, and donor-site problems — abdominal weakness or bulge after a TRAM flap, shoulder stiffness and seroma after a latissimus dorsi flap. Implant reconstruction carries risks of capsular contracture, malposition, rupture, and the need for replacement over time; radiotherapy substantially increases the risk of capsule-related problems. Grafted fat is partly reabsorbed and sessions are commonly repeated. A reconstructed breast will not look or feel identical to the other side, and sensation is usually reduced. Reconstruction does not change the risk of the cancer returning, and surveillance continues as directed by the oncology team.

This page provides general information only and does not constitute medical advice. Suitability, benefits, limitations and risks of any procedure can only be determined at a medical consultation.