Breast Reconstruction Surgery After Mastectomy

You’ll need to wait many months after a mastectomy until it’s safe

There are different methods for breast reconstruction done in stages in the months after a mastectomy. Options include implant-based or autologous (using your body's tissue) reconstruction.

In this article, you will learn what to expect during breast reconstruction surgery, the risks involved, and what you should know about paying for breast reconstruction surgery.

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What Is Breast Reconstruction After a Mastectomy?

Breast reconstruction is the surgical rebuilding of breast tissue removed during a mastectomy (surgical removal of the breast). A mastectomy is typically done to prevent or treat breast cancer.

Your reconstruction needs depend on whether you had a single (one breast) or double (both breasts) mastectomy. Your surgeon will consider the size, location, degree of breast cancer risk, and more to determine which type of mastectomy you need.

Surgical Techniques

Once you and your care team determine the type of mastectomy needed to prevent or treat breast cancer, you may begin discussing your specific reconstruction plan. Timing is a significant part of the plan.

Immediate reconstruction after a mastectomy is standard and accounts for an estimated 75% of breast reconstruction surgeries. Not everyone is a candidate for immediate reconstruction, however. Factors like radiation therapy after an immediate reconstruction could increase your risk of complications.

Delayed reconstruction is typically done two to six months following a mastectomy, usually after chemotherapy or radiation treatments. It occurs in these two phases:

  • Stage 1: After mastectomy, a tissue expander is placed under the skin or breast muscle. The expander is incrementally filled with saline during outpatient visits in the following weeks.
  • Stage 2: The expander is removed and replaced with an implant when the chest tissue heals, typically within two to six months.

Beyond timing, different types of reconstruction are categorized based on the material used to create new breast tissue.

Implant-Based Reconstruction

Most reconstruction surgeries in the United States (81%) involve a single-stage or two-stage implant placement, as follows:

  • Single-stage implants avoid expanders, are placed instantly (also called direct-to-implant), and are the only device inserted during reconstruction. They account for 13% of reconstruction surgeries in the United States.
  • Two-stage implants involve tissue expander placement during the first surgery, which is eventually swapped for a permanent implant later. About 68% of all reconstructions in the United States are this type.

There may be additional subtypes of implant-based reconstruction options depending on the material used in the implant, such as silicone vs. saline, and any other special considerations like placement or skin treatments.

Autologous Reconstruction

Autologous reconstruction uses tissue from another area of your body to reconstruct the breasts. Your provider may consider using tissue from one of the following sites:

  • Abdomen
  • Back/shoulder area
  • Buttocks
  • Thigh

About 19% of reconstruction surgeries fall into this category. Some people opt for autologous reconstruction over implants because it can be done in a single surgery at the time of the mastectomy.

Unlike implants, which you must replace approximately every 10 years, autologous reconstruction produces a lifelong result.

How to Prepare

If you are undergoing cancer treatments alongside your reconstruction surgery, discuss your plans for reconstruction with your oncologist. Aside from determining which type of reconstruction you'll undergo, here are some things to consider and discuss with your care team:

  • Areas of the body (in addition to your breasts) that will be impacted by surgery
  • Lifestyle changes to accommodate recovery, such as time off work
  • Coordinating with friends and family to assist with household chores, childcare, or other tasks that require lifting during your recovery

What to Expect on the Day of Surgery

The steps involved on the day of your breast reconstruction surgery will depend on whether you are having reconstruction at the time of your mastectomy or in the following months.

Whether you are having delayed reconstruction with an implant or immediate reconstruction with your tissue, your surgeon will follow a path similar to the one below:

  1. You will be placed under general anesthesia.
  2. Once the mastectomy is complete, your surgeon will use any remaining tissue, plus skin, fat, or muscle, to construct a flap of tissue over the site of the reconstructed breast.
  3. If you opt for implants placed later, a tissue expander is inserted under the flap. This expander slowly stretches the flap tissue over several months until you are ready for an implant.
  4. If you are having immediate reconstruction, your surgeon will use more tissue to create the entire breast, not just a tissue flap.
  5. When the reconstruction is complete, the surgical areas at the reconstructed breast site and any donor tissue sites will be surgically closed, and dressings will be applied.

Recovery

You will need to stay in the hospital for a few days after your reconstruction and should plan on being sore for a few weeks. Your return to activity will depend on any additional revisions you need or whether or not you plan to have a nipple or areola created on the reconstructed breast.

Complete healing can take a year or two, and the full sensation in your breast tissue may not return after the procedure. Swelling and bruising can last for up to eight weeks after surgery. You will need to wear a special support bra during recovery.

