Breast reconstruction

At Institut Ruiz Castilla (IRC), we plan breast reconstruction alongside the specialists responsible for your cancer treatment. After a lumpectomy, we may reshape the breast using oncoplastic techniques. Following a mastectomy, we offer immediate and delayed reconstruction options.

When reconstruction requires a microsurgical flap, such as a DIEP flap, we coordinate assessment and treatment with the IRC surgeons who specialise in these techniques.

The gynaecology and oncology teams assess your case, which is discussed at the multidisciplinary breast meeting. The order of consultations may vary.

The reconstructive consultation usually takes place once the broad cancer treatment plan has been established. This allows us to integrate the reconstruction options and adapt them if new findings emerge.

At Institut Ruiz Castilla (IRC), we listen to your concerns and provide empathetic, personal care. We want to help you understand your options and each stage of treatment.

Surgical coaching is one of the available support resources. It offers guidance throughout the surgical journey and does not replace specialist psychological care. The oncology service provides access to psychologists and support programmes; we coordinate these resources to avoid duplication and maintain continuity of care.

Before surgery, we assess smoking, nutritional status, weight, existing medical conditions and medication. We recommend stopping smoking and review whether any treatment needs adjustment with the prescribing professional. Do not stop medication on your own.

For immediate reconstruction, timing is guided by cancer treatment. If the risks of reconstruction are too high, we may recommend delayed reconstruction and use the intervening period to improve your health before surgery. Necessary cancer surgery continues according to the plan agreed with the gynaecology team.

Please bring any available records relevant to your care: oncology reports, previous operation reports, pathology results, imaging reports and the images themselves where available, details of treatments received and the proposed treatment plan. Please also bring identification cards for implants, tissue expanders and other implanted devices, even if they are unrelated to breast reconstruction.

You can still attend your consultation if some records are missing. Contact details for the centres where you received treatment will help us identify where to request the information needed. We can guide you through obtaining it or, where appropriate and with your permission, request it on your behalf.

The Institut Ruiz Castilla (IRC) team includes professionals who speak several languages. If you have translated versions of your reports, please bring them. When needed, we can use the hospital’s translation service to help review your records.

The location of the lesion, the amount of tissue to be removed and the shape of the breast guide surgical planning. Some areas can be treated using techniques similar to a breast lift or reduction; others require more complex tissue rearrangement. The priority is to remove the tissue required for cancer treatment.

Not always. The breasts may be sufficiently similar after treatment, and surgery may even improve an existing asymmetry. If we anticipate a significant difference, we explain the options for improving symmetry, including the scars and recovery involved.

Choosing not to have surgery for symmetry initially does not prevent you from considering it later, when your treatment plan allows.

The indication for a risk-reducing mastectomy is assessed by the breast, genetics, gynaecology and oncology teams. It may be considered for both breasts or for the opposite breast after a breast cancer diagnosis, depending on individual risk and each patient’s informed preferences.

The plastic surgery team explains the reconstructive options—direct-to-implant reconstruction, a tissue expander or your own tissue—and assesses whether the nipple and areola can be preserved. The decision also depends on your anatomy, previous treatments and tissue quality.

This is major, irreversible surgery. It can substantially reduce the risk of breast cancer but cannot eliminate it completely. Decisions and follow-up therefore remain part of specialist breast care.

Immediate reconstruction begins during the mastectomy when the cancer treatment plan, tissue condition and your health allow, and you wish to proceed. It may avoid a period without breast volume, but it does not guarantee that reconstruction will be completed in one operation.

Delaying reconstruction may be appropriate for medical reasons or personal preference. Choosing not to have reconstruction is also a valid option. We discuss this without assuming that everyone has the same wishes.

Your own tissue becomes part of the reconstructed breast and may change with ageing and weight fluctuations. Without an implant, there is no prosthesis to replace, although further surgery may still be needed. Taking tissue from another area leaves scars and may have lasting effects at the donor site.

