Implant breast reconstruction: what happens, risks and recovery

Reconstruction is not compulsory after mastectomy. It is an option the NHS says can be done at the time of the mastectomy or later. Implants are the simpler of the two main families, the other being operations that move your own tissue, such as a latissimus dorsi flap or a DIEP flap taken from the abdomen.

The Cambridge leaflet describes factors that make implant reconstruction less suitable or riskier. A body mass index of 30 or above increases the chance of complications, and 35 or above significantly increases the risk of serious ones. Smoking raises the risk substantially. Previous radiotherapy may mean an implant alone is not advised, and in that case a flap, or a combination, may be offered.

Another reasonable choice is to have no reconstruction at all and use a prosthesis in a bra, or to wait. Delaying is possible if radiotherapy or other treatment is planned.

In the one-stage approach described by Plymouth, an implant is placed straight away to replace the removed volume. The leaflet says silicone implants may be round or teardrop shaped, smooth or textured, and that a mesh, often derived from animal tissue and sometimes synthetic on request, supports the implant against the chest muscle.

In the two-stage approach described by Cambridge, the implant has a port and an inflatable chamber. It is filled with saline through a needle at clinic visits, so skin and muscle stretch gradually until the desired size is reached. Your surgeon will explain which method suits your tissues and treatment plan.

Planning starts with a joint conversation between the breast surgeon and plastic surgeon about timing, treatment and what shape you want. Weight, smoking and other health issues come up, since the Cambridge leaflet says they matter for safety. The day is a general anaesthetic with fasting beforehand, and your hospital will give written instructions.

The Cambridge leaflet gives 3 to 5 hours for implant reconstruction alone and a stay of 3 to 5 days, with a recovery of 4 to 6 weeks. Drains are used, and the Plymouth leaflet says people go home with a drain, reviewed at a dressing appointment about a week later.

Plymouth lists infection, bleeding into the wound, fluid collections, implant rupture and loss of the implant as risks. It also gives a figure of 1 in 100 for impaired blood supply to the nipple, and 1 in 5 for altered nipple sensation. Reduced skin sensation over the reconstructed breast is expected.

Capsular contracture, where scar tissue tightens around the implant, is raised by radiotherapy and by smoking according to Plymouth, and the Cambridge leaflet puts it at approximately 10% of women. Breast implant-associated anaplastic large cell lymphoma is a rare cancer linked to textured implants, and the two leaflets quote different figures because they refer to different implants, so ask which type would be used.

Implants have no fixed expiry date but may need replacement or revision. Plymouth notes that complications can delay radiotherapy or chemotherapy if those are still due, which is a reason some people choose delayed reconstruction. The reconstructed breast feels heavier and colder than a natural one, and it does not change with weight in the way your other breast will.

Plymouth advises avoiding driving for up to four weeks, a minimum of four to six weeks off work and no strenuous activity for six weeks or more. A supportive bra is worn day and night for at least six weeks, and Cambridge mentions supportive garments for three months. Arm movement above shoulder height is limited at first.

Nipple reconstruction and tattooing are possible later. Cambridge describes grafted or prosthetic nipples, with tattooing considered after three to six months. The recovery timeline for implant reconstruction sets this out stage by stage.

• Is the implant placed above or below the muscle, and will mesh be used?

• Which implant type, textured or smooth, and what is the figure for BIA-ALCL for that type?

• What happens if I need radiotherapy afterwards?

• What does the other breast need to look like, and could it be adjusted to match?

• How many operations might I realistically need?