Breast Reconstruction Surgery

The first step will be to meet with your surgeon, who will discuss your needs and expectations and explain the best options for you. Risks of surgery are higher in people who are overweight, so you might be asked to reduce your weight to a body mass index of under 30 prior to surgery.
You will need to wait for 12 months after completion of radiotherapy before having reconstructive surgery.
Once you are booked for surgery, you will attend a pre-operative assessment of your fitness for your planned operation. You may need scans, blood tests and photographs before your operation. You and your household will need to isolate for two weeks before your operation and you will have a Covid-19 PCR test three days before surgery.
Pack a bag for your hospital stay:
Your regular medications
Nightwear (with buttons at the front), dressing gown and slippers
Underwear including sports bra/crop top and supportive knickers (if applicable)
A change of clothes
A wash bag and toiletries
Books/magazines/tablet/phone and charger to provide entertainment

If you are having a Free flap (DIEP or TUG flap) you will come into hospital the night before or on the morning of your operation. You will have a blood thinning injection into your thigh the night before your operation and for seven days after surgery (we will teach you how to do this).
You will be given compression stockings to prevent blood clots for as long as you are less mobile (usually 2-3 weeks) and you should not have ANY food or drink on the morning of your operation apart from medications or special carbohydrate rich drinks that we give to you (if you are not diabetic).

On the morning of your operation your surgeon will go through the operation with you and ask you to sign some forms. We will take some photographs for your medical records (with your permission) and put some markings on your skin. Your anaesthetist will discuss with you the anaesthetic and what to expect from this.

You will be checked multiple times and brought from the ward to the operating theatre. Once in the anaesthetic room, you will have some monitoring equipment applied, an intravenous cannula inserted and will be given some anaesthetic medicine. Once you are asleep a urinary catheter and a number of intravenous lines are placed.
The operation will last for four to eight hours and there will be a number of drains placed during the surgery which will be checked every day to see if they can be removed, depending on how much fluid is coming out.

After the operation you will be closely monitored for two days to allow any potential problems to be picked up early and managed, for the first 12 hours this will be every half an hour so your sleep will be disrupted.
You can eat and drink as you feel able. Over the next few days we will gradually encourage you to get up, walk around, sit out of bed and use the shower. We aim to discharge you home four days after your operation, this may be with a drain if there is too much fluid coming out. Once the swelling reduces we will encourage you to use a sports bra and supportive knickers.

For more details, click on the links below:

TUG Flap
DIEP Flap
Latissimus dorsi flap
Implant based reconstruction
Lipomodelling

• Pain
• Infection
• Numbness on the breast, inner arm and tummy

Bleeding
Surgery can sometime cause a collection of blood under the skin called a haematoma, which may mean that you need to return to theatre to drain this. If you are having lipomodelling this will cause bruising where the fat is harvested. This can be quite extensive and is reduced by wearing compression garments (Spanx/girdle/compression underwear) which you should bring to hospital with you, if you are having this surgery.

Flap failure
Part or all of the flap may not survive if the blood supply becomes compromised. This is more likely to happen in the first two days following your surgery so you are closely monitored for signs of this as this may necessitate an emergency return to theatre to try to restore the blood flow. The risk of return to theatre is about six per cent, overall the risk of complete flap failure is two to three per cent.

Asymmetry to the other side
While your surgeon will try to match your reconstruction to the other side there will always be a small amount of asymmetry.

Seroma
Where the flap was taken from your body may produce tissue fluid that collects in the newly created space. This usually gets absorbed with time but, if it causes a problem, it may need to be drained.

Nipple loss
Occasionally the blood supply to your nipple (if still present) may become compromised, meaning that part or all of your nipple may be lost. If this happens you may need to return to theatre to try to save the nipple, or it may be removed and stitched back on as a graft.

Blood clots (DVT/PE)
To prevent this you will have blood thinning injections while you are in hospital and given stockings to wear at home while you are less mobile (usually two to three weeks).

Breast implant associated anaplastic large cell lymphoma (BIA-ALCL)
If you are having an implant inserted there is a small risk of a rare blood cancer called BIA-ALCL. This is a newly discovered disease that we think happens in up to one in 3000 women who have breast implants inserted. This usually happens a few years after insertion of the implant and presents with swelling in your breast. Usually this cancer is completely curable by removing the implant.

Capsular contracture
If you are having an implant inserted your body will form a fibrous coating around the implant called a capsule. This is normal. In some women over time this capsule can contract, causing your breast to feel hard, tight and more spherical. It is sometimes painful. If this occurs the capsule and implant may need to be removed.

Fat necrosis
Sometimes fat cells die, causing a small hard lump which can be worrying for you as it can mimic breast cancer. You should always get any breast lumps checked out by your breast surgeon. If this occurs you may need a small operation to remove the lump.
Microcalcifications Fat transferred to your breast from lipomodelling can sometimes cause white flecks to be seen on mammograms. These are not dangerous and can be distinguished from worrying white flecks by an experienced breast radiologist.

You will be encouraged to get up out of bed and move around once you are comfortable enough to do so. You will also be given a leaflet showing exercises to prevent shoulder stiffness. Once the swelling has reduced you will be encouraged to wear a sports bra or crop top (no underwiring) and high waisted supportive knickers (if applicable) for six weeks after your surgery.

On discharge from hospital, you might have dressings on your wounds which should be kept on until we bring you back for a check one week later. If you have any problems with the dressings at home please contact the plastic surgery dressings clinic for advice.
Continue to do your shoulder exercises, wear antiembolic stockings and supportive underwear while at home. Make sure that you eat three healthy meals a day with snacks to maintain good nutrition and allow your body to heal.
Do not participate in strenuous exercise or heavy lifting for six weeks after your operation and you will need to take time off work to recover (two weeks – three months depending on your type of operation). Please ask your surgeon for a sick note before you leave hospital.
You are advised to not drive for some time after your operation, the timing of which will depend on the type of surgery you have. You are advised to not fly for at least six weeks after your operation as you will be at higher risk of blood clots. After this it is advisable to wear flight socks.

You will be given an appointment to see your surgeon a few weeks after your operation. Your breast reconstruction will take three to six months to settle before adjustments or nipple reconstruction (if needed) can be considered. Your surgeon will discuss this with you if necessary.