Implants avoid taking tissue from another area when they are used without a flap. However, they require follow-up and may need removal or replacement. In selected cases, implant reconstruction can later be converted to reconstruction using your own tissue.

Skin quality, previous surgery, radiotherapy, your health and your preferences all influence the choice. We explain the alternatives that may benefit you.

Sometimes we plan to use a tissue expander from the outset. In other cases, an implant is the intended option, but we must assess the condition of the tissues during surgery before proceeding.

If placing an implant is not safe, we may use an expander as the first stage. This does not mean that the operation has gone wrong. If an expander is also unsuitable, reconstruction may need to be postponed.

The expander is temporary. Filling begins when the wound and tissues allow, at a pace adapted to your tolerance, healing and circumstances.

The timing of removal depends on tissue adaptation, your health and coordination with the cancer treatment schedule. An expander may be followed by an implant or reconstruction using your own tissue.

A mastectomy can damage sensory nerves, leaving areas numb or with altered sensation. Preserving the skin, nipple or areola does not guarantee that their sensation will be preserved.

Some sensation may return over time, but certain changes are permanent. Restoring breast shape and volume does not necessarily restore previous sensations.

Not having reconstruction is a valid, personal choice. We explain the appearance you can expect based on your anatomy and treatment, alongside the potential benefits of reducing the duration and complexity of surgery and recovery.

You can reconsider this decision later. The feasibility and options for future reconstruction will depend on your health, the tissues and treatments received. In some cases, reconstruction may be technically more complex.

When the plastic surgery team is involved in shaping the contour or closing the wound, we provide the corresponding surgical follow-up. If our involvement is not needed, the gynaecology team continues your care and can refer you back if you wish to explore reconstruction in the future.

We can create nipple projection using a small local flap or, in selected cases, a graft taken from part of the opposite nipple, taking into account the potential effects on the donor site.

The areola can be recreated with medical tattooing or, in selected cases, a skin graft from the groin. External silicone prostheses are another option, as is choosing not to have further procedures.

We usually wait until the breast shape and position are sufficiently stable. We also consider any cancer treatments still planned or already completed, alongside your preferences.

Fat grafting, also known as lipofilling, can complement the initial reconstruction or later improve contour irregularities, asymmetry and areas with limited tissue coverage. In selected patients, it can also play a central role in reconstruction without implants.

A small, localised correction may be achieved in one session, while reconstruction requiring more volume may need several. There is no fixed number of sessions: this depends on the available tissue and the intended result.

We wait for clearance from the oncology team and coordinate the timing with your treatments and imaging appointments. Reconstruction should not delay necessary treatment or unnecessarily interfere with a scheduled investigation.

Fat grafting may improve the thickness and quality of certain tissues, including after radiotherapy, but it cannot reverse all radiation-related changes. It may cause fat necrosis, oil cysts or benign calcifications, which sometimes require further investigation.

Some of the transferred fat may not survive, leading to areas of fat necrosis, oil cysts or calcifications. These are benign changes, but they may sometimes be felt as a lump or appear on imaging.

We coordinate fat grafting with the oncology team and multidisciplinary breast team to minimise interference with planned treatments or investigations. Even so, we recommend reporting and assessing any persistent change. You are not expected to distinguish a reconstruction-related change from a possible cancer recurrence yourself.

Assessment usually begins with a clinical examination and imaging. If uncertainty remains, a biopsy may be needed. When the diagnosis is clear and there are no symptoms, observation may be sufficient. Pain, changes in shape, inflammation or diagnostic uncertainty may warrant treatment.

Major breast reconstruction is usually performed under general anaesthesia. Immediate reconstruction using a tissue expander, an implant or a latissimus dorsi flap usually involves a hospital stay of a few days.

Replacing a tissue expander with an implant and many secondary procedures can be performed as day surgery. In our practice, DIEP flap reconstruction usually requires around one week in hospital.

