Breast reconstruction after a mastectomy is a vital part of recovery and rehabilitation after breast cancer. It is now an intrinsic part of breast cancer treatment (the most common reason for a mastectomy although there are other reasons). There are a number of ways that your breast can be reconstructed after a mastectomy. They can broadly be broken down into reconstruction using a breast implant, reconstruction using a combination of a breast implant and transferring your own tissue, and reconstruction using a transfer of your own tissue alone.

The exact option of reconstruction available to you will depend on a number of factors including if you have needed radiotherapy to your breast, the size and shape of your opposite breast if one or both breasts are being reconstructed, what tissue you have available that is suitable to transfer and use to reconstruct your breast and practical considerations such as local availability, recovery time, time off work. Breast reconstruction may be immediate (done at the time of your mastectomy) or delayed (done at a later stage and after any chemotherapy or radiotherapy needed). A second stage to further adjust the reconstruction size or shape or to reshape or resize the opposite breast to achieve a better match is often needed.

Reconstruction using an implant is best for small to medium-sized breasts that have not undergone radiotherapy. It may be necessary to expand (stretch out gradually) your chest skin with a tissue expander before placing the planned implant if performed sometime after your mastectomy. The mastectomy scar can be used to place the implant and no additional scars or surgery areas are needed. Further surgery will be needed in the future to replace the implant when it reaches the end of its lifespan (long-term rather than life-long device).

Reconstruction using a combination of an implant and your own tissue e.g. skin and latissimus dorsi muscle from your back can be used to reconstruct a medium to the large breast. The tissue from your back gives additional padding over the implant and therefore a softer feel and shape to your breast and also adds some volume to achieve a slightly larger breast.

Reconstruction using your own tissue alone is better for breasts that have undergone radiotherapy and larger breasts. Although it too has size limits and it can also be used to reconstruct small and medium-sized breasts. Common areas to donate tissue (flaps) to reconstruct breasts include your abdomen (DIEP and TRAM flaps), thighs (TUG and PAP flaps), back (latissimus dorsi flap), and bottom (SGAP and IGAP flaps). Apart from the back tissue, these tissues are detached from the donor area and reattached using microsurgery to your chest blood vessels and shaped into a breast shape. While these are long operations, once any adjusting operations for size and shape are done, no future surgery is anticipated and soft, natural feeling and looking breasts can be created for the long term.

Symmetrising surgery (surgery to match your opposite breast in size and/or shape) may be carried out at the same time or separately at a later stage. Nipple reconstructions can be carried out under local anaesthesia.

Light dressings and a support bra will be needed afterward. Support bras are usually advised to be worn between one and three months after surgery. You will also be advised on the care of your breast scars while they heal and fade. If tissue transfers are done, you will have dressings and/or support garments for these areas too.