When you receive a breast reconstruction, it is important to know how long it takes to heal. In this guide, we review the aspects of How long does it take to heal after breast reconstruction, how painful is delayed breast reconstruction, recovery time for second stage breast reconstruction, and hardness in breast after reconstruction.
The recovery time following breast reconstruction surgery might vary depending on the kind of reconstruction, the patient’s general health, and their body’s innate capacity to heal. Although each person’s healing process may be different, the following is a broad outline of what to anticipate:
Immediate Postoperative Period: You will probably stay in the hospital for a few days following breast reconstruction surgery for monitoring and pain treatment. You may have drains in place to aid with fluid removal, and your surgical site(s) will be covered with dressings or bandages. You’ll receive advice on how to take care of your incisions, deal with any pain, and gradually resume your normal activities.
First Week: It’s crucial to relax and carefully adhere to your surgeon’s postoperative recommendations throughout the first week of recuperation. Swelling, bruising, and soreness in the chest region are possible side effects. Antibiotics and painkillers may be recommended to treat pain and lower the chance of infection. Heavy lifting and vigorous activity need to be avoided during this period.
Weeks two through four: Depending on their employment needs and the advice of their surgeon, most people can resume mild activities by the second or fourth week and perhaps return to work. The initial discomfort should progressively lessen, and swelling and bruising should start to go down. Your surgeon can check on your development and resolve any problems during follow-up visits.
Weeks 4 to 6: By this time, your breast(s) that have undergone reconstruction may be looking and feeling better. The incision scars should start to heal and swelling should continue to reduce. Your surgeon will advise you on scar maintenance and any suggested actions to speed up scar healing. You can gradually resume exercise and physical activities by following the recommendations of your surgeon.
Months two to three: With the surgeon’s permission, most people may resume their regular daily activities by this point, including exercise and more strenuous physical activity. The breast(s) will continue to settle and change in size and form after the edema has subsided somewhat. Your progress will be tracked at routine follow-up appointments with your surgeon, who will also address any lingering issues.
It’s crucial to remember that everyone’s recovery from breast reconstruction is different, and times may vary. It’s important to carefully adhere to your surgeon’s postoperative instructions, show up at all planned follow-up appointments, and share any changes or issues that crop up while you heal. In order to guarantee a good recovery process and assist you in getting the greatest outcomes from your breast reconstruction surgery, your surgeon will offer you individualized guidance and assistance.
how painful is delayed breast reconstruction
One in eight American women develop some form of invasive breast cancer in her lifetime, so these questions around whether and when to get reconstructive breast surgery are asked with regularity, says Frederick L. Durden Jr., MD, Plastic and Reconstructive Surgeon & Microsurgical Reconstructive Surgeon at Cancer Treatment Centers of America® (CTCA), Atlanta. But, he says, the answers are not always black and white. A variety of breast reconstruction options may be available and each patient must weigh the pros and cons before choosing the best fit for her breast cancer type and lifestyle. Some patients may not be candidates for reconstruction, while others may choose not to do it at all.
“Breast reconstruction can have a significant impact on a woman’s post-operative life,” says Dr. Durden. “For some women, it can greatly improve their ability to interact socially, to enjoy life, and it may reduce the stress caused by seeing surgical scars as a daily reminder of their cancer, so it may have a clear benefit. Choosing whether to do immediate or delayed reconstruction varies greatly based on a number of factors.”
The number of women opting for breast reconstruction after a mastectomy or lumpectomy has been rising steadily, though the data varies slightly by study. The U.S. Department of Health and Human Services’ Agency for Healthcare Research & Quality (AHRQ) reported that as of 2016, more than 40 percent of American women who underwent a mastectomy chose to have breast reconstruction, a jump from 27 percent nine years earlier.
Experts believe the increase may be attributed to psychosocial benefits, surgical advances and the Women’s Health and Cancer Rights Act of 1998 (WHCRA), a federal law requiring health insurers to cover breast reconstruction for those who opt for it following a mastectomy.
In this guide, we’ll cover the factors that typically are considered in deciding when to undergo breast reconstruction surgery, including:
Other considerations include the patient’s overall health, the stage of the cancer, and whether the patient will need radiation therapy.
If you’re interested in learning about breast reconstruction options at CTCA, or if you or a loved one is interested in getting a second opinion for a breast cancer diagnosis and treatment plan, call us or chat online with a member of our team.