Some small local flaps used to reconstruct the nipple can be performed as outpatient procedures under local anaesthesia. The plan is tailored to each patient.

We do not use drains for every procedure. They are common in extensive reconstructions, such as DIEP or latissimus dorsi flaps, and are removed once fluid output has decreased sufficiently. There is no single removal date that applies to everyone.

We apply a dressing during surgery and, depending on your recovery, later replace it with a postoperative bra.

After DIEP flap reconstruction, we recommend an adjustable abdominal support garment similar to the one used after a tummy tuck, usually for approximately one month.

We recommend sleeping on your back. After DIEP flap reconstruction, an initial position with your upper body and knees slightly raised helps reduce tension on the abdomen. Arm movements are protected during the first few days, without keeping the arms completely still for longer than advised.

We encourage early walking. Your care also takes account of any accompanying underarm lymph node surgery: sentinel lymph node biopsy and axillary lymph node dissection differ in the frequency and severity of their complications.

Before reconstruction, we assess your individual risk of blood clots and bleeding, taking into account your medical history, cancer treatment and the planned operation. Tools such as the Caprini score help guide this assessment.

Prevention may combine early walking, compression measures and anticoagulant medication when indicated. The treatment and its duration are tailored to each patient.

For microsurgical reconstruction, such as a DIEP flap, we also follow a specific team protocol adapted to the operation and any contraindications. Before discharge, we explain which medicines to continue, for how long and what precautions to take.

Your discharge medication is tailored to your procedure, recovery and medical history. It includes pain relief and, when indicated, other medicines.

We coordinate your medication plan with treatments you already receive, including cancer treatments. Before discharge, we explain how to take each medicine and for how long.

If you have questions or experience problems related to your medication, contact the team before changing it.

Sun protection, moisturising, massage and silicone products, when indicated, are tailored to the scars on the breast and at any donor sites. We adjust when to start these measures according to wound healing and your cancer treatments.

Care continues as the scars mature. Not all scars mature at the same pace, even in the same person. If a scar becomes raised, firm or itchy, or develops unfavourably, we assess whether specific treatment is needed.

Wound care is tailored to the type of reconstruction, your dressings, any drains and how the wounds are healing, both on the breast and at any donor sites.

Before discharge, we explain how to wash and protect the operated areas. The nursing team provides wound care and, together with the medical team, adjusts your instructions during follow-up appointments.

Showering and soaking in a bath, swimming pool or the sea are assessed separately. There is no single timeframe that applies to every reconstruction.

Recovery depends on the reconstruction technique, the cancer surgery and any donor site. Small secondary procedures may allow a quicker return to everyday activities, while DIEP or latissimus dorsi flap reconstruction requires a longer recovery.

Walking begins early. Returning to work, driving, exercise and lifting progresses in stages, once pain is controlled, wounds are healing well and you can safely perform the movements these activities require.

Being able to look after yourself does not necessarily mean you are ready to care for someone else.

Swelling and breast shape continue to change over several months. Flaps and their donor sites may need revision or additional procedures, particularly if there has been partial tissue loss or healing problems.

Reconstruction often involves several stages. It is considered sufficiently stable to plan the next step when relevant cancer treatments have been completed, swelling has settled and the tissues allow further surgery to be planned safely.

Radiotherapy can damage the skin and soft tissues and increase implant-related complications. Sometimes this means adding tissue with a good blood supply or converting an implant reconstruction to reconstruction using your own tissue.

Surgery to improve symmetry can take place at the same time as reconstruction or later. Revision procedures and nipple and areola reconstruction usually wait until breast shape and scars have stabilised.

Over the years, the two breasts may age differently, leading to renewed asymmetry.

Returning to intimacy depends on the individual, the type of reconstruction and recovery. There is no fixed timeframe: we guide you according to wound healing, pain control and how comfortably you can move.

We recommend a gradual return, avoiding pressure on the reconstructed breast and donor sites and following the same limits on physical exertion advised for other activities. If you experience pain or discomfort, stop and adjust the activity.

