The recovery time depends on the type of your breast reconstruction.
Typically, after an implant-based reconstruction with tissue expanders or implants you may go back to your normal, every day activities 2 – 4 weeks after the procedure. Following a breast reconstruction using your back muscle (latissimus dorsi muscle) combined with a tissue expander/implant recovery will take 4 – 6 weeks. After breast reconstruction using skin and fatty tissue from your belly (DIEP flap) average recovery may take up to 8 weeks. The skin on your abdomen will feel tight in the first weeks and you may have to walk and stand slightly bent over for a while. The skin will stretch over time and you will be able to move without any restrictions. All these times are given as an estimation; your personal recovery may be slower or quicker.
In any type of breast reconstruction you will usually have at least one drain for the first couple of days. A referral to the Local Health Integration Network (LHIN) will be made within your community for a nurse to help assist you with your wounds and drains once you have been discharged from the hospital. You will also have regular follow up visits in our clinic that will be arranged through our surgeons’ offices. Possible complications during recovery time may include pain, swelling, fluid accumulation (hematoma, seroma), infection and wound healing problems. Your nurse from your local LHIN community will alert our surgeons’ office if they have any of the above concerns. In addition our breast reconstruction nurse will be available to help you in case you have further concerns.
Breast reconstruction is a staged process and some minimal time intervals should be respected. Creating the breast mound represents the first step of the reconstruction, which can be done in one or two steps depending on the type of reconstruction you are having performed. Following this operation the tissue needs time to settle in its final position and for the swelling to decrease. The second stage can be scheduled 3 – 6 months after the breast mound reconstruction. At this point, balancing procedures for the healthy breast in a unilateral breast reconstruction can be done as well as refinements to the reconstructed breast or the donor site and also the reconstruction of the nipple areola complex. Between the reconstruction of the nipple and the tattooing of the areola, a healing time of at least 6-8 weeks should be allowed.
When your back muscle (latissimus dorsi muscle) is used for your breast reconstruction you might experience a mild weakness in your arm/shoulder especially when performing strenuous and prolonged overhead activities. During activities of daily living, however, you should not experience any impairment or restrictions.
When using your abdominal tissue there is a small risk of development of an abdominal bulge following your breast reconstruction. An abdominal bulge will not result in any functional problems, but might be dissatisfying from a cosmetic point of view. Bulges can be repaired using a permanent mesh that acts as an internal girdle for the lower abdomen.
In many cases it is possible to have a breast reconstruction at the time of the mastectomy (eg. prophylactic mastectomies or when radiation therapy after the mastectomy is unlikely to be necessary). In some cases, however, it may be beneficial to have a delayed breast reconstruction after termination of all additional therapies and a recovery period of around 6-12 months has passed for the radiation changes to improve. Especially radiation therapy can have an unfavorable effect on the cosmetic result and the complication rate of your breast reconstruction. Your plastic surgeon and your breast surgeon can give you specific recommendations about the timing of your breast reconstruction based on your individual case.
The implants that are used nowadays are considered to be medical products and are subject to rigorous quality assurance assessments. There is no expiry date and theoretically it is possible to keep your implants during your entire lifetime.
Your body, however, reacts on the implantation of any foreign body (e g. a silicone implant) with the formation of a thin capsule of connective tissue similar to a very fine scar. Over time, this capsule may become firm and tight and can lead to increasing pain and distortion of your breast shape. To resolve this problem the capsule has to be removed surgically and the implants are replaced. It is also possible that the implant wears out or will shift in position in which case replacement is usually recommended.
Yes, OHIP will cover almost all the treatments directly related to your breast reconstruction including implant or tissue reconstruction, balancing, and nipple areolar reconstruction. There are certain procedures that are NOT OHIP-covered benefits, such as liposuction contouring of the flanks, abdomen, lateral bra rolls, and fat transfer or injection for breast augmentation.
The goal is to achieve as much symmetry as possible, but your breasts will not look or feel exactly the same. Depending on your type of reconstruction, there are several procedures that can be done to your other breast to improve symmetry, including a breast lift (mastopexy), breast reduction, or breast augmentation with an implant. This balancing procedure is often done after your main reconstruction and can be combined with nipple areolar reconstruction.
There are several websites that show before and after photos for patients who have undergone breast reconstruction, such as this website or:
It is important to remember that depending on your specific circumstances different options may apply to you. Willow Breast Cancer Support Canada also has peer support groups (www.willow.org). You may also call your surgeon’s office to speak to one of our patient volunteers.
In some specific cases, yes they can be saved. Possible circumstances include prophylactic (risk reducing) mastectomies, or mastectomies with small tumors that are far enough away from your nipple-areolar complex. In some patients (e.g. patients with large, sagging breasts), it may be favorable for the cosmetic outcome to remove the nipple together with the redundant skin. Your breast and plastic surgeons can review your specific case.
The goal is to reconstruct a breast that looks and feels like your own. However, your breasts will still feel different after your reconstruction, including sensation, shape and firmness. This varies a lot from patient to patient, and can change over time.
There is no evidence that breast reconstruction increases the risk of breast cancer recurrence or will delay detection of breast cancer recurrence. If you have had bilateral mastectomies, then a major benefit is that you will no longer require any more routine screening or surveillance. If you have had a mastectomy on only one side, then you continue to be screened using mammogram, ultrasound, or MRI on your other breast. If you have had a lumpectomy, regular screening mammograms continues, with a new baseline mammogram ordered approximately 6 months after your reconstruction.
