Breast reconstruction can help restore the look of the breast after a mastectomy. The surgery is done by a plastic surgeon. Although most breast reconstruction is done in women, men may get reconstruction if they wish.
Timing of breast reconstruction
Breast reconstruction can be done at the same time as the mastectomy (“immediate”) or at a later date (“delayed”).
Many women now get immediate breast reconstruction. However, the timing depends on:
- Physical exam by the plastic surgeon
- Surgical risk factors, such as smoking and being overweight
- Treatments you will need after surgery
Not all women can have immediate reconstruction.
Discuss your options with your plastic surgeon, breast surgeon and oncologist (and your radiation oncologist if you are having radiation therapy).
Benefits of breast reconstruction
Breast reconstruction may help you feel more comfortable about how you look after a mastectomy.
Although a reconstructed breast will never match the look or feel (sensation) of your natural breast, this area of plastic surgery continues to improve.
Possible challenges of breast reconstruction
You may not live near the hospital where the reconstruction will be done. This can be a challenge because of the number of follow-up visits needed after reconstruction. Most breast reconstruction methods involve several steps.
Immediate reconstructions and some delayed reconstructions require a hospital stay for the first procedure. Follow-up procedures may be done on an outpatient basis.
If you need transportation, lodging, child care or elder care, there may be programs that can help.
Federal law requires most insurance plans to cover the cost of breast reconstruction after a mastectomy.
Learn more about insurance and breast reconstruction.
Choosing the type of breast reconstruction that’s right for you
Breast reconstruction can be done with:
- Breast implants (filled with saline or silicone)
- Natural tissue flaps (using skin, fat and sometimes, muscle from your own body)
- A combination of these methods
There’s no one breast reconstruction method that works best for everyone. You may be a good candidate for one reconstruction method, but not another. There are pros and cons to each method.
For example, breast implants require less invasive surgery than procedures using your own body tissues, but the results may look and feel (have sensation) less natural .
It’s important to keep in mind multiple factors determine the best reconstruction method for you, as well as the final result.
Your body shape and anatomy may affect the types of breast reconstruction likely to give you the best results.
For example, women with larger breasts may need breast reduction surgery on the opposite, natural breast to create a more even look.
Your lifestyle may affect the type of reconstruction you choose.
For example, some types use muscles from other parts of the body, causing weakness in the area. These may not be good options for athletic women or women who rely on those muscles to function.
Some women with chronic medical conditions or suppressed immune systems may not be good candidates for breast reconstruction.
Smoking and body weight
Smokers and women who are overweight have an increased risk of complications for all types of breast reconstructive surgery [8,180-183].
If you smoke or are overweight, talk with your plastic surgeon about problems that may occur after surgery with implant or flap procedures, such as delayed wound healing, infection and reconstruction failure.
Sometimes, it’s best to delay breast reconstruction until after quitting smoking or losing weight to lower these risks.
Your plastic surgeon or health care provider may discuss ways to quit smoking and/or lose weight before you have reconstruction.
Making an informed choice
Each person is unique. Your breast cancer treatment, your body, your breast shape and your lifestyle affect not only your reconstruction options, but also the pros and cons of your options.
Your plastic surgeon will help you choose the type of reconstruction that will give you the best results and fit your lifestyle, while minimizing the risk of complications.
Study your options and make a thoughtful, informed choice after carefully considering the pros and cons of each option.
Although this decision may seem overwhelming, it may help to know most women who’ve had breast reconstruction don’t regret the method they chose [184-186].
If you’re a good candidate for a procedure, there are fairly few complications with any of the current methods .
Choosing to go flat
You can choose not to have breast reconstruction. If you decide not to have breast reconstruction, you can have a flat closure after a mastectomy by the breast surgeon. This is also called going flat.
Learn more about going flat.
Getting a second opinion
It’s always OK to get a second opinion. Your plastic surgeon shouldn’t discourage you from getting a second opinion.
Getting a second opinion from a plastic surgeon from a different hospital or group practice can:
- Instill confidence in the first plastic surgeon by confirming your reconstructive options
- Give another perspective on your reconstructive options
- Give you a chance to meet with another plastic surgeon, who may be better suited to perform your surgery
However, getting a second opinion shouldn’t delay your breast cancer treatment.
Learn more about getting a second opinion.
Basic types of breast reconstruction
The table below compares the basic types of breast reconstruction.
Specific types of reconstruction are discussed in more detail below.