Types of breast reconstruction
Generally speaking, there are two main options on when reconstructive surgery is performed:
Immediate reconstruction is done at the same time as the mastectomy or lumpectomy. It may be performed using breast implants or by taking tissue from another part of the body—usually the abdomen—to form a breast, or sometimes, a combination of the two. Immediate reconstruction is typically only an option for patients with early-stage disease.
Delayed reconstruction is performed in a different surgical procedure, weeks, months or even years after the mastectomy. One reason the oncologist and patient may opt for delayed reconstruction is to allow for time for the patient to complete chemotherapy and/or radiation therapy. This allows the patient to take more time to decide when, or if, to have reconstructive surgery.
In addition to these two options, there’s a third option that many women choose instead: a combination of the two, known as immediate-delayed breast reconstruction. In this procedure, the surgeon inserts a tissue expander to maintain the form of a breast at the time of the mastectomy or lumpectomy. The patient may undergo additional treatment, if needed, then undergo reconstruction later.
The tissue expander acts as a placeholder for the new breast. It gradually stretches the skin and muscle, creating a pocket in the skin and tissue of the chest wall to make sufficient room for the implant or reconstructed breast. Tissue expanders may be uncomfortable, and it may take months for the tissue to expand enough to allow for reconstruction.
Another option, of course, is to forego breast reconstruction altogether. “There’s an entire spectrum of women who do not have additional surgeries after their lumpectomy or mastectomy,” says Dr. Durden.
The advantages and disadvantages of immediate reconstruction
With an immediate reconstruction, the patient only has to undergo a single operation, meaning just one time under general anesthesia, and she doesn’t have to live without a breast, which may help some women with the psychological aspect of healing. “A mastectomy is body-changing surgery, and to come out of surgery with no breast may be very traumatic for many women,” Dr. Durden says. “We can talk about it, but actually seeing it is a different thing.”
Immediate surgery typically leaves fewer scars on the reconstructed breast, and in many cases, the nipple may be spared.
However, immediate reconstruction means a longer surgery, which requires taking the patient’s overall health into account. Smokers, or those who have co-morbidity conditions, such as diabetes or obesity, may be at an increased risk for complications.
Whether the patient needs radiation therapy also is a major consideration when it comes to the timing of breast reconstruction. According to breastcancer.org, some research indicates that a reconstructed breast may prevent some of the radiation dose from reaching the cancer.
Other risks for undergoing immediate breast reconstruction before radiation therapy include:
The advantages and disadvantages of delayed reconstruction
For patients who are uncertain about whether they want a breast implant or a new breast made from their own tissue, or they haven’t yet decided whether they want reconstruction, delaying the procedure is typically the preferred option. Some patients want time to recover from the cancer surgery before deciding about next steps for cosmetic purposes.
If radiation therapy is part of the treatment plan, delayed reconstruction is usually recommended for the reasons mentioned above.
Other advantages of delaying reconstruction include:
Should you choose implants or tissue transfer?
The vast majority of women choose breast implants (81 percent) over an autologous surgery (19 percent). In the latter procedure, also called tissue or fat transfer, the plastic surgeon constructs the breast out of the patient’s own tissue taken from somewhere else on their body.
There are advantages and disadvantages to any of these types of procedures, and a number of considerations must be weighed prior to deciding, Dr. Durden says.
“The patient’s overall health is part of the decision,” he says. “Is she healthy enough for a longer operation, or does she need a shorter one? There’s also a limitation to the size of breast implants. Larger women may need a tissue transfer because implants are not available that match the size of the other breast. Obesity, diabetes and other health conditions factor into choosing which type of surgery is best for that patient. There’s an increased risk of infection with diabetes that needs to be part of the discussion about implants. Medical conditions factor heavily into the decision. And we always try to optimize patient health before any surgery.”
