As a breast reconstruction patient, you’re going through an intense and emotional time. You’re losing your breast(s) and starting over again. This can be a scary process, but it’s also an opportunity to start fresh and learn how to take care of yourself in new ways.
You’ll have to juggle a lot of different feelings as you go through this transition. You may be worried about how others will react to your new body and the way you look now. You might be scared that your scars will be too visible or that they’ll hurt when you touch them or put on clothes. You might feel really excited about what’s happening with your body, but also nervous that something won’t go according to plan—or worse, that nothing will happen at all!
We hope that this blog helps answer some questions about problems with breast reconstruction after mastectomy and recovery time for second stage breast reconstruction
After Breast Reconstruction What To Expect
Your Recovery
Breast reconstruction is surgery to rebuild the shape of your breast after you’ve had part or all of your breast removed because of cancer. You may have had a tissue expander or an implant placed during the surgery. If an expander was placed, salt water (saline) or air was added to it to start stretching your skin.
Right after the surgery, you will probably feel weak, and you may feel pain for 2 to 3 weeks. You may have a pulling or stretching feeling in your breast area. You can expect to feel better and stronger each day, although you may need pain medicine for a week or two. You may get tired easily or have less energy than usual. This may last for several weeks after surgery.
You will likely have several drains near your incision. These help with healing. The drains will be removed when the fluid buildup slows. Drains are usually removed in the first few weeks after surgery.
Stitches usually are removed in 5 to 10 days.
If you had an expander placed, you will need to regularly see your doctor every couple of weeks. During these visits, more salt water will be added to the expander. Or if you have an expander that uses air, you may need to add air at home. After several months, this will stretch the skin enough to cover the implant.
Your new breast may feel firmer and look rounder or flatter than your other breast. The new breast may not have the same shape as your breast did before it was removed. Breast reconstruction with an implant won’t restore normal feeling to your breast. It may take several months for your breast to heal.
This care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace. Follow the steps below to get better as quickly as possible.
How can you care for yourself at home?
Activity
Rest when you feel tired. Getting enough sleep will help you recover.
For about 6 weeks after surgery, avoid lifting anything that would make you strain. This may include a child, heavy grocery bags, milk containers, a heavy briefcase or backpack, cat litter or dog food bags, a vacuum cleaner, or anything that weighs more than 4.5 to 7 kilograms (10 to 15 pounds). Do not lift anything over your head for 3 to 6 weeks.
You may have pain for a few weeks after surgery. Support the area with your hands or a firm pillow when you bend, cough, or move.
Ask your doctor when you can drive again.
Ask your doctor when it is okay for you to have sex.
You can take your first shower the day after the drain near your incision is removed. This is usually in about 1 week. Do not take a bath or soak in a hot tub for about 4 weeks.
You will probably be able to go back to work or your normal routine in 3 to 6 weeks. This depends on the type of work you do and any further treatment.
Diet
You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
Drink plenty of fluids (unless your doctor tells you not to).
You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fibre supplement. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.
Medicines
Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
If you take aspirin or some other blood thinner, ask your doctor if and when to start taking it again. Make sure that you understand exactly what your doctor wants you to do.
Take pain medicines exactly as directed.
If the doctor gave you a prescription medicine for pain, take it as prescribed.
If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
If you think your pain medicine is making you sick to your stomach:
Take your medicine after meals (unless your doctor has told you not to).
Ask your doctor for a different pain medicine.
If you were given medicine for nausea, take it as directed.
If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
Incision care
If your doctor gave you specific instructions on how to care for your incision, follow those instructions.
You may be wearing a special bra that holds your bandages in place after the surgery. Your doctor will tell you when you can stop wearing the bra. Your doctor may want you to wear the bra at night as well as during the day for several weeks. Do not wear an underwire bra for 1 month.
If you have strips of tape on the incision, leave the tape on for a week or until it falls off.
Wash the area daily with warm, soapy water, and pat it dry. Don’t use hydrogen peroxide or alcohol, which can slow healing.
You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage 1 to 2 times every day. Consider having someone help you with this.
Keep the area clean and dry.
Drain care
You may have one or more drains near your incision. Your doctor will tell you how to take care of them.
Exercise
Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia, constipation, and blood clots in your legs.
Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay. This includes housework, especially if you have to use the arm on the side of your surgery.
Your doctor will tell you when to begin stretching exercises and normal activities.