Long-Term Care

Although the appearance and sensation of your breast tissue may be the most noticeable change after your surgery, there are a lot of other changes beneath the skin's surface that can take some time and rehabilitation to heal.

Changes to muscle tissue, shoulder mobility, and posture are relatively common after breast reconstruction surgery. You may require physical therapy to gain strength and mobility back.

Contraindications

Your chances of successful breast reconstruction after a mastectomy depend primarily on your overall health, other medical conditions, and the type of mastectomy.

If you had a mastectomy to treat cancer and not as a preventive measure, additional cancer treatments like radiation and chemotherapy could complicate your reconstruction.

Some additional conditions or situations that could prevent you from being a candidate for breast reconstruction include:

  • Severe heart or lung disease
  • Collagen vascular disease
  • Obesity
  • Age over 65
  • Current smoker
  • Emotional or mental instability
  • Previous abdominal or thoracic surgeries that threaten blood supply for flaps
  • Prior radiation therapy
  • Advanced breast cancer

Potential Risks

As with other types of major surgery, there are risks involved with breast reconstruction after a mastectomy. Some of the most common include:

While complications can happen, studies suggest that very few postoperative problems lead to reconstruction failure. It's also possible that some long-term effects—like lack of sensation in the new breast—might not be evident for a year or more after surgery.

Financial Planning and Insurance

Health insurance plans that cover the cost of a mastectomy must also cover the cost of breast reconstruction, thanks to a 1998 law called the Women's Health and Cancer Rights Act (WHCRA). Although the average cost of breast reconstruction after a mastectomy is around $49,000, if you have health insurance, your insurer will pay a portion.

You may still have to pay for a share of the surgery cost depending on the deductibles and out-of-pocket cost sharing required by your plan, but coverage must include the following:

  • Reconstruction after a mastectomy
  • Any surgeries to make breasts appear symmetrical or balanced after mastectomy
  • External breast prostheses needed before or during reconstruction
  • The treatment of any mastectomy-related complications

If you have Medicare, reconstruction after a mastectomy is covered but varies from state to state.

Summary

Many people who have undergone a mastectomy to treat or prevent breast cancer opt for breast reconstruction following a mastectomy. Your surgeon will determine the type of mastectomy you require and offer breast reconstruction options that best fit your needs and lifestyle. If you have health insurance, your insurance company has to cover the cost of this procedure if they cover a mastectomy.

A Word From Verywell

Treating and preventing breast cancer requires intense efforts. While chemotherapy and radiation are cornerstones of cancer treatment, a mastectomy is a standard tool used to fight breast cancer. Removing your breast tissue is a major surgery that can take a physical and an emotional toll. There are several options for reconstruction, and you and your care team should make those choices based on your health and diagnosis.

Frequently Asked Questions

  • How safe is reconstructive breast surgery after a mastectomy?

    Very few reconstructions fail, but there are risks of typical surgical complications like bleeding and scarring. Some people also report a lower quality of life after a mastectomy and breast reconstruction than those with more conservative tissue-sparing surgeries to treat breast cancer. There have also been some risks associated with using artificial breast implants.

  • When can you have breast reconstructive surgery?

    Most people who get mastectomies opt for immediate reconstruction, but not everyone is a candidate for this option. If you are not a candidate for immediate reconstruction, your surgeon will plan a delayed reconstruction in the months after your mastectomy.

  • How many people go through reconstructive surgery after a mastectomy?

    Roughly 40% of women who had mastectomies in 2016 had reconstruction. The American Society of Plastic Surgeons estimated in 2018 that more than 100,000 women undergo breast reconstruction yearly due to mastectomy.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Cancer Society. Breast reconstruction options.

  2. Agency for Healthcare Quality and Research. Breast reconstruction after mastectomy.

  3. American Cancer Society. Breast reconstruction using your own tissue (flap procedures).

  4. American Society of Plastic Surgeons. Breast reconstruction.

  5. American Cancer Society. What to expect after breast reconstruction surgery.

  6. Regan JP, Casaubon JT. Breast reconstruction. StatPearls,

  7. Wilkins EG, Hamill JB, Kim HM, et al. Complications in postmastectomy breast reconstruction: One-year outcomes of the mastectomy reconstruction outcomes consortium (MROC) study. Ann Surg. 2018;267(1):164-170. doi:10.1097/SLA.0000000000002033

  8. American Cancer Society. Women's health and cancer rights act: the federal law.

  9. The Aesthetic Society. Breast reconstruction: associated costs.

  10. National Cancer Institute. Breast cancer surgery choice may affect young survivors' quality of life.

By Rachael Zimlich, BSN, RN
Rachael is a freelance healthcare writer and critical care nurse based near Cleveland, Ohio.