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Physical changes after breast reconstruction

It may take time to adjust to the different way a reconstructed breast(s) look, feel and move.

109727350_8.jpgA reconstructed breast(s) will not be the same as the breast(s) before mastectomy. The appearance of the reconstructed breast(s) is likely to improve over time, which may also help with feelings. It can help to talk about your feelings with your breast reconstruction surgeon, breast care nurse or another woman who has also had a breast reconstruction.

It usually takes 3–12 months after breast reconstruction for women to feel better about their body image.

"Me is what's on the inside, what's on the outside whether I've got one boob, two boobs, no boobs; and I've had all of that; doesn't change who I am.  This is just the vessel that I've been given to do this journey which is life and one boob, two boobs, no boobs, doesn't change who I am."

Living with a breast reconstruction using implants

After a breast reconstruction using implants, when clothed, your breast(s) are likely to look similar to how they looked before the mastectomy when you are standing or sitting. However, the reconstructed breast(s) will not move or fall naturally when you lie down flat, lean to the side, or lean forward.

Some women find it uncomfortable to sleep on their side or front because breast implants do not move or squash like their breasts did previously. This is more likely to happen if you have larger breasts.

The breast will also not change size with changes in body weight.

Some women experience some loss of sensation when the breast is touched. This may be temporary or permanent and is because of interference with nerves during surgery.

Women who have breast reconstruction using implants may experience fewer problems with body movement once they have healed from surgery. This is because no muscles or tissue are moved from other areas of the body. However, some women may experience tightness across the chest.

Over time, breast implants may need to be replaced. This is usually done as a day surgery procedure as long as there are no complications.

"I was always slim, I didn't have any marks, so you know, I felt good about myself.  And so I think having that, I did go through that sort of first initial months thinking "Oh you know, I've got scars now, I've got this and that", and it was hard, you know.  It was hard and I did feel yuck about myself."

Living with a tissue flap breast reconstruction

After a tissue flap breast reconstruction, the reconstructed breast(s) will look, feel and move more naturally than with a breast reconstruction using implants.

Breast sensation will not be the same as it was before mastectomy. About two-thirds of women notice some sensation returning to their reconstructed breast(s) after 6 months. However, one-third continue to have no sensation. Other women find their breast(s) become extremely sensitive.

Living with an LD flap breast reconstruction

Following an LD flap breast reconstruction, the breast(s) will change somewhat with changes in body weight, but not as much as with a TRAM or DIEP flap reconstruction.
Some women report an odd sensation in their back when their reconstructed breast is touched. This is caused by nerve endings that were moved from the back to create the breast.

Some women also experience muscle spasms in their reconstructed breast(s).

Some women find that movement of their arms and shoulders is affected in the medium to long term. Other muscles in the back help to make up for the lost strength of the latissimus dorsi muscle. However, reduced movement can affect some occupations and some physical/sporting activities (such as tennis and climbing).

Living with a TRAM flap or DIEP flap breast reconstruction

Following a TRAM flap or DIEP flap breast reconstruction, the reconstructed breast(s) will look and feel more like natural breasts than with implant or LD flap breast reconstruction techniques. In particular, the softness and droop of the breast(s) will be more like natural breasts. The breast(s) will change size if you gain or lose weight.

There will be some loss of sensation in the lower abdomen, just below the navel (tummy button). The abdominal muscles may also be weaker, particularly following TRAM flap breast reconstruction. This will be particularly noticeable during strenuous exercise and when doing abdominal exercises like sit-ups or crunches. All heavy lifting (more than 10kg) should be avoided for at least 6 weeks and possibly up to 3 months after surgery. A physiotherapist can with a gradual and safe return to usual activities.

Women who are considering pregnancy should discuss this with their breast reconstruction surgeon. Removal of a section of the abdominal muscle and tissue may prove problematic as the baby grows.

"It's taken twelve months for me to get used to it (reconstructed breast) and for me not to go "Oh, I hate that nipple", or anything…That doesn't happen overnight... In the first few months you are still in a sense of shock about the whole thing."

What to do if you are unhappy with your reconstructed breast(s)

It will take some time for your reconstructed breast(s) to reach their final look, feel and movement. Scars will fade over time, the breast tissue will ‘settle’ into position, and refinement procedures may be done. This process can take up to 18 months.

It is important to give your breast(s) time reached their final look, feel and movement, and to give yourself time to get used to her new breast(s).

If you are unhappy with the look and feel of your reconstructed breast, discuss this with your breast reconstruction surgeon. Your breast reconstruction surgeon can advise on whether the healing process is still in progress and may be able to suggest ways to optimise the look and feel of the breast(s). Breast refinement procedures may help improve the final look and feel of your breast(s).

A second opinion may be helpful if you remain unhappy with the outcome of your breast reconstruction.