What happens after breast reconstructive surgery?

After surgery, the nurses give you painkillers to control any pain is controlled. If you had reconstruction using your own tissue you may have a special blanket to keep the breast warm. The reconstructed breast will be swollen but this will reduce over a few weeks. Your nurse or physiotherapist or will show you exercises to do. You may be in hospital for 3 to 7 days depending on the operation you had.

When you get home you will need help at first. Follow the advice from your hospital team and contact them if you have any concerns. Your wounds will take about 6 weeks to heal. You will be given advice on looking after the skin and massaging it.

You need time to get used to how your reconstructed breast looks and feels. If this is difficult talk to your breast care nurse. It is usually fine to have sex after surgery. Take things at your own pace.

You will not need mammograms of the reconstructed breast after mastectomy. But your breast care nurse will give you advice on how to check it.

You may have concerns about the way you see your body (body image). If these concerns do not improve, talk to your breast care nurse.

Recovery after your operation

Your breast care nurse will give you advice and support before and after surgery to help with your recovery.

When you wake up, you will have a drip (infusion) into a vein in the back of your hand or in your arm. It will be removed when you are able to drink enough.

If you are having reconstructive surgery using tissue flaps, you will also have a catheter to drain urine from your bladder. This will be taken out once you are able to get up and move around.

Immediately after surgery, your wound may be covered with dressings or sticky plastic strips. These are left in place until the wound has healed.

Your reconstructed breast will be swollen to begin with. The swelling gradually gets better over a few weeks.

If you have breast reconstruction using your own tissue, the reconstructed breast will need to be kept warm for the first few hours after the operation. Warmth improves blood flow to the tissue. You may have a special blanket called a Bair Hugger™, which circulates warm air over you. Or you may have thick gauze pads over the breasts.

There will be drainage tube(s) coming out of the wound(s). These will be attached to a small container to collect any excess blood or body fluid. A nurse will remove them a few days after the operation.

Once you are up and moving, your surgeon or nurse will tell you whether you should keep the area dry or if you can gently shower the wound with clean water.

Pain or discomfort

After any type of operation, you will have some pain or discomfort. Some women need painkillers for a few weeks after surgery. Make sure you ask for pain-relieving medicines if you need them. This will help you recover more quickly.

Numbness

You will usually have some numbness or pins and needles across your chest or reconstructed breast. You may also have numbness under your upper arms.

These symptoms improve over months to years, but it is common to have some permanent numbness. Most people adjust to this over time.

Constipation

Constipation is common after surgery. Here are some tips that can help:

  • Drink plenty of fluids.
  • Increase the amount of fibre in your diet.
  • Eat fruit and vegetables.

Some painkillers can cause constipation. You may need to take laxatives while you are on these. Your doctor can prescribe these for you or you can get them from your local chemist.

Wearing a bra

You may be advised to wear a bra to support your newly reconstructed breast. A soft, supportive bra without underwires will be more comfortable to begin with. Ask your breast care nurse for advice.

If you have reconstruction with an implant, you may be given a Velcro® band to wear for several weeks. This sits on top of the implant and helps make sure they stay in the correct position. You should wear this during the day and at night.

Exercises

Your physiotherapist or breast care nurse will show you exercises to do. At first, you may have some discomfort when you move your arm. But it is important to continue to use your arm and to do the exercises suggested. You will also be given specific exercises to do if you have had surgery to another part of your body, such as your tummy.

Going home

Your surgical team will let you know how long you can expect to be in hospital for after your operation. This will depend on:

  • the type of surgery you have
  • whether you have had immediate or delayed reconstruction.

If you have a breast implant, you may be in hospital for up to 3 days. After an operation using a tissue flap you may be in hospital for up to 7 days.

At home

When you first get home, it is a good idea to have someone around who can help you. You will probably feel tired for the first 1 to 2 weeks at home. After this, you can start doing more and gradually increase your level of activity. Avoid strenuous housework such as vacuuming. Just do light tasks to begin with and slowly build up from there. Don’t move or lift anything heavy for a few weeks until your surgeon says it is okay to do so. This includes lifting babies or children.


Recovering at home

Adjusting to the change in your body

You will need time to adjust to the change in your body and to see the reconstructed breast as your own. Looking at and touching your reconstructed breast will help you get used to it. Try to gradually build up the amount of times you look at and feel your breast. If you find this difficult or are avoiding looking at your breast, it is important to talk to someone. Your healthcare team can give you extra support if you need it.

Sex

It is usually fine to have sex after your operation. But it is important that you feel comfortable when having sex. This will probably be a few weeks after your operation, but it may take longer. Ask your surgeon or specialist breast nurse if there is anything you need to be careful about.