Natural tissue flaps
Mimic the look and feel (to the touch) of a natural breast
Less able to mimic the look and feel of a natural breast (silicone implants look and feel more natural than saline implants)
Better able to mimic the look and feel of a natural breast
Loss of sensation (feeling)
Will lose most sensation in the breast
Will lose most sensation in the breast and in the area of the body where tissue was taken to create the reconstructed breast
Is a hospital stay needed?
Will the procedure need to be repeated?
Implants may need to be replaced in your lifetime.
Tissue flaps won’t need to be replaced in your lifetime.
However, if there are complications, some procedures can’t be repeated.
Risk of complications
Risk of complete reconstruction failure
Adapted from selected sources [179,187-188].
Reconstruction using a breast implant is the least invasive breast reconstruction procedure.
It may not require extra time in the hospital if it can be done at the same time as the mastectomy.
The shape of the reconstructed breast with an implant may not match the look or feel (to the touch) of the natural, opposite breast over time. The natural breast will change in size and shape with weight changes and as you grow older, while the breast implant will not change. This may lead to a less even look. More surgery may be needed to maintain a similar look.
For this reason, implants are better for women with small or medium-sized breasts with little or no sagging .
If the shape of the reconstructed breast does not match the natural, opposite breast, it’s possible to have surgery to enlarge or reduce the size of the opposite, natural breast to help make your breasts look more alike.
Learn about managing pain after reconstructive surgery.
Natural tissue flap surgery
Reconstruction using skin and soft tissue flaps from your own body tends to mimic the look and feel (to the touch) of a natural breast better than reconstruction with implants.
However, natural tissue flap procedures are more invasive and complex than reconstruction with implants. So, they usually require a longer hospital stay and a longer recovery time.
These procedures require surgery to the area of the body where the tissue for the reconstruction is taken (donor site). The surgery will leave scars at the donor site.
The most common natural flap procedures use tissue from the abdomen or back. Flaps can also be taken from the buttocks or thighs (a microvascular surgeon is needed for these surgeries).
In some procedures, part or all of a muscle needs to be taken from the donor site to provide blood flow to the flap tissue. This may cause weakness in that area of the body and limit certain physical or athletic activities. If you’re active, discuss this risk with your plastic surgeon.
Learn about managing pain after reconstructive surgery.
Some of the lymph vessels can become blocked when axillary lymph nodes are removed during breast surgery (with sentinel node biopsy or axillary dissection) or are treated with radiation therapy. This may prevent lymph fluid from leaving the tissue in your arm below the area where the lymph nodes were removed.
Lymphedema occurs when lymph fluid collects in your arm, causing it to swell (edema). Lymphedema can also occur in your hand, fingers, chest/breast or back.
Lymphatic surgery to reduce the risk of lymphedema
Lymphatic surgery is an emerging field. The goal of lymphatic surgery is to prevent or treat lymphedema.
Lymphatic surgery is performed by trained plastic surgeons using microsurgery and supermicrosurgery techniques.
Preventive lymphatic surgery involves connecting lymphatic channels to nearby veins. This procedure is called lymphatic microsurgical preventing healing approach (LYMPHA) . It may be done at the time of axillary lymph node dissection in people at high risk of lymphedema.
Learn more about lymphedema.
If you’re having immediate breast reconstruction, your surgeon may perform a skin-sparing mastectomy to keep as much of the skin of the breast as possible.
With a skin-sparing mastectomy, the tumor and clean margins are removed, along with the nipple, areola, fat and other tissue that make up the breast.
What remains is much of the skin that surrounded the breast. This skin can then be used to cover a tissue flap or an implant.
The major benefit of a skin-sparing mastectomy is that it avoids having to use skin from other parts of the body for reconstruction. That skin can have a different color, texture and thickness compared to natural breast skin, creating a “patch” look.
In the past, there were concerns skin-sparing mastectomy might increase the risk of breast cancer recurrence. However, most studies to date have not found an increased risk and the procedure is considered safe [8,205-208].
Nipple and areola reconstruction
Creating the nipple and areola is the last surgical step of breast reconstruction (if you choose to do this procedure).
These procedures give the reconstructed breast a more natural look and can help hide some of the mastectomy scars.
Nipple and areola reconstruction are usually outpatient procedures and have few risks . However, those who have had radiation therapy may have more surgical risks, and these procedures may not be recommended.
Methods of recreating the nipple and areola
The nipple can be recreated using skin from the reconstructed breast itself after the implant or tissue flap reconstruction has healed.
The areola can be created with a tattoo or by grafting skin from the groin area. Skin in the groin area may have a similar tone as the skin on the areola. The scar from where the skin is taken can be hidden in the bikini line.
Not all women can have these procedures.