Adjusting to changes in your body also takes time. There is no need to rush. The Institut Ruiz Castilla (IRC) team can answer your questions and adapt the recommendations during follow-up appointments.

The support you need depends on the type of reconstruction, any donor sites and your recovery. Before discharge, the Institut Ruiz Castilla (IRC) team will explain which activities you can manage and where help may be useful.

Being able to look after yourself does not mean you are ready to care for others. If you have young children or dependants, we recommend arranging support during your initial recovery. Preparing meals in advance, keeping everyday items within easy reach and arranging help with lifting or strenuous household tasks can also be useful.

We review how much support you need and for how long during follow-up appointments, as you regain comfort and independence.

Advice depends on the type of reconstruction, your recovery and any follow-up appointments still needed. More complex procedures may require a longer wait before travelling, so we agree on the timing with each patient during follow-up.

Plan your journey with help for luggage, avoiding heavy lifting, knocks to the operated areas and exertion beyond your recovery restrictions. We also arrange the necessary appointments to maintain continuity of care.

Before booking a trip, particularly a long journey or one that takes you far from your treating team, we recommend discussing it with us.

If you would like to become pregnant, it is important to plan this with your oncology and gynaecology teams. The right timing depends on your clinical situation and treatments already received or still planned, not just your recovery from reconstruction. Do not stop cancer treatment on your own.

Your ability to breastfeed depends mainly on the cancer surgery and other treatments. After a mastectomy, the operated breast cannot breastfeed, even if the nipple and areola have been preserved. Reconstruction restores shape and volume but does not restore the function of the breast gland.

After breast-conserving surgery, some milk production may remain, although surgery and radiotherapy can reduce or prevent it. If the other breast has not been treated, breastfeeding from that breast may be possible. Your team should also review whether your medication is compatible with breastfeeding.

Reconstruction aims to restore breast shape and volume and achieve the best possible balance with your body. Appearance is an important part of treatment, alongside your comfort and wellbeing.

The starting point depends on your cancer surgery and other treatments. The amount and quality of remaining tissue, scars, radiotherapy and the reconstruction technique all influence what can be achieved. We therefore discuss expectations for your individual case: another patient’s result cannot predict yours.

We may achieve a close resemblance between the breasts, but cannot guarantee identical shape, size, position, feel, sensation or movement. Reconstruction also cannot reproduce every structure and characteristic of the original breast.

Symmetry can change over time. Even when the breasts initially look very similar, the reconstructed breast and the untreated breast may respond differently to ageing and weight changes. These differences may remain subtle or become more noticeable. If they concern you, we can assess the options and whether further treatment would be worthwhile.

At Institut Ruiz Castilla (IRC), we explain which improvements are realistic, which differences may remain and what cannot be predicted precisely. We want to help you decide with clear expectations, focusing on what matters most to you while recognising the improvements reconstruction can offer.

Alongside bleeding, infection, fluid collections known as seromas and delayed wound healing, implant reconstruction may involve implant exposure, displacement or capsular contracture. The implant may need to be removed and the reconstruction plan reconsidered.

Reconstruction using your own tissue can develop problems with blood supply or partial or complete flap loss. Partial loss does not necessarily mean losing the entire reconstruction. Depending on its extent, treatment may involve wound care, removal of tissue that has not survived, a skin graft, fat grafting or another operation.

The donor site may also develop a seroma, scarring, altered sensation, pain or weakness. After a DIEP flap, there is also a risk of an abdominal bulge or hernia.

Contact the team if you notice rapidly increasing swelling, changes in skin colour or temperature, worsening pain, redness, fever, pus, an unpleasant smell, wound opening or persistent bleeding. Difficulty breathing, chest pain or fainting require immediate medical attention.

If you are unsure, contact the team. You are not expected to decide on your own whether a change is urgent.