Elevation
Prop up the arm on the side of your surgery on a pillow when you sit or lie down. Try to keep your arm above the level of your heart. This will help reduce swelling.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.
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.
Breast Reconstruction
Medically Reviewed by Stephanie S. Gardner, MD on March 25, 2022
Is Breast Reconstruction Right for Me?
Is It Cosmetic Surgery?
When’s the Best Time to Have Breast Reconstruction?
What Are the Different Reconstruction Options?
How Long Does Breast Reconstruction Surgery Take?
More
If you’ve had a mastectomy because of breast cancer, you may choose to have reconstructive plastic surgery. It can restore balance between the two breasts by replacing skin, breast tissue, and the removed nipple.
The amount of reconstruction will depend on the mastectomy and the width, size, and location of the removed tumor.
Is Breast Reconstruction Right for Me?
The idea of living without a breast or without part of one affects each woman differently. It’s a personal decision, and it’s often not easy to make.
You don’t have to have reconstruction. You can wear external breast forms or pads, or change nothing at all.
Plastic surgery now gives better results than ever before. You can have breast reconstruction using breast implants or your own tissue.
The operation changes your appearance, but it can have psychological benefits as well. It can add to a sense of wellness for you and your family.
Is It Cosmetic Surgery?
Restoring a breast isn’t considered a cosmetic procedure. It’s reconstructive surgery. Since it’s considered part of the treatment of a disease, the law says insurance providers must provide coverage.
When’s the Best Time to Have Breast Reconstruction?
The timing is based on what you want to do, your medical conditions, and your cancer treatment. You can have it done during the operation to remove the breast, or you can have it months or years after a mastectomy.
If you’ve started chemotherapy or radiation treatments, reconstruction is usually put off until they’re finished. Your surgeon can help you decide the best timing for you.
What Are the Different Reconstruction Options?
Before you decide, you and your doctor will need to discuss your wants and needs, your medical condition, and any previous surgery.
Implants involve stretching the skin with a tissue expander that goes inside your body and then inserting a silicone-gel or saline (saltwater) implant weeks later. The tissue expander is filled to a certain volume by adding saline, usually once a week for a few sessions. You may have some pain, but many women are pleased with the final result.
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Implants can rupture, causing pain and infection. You may need surgery to remove or replace them.
TRAM flap procedures use the tissue from a woman’s abdomen to create a mound to reconstruct the breast. In general, this means cutting away at least some of your stomach muscles, fat and blood supply to use for the reconstruction.
Sometimes, the tissue that’s being moved is kept attached to its blood supply. This is called a pedicle or tunneling procedure. The flap has a better chance of surviving because the blood supply remains in place, but the breast may not look exactly the way you want.
In a free-flap procedure, the tissue is disconnected and then attached to a blood supply near the new location. This is a more complicated procedure. The biggest risk is that the blood vessels may get clogged and the flap might die. The benefit is that the reconstruction looks more like a natural breast.
A new version of the procedure, called the muscle sparing free TRAM flap, cuts away far less abdominal muscle. This often makes for a quicker recovery and less risk of losing core strength after surgery.
For all TRAM surgeries, you can expect a scar across your belly from one hip to the other, typically below the bikini line. You might also notice a flatter and tighter stomach because of the missing fat, skin, and muscle. The surgery lasts from 4 to 8 hours and you usually stay in the hospital for about 5 days total. Your health care provider will give you detailed instructions on how best to care for your surgical wounds after surgery. It should take 6 to 8 weeks to fully recover from your surgery.
Though it’s the most common flap procedure, TRAM flap isn’t for everyone. It may not be for you if you:
Have had numerous prior surgeries in the belly area
Are especially thin or don’t have enough extra belly tissue
Are concerned about losing core strength, especially in lower abdomen
In addition, talk to your doctor if you plan to become pregnant as the TRAM surgeries could be a problem in some cases.
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Other, less common tissue flap procedures use tissue from different areas. Taking tissue from the back is called a latissimus dorsi flap.
Aesthetic flat closure (AFS) may be considered. This is a surgical repair procedure that removes or rearranges excess breast skin and fat after a mastectomy. This corrects contour deformities and can be done at the time of mastectomy or as a second procedure. If needed, fat grafting can also be done for the best cosmetic outcome.
The shape, feel, and contour of a breast made from a woman’s own tissue are more like those of a natural breast. But flap surgery is more involved than implant surgery. And, as with all major surgeries, you could have complications, such as bleeding, infection, or poor healing.