Women who can’t have nipple reconstruction surgery (or choose not to have it) can consider a 3-dimensional (3D) tattoo to create the look of the nipple and areola.
It’s a good idea to check with your insurance company before getting a 3D tattoo, as this step may not be covered.
Read our blog, Corina’s Story: Breast Cancer Inspired Me to Help Others.
A nipple-sparing mastectomy is a skin-sparing mastectomy that leaves the nipple and areola intact. This usually improves the overall look of the reconstructed breast.
For women who are good candidates for nipple-sparing mastectomy, the risk of breast cancer recurrence appears to be low [209-213].
Learn about clinical trials of breast reconstruction.
Who can have a nipple-sparing mastectomy?
Not everyone can have a nipple-sparing mastectomy. For example, if the breast cancer is close to the nipple and areola, the nipple and areola are removed during surgery (to make sure all of the tumor is removed).
Nipple-sparing mastectomy is an option for [8,209-210,214-215]:
- Some women with breast cancer who have small breasts and clean margins in the nipple area at the time of surgery
- Women having a risk-reducing (preventive) mastectomy
Some women are not good candidates for nipple-sparing mastectomy because of the size and/or shape of their natural breasts. For example:
- Women with large, sagging breasts may not be good candidates. These women may have an increased risk of the nipple moving out of position after surgery and an increased risk of nipple tissue loss due to a poor blood supply. Also, the excess skin may cause unevenness and problems with shaping the breast reconstruction.
- Women with uneven breasts or uneven nipple positions before surgery (naturally or due to past surgery near the nipple and areola) may not be good candidates as the unevenness may become worse.
- Women getting radiation therapy after nipple-sparing mastectomy may not be good candidates as radiation therapy may change the nipple position.
Some women who are poor candidates for nipple-sparing mastectomy due to the large, sagging shape of their natural breasts may have the option of getting breast reduction first, healing completely and then having a nipple-sparing mastectomy and reconstruction. However, this is only possible in the risk-reducing (preventive) mastectomy setting.
After a nipple-sparing mastectomy
With nipple-sparing mastectomy, the nipple will likely lose sensation and some projection. Sometimes, the position of the nipple can move after surgery.
In some cases, the tissue may lose its blood supply and become nonviable (the tissue dies), and some or all of the nipple and areola may need to be removed .
After breast reconstruction
Most women feel tired and sore for several weeks after breast reconstruction. Your surgeon or plastic surgeon may prescribe medications to ease the pain. You will need to limit upper body and arm activities after surgery.
Talk with your plastic surgeon about specific instructions after surgery.
You may need to wear a special bra while your reconstructed breast heals.
For some types of surgery, you may still have a small tube(s) called a surgical drain(s) in place when you go home from the hospital. This allows extra fluid from the surgery to escape.
You will learn how to take care of the drain(s).
Pain and discomfort after surgery
You will likely have some pain after surgery. For most people, this pain is temporary.
The bruising and swelling from the surgery may take up to 8 weeks to go away .
Starting after the mastectomy, you will be numb across your chest, from your collarbone to the top of your rib cage. Unfortunately, this numbness usually doesn’t go away. You may get some feeling back over time, but it will never be the same as before surgery.
Learn about managing pain after surgery.
Getting back to your normal routine
Talk with your health care provider about activities to avoid and when you can get back to your normal routine.
Although breast reconstruction techniques continue to improve, a reconstructed breast will never look or feel (have the same sensation) the same as your natural breast.
After the mastectomy, you will be numb across your chest (from your collarbone to the top of your rib cage). Unfortunately, this numbness usually doesn’t go away completely. You typically get some feeling back over time, but it will never be the same as before surgery. Researchers are studying whether the use of nerve grafts may improve breast sensation after mastectomy and breast reconstruction.
It’s important to have a realistic expectation of the final look of the breast. Reconstruction results vary and depend on the quality of the tissue left after a mastectomy.
How your reconstructed breast will look and feel (to the touch) depends on many factors including your natural breast anatomy and your treatment plan.
Sometimes, the types of treatments you will have (for example, radiation therapy) limit your reconstruction options and can impact the final look and feel of your reconstructed breast.
This can be upsetting. However, the goal of treatment is to get rid of the breast cancer and keep it from coming back.
Your plastic surgeon will help you choose the reconstruction method that will give you the best results. Keep in mind, your overall health and breast cancer treatment come first.
Final look of the breast
It will take some time to see the final results of your reconstructed breast.
How you feel about the final results may depend on your expectations. A reconstructed breast will never look or feel (to the touch) the same as a natural breast.