The advantages and disadvantages of implants
Breast implants are popular among those getting them solely for cosmetic purposes. Perhaps for this reason, among others, most breast reconstruction patients choose breast implants over using their own tissue. It’s important for women to know ahead of time that breast implants are not lifetime medical devices, and the longer they’re in place, the greater the risk of complications.
recovery time for second stage breast reconstruction
The precise type of reconstruction, the person’s general health, and the body’s capacity for healing can all affect the recovery period for the second stage of breast reconstruction. Additional operations, such as nipple repair and/or the insertion of a breast implant or tissue expander, are frequently performed during the second stage of breast reconstruction. Here is a rough outline of what to anticipate during the healing process:
Immediate Postoperative Period: Following the second step of breast reconstruction, you can feel sore, swollen, or bruised where you were treated. You could have drains in place to assist in removing extra fluid, and dressings or bandages will likely be used. You’ll receive instructions from your surgeon on how to take care of your wounds, manage discomfort, and limit your activities.
First Week: It’s crucial to relax and pay close attention to your surgeon’s recommendations throughout the first week of recuperation. To manage pain and lower your risk of infection, you might need to take prescription painkillers and antibiotics. Avoiding intense exercises, heavy lifting, and motions that strain the chest is vital.
Weeks 2 to 4: Depending on their employment needs and the advice of their surgeon, most people are able to gradually resume light activities by the second to fourth week and maybe return to work. The discomfort should progressively lessen, and swelling and bruising should start to go down. Having follow-up consultations with your surgeon can help them keep track of your development and handle any issues.
Weeks 4 through 6: Your body will adjust to the rebuilt breast(s) during this time as the healing process progresses. Incision scars should progressively go away, and swelling should continue to reduce. Your surgeon may offer advice on how to treat scars and any suggested actions to speed up scar healing. Following your surgeon’s advice, you can gradually resume exercise and physical activities.
Months 2 to 3: Most people may resume their regular daily activities at this point, and with their surgeon’s permission, they may start to progressively engage in more strenuous physical activities like exercise. The breast(s) that were rebuilt should have substantially less swelling, and they will continue to settle and change in size and appearance. Your progress will be tracked regularly at follow-up appointments with your surgeon, who will also address any lingering issues.
It’s significant to keep in mind that recovery timeframes might change depending on personal factors, the extent of the reconstruction, and the healing process. It’s important to carefully adhere to your surgeon’s postoperative instructions, show up at all planned follow-up appointments, and share any changes or issues that crop up while you heal. To ensure a smooth recovery and assist you in getting the results you want from your breast reconstruction, your surgeon will offer tailored guidance and assistance.
hardness in breast after reconstruction
After your operation you will wake up in the recovery room, probably feeling sleepy and you may have an oxygen mask over your mouth to help you breathe. You will have a transparent dressing over your wound. Unless advised to the contrary, this is to be left in place until removal is advised by Jane O’Brien (usually 10-14 days). You may shower as normal, as the dressing is splash proof, but try to avoid getting it soaking wet as it will tend to lift off. Simply pat it dry after your shower with a soft towel. The stitches in your wound are buried and dissolvable and do not need to be removed. Depending on the nature of your surgery you may have one or two fine plastic drain tubes coming out from near the wound which drain blood and fluid. The tubes are stitched in place and therefore quite secure. They are attached to small portable, plastic bottles which will be placed in a bag which you will need to carry around with you. You will have been advised prior to the operation as to whether it is likely that a drain tube/s will be required.
If you are staying in the hospital it is likely when you wake up that you will have a small, plastic tube in one of the veins in your arm connected to a bag of liquid (a drip). This gives your body fluid until you are able to drink, and medications e.g. antibiotics and painkillers can be given via this route. After your operation you will be able to eat as soon as you are wide awake and the drip can often come out the next day. Sometimes people feel sick after breast surgery and may vomit. If this happens medication will be given to stop the vomiting. If you have had a sentinel node biopsy there will be some blue staining of the skin around the injection site on the breast. This fades gradually, but may be visible for some months. The blue dye will also turn your urine blue-green for about 24 hours.
Visiting is allowed on the day of surgery, and a relative is welcome to phone the ward.
Will I have any pain or discomfort?
You are likely to have some discomfort after surgery but everyone’s experience will be different. Before your operation, the anaesthetist will talk to you about different types of pain control and what is likely to be useful in your particular case. You should be able to get up and out of bed the next day. You will be offered painkillers regularly whilst in hospital to ensure that you are comfortable and pain-free and able to move your shoulder and arm adequately.. Your breast care nurse, physiotherapist or ward staff will monitor your progress. Following discharge home, continue to take prescribed painkillers as required. Depending on your individual circumstances you may be encouraged to start gentle arm/shoulder exercises a few days after surgery. The physiotherapist will be able to advise on appropriate exercises. For further information see our fact sheet – Exercises after breast surgery.
