What to expect after breast reconstruction

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

If you have reconstruction using free flaps, you will also have a catheter to drain urine (pee) from your bladder. This will be taken out once you can get up and move around.

There may be drainage tubes coming out of the wounds. These will be attached to a small container. This collects any excess blood or body fluid. A nurse will remove the tubes and container a few days after the operation. Or these may be removed after you go home.

Straight after surgery, your wounds may be covered with dressings or sticky plastic strips. You will wear these until the wounds have healed.

Once you are moving around, your surgeon or nurse will tell you whether you should keep the area dry. They will let you know when you can gently shower the wounds with clean water.

They will also tell you if and when your stitches need to be removed. The stitches may be soluble. This means they will dissolve and not need to be removed by a doctor or nurse.

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 lets warm air flow over you. Or you may have thick gauze pads over the breasts.

The tissue flaps will be checked frequently for the first 24 to 48 hours. This is to make sure they have a good blood supply.

Your reconstructed breast will be swollen to begin with. Swelling will reduce over a few weeks but may take longer to fully settle.

Some people may have some general post-surgery swelling in their body, hands and feet. This will start to go down after couple of days.

Bruising to the breasts and donor site is very common after the operation. It usually goes away within 3 weeks.

After any type of operation, you will have some pain or discomfort. You will be given painkillers to keep you comfortable. After the operation, you may have these as an injection or through a pump you control yourself. These will be replaced by tablets or syrup as you start to eat and drink. Make sure you ask for painkillers if you need them. This will help you recover more quickly.

Before you go home, the nurses will give you medicines to take at home while the area continues to heal. They will explain how to take them.

You will usually have some numbness or pins and needles across your chest or reconstructed breast. If you have a tissue flap, you may also have numbness under your upper arms and around the donor site. Some people may notice a change in how materials such as lace feel against their skin.

These sensations improve over months or sometimes years. But it is common to have some numbness that will not go away. Most people adjust to this over time.

Constipation can be common after surgery. It means you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:

• Drink at least 2 litres (3½ pints) of fluids each day.
• Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
• Do regular gentle exercise, like going for short walks.

Some painkillers can cause constipation. You may need to take medicine called laxatives to help. Your doctor can prescribe these for you. Or you can get them from your local pharmacy.

You may be advised to wear a bra to support your reconstructed breast. To begin with, you will need to wear a soft, supportive bra without underwires. This will be more comfortable. A front-fastening bra can be easier to take on and off. 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 is called a stabiliser band. It sits on top of the implant and helps make sure it stays in the correct position. You should wear this day and night

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 do your exercises. You will also be given specific exercises to do if you had surgery to another part of your body, such as your tummy.

After risk-reducing breast surgery, samples of your breast tissue are sent to a laboratory and examined under a microscope. This is to make sure there are no changes in the cells that might be the early stages of cancer.

If any cancer changes are found, your doctor and nurse will talk to you about any further treatment you might need.

Most of the possible complications after surgery are mild and can be treated. But there can sometimes be more serious or long-term problems. Smoking, being overweight or having diabetes can increase this risk.

Sometimes blood may collect in a reconstructed breast or donor site. This is called a haematoma. It is most likely to happen in the first 24 hours after surgery. It can cause swelling and pain. If you have a wound drain, this will usually collect any excess blood. If the haematoma gets worse, you may need an operation to stop the bleeding and remove it.

Surgery and bed rest increase the risk of developing a blood clot in the legs. This is called deep vein thrombosis (DVT). Straight after surgery, you may notice you have something around your lower legs which pumps air up and down. This helps keep your blood flowing and prevents blood clots while you are on the bed.

You will usually be given compression stockings to wear to try to prevent DVT. You will be encouraged to move around as soon as possible after the operation. You may also be given blood-thinning injections for a few days after the operation.

Sometimes after wound drains are taken out, fluid builds up under the wound. This is called a seroma.

Seromas are usually absorbed back into the body. If this happens, it may settle on its own. But you may need to have the fluid removed. A surgeon or nurse can do this with a small needle and syringe. The fluid can build up again, so it may need to be removed more than once.

Wounds usually heal within 6 weeks. But sometimes wound healing can take longer. This may be because of infection. Or there may not be a good enough blood supply to the wound.

Smoking, radiotherapy or being very overweight can delay wound healing. Stopping smoking and eating a healthy, balanced diet with enough protein and vitamin C help tissues heal.

When you go home after your operation, you will be told how to check your wounds regularly. Tell your breast care nurse or surgeon straight away if you have any signs of infection, such as:

• heat, redness, pain, swelling or a change in colour over the breast, around the scar, or both
• fluid coming from the wound
• a temperature above 38°C (100.4°F)
• feeling shivery and shaky
• feeling generally unwell.

Your nurse or surgeon will look at the wound and may take a swab to send for testing. If you have implants, you may need to go to the hospital for observation. Your doctor may give you antibiotics into the vein to treat an infection.

If you are having immediate reconstruction and need to have radiotherapy to the chest, there is a higher risk of certain complications. This can depend on the type of reconstruction.

If there are problems with wound healing, this might delay radiotherapy. Having radiotherapy to the chest can also affect wound healing.

Your doctor can tell you more about possible complications of breast surgery. They can answer any questions you may have. They may also be able to show you some photos of what some of the possible complications may look like.

If there is not a good enough blood supply, it may mean part of the tissue flap will be unsuccessful. This is called partial flap loss. If this happens, you may need another operation to remove the affected tissue.

There is a small risk that radiotherapy could affect blood supply to the flap. Having radiotherapy to the chest after a breast reconstruction may increase the risk of this happening. Your surgeon can explain more about this risk.

If you have radiotherapy to the chest after reconstruction using your own tissue, there is an increased risk of developing a fat necrosis. Fat necrosis is an area of dead fat cells that can cause a firm lump in the reconstructed breast. It can happen when fatty tissue does not have a good enough blood supply.

When you have an implant reconstruction, your body forms fibrous (hard) tissue around the implant. This is called a capsule. For some people, the capsule contracts and the tissue tightens around the implant. This is called capsular contracture. Having some capsular contracture is quite common. But, occasionally, more severe capsular contracture can happen. You have a greater risk of this if you have an implant reconstruction and also have radiotherapy to the chest.

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

• use plain English
• explain medical words
• use short sentences
• use illustrations to explain text
• structure the information clearly
• make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.