Breast Reconstruction After Cancer: Your Options Explained

Breast reconstruction is surgery to rebuild the shape of a breast after it has been partly or fully removed, most often as part of breast cancer treatment. There’s no single right choice: some women choose reconstruction using their own body tissue, others prefer breast implants, some have it done immediately alongside their mastectomy, and some decide not to have reconstruction at all.

We spoke to Consultant Plastic and Reconstructive Surgeon Professor Dariush Nikkhah, to create a guide which walks through the main types of breast reconstruction surgery, including DIEP flap (currently considered the gold standard for reconstruction using your own tissue) along with breast-conserving surgery, nipple reconstruction, and the practical questions patients ask most: sensation, timing around radiotherapy, recovery, and how the whole journey typically unfolds.

Types of Breast Reconstruction: An Overview

Breast reconstruction surgery generally falls into two broad categories. Autologous reconstruction, sometimes called flap reconstruction, uses your own body tissue, usually taken from the lower abdomen, back, or thigh, to rebuild the breast shape. Implant reconstruction instead uses a breast implant, sometimes alongside a tissue expander, to recreate the breast’s volume. Some women have a combination of both.

Timing is another key decision. Immediate reconstruction takes place during the same operation as the mastectomy, so you wake up with a reconstructed breast already in progress. Delayed reconstruction happens later, sometimes many months or even years after the original cancer surgery, once other treatment such as chemotherapy or radiotherapy is complete. Delayed breast reconstruction is often chosen when radiotherapy is planned, or simply because a patient needs time before deciding.

For women who’ve had breast-conserving surgery rather than a full mastectomy, only part of the breast has been removed, and a smaller-scale partial reconstruction may be used to reshape the remaining breast tissue, often using oncoplastic techniques at the same time as the cancer surgery itself.

How Radiotherapy Can Affect Your Options

If radiotherapy is needed after a mastectomy, it can affect the skin and underlying tissue in ways that make reconstruction more complex, particularly for implant reconstruction. Because of this, some surgical teams recommend delaying reconstruction until radiotherapy is finished, or favour an autologous approach using your own tissue, which tends to tolerate radiotherapy better than an implant. The right sequence depends on your specific cancer treatment plan, and is something your treatment team, working alongside your oncologist, will discuss with you individually.

DIEP Flap Reconstruction: The Gold Standard

DIEP flap surgery is widely considered the gold standard of autologous breast reconstruction. It uses skin, fat and blood vessels from the lower abdomen, without taking the underlying muscle, to rebuild the breast using your own body tissue. Because DIEP flap reconstruction uses your own tissue, the reconstructed breast has a similar consistency and feel to natural breast tissue, and will change shape over time as your body gains or loses weight, much like your remaining breast tissue would. This is different to an implant, which is a foreign body and may eventually need replacing.

During DIEP flap surgery, the surgical team carefully separates the skin and fat, along with their blood supply, from the lower abdomen, and reconnects the blood vessels to the chest wall using microsurgery, a technique that uses magnification and specialised instruments to join very small blood vessels together. This microsurgical step is what allows the transferred tissue to survive and develop a working blood supply in its new position. Because no muscle is taken, recovery tends to involve less scarring and reduced impact on abdominal strength compared with older flap techniques. You can receive DIEP Flap Surgery at St John & St Elizabeth Hospital in London.

Who Is DIEP Flap Surgery Suitable For?

Not everyone is a candidate for DIEP flap reconstruction. Your surgeon will consider factors including whether you have enough tissue in your lower abdomen to reconstruct a new breast shape, your general health and any medical conditions that could affect wound healing or blood supply, whether you smoke, since smoking significantly increases the risk of complications with flap surgery, and whether you’ve had previous major abdominal surgery, which can affect the blood vessels needed for the procedure.

Being at a stable, healthy weight also matters: patients who are significantly underweight may not have enough donor tissue, while those at high risk of surgical complications may be advised to lose weight or address other health factors before surgery. If DIEP flap isn’t suitable, other options such as an LD flap or implant reconstruction may be considered instead.