You need a referral from your doctor to become a patient at the UHN Breast Reconstruction Clinic. Your doctor may be your oncologist, breast surgeon, or your GP.
Your referral should include:
Not all plastic surgeons in Canada will perform all types of breast reconstructions. It is important to ask your plastic surgeon if he/she is proficient at all types of breast reconstruction, including microsurgical breast reconstruction using the patient’s own abdominal tissue (DIEP flap). Also it is important to ask how frequently the plastic surgeon performs breast reconstruction, as the quality of the surgery is directly associated with the surgeons’ volume of breast reconstruction surgery.
At UHN, all four of our plastic surgeons are fellowship trained to perform and offer all types of breast reconstruction. Our plastic surgeons are highly trained in autologous breast reconstruction where microvascular surgery is involved as well as reconstruction using implants and collectively perform breast reconstruction in approximately 350 new patients per year.
“Immediate” refers to undergoing breast reconstruction at the same time as mastectomy. Whereas “delayed” refers to having breast reconstruction at a later date; this could be months to years after mastectomy.
Choosing a breast reconstruction is multifactorial. Many factors contribute to the decision process including:
During your consultation, the plastic surgery team will discuss the different reconstructive options with you and work together to determine which is best for you.
Acellular dermal matrix (ADM) is a soft connective tissue graft generated from donated cadaveric skin aseptically processed to remove cells. Upon implantation, this structure serves as a scaffold upon which the patient’s own cells are incorporated and revascularize. Generally, ADM serves to provide support, coverage and positioning to the reconstructed breast. ADM may or may not be utilized in your implant-based breast reconstruction based on a number of factors. Please discuss with your plastic surgeon whether your reconstruction requires utilization of ADM.
The risks vary slightly between the different types of breast reconstruction. The plastic surgery team will review the risks specific to each reconstruction. However generally, the risks of breast reconstruction surgery may include:
• Delayed wound healing
• Sensory changes
• Fluid accumulation (e.g. hematoma, seroma)
• Implant failure/rippling/extrusion
• Partial or complete flap loss
Tissue expander/implant-based reconstruction takes approximately 4 weeks, autologous reconstruction (using your own redundant tissue) takes approximately 2-3 months and a combination of your own tissue and tissue expander/implant takes approximately 4-6 weeks.
The options for reconstruction of the nipple include:
The options for reconstruction of the areola include:
Depending on the type of surgery and the surgeon, you may have drains following surgery. These drains help remove any fluid or blood which may collect postoperatively. It is anticipated that you will have these in for a short period of time. Please discuss further with your surgeon.
If there is any concern that cancer is in close proximity to the nipple, it may be removed. There are other factors which may be included in this decision as well, however our General Surgery colleagues will be happy to discuss this in more detail with you.
No. Your reconstructed breast has no breast tissue. Rather, it is comprised fully of either tissue from another body site (e.g. abdomen) or prosthetic device (tissue expander/implant). However, if there are any concerns about a recurrence or any clinical findings, the appropriate investigations will be completed accordingly as decided by your cancer care team.
A “balancing” or “symmetrisation” procedure can be completed approximately 6 months following your first surgery to assist in matching the native breast to the reconstructed breast. Some options include:
The amount of feeling varies person to person but it’s common to have numbness, limited sensation, and sensory changes to the reconstructed breast.
This varies depending a few factors such as the type of reconstruction, breast size and if you are having a nipple/skin sparing mastectomy. Discuss with your Reconstructive and General surgeons.
In the initial post-op phase, there are limitations to activity. Long term you should be able to resume exercises you participated in before the operation.
This depends on many factors. If you are interested in changing your breast size discuss this with your reconstructive surgeon.
You need a referral from your doctor to become a patient at the UHN Breast Reconstruction Clinic.
Your referral should include:
It is important to follow the recommended range of motion exercises and booklet provided to you after your surgery to keep your joints lubricated and to avoid a frozen shoulder. Most patients are able to return to their normal pre-operative range of motion and strength after surgery. This may take up to 6-8 weeks or longer depending on the type of breast reconstruction you had. UHN has many resources available to patients should they need further assessments and individual exercise programs. Speak to your team if you have any questions or need a referral.
You may begin scar massage 3 weeks after your surgery and after your incisions (cuts) are completely healed. It softens and loosens the scar, and helps you to move your shoulder again. If your scar feels tight or itchy or the area is very sensitive, a scar massage may also help. Remember to protect your scars from direct sunlight as they are healing.
To massage your scar: 1. Put a small amount of vitamin E or oil ointment (such as coconut oil or bio oil) on the scar. 2. Place two fingers or your thumb right on the scar. 3. With firm but gentle pressure, move your fingers along the scar in an up and down zig-zag pattern. Move in one direction and then back in a circular motion. 4. Do this 2 to 3 times a day for 2 to 3 minutes.
You may feel some tightness and pressure after the expansion. To help relieve pain you can take Tylenol or Advil (acetaminophen and ibuprofen) before or after the expansion. Most women tolerate the expansions quite well and don’t require.