The frequency of appointments depends on the reconstruction technique, your recovery, ongoing treatments and individual needs. Whenever possible, we coordinate nursing, surgical and physiotherapy appointments to reduce the number of journeys.

During the first three days in hospital, the nursing team checks microsurgical flaps every hour, with an on-call medical team available.

Once the wounds have healed, tissue expander follow-up is adapted to the filling schedule. We monitor scars until they have clinically matured, often over six to eighteen months and, when necessary, for longer.

The oncology and gynaecology teams continue their own follow-up, with information available through a shared medical record.

Discomfort is usually greatest during the first few days and gradually improves. Its intensity and the course of recovery depend on the reconstruction technique and any donor sites. We tailor pain relief to each patient.

Persistent or nerve-related pain may develop in the breast, chest wall, underarm, arm or shoulder. This may feel like burning, electric shocks or sensitivity to light touch. Underarm lymph node surgery also affects the risk: axillary lymph node dissection carries a higher risk than sentinel lymph node biopsy.

If pain does not improve, gets worse or interferes with sleep, movement or everyday life, we assess it and may involve the pain service early. This service provides its own follow-up, which may continue over a longer period, and shares the medical record with the other teams. You do not need to wait until your next scheduled appointment to seek advice.

The DIEP flap is designed to preserve the rectus abdominis muscle. However, dissecting its blood vessels may affect muscle fibres, nerves or supporting structures, depending on the anatomy. Temporary or persistent weakness, an abdominal bulge or a hernia may occur. In selected cases, we use mesh, sutures to tighten the supporting tissue, or both, although these measures do not eliminate the risk completely.

The latissimus dorsi muscle contributes to pulling movements and activities requiring arm strength. Other muscles can compensate for some of its function, but strength or endurance may remain reduced. This can be particularly relevant for demanding activities such as climbing, rowing or certain sports.

Before deciding, we discuss your work, physical activities and priorities. Limitations vary between individuals, and we tailor rehabilitation to the technique, your recovery and your functional goals.

Imaging follow-up depends on the treatment you have received. After breast-conserving surgery, or when the opposite breast remains, you continue the screening and follow-up programme recommended by oncology, gynaecology and radiology. After a mastectomy, routine mammograms of the reconstructed breast are not always performed, and follow-up may rely mainly on clinical examination.

The shared medical record allows us to review previous tests and avoid unnecessary duplication. If you develop a lump, persistent pain, hardening, swelling or a change in shape, we may request an ultrasound, diagnostic mammogram or MRI.

If you have implants, their integrity may require specific monitoring, separate from cancer follow-up. This depends on the implant type, how long it has been in place and any findings.

Reconstruction does not protect against recurrence, but it does not itself increase the risk of cancer returning. That risk depends mainly on the tumour’s characteristics, its extent and the treatments received.

A recurrence may cause a lump, hardening, persistent skin changes, swelling or progressive changes in breast shape. However, it may initially cause no visible or noticeable signs. This is why your individual follow-up programme continues.

Appointments, imaging, blood tests and other investigations are arranged according to your clinical situation; not everyone needs the same tests. Benign changes related to reconstruction may also require investigation to distinguish them reliably from other causes.

Sentinel lymph node biopsy carries a low, but not zero, risk of lymphoedema. Axillary lymph node dissection increases this risk considerably, although not everyone will develop it. Radiotherapy to the regional lymph nodes and individual factors also influence the risk.

Contact the team if you notice swelling in the arm, hand, breast or chest wall; heaviness or tightness; new marks from clothing or jewellery; reduced movement; pain, redness or warmth in the area.

Early detection and treatment help manage the condition.

We recommend monitoring and physiotherapy tailored to the affected arm and operated breast. From the early stages, we aim to maintain safe shoulder movement and prevent stiffness. Movement, stretching and exercise progress according to the reconstruction technique, wound healing and associated treatments.

Compression garments may be recommended preventively for selected patients at higher risk or when early signs of lymphoedema appear. They must be properly measured and their use supervised. Not everyone needs them in the same way or for the same length of time.

