After a mastectomy, some women choose to have cosmetic surgery to re-create their breast. This surgery can be performed during mastectomy itself or later.

The breast is usually reshaped in 2 stages, first using a tissue expander and then placement of a saline implant. Sometimes the implant can be inserted in the first stage.

If you are having reconstruction at the same time as your mastectomy, your surgeon may do a skin sparing mastectomy. This means only the area around your nipple and areola is removed and more skin is left to make reconstruction easier.

If you will have breast reconstruction later, your surgeon will remove enough skin over your breast during the mastectomy to be able to close the skin flaps.

Breast reconstruction with implants is usually done in 2 stages. You will receive general anesthesia (asleep and pain free).

In the first stage:

• Your surgeon will place a small tissue expander under your chest muscle and skin. The expander is a pouch made out of silicone, similar to a balloon.
• Your chest will still look flat right after this surgery.
• Starting about 2 to 3 weeks after surgery, you will see your surgeon every 1 or 2 weeks. During these visits, your surgeon will inject a small amount of saline (salt water) through your skin into the pouch through a valve.
• The pouch or tissue expander slowly enlarges the pouch in your chest to the right size for the surgeon to place an implant.
• When it reaches the right size, you will wait 1 to 3 months before the permanent breast implant is placed (the second stage).

In the second stage:

• Your surgeon will remove the tissue expander from your chest and replace it with a breast implant. This surgery takes 1 to 2 hours.
• Before this surgery, you will have talked with your surgeon about the different kinds of breast implants. Implants may be filled with either saline or a silicone gel.

You may have another minor procedure later that remakes the nipple and areola area.

You and your doctor will decide together about whether to have breast reconstruction, and when.

Having breast reconstruction does not make it harder to find a tumor if your breast cancer comes back.

Getting breast implants does not take as long as breast reconstruction (which uses your own muscle tissue). You will also have fewer scars. But the size, fullness, and shape of the new breasts are more natural with reconstruction that uses muscle tissue.

Many women choose not to have breast reconstruction or implants. They may use a prosthesis (an artificial breast) in their bra that gives them a natural shape, or they may choose to use nothing at all.

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Infection, including in the surgical wound, lungs (pneumonia), bladder, or kidney
• Blood loss
• Heart attack or stroke during surgery
• Reactions to medicines

The risks for breast reconstruction with implants are:

• The implant in 1 out of every 10 women will break or leak in the first 10 years. If this happens, you will need more surgery.
• A scar may form around the implant in your breast. If the scar becomes tight, your breast may feel hard and you may have pain or discomfort. This is called capsular contracture. You will need more surgery if this happens.
• Infection soon after surgery. This would require removal of the expander or the implant.
• Breast implants can shift some. This will cause a change in the shape of your breast.

Always tell your doctor or nurse if you are taking any drugs, supplements, or herbs you bought without a prescription.

During the week before your surgery:

• Several days before surgery, you may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and other drugs like these.
• Ask your doctor which drugs you should still take on the day of surgery.

On the day of your surgery:

• Do not eat or drink anything after midnight the night before surgery.
• Take your drugs your doctor told you to take with a small sip of water.
• Shower the night before or the morning of surgery.
• Your doctor or nurse will tell you when to arrive at the hospital.

You may be able to go home the same day as the surgery, or you may need to stay in the hospital for 1 or 2 days.

Results of reconstruction surgery are usually very good. It is nearly impossible to make a rebuilt breast look exactly the same as the remaining natural breast. You may need more operations for the result you want.

Reconstruction will not restore normal sensation to the breast or the new nipple.

Having cosmetic surgery after breast cancer can improve your sense of well-being and your quality of life.

Burns JL, Blackwell SJ. Plastic surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 73.

Wilhelmi BJ, Phillips LG. Breast reconstruction. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 35.