What’s the Breast Reconstruction Timeline After Surgery for Breast Cancer?

If you need to have surgery for early breast cancer, you’ll have the chance to decide whether you want to undergo breast reconstruction surgery. Some women choose not to. Others want their chests to look as close as possible to the way they did before mastectomy (or even a little fuller or uplifted). It’s all up to you.

If you do choose reconstruction, what sort of timeline can you expect?

“When breast cancer is detected early or for preventive cases, many women are able to do a single-stage mastectomy and reconstruction — meaning it happens all in one surgery,” says plastic surgeon Risal Djohan, MD.

How long does the early breast reconstruction process take?

Ultimately, how long your breast reconstruction process takes will depend on your cancer treatment plan, your preferences and the type of surgery you have. But when breast cancer is caught early, you may be able to expect a timeline of as little as six months — or even less, Dr. Djohan says.

Here’s a look at the general reconstruction timeline for early breast cancer, including factors that play a role:

1. Initial breast cancer surgery: You may have immediate reconstruction done at the same time as your mastectomy. Or your care team may recommend two-stage reconstruction, where you have a second surgery down the road to focus on reconstruction.
2. Expansion phase (two to six months): If you’re having two-stage reconstruction, your surgeon will place a tissue expander during your initial surgery. The length of this phase depends on how much time your breast tissue needs to expand.
3. Breast reconstruction surgery: When your skin and tissue have expanded enough, you’ll have a second surgery. Your breast surgeon will reconstruct your breasts using either implants or a tissue transfer.
4. Finishing touches, as needed: You’ll continue to see your plastic surgeon for follow-up visits to determine any final aspects of your breast reconstruction, like adding a fatty layer over the implants, nipple reconstruction and nipple tattooing.

An important note: We’re specifically talking here about options for early breast cancer. Advanced breast cancer often requires “delayed reconstruction” — flat closure after a mastectomy, without a tissue expander. “That gives your care team time to treat the cancer and optimize your health so they can do reconstruction later on,” Dr. Djohan explains.

But for early breast cancer, here’s a deeper look at the options and possible timeline.

Planning your reconstruction

Your timeline starts before you ever enter the operating room. After a breast cancer diagnosis, you’ll meet with your care team to talk about plans for mastectomy and reconstruction. That includes:

• Initial surgery timing: “Depending on the stage of the cancer, surgery is often recommended up front,” Dr. Djohan says. For early breast cancer, you may not need additional treatments beyond surgery.
• Reconstruction timing: “In the past, reconstruction usually followed the completion of other cancer treatment,” Dr. Djohan explains. “But these days, we’re often able to start reconstruction immediately.”
• What type of incision you need: Options like a skin-sparing mastectomy or a nipple-sparing mastectomy preserve as much breast skin as possible. This helps create an envelope of skin that your plastic surgeon can use to rebuild your breast.

Your surgeons will share all the factors that will guide these decisions. They’ll also help decide what type of breast reconstruction is right for you:

• Implant reconstruction uses saline or silicone implants.
• Flap reconstruction uses tissue from other areas of your own body to reconstruct your breasts.
• Combination reconstruction uses a combination of implants and tissue from your body.

If you’re having a lumpectomy, your options will look a little different. If your breasts are small, you may not need any reconstruction. If your breasts are large, your surgeon may recommend oncoplasty — breast reconstruction using breast reduction techniques and/or breast lift techniques. That happens during the same surgery as your lumpectomy. 

We know: It’s a lot to figure out. But your team will be by your side to answer questions and help guide you throughout the process.

Initial surgery, with or without immediate reconstruction

When the mastectomy is done, your plastic surgeon will step in. If you’re having immediate reconstruction, they’ll do the procedure right then and there.

“If you’re going with two-stage reconstruction, your surgeon will place a tissue expander,” Dr. Djohan explains. “This temporary implant helps shape the breast area before you get your permanent reconstruction.”

Recovery from mastectomy surgery

Recovery begins immediately after surgery. But how long it takes will depend on the specifics of your procedure. “We estimate about six to eight weeks,” Dr. Djohan says. “But your care team will provide a timeline that’s specific to you.”

They’ll also tell you what activities to avoid and what symptoms to be on the lookout for after surgery, like any signs of infection.

Your first follow-up visit

About a week after surgery, you’ll attend a postoperative visit so your surgeon can check on your incisions. They’ll likely remove any surgical drains placed during surgery. 

“If you had immediate reconstruction, your surgeon will let you know how often you need to come in for follow-up visits,” Dr. Djohan says. “They’ll want to assess your breast shape, see how your scars are healing and discuss options like nipple tattooing.”

Phases of two-stage breast reconstruction

If you’re having two-stage reconstruction, you’ve got a few more steps to go. Here’s what it’s likely to entail.

Expansion phase

Once your surgeon has placed a tissue expander, you’ll need to go through an “expansion phase” to stretch your breast tissue before reconstruction.

Starting a few weeks after surgery, you’ll attend appointments to have your tissue expander filled with saline or air. You’ll return every week or two for several weeks — until the skin has expanded enough so your surgeon can create as natural a breast shape as possible.

“After the final expansion, the tissue expander will be left in place for a few months to give that newly stretched tissue some time to settle into place,” Dr. Djohan says.

Breast reconstruction surgery

Reconstruction happens during a second surgery. This is when your tissue expander is removed and replaced with either implants or tissue from elsewhere in your body.

• If you’re having implant reconstruction: Your surgeon will place a permanent implant into the pocket that the tissue expander has created. They may also do a fat transfer to add fat underneath your skin to improve the shape and feel of your breast(s). 
• If you’re having flap reconstruction: “The most common type of flap reconstruction procedure is DIEP flap surgery,” Dr. Djohan says. “Your plastic surgeon will use blood vessels, fat and skin from your lower belly to rebuild your breast.”

Recovering from reconstruction surgery

Again, your recovery depends on the type of surgery you had.

• After implant reconstruction, you’ll probably be able to go home the same day.
• DIEP flap reconstruction typically requires a two- to five-day hospital stay.

You’ll need to avoid strenuous physical activity for four to six weeks, and you’ll have some bruising and swelling that will go down with time. But again, your care team will give you aftercare instructions.

Follow-ups and final touches

“In the months after your surgery, the appearance of your reconstructed breast will start to improve,” Dr. Djohan reassures.

During this time, you’ll attend follow-up appointments with your surgeon. They’ll want to keep a close eye on how you’re healing and talk about the possibility of any additional procedures, like:

• Fat grafting: Your surgeon may refine the contour and volume of your breast by using fat cells from your abdomen or thigh. Recovery is usually about three weeks.
• Nipple/areola reconstruction: “This is typically the last step, when your breast symmetry and volume are optimal,” Dr. Djohan explains. Recovery is typically one to two weeks.

Both are outpatient procedures that don’t usually require hospital stays.

Final thoughts

The decision to have breast reconstruction is extremely personal, and you’ll have a lot of decisions to make along the way. But you won’t be going through any of it alone.

“Every detail of your treatment and reconstruction will be tailored to your diagnosis and preferences,” Dr. Djohan emphasizes. “And your plastic surgeon, breast surgical oncologist and the rest of your care team will be there every step of the way to help you make all those decisions.”