Post-Operative Problems After Breast Surgery
Some of the following post-operative problems are not specific to breast surgery and others are directly related to the type of surgery you have had. Some will have been discussed with you preoperatively as part of the routine “informed consent” process.
Bruising and Haematoma
Bruising is common after all forms of surgery. It can be mild, moderate or even severe but will gradually disappear with time. Occasionally, blood/blood clot collects within the tissues under the wound, causing swelling, hardness and discomfort. This can sometimes occur even if a drain tube is in place. If the swelling is pronounced and occurs rapidly, especially in the first few hours after the operation, it may sometimes be necessary to consider returning to the operating theatre to explore the wound, remove the blood clot and to check that there is no ongoing bleeding. If it occurs more gradually, it is often left for the body to re-absorb which can take a few weeks.
Wound Infection
A wound infection can develop at any time from a few days after surgery until the wound is completely healed, which usually takes 2-3 weeks. Any of the following symptoms could possibly indicate a wound infection
Seroma
It is common for women who have had some or all of the lymph glands removed from under the arm to develop a collection of clear, straw coloured fluid under the wound called a “seroma”. You may experience fullness under the arm, which is often described as like having a ball fixed in the armpit. If you have had a mastectomy, similar fluid can also build up on the chest wall. As with haematoma, this fluid is re-absorbed by the body over time but if it causes discomfort, as it is watery in nature, it can be easily “drawn off or drained” (aspirated) using a small needle and syringe. This is a very simple and almost painless procedure. In some cases, the fluid may collect again on several occasions requiring repeated aspiration.
Change in Sensation
If you have had lymph glands removed from under your arm, you may experience a loss or change in sensation running down the inner side of your upper arm. This occurs because the nerves running across the armpit to the upper arm, which supply sensation to the skin in that area, often have to be disturbed to reach the lymph glands. This can cause trauma to the nerve, which can lead to a variety of symptoms
These symptoms are usually temporary and improve or completely disappear about 3 months after surgery. In some cases you may be left with a degree of permanent loss or altered sensation in your upper arm (e.g. if the nerve had to be divided at the time of surgery in order to properly perform the operation)
Cording
Occasionally following surgery to the glands under the arm (either sentinel node biopsy or axillary node clearance) you may develop a tender cord running across your armpit. A pulling sensation can sometimes be felt down to the elbow or wrist. This is called “cording”. It is due to hardened lymph vessels. You may even be able to see and feel raised cord-like structures that “bow-string” across your armpit, and it can significantly restrict your arm movement. You may need physiotherapy to maintain your shoulder movement and to stretch the cords. Cording ALWAYS gets better although it can sometimes take a few months.
Pain
Persistent minor discomfort and swelling in the breast after the initial post-operative recovery period is not uncommon, especially when you have also had radiotherapy.
Activity Guidelines
The exact nature of your breast surgery will obviously influence when you can resume your usual activities. After a breast biopsy or removal of a small breast lump most people can return to day-to-day activities within a couple of days. You should avoid vigorous exercise, but other activities can be undertaken as pain permits. After a larger operation such as a mastectomy, getting back to normal will take longer. At what time it is safe to resume driving depends on the extent and nature of your surgery and your personal recovery. Usually you can start driving again once your wound has healed and you have regained full movement of your arm. If the area is still sensitive you may need extra padding around your seatbelt. Ask Jane O’Brien or one of our breast care nurses for guidance if necessary.
When can I leave the hospital?
The length of time you spend in hospital will depend on the nature and extent of your surgery and how quickly you recover. A lot of breast surgery these days is able to be done as “day case” surgery or as on overnight stay only. We are usually able to give you a fairly accurate estimate of the likely length of your hospital stay before the operation. For additional information see individual operation pamphlets.
When can I expect to recover from surgery?
Recovery after surgery involves healing both on a physical and emotional level and the time taken varies from individual to individual. The length of time you spend in hospital will depend on the extent of your surgery and how quickly you recover. Going home can arouse mixed emotions. You may feel enormous relief that the operation is over. You may feel isolated or insecure because you no longer have the immediate support of the nurses, doctors and the hospital team. Feel free to contact our breast care nurses if you have any queries or just need some psychological support if you feel a bit “down” after discharge.