Other Breast Reconstruction Options

Breast implants remain a common choice, either as the sole method of reconstruction or in combination with your own tissue. Implant reconstruction is generally a shorter operation with a quicker initial recovery than flap surgery, though implants don’t last indefinitely and further surgery to replace or adjust them is sometimes needed later.

An LD flap, using tissue from the latissimus dorsi muscle in the back, is another autologous option, sometimes used alongside an implant, particularly when DIEP flap surgery isn’t suitable or hasn’t given quite enough volume on its own.

Reconstruction doesn’t always stop at the affected breast. Many women also choose surgery on the opposite, unaffected breast to improve symmetry, whether that’s a lift, reduction, or augmentation. This is sometimes achieved through therapeutic mammoplasty, which reshapes or resizes the other breast so that both breasts match as closely as possible in size and shape.

Will I Have Feeling in My Reconstructed Breast?

Mastectomy removes the nerves that once supplied sensation to the breast, so a reconstructed breast, whatever technique is used, doesn’t automatically have normal feeling. Many women describe the reconstructed breast area as numb, at least initially, and for some this numbness is long-lasting.

In DIEP flap and other flap reconstructions, it’s sometimes possible to reconnect a sensory nerve from the transferred tissue to a nerve in the chest wall, a technique known as nerve coaptation. Over time, this can allow some sensation to return, though the result is rarely the same as the sensation in your natural breast tissue before surgery. Not every patient is a suitable candidate for this additional step, and it’s worth asking your surgeon directly whether it’s an option for you.

Breast-Conserving Surgery: An Alternative to Full Reconstruction

Not every breast cancer diagnosis requires a mastectomy. Breast-conserving surgery, also known as a lumpectomy or wide local excision, removes only the part of the breast containing the tumour, along with a margin of healthy tissue around it, rather than the entire breast. This approach allows many women to keep most of their natural breast tissue while still effectively treating the cancer, and is often followed by radiotherapy to reduce the risk of the cancer returning.

Where breast-conserving surgery is suitable, some patients are offered oncoplastic surgery at the same time, sometimes called oncoplastic breast-conserving surgery, which reshapes the breast area immediately after the tumour is removed, or reduces the size of the opposite breast to maintain symmetry. This can reduce, or sometimes remove entirely, the need for a later, separate reconstruction.

Choosing Not to Reconstruct

Reconstruction is not compulsory, and going without it, sometimes called going flat, is a valid and increasingly recognised choice. Some women feel that reconstruction isn’t right for them, whether for personal, medical, or practical reasons, and choose to wear a false breast, or breast prosthesis, in their bra instead, or nothing at all. Whatever you decide, your treatment team and breast care nurse are there to support you, and it’s a decision you can revisit over time; some women who initially decline reconstruction choose to have it later, and vice versa.

Nipple Reconstruction

Nipple reconstruction is usually a later, separate step, carried out once the reconstructed breast has settled into its final shape, often several months after the main reconstruction surgery. A new nipple can be created surgically using local tissue from the reconstructed breast, giving it a three-dimensional shape.

Nipple tattooing is then often used afterwards to add colour and the appearance of the areola, and can also be used on its own for a flatter, two-dimensional result without further surgery. Some women instead choose a nipple prosthesis, a removable, custom-made false nipple that attaches to the skin, as an alternative to surgical reconstruction.

Choosing the Right Type of Reconstruction For You

There’s no single best option for everyone, and choosing the right type of reconstruction is a decision made together with your surgeon at a specialist breast clinic, usually alongside a specialist nurse or breast care nurse who can talk you through what each option involves.

Factors that typically influence the decision include your general health and any medical conditions, the size and shape of your remaining breast tissue and the breast area more broadly, your body shape, particularly how much donor tissue is available in areas such as the lower abdomen or back, whether you’re planning further cancer treatment such as radiotherapy, and your own preferences about scarring, recovery time, and how much you want your new breast shape to resemble your original one.

