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It’s important to have an idea of what to expect after surgery to rebuild your breast, including the possible risks and side effects.

How long it takes you to recover from breast reconstruction surgery will depend on the type of reconstruction you have. Most women begin to feel better in a couple of weeks and can return to usual activities in a couple of months. Talk to your cancer care team about what you can expect.

Be sure you understand how to take care of your surgery sites and how to follow up with your breast care. Follow up care could include regular mammograms and other breast imaging tests, depending on the surgery you had.?

Possible risks during and after reconstruction surgery

Any type of surgery has risks, and breast reconstruction may pose certain unique problems for some women. Even though many of these are not common, some of the possible risks and side effects during or soon after surgery include:

• Problems with the anesthesia
• Bleeding
• Blood clots
• Fluid build-up in the breast or the donor site (for a tissue flap), with swelling and pain
• Infection at the surgery site(s)
• Wound healing problems
• Extreme tiredness (fatigue)

Problems that can develop later on include:

• Tissue death (necrosis) of all or part of a tissue flap, skin, or fat
• Loss of or changes in nipple and breast sensation
• Problems at the donor site, such as loss of muscle strength, bulging of the abdominal (belly) wall, and dimples in the skin
• The need for more surgery to fix problems that come up
• Changes in the arm on the same side as the reconstructed breast
• Problems with a breast implant, such as movement, leakage, rupture, rippling (when an implant or the skin over the implant wrinkles), or scar tissue formation (capsular contracture)
• Development of a rare type of cancer in the scar tissue around a breast implant
• Uneven breasts

Risks of infection

Infection can happen with any surgery, most often in the first couple of weeks after the operation. If you have an implant, it might have to be removed until the infection clears. A new implant can be put in later. If you have a tissue flap, surgery may be needed to clean the wound.

Risks of capsular contracture

The most common problem with breast implants is capsular contracture. A scar (or capsule) can form around the soft implant. As it tightens, it can start to squeeze the implant, making the breast feel hard and look distorted. Capsular contracture can be treated. Sometimes surgery can remove the scar tissue, or the implant can be removed or replaced.

Additional risks for women who smoke

Using tobacco narrows blood vessels and reduces the supply of blood, nutrients, and oxygen to tissues. Smoking can delay healing in any surgery and is linked to a higher chance of wound complications. This can cause more noticeable scars and a longer recovery time. Sometimes these problems are bad enough that a second operation is needed to fix them. You may be asked to quit smoking a few weeks or months before surgery to reduce these risks. This can be hard to do, so ask your doctor for help. Sometimes your plastic surgeon might choose to delay your surgery until you stop smoking. 

Recovering after reconstruction surgery

You’re likely to feel tired and sore for a week or 2 after implant surgery, or longer after a flap procedure (which will leave you with 2 surgical wounds). Your doctor will give you medicines to help control pain and other discomfort.

Depending on the type of surgery you have, you will most likely be able to go home from the hospital within a few days. You may be discharged with one or more drains in place. A drain is a small tube that’s put in the wound to remove extra fluid from the surgery site while it heals. In most cases, fluid drains into a little hollow ball that you’ll learn how to empty before you leave the hospital. The doctor will decide when the drains can be safely removed depending on how much fluid is collecting each day. Follow your doctor’s instructions on wound and drain care. Also be sure to ask what kind of support garments you should wear. If you have any concerns or questions, ask someone on your cancer care team.

Getting back to normal

Most women can start to get back to normal activities within 6 to 8 weeks. If implants are used without flaps, your recovery time may be shorter. Some things to keep in mind:

• Certain types of reconstruction surgery do not restore normal feeling to your breast, but in other types some feeling might return over time.
• It may take up to about 8 weeks for bruising and swelling to go away. Try to be patient as you wait to see the final result.
• It may take as long as 1 to 2 years for tissues to heal fully and scars to fade (the scars never go away completely).
• Ask when you can wear regular bras. Talk with your surgeon about the type of bra to wear – sometimes it will depend on the type of surgery you had. After you heal, underwires and lace in your bra might feel uncomfortable if they press on scars or rub your skin.
• Follow your surgeon’s advice on when to begin stretching exercises and normal activities, because it’s different with different types of reconstruction. As a basic rule, you’ll want to avoid overhead lifting, strenuous sports, and some sexual activities for 4 to 6 weeks after reconstruction. Check with your surgeon for specific guidance.
• Women who have reconstruction months or years after a mastectomy may go through a period of emotional adjustment once they’ve had their breast reconstructed. Just as it takes time to get used to the loss of a breast, it takes time to start thinking of the reconstructed breast as your own. Talking with other women who have had breast reconstruction might be helpful. Talking with a mental health professional might also help you deal with anxiety and other distressing feelings.
• Silicone gel implants can open up or leak inside the breast without causing symptoms. Surgeons usually recommend getting regular magnetic resonance imaging (MRI) of implants to make sure they aren’t leaking. (This isn’t needed with saline implants.) You’ll likely have your first MRI 1 to 3 years after your implant surgery and every 2 years from then on, although it may vary by implant. Your insurance might not cover this. Be sure to talk to your doctor about long-term follow-up.
• Call your doctor right away if you notice any new skin changes, swelling, lumps, pain, or fluid leaking from the breast, armpit, or flap donor site, or if you have other symptoms that concern you.

Talk to your doctor about mammograms

Women who have had a mastectomy to treat breast cancer generally do not need routine screening mammograms on the side that was affected by cancer (although they still need them on the other breast). There isn’t enough tissue remaining after a mastectomy to do a mammogram. Cancer can come back in the skin or chest wall on that side, but if this happens it’s more likely to be found on a physical exam.

It’s possible for women with reconstructed breasts to get mammograms, but experts agree that women who have breast reconstruction after a mastectomy don’t need routine mammograms. Still, if an area of concern is found during a physical exam, a diagnostic mammogram may be done. (Ultrasound or MRI may also be used to look at the area closely.)

If you’re not sure what type of mastectomy you had or if you need to have mammograms, ask your doctor.