Having breast reconstruction will create a new breast shape. But the sensations in the breast and nipple will not be the same as before. If you were previously aroused by having your breasts touched, you may find that your sexual arousal is affected.

Take things at your own pace. If you have a partner, talk to them about any concerns you have. Some women feel nervous about how their partner will react to their body. It may take some time for you to feel comfortable talking about your surgery and showing them your reconstructed breast.

Sometimes a partner may worry about touching the reconstructed breast, because they think they may hurt you. It can help for you and your partner to talk about how you feel and any fears you have. Your breast care nurse can also advise you.

Looking after your skin

Your wounds may feel itchy after your operation. But try not to scratch the healing skin. The itching will get better as the wounds heal. It usually takes about 6 weeks for wounds to heal fully.

Once your wounds have healed, most surgeons recommend you massage the scars over your reconstructed breast and at the donor site (if you have one). Do this with body oil or moisturiser at least once a day. Massaging along the length of the scars helps stop them sticking to tissue underneath. It can also help soften your scars. Your surgeon or breast care nurse can tell you what they recommend and show you how much pressure to use.

After your operation, scars will be quite firm and may be slightly raised. If you have lighter skin they will be red, and if you have dark skin they will be darker.

It can take from 18 months to 2 years for scars to settle and fade. Tell your doctor or specialist breast nurse if:

  • the scars remain red and raised
  • you have concerns about how your scars are healing.

There are specific scar treatments that can help the scars settle and fade.

It is very important to protect your scars from the sun. Use a suncream with a high sun protection factor (SPF) of at least 50 if any area of scarring is exposed to the sun. You may be advised to do this for up to 2 years.

Work

When you can return to work depends on the type of work you do and the type of operation you had. If your job does not involve heavy manual work, you should be able to go back to work sooner. You are likely to feel more tired than usual for a while. You may find it difficult to concentrate fully at first.

Driving

You can usually start driving again:

  • once you can use the gear stick and handbrake
  • as long as you can do an emergency stop and move the steering wheel suddenly if necessary.

Some women are able to drive within a few weeks after surgery. Others find it takes longer. Insurance companies often have their own guidelines about when you can drive again after an operation. You should check this with your car insurance company.


Mammograms and checking your breasts

Mammograms

You will not usually need to have mammograms of the reconstructed breast after a mastectomy. But you will be invited to have regular mammograms of the other breast.

If you have had breast-conserving surgery followed by breast reconstruction, you will continue to have mammograms on that breast. The photo below shows someone having a mammogram.

Breast implants may hide part of the breast during a mammogram. But experts believe that mammograms are still useful to check breast tissue that covers the implant. Your doctor can advise you on how any possible recurrence of cancer can be found.

Having a mammogram
Having a mammogram

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Checking your breasts

You cannot develop breast cancer in any fat or muscle moved into your breast from another part of your body. But there is a small chance of breast cancer developing in any breast tissue left under the skin or in the skin left behind. So it is important to continue checking both your natural breast and your reconstructed breast for any abnormalities or changes. Your doctor will also regularly examine your breasts after your reconstruction.

It may take some time for you to get used to the feel and look of your reconstructed breast. Ask your nurse to show you how to check your breasts. They can also give you leaflets to remind you what to do.

Things to look out for include:

  • breast tissue that feels different, for example harder or tighter
  • a change in the appearance or shape of a breast
  • a change in the skin’s texture, for example puckering, dimpling, a rash or thickening
  • a lump or lumpy area you can feel in the breast or armpit
  • a change in the appearance or colour of the breast
  • a rash or change along the scar line
  • swelling of the upper arm
  • discharge from the nipple (if not removed)
  • a rash or swelling on the nipple or the areola (if not removed)
  • pain or discomfort.

There can be other causes for these changes other than cancer. But it is important to tell your nurse or doctor if you find anything that concerns you. They will examine you and arrange tests to check for anything unusual. These can include an ultrasound, MRI scan or biopsy.


Your feelings

Breast reconstruction surgery can cause many different emotions and feelings. Many women are pleased with the result of the surgery. But they may still have feelings of loss for their previous appearance and health.

It is also normal to have some concerns about how you see and feel about your body (body image). For example, the change in your breast shape will take some time to get used to. At first, your reconstructed breast might not really feel like you. It will take some time to get used to your new shape and the way the reconstructed breast feels.

If you have concerns about your body image that do not improve, talk to your breast care nurse about how you feel. Many people and organisations can help you talk about and deal with your feelings.

Back to Having breast reconstruction

Making your decision

An important part of making your decision about breast reconstruction is having realistic expectations about the result.

Talking to your surgeon

Your reconstruction surgeon will explain what types of operation can be done and answer any questions you have.

Your feelings

Breast reconstruction surgery can cause many different emotions. It can take time to adjust to your new breast(s).