What you can expect depends on how you and your surgery team decide to do your reconstruction. Surgery to do breast reconstruction with implants often starts right after mastectomy surgery. Some people want to wait to have reconstruction surgery after they've healed from a mastectomy.

Ways that plastic surgeons can do breast reconstruction using implants include:

• Placing the breast implant right away. The plastic surgeon puts the breast implant in place once the breast surgeon completes the mastectomy.
• Placing a tissue expander right away. The plastic surgeon puts a balloonlike tissue expander in place once the breast surgeon completes the mastectomy. Surgery to put in a breast implant happens later.
• Doing the reconstruction later. If you don't want breast reconstruction right away, you can have this surgery later. Doing the reconstruction later may make it harder to get the most natural breast shape.

Placing the breast implant right away

Sometimes the plastic surgeon can place the breast implant at the time of the mastectomy. This is called direct-to-implant reconstruction.

While you are still in a sleeplike state, the plastic surgeon places the implant after the breast cancer surgeon has removed all the breast tissue. The plastic surgeon most often puts the implant above the chest muscle, also called the pectoral muscle. A breast implant is a round shell that's typically filled with silicone gel.

Placing the implant in front of the chest muscle is called a prepectoral breast implant. The implant sits just under the skin. Placing the implant under the chest muscle is called a subpectoral breast implant.

The plastic surgeon might use mesh or tissue called acellular dermal matrix to help hold the implant in place. Over time, the body replaces this tissue with its own cells.

Placing a tissue expander right away

Most people having breast reconstruction with implants don't get breast implants right away. Instead, the plastic surgeon places a tissue expander in the chest. A tissue expander is like a balloon. A healthcare professional can slowly fill it over a few weeks to months.

As the tissue expander gets bigger, it slowly stretches the chest skin and tissue. This makes enough space on the chest to place a breast implant.

If you're having tissue expanders placed right away, the process starts just after your mastectomy surgery. While you're still in a sleeplike state, the plastic surgeon places the tissue expander. The surgeon may put the expander in front of the chest muscle or under the muscle.

After surgery you will return to see your healthcare team every week or two over the next months. A healthcare professional uses a needle to put saline into a small valve in the tissue expander. The valve is under your skin. Filling the expander slowly stretches the skin and tissue on the chest.

Once the expander makes enough room for an implant, you'll have another surgery. The plastic surgeon takes out the expander and replaces it with a breast implant. This might happen in 3 to 6 months if there's no need for radiation.

Doing the reconstruction surgery later

If you choose to wait to have breast reconstruction with an implant, the surgery most often starts with placing a tissue expander. The expander slowly stretches the skin and tissue on the chest. Then the plastic surgeon does another operation to take out the expander and replace it with an implant. Surgeons typically prefer to start reconstruction right away, rather than waiting. Doing the breast reconstruction later may make it harder to create the most natural breast shape.

After the procedure

After surgery, you may wear a stretchy bandage or support bra to keep swelling down and support the reconstructed breast. You may have a small tube under your skin for a time to drain blood or fluids. Your healthcare professional prescribes medicine to help manage your pain.

You may be tired and sore for several weeks after surgery. Getting back to usual activities takes time. Take it easy during this period.

You might need to restrict your activities. Follow your healthcare team's instructions on what activities are not OK. This may include not doing any overhead lifting or anything that could cause strain.

Contact your plastic surgeon right away if you have worries about your reconstruction.

Nipple reconstruction

If your breast cancer surgery involved removing the nipple, you might think about surgery to create a new nipple. Surgery to make a new nipple is called nipple reconstruction. The plastic surgeon might make the new nipple with some of your skin. You might choose to have a tattoo applied to the nipple and to the circle of skin around it, called the areola.

Most often, a plastic surgeon does nipple reconstruction after you've healed from the implant surgery. But some people might have nipple reconstruction at the same time as the implant surgery.

Future breast cancer screening

If you have only one breast reconstructed, continue with mammograms for breast cancer screening on your other breast. You typically don't need mammograms on breasts that are reconstructed.

Continue to do breast self-exams on your natural breast and the skin and area around your reconstructed breast. Tell your healthcare professional about any changes you find.