Most of the scarring will fade and improve over time, but it doesn’t go away completely.
As you age and the opposite breast changes shape, the reconstructed breast may look and feel less natural.
Most women have a period of emotional adjustment after breast reconstruction. Feeling anxious or depressed is common. Give yourself time and be gentle with yourself.
You may feel many different emotions. You may be grieving the loss of your natural breast(s). You may be concerned about your appearance and feel vulnerable for a period of time.
You may not feel like being intimate or having sex as you adjust to the look and feel of your new breasts. It may help to talk with your partner about your feelings.
Social support can help with the emotional impact of breast reconstruction. It may help to talk with a counselor or other women who’ve had breast reconstruction.
Susan G. Komen® Support Resources
Insurance coverage for reconstructive surgery
Medicare and Medicaid
- Medicare is health insurance provided by the federal government to people 65 and older. It covers breast reconstruction after a mastectomy.
- Medicaid provides health care to people with low income. It’s run jointly by the federal and state governments, so benefits and eligibility (who can join) vary from state to state.
Many states require all health insurance companies, including Medicaid, to cover breast reconstruction after a mastectomy (learn more).
Women’s Health and Cancer Rights Act
- Reconstruction of the breast removed with a mastectomy (all types)
- Surgery and reconstruction of the opposite breast to get a symmetrical look
- Breast prostheses
- Treatment of any complications of surgery, including lymphedema
The Women’s Health and Cancer Rights Act doesn’t apply to some church and government insurance plans.
Many states require all health insurance companies (including those not covered under the Women’s Health and Cancer Rights Act) to pay for reconstructive surgery after a mastectomy.
Check with your state insurance commissioner’s office or your health insurance company to find out which services are covered by your state’s laws and your health plan.
Transportation, lodging, child care and elder care assistance
You may not live near the hospital where you’ll have your surgery.
Sometimes, there are programs that help with local or long-distance transportation and lodging. Some also offer transportation and lodging for a friend or family member going with you.
There are also programs to help with child and elder care costs. A social worker or patient navigator may be able to help you find programs and resources.
Komen Financial Assistance Program
Susan G. Komen® created the Komen Financial Assistance Program to help those struggling with the costs of breast cancer treatment by providing financial assistance to eligible individuals.
Funding is available for eligible individuals undergoing breast cancer treatment at any stage or living with metastatic breast cancer (stage 4).
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Questions you may want to ask your plastic surgeon
- What types of breast reconstruction can I have?
- Which type is best for me and why?
- When is the best time for me to have breast reconstruction — at the time of the mastectomy or later? Is there a time limit for having reconstruction done?
- How many procedures are involved in the type of reconstruction I’m having?
- How many hospital stays are needed? How long will each hospital stay be?
- If I need to have radiation therapy after my mastectomy, how will that affect my reconstruction options and cosmetic outcomes?
- How many of these procedures have you performed?
- Would you please show me photos of both your best and your more typical results?
- What are the chances of infection and failure with my reconstructive surgery? Are there other possible complications or side effects to consider?
- If I have implant reconstruction, am I at risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)?
- What are the short-term and long-term results with implant versus natural tissue reconstruction?
- Will I have a surgical drain in place when I go home? If so, how will I care for it? When will it be removed?
- What can I expect regarding pain after surgery?
- Will I have any numbness after surgery?
- What side effects might I expect after surgery? What problems should I report to you right away?
- What restrictions will I have on my activities after the surgery? For how long?
- Where will the surgical scar(s) be?
- What body changes should I expect after surgery?
- How can I expect the reconstructed breast to look and feel? How will it look compared to my natural breast?
- Will I be able to detect a possible return of cancer after reconstructive surgery?
- What breast cancer screening is recommended for me?
Learn more about talking with your health care provider.
If you’ve been recently diagnosed with breast cancer or feel too overwhelmed to know where to begin to gather information, Susan G. Komen® has a Questions to Ask Your Doctor About Breast Reconstruction resource that might help.
You can download and print it to bring with you to your next doctor’s appointment or you can save it on your computer, tablet or phone using an app such as Adobe. Plenty of space and a notes section are provided to write or type the answers to the questions.
There are other Questions to Ask Your Doctor resources on many different breast cancer topics you may wish to download.
Susan G. Komen® Breast Care Helpline
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BreastCancerTrials.org in collaboration with Komen offers a custom matching service to help find clinical trials on breast reconstruction that fit your needs.
Learn more about clinical trials and find a list of resources to help you find a clinical trial.
Read our perspective on clinical trials.*
* Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date.