You may want to think about nipple reconstruction, too. Usually, the nipple and areola (the dark area around the nipple) are removed during the mastectomy to lower the chance of cancer returning.
Nipple reconstruction is typically an outpatient procedure done with local anesthesia. You may have it after breast reconstruction. This allows the new tissue to heal and settle into place. Your doctor can make small changes in size and position of the breast when the nipple and areola are rebuilt.
Surgeons can make a nipple out of tissue taken from the back or abdominal flap. It’s then tattooed to resemble the color of a nipple.
In rare cases, the nipple from the original breast can be reattached, but only if the surgeon is convinced that the tissue is cancer-free. Because of a lack of nerve connections, the nipple won’t rise or flatten in response to touch or temperature.
A prosthetic nipple is another option. The plastic surgeon makes a copy of your natural nipple and colors the areola. It can be glued to the breast and re-glued every week or so.
How Long Does Breast Reconstruction Surgery Take?
Preparation for the procedure, including anesthesia, may take 2 hours. The reconstruction will take 1 to 6 hours.
After the surgery, you’ll spend about 2 to 3 hours in recovery before being transferred to a hospital room.
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Recovery From Breast Reconstruction Surgery
You may have some discomfort for the first few days afterward. You’ll get pain medication as needed. Throughout your hospital stay, the staff will closely watch you.
Soon after surgery, you’ll be encouraged to move your arms, but not for any forceful activity like pulling yourself up, getting out of bed, or lifting heavy objects. Nurses will help you in and out of bed. The day after surgery, you may be able to sit in a chair beside the bed. On the second day, most patients are walking without help.
You’ll probably get IV fluids for a day or two. You may have a urinary catheter overnight or until you can walk to the bathroom. And where the surgeon made cuts (the incision sites), you’ll have drains. If you go home with these drains in place, you’ll get instructions on how to care for them.
The length of your hospital stay depends on the type of operation and how your recovery goes. If you got implants, the average hospital stay is 1 to 2 days. Flap procedures may require a stay of 5 to 6 days.
Follow-Up Care for Breast Reconstruction
After you go home, you can expect some soreness, swelling, and bruising for 2 to 3 weeks. You may be told to put medications on the suture area or change bandages at home. Your plastic surgeon will advise you about showering, bathing, and wound care.
Most women return to regular activities within 6 to 8 weeks after surgery. It may be several weeks before you can do strenuous exercise.
The mastectomy and breast reconstruction will leave areas of numbness where the surgery was done. Instead of pain where the tissue was taken, you may feel numbness and tightness. In time, some feeling may return to your breasts. Most scars will fade over time.
The shape of your reconstructed breast will slowly improve.
You’ll need regular checkups at first. If you have a temporary expander, it will be expanded with saline once a week, on average, until the desired size is reached (usually within six to 10 office visits).
Keep doing self-exams of your breasts every month, and have an annual mammogram.
Breast reconstruction doesn’t change the chance of cancer coming back, and it generally doesn’t interfere with treatment. If the disease does come back, your medical team can still treat you with surgery, radiation, chemotherapy, and targeted therapy.
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What Are the Possible Side Effects?
Infection at the surgery site. As with any surgery, infection is a risk. An antibiotic will usually get rid of the infection.
Pain and discomfort. Your doctor will advise you on a pain relief medication. Some women have more pain than others.
Itching. The wound will itch as it heals. But no matter how strong the urge, avoid scratching it. Your doctor can recommend an ointment or cream to calm the itching.
Numbness or tingling. You may have these sensations because the nerves have been affected. They can last up to 12 months after surgery.
Fluid collection under the wound. Fluid may build up under the wound, even after your drainage tubes are removed several days after the operation. If there’s not much fluid, it may go away by itself. But if there’s a lot, your surgeon may have to drain the site using a needle and syringe.
Problems With Breast Reconstruction After Mastectomy
Surgery of any kind carries hazards. Breast reconstruction has the following risks:
Bleeding
fluid buildup near the operating table (called a seroma)
Infection
Clots of blood
a lot of scar tissue
Recovery Time For Second Stage Breast Reconstruction
The average surgery lasts between 2-4 hours, and the recuperation time is between 1-6 weeks. Although we advise avoiding any sort of intense activity for six weeks, modest activity can frequently start after four (consult with your doctor).