The Overall Breast Reconstruction Journey: How Long Does It Take?

For many women, breast reconstruction isn’t a single operation but a staged journey. The main reconstruction, whether that’s a DIEP flap, another flap technique, or implant reconstruction, is often followed some months later by a second procedure to fine-tune the shape, symmetrise the opposite breast, or adjust the reconstructed breast once swelling has fully settled. Nipple reconstruction and tattooing typically follow after that, once the breast shape is stable, often around six to twelve months after the initial surgery.

Taken together, the full journey from mastectomy to a finished result can span well over a year for women having staged, multi-step reconstruction, though some choose to stop after the first stage if they’re happy with the outcome.

Recovery and What to Expect After Breast Reconstruction

Recovery time varies considerably depending on the type of reconstruction surgery:

• DIEP flap and other flap-based procedures are more involved operations with a longer initial hospital stay and recovery period, since they combine surgery at two sites, the breast area and the donor site, such as the lower abdomen.
• Implant reconstruction generally involves a shorter procedure and a quicker initial recovery, though full recovery and wound healing still take time.
• Possible complications to be aware of include infection, bleeding, or issues with wound healing, as with any surgery.
• A small risk with flap surgery: the reconstruction doesn’t fully heal or take as expected, particularly since blood supply to the transferred tissue is critical in the early days after surgery. Your surgical team will monitor you closely in the days after your operation for exactly this reason.
• Further surgery is sometimes needed afterwards, whether planned, such as symmetrising surgery or nipple reconstruction, or to address a complication. Most patients go on to heal well.

Will Reconstruction Affect Future Cancer Monitoring?

Breast reconstruction doesn’t prevent your treatment team from monitoring you for signs of cancer returning. Your surgical oncology and treatment team will continue to examine you and arrange any imaging or follow-up appropriate to your individual case, taking your reconstruction into account. It’s still important to attend all follow-up appointments and report any new changes in the breast area to your team, just as you would without reconstruction.

Frequently Asked Questions About Breast Reconstruction After Cancer

What is the difference between DIEP flap and implant reconstruction?
DIEP flap reconstruction uses your own body tissue, taken from the lower abdomen, to rebuild the breast, giving a natural feel and shape that changes with your body over time. Implant reconstruction instead uses a breast implant to recreate the breast’s volume; it’s generally a shorter operation with a quicker initial recovery, but implants may eventually need replacing, whereas DIEP flap reconstruction, using your own tissue, generally doesn’t.

Can I have immediate reconstruction at the same time as my mastectomy?
In many cases, yes. Immediate reconstruction is done during the same operation as your mastectomy, and can help preserve your own skin, giving a more natural result. However, if radiotherapy is planned afterwards, your team may recommend delayed reconstruction instead, since radiotherapy can affect the skin and tissue in ways that make reconstruction more complex if it’s already in place.

Will my breasts match after reconstruction?
Surgeons aim to get as close a match as possible between the reconstructed breast and your remaining, unaffected breast, but a perfect match isn’t always possible in one operation. Many women have further surgery, such as therapeutic mammoplasty on the opposite breast, to improve symmetry once the reconstructed breast has settled into its final shape.

Do I need a mastectomy to have breast reconstruction, or are there other options?
Not necessarily. If you’ve had breast-conserving surgery, where only part of the breast is removed, a smaller-scale partial reconstruction, often using oncoplastic techniques at the time of your cancer surgery, may be enough to reshape the breast without needing full reconstruction later.

Is nipple reconstruction painful, and when can I have it?
Nipple reconstruction is usually a relatively minor procedure compared with the main reconstruction surgery, and most women find any discomfort manageable. It’s typically carried out several months after the main reconstruction, once the breast shape has settled, so that the position and size of the new nipple can be planned accurately.

Will breast reconstruction affect how my cancer is monitored afterwards?
No, reconstruction doesn’t prevent ongoing monitoring for recurrence. Your treatment team will continue routine follow-up and any necessary imaging, adapting their approach to take your reconstruction into account.