When a breast has been removed (mastectomy) because of cancer or other disease, it is possible in most cases to reconstruct a breast. A breast reconstruction can be performed as part of the breast removal operation (immediate reconstruction) or can be performed months or years later (delayed reconstruction). There are two main methods of breast reconstruction: one involves using an expander and/or implant; the other uses tissue taken from another part of your body. There may be medical reasons why one of these methods is more suitable for you or, in other cases, you may be given a choice. Implant Based Reconstruction In implant based reconstruction, an implant filled with cohesive silicone gel is inserted underneath the chest muscle and skin. Before being inserted, the skin and muscle will often need to be stretched using a tissue expander to the required breast size. This is done by placing the tissue expander (an empty bag with a fill port) where the implant will finally go, and gradually filling it with saline over weeks or months. Once fully stretched, the expander can then be replaced by the final implant after waiting several months. This process therefore requires two operations several months apart. Each operation will probably take 1-2 hours under general anaesthesia (you will sleep through it). You will probably stay in hospital for 1-2 days each time. Flap Reconstruction In this operation, tissue is taken from another part of the body and used to reconstruct the breast. The most common place to get this tissue from is your stomach. The tissue can be moved up in two ways - either remaining attached to the muscle underneath (pedicled TRAM flap) or being completely detached from your body and re-attached to blood vessels in the chest using microsurgery (free DIEP flap). Flap reconstruction is generally a more complicated operation than having an implant but can produce a more natural breast using your own tissue. A pedicled flap may take 4-5 hours and a free flap may last 8 hours or more. In each case, you will require a 3 to 5 day stay in hospital.

Surgery to reduce breast size involves making a cut (incision) around the areola (the dark area around the nipple) straight downwards and along the crease beneath the breast. Glandular tissue, fat and skin are removed and the breast reshaped. The surgery is performed under general anaesthesia (you will sleep through it) and will take 2-4 hours. You will probably stay in hospital 1-2 nights and will need to arrange for someone else to drive you home. You may need to take some medication for pain relief for several days and you must wear a special support bra continuously for 2 weeks after surgery. You will probably be able to return to work after about 2 weeks. It will take several months for the scars to fade.

Surgery to increase breast size involves inserting silicone sacks (implants) filled with silicone gel or salt water (saline) under the chest muscle and skin. The procedure involves making a cut (incision) in the armpit, under the breast or around the areola (the dark area around the nipple) from where the implant is inserted. The surgery is usually performed under general anaesthesia (you will sleep through it) and it will probably take 1–2 hours. You will probably be able to go home the day of the operation, but you will need to arrange for someone else to drive you. You may need to take some medication for pain relief for 2-3 days and you should rest for a few days after the surgery. You will probably be able to return to work after 7-10 days. It will take several months for the scars to fade.

This is an operation that can lift and reshape sagging breasts. The procedure usually involves removing skin from an area below the nipple and reshaping the breast. The surgery is performed under general anaesthesia (you will sleep through it) and will take about 2 hours. You will probably stay in hospital overnight and will need to arrange for someone else to drive you home the next day. Your breasts will be bruised and swollen for several days and you may need to take some medication for pain relief. You will need to wear a special support bra continuously for 3-4 weeks after surgery. You will probably be able to return to work after about 1 week. It will take several months for the scars to fade.

This procedure removes unwanted pockets of fat from under your skin in specific parts of the body such as the chin, neck, upper arms, stomach, hips and thighs. Liposuction should not be regarded as a means of general weight loss, but instead as a way to improve the shape of particular areas of your body. A small cut (incision) is made, through which a narrow, hollow tube (cannula) is inserted. The tube is moved around to loosen the fat cells, which are then sucked out with a vacuum device. During the procedure you will lose a lot of fluid, so you will be given intravenous (injected straight into the vein) fluid to stop you becoming dehydrated. The procedure usually takes 1-3 hours and is carried out under local anaesthetic (the area being treated is numb but you are awake). You will probably be able to go home the same day but will need someone to drive you. However, if the procedure is more extensive and numerous areas are being treated at the same time, it may require general anaesthesia (you will sleep through it) and you may have to remain overnight in hospital. The area treated will be swollen and bruised after the surgery and you may need to take pain relief medication for several days. You will be given an elastic dressing or support garment that you may have to wear continuously for 2-3 weeks. You will probably be able to return to work after 1-2 weeks.

Scar appearance can be improved by various methods including a surgical procedure known as scar revision. This usually involves cutting out the old scar, closing the wound with stitches and, in some cases, moving the scar so that it is hidden by natural features of the body. Scar revision is usually performed under local anaesthesia (the area around the scar is numbed by injecting a local anaesthetic). Sometimes you may also be given steroid injections at the time of surgery. Immediately following the procedure, you will need to remain at the clinic for about an hour, during which you will be encouraged to walk around. You may or may not have a dressing put on the wound and it is important to keep the area dry for 24 hours. Stitches may be removed in 1-2 weeks. You may need to take a few days off work after the surgery.

Fat grafting, also known as fat injections or lipofilling, is a procedure that moves a person’s own fat from one place to another. It is a well established procedure in breast reconstruction to fill in irregularities and grooves, or increase volume.