When lymphoedema is present, compression is a usual part of treatment.

The first consultation aims to understand your concerns and identify what may be causing discomfort or the changes you have noticed. We listen to your experience and assess which aspects have the greatest impact on your life.

We review previous treatments, examine the reconstruction and arrange further tests when needed. We then explain which improvements are realistic, what limitations remain and what each option would involve in terms of surgery, recovery and risks.

Another operation does not always offer enough improvement to justify it. When options are available, we discuss them with you so you can decide whether to proceed and whether the expected benefit makes the process worthwhile.

Our aim is to provide an objective, respectful assessment, without minimising your experience or making premature judgements about previous treatments. We want you to have clear information and confidence when deciding your next steps.

This may be an option if complications arise or your preferences change. We assess it according to your health, the tissue available and the balance between expected benefits, risks and recovery.

During the consultation, we explain what removing the implant and reconstructing with your own tissue would involve, including scars and possible effects at the donor site. We take the time needed to answer your questions and understand what matters most to you.

An option that suited you years ago may no longer be your preferred choice. Reconsidering it does not mean the earlier decision was wrong.

The Institut Ruiz Castilla (IRC) team helps you identify medically suitable alternatives and understand their limitations. We make the decision with you, taking into account your expectations, circumstances and personal assessment of the risks and benefits.

From the first consultations, we explain the likely stages of your reconstruction. Based on the proposed technique and your individual circumstances, we can estimate the number of operations and the overall timeframe, including recovery between procedures.

This estimate helps you plan, but it is not an exact prediction. Healing, cancer treatments, new test results and your own preferences may lead to changes.

We distinguish between procedures needed for the chosen treatment and optional procedures to improve particular aspects of the result. Having several operations does not necessarily mean a complication has occurred: some reconstructions are planned in stages from the outset.

The Institut Ruiz Castilla (IRC) team will review the plan with you during follow-up, explaining the reason for each proposal, the alternatives and what to expect from the next step.

Once the reconstruction is stable and any remaining improvements are optional, we dedicate a consultation to considering whether further treatment would be worthwhile.

We explain the realistic benefit each treatment could offer, its risks, the recovery involved and the limitations that would remain. We also discuss keeping the current result without further procedures.

Among medically appropriate options, this is a personal decision. It depends on how you feel, your priorities and what another treatment would mean for you. Our role is to provide clear information, answer your questions and support you without pressure to continue or to bring the process to an end.

Completing this stage of reconstruction does not mean stopping the follow-up you need. You can return for another consultation if your needs change.

The radiation oncology service plans and delivers treatment and provides the main skin care instructions. At Institut Ruiz Castilla (IRC), we coordinate our recommendations so that the advice is consistent and tailored to your reconstruction.

Care usually includes gentle washing and moisturising with the recommended products. Silicone products, compression and massage are introduced only when your skin can tolerate them and the team has approved their use.

Our physiotherapists can teach you how to care for your scars and help you maintain mobility.

If a complication develops before chemotherapy or radiotherapy, the priority is to resolve it without causing an avoidable delay to cancer treatment. The teams involved agree on a plan, which may include more intensive wound care, drainage, another operation or temporarily simplifying the reconstruction.

Aesthetic procedures or reconstructive stages that can wait are postponed until the cancer treatment plan allows. Changing the sequence does not mean abandoning reconstruction: it means arranging each treatment at the safest time.

When it is safe and reasonable, we try to preserve the reconstruction. Depending on the situation, treatment may include antibiotics, wound care, drainage of fluid collections, surgical cleaning or replacement of the device.

The possibility of preserving the reconstruction depends on your general health, whether there is a systemic infection, the extent of infection or exposure, tissue quality and blood supply, the microorganisms identified and the cancer treatment schedule.

In some situations, removing the implant or tissue expander is the safest option. This does not necessarily prevent reconstruction later, once the infection is controlled and the tissues have recovered.