Losing one of your breasts — or both — to treat breast cancer can be traumatic enough. Reconstructive surgery is a tremendous milestone — and another whole struggle.

If you're considering breast reconstruction, here's what Joshua Fosnot, MD, plastic surgeon, and Suhail K. Kanchwala, MD, plastic surgeon and Surgical Lymphedema Program Director, say are some of the key physical, emotional and psychological events you can expect in the year after your breast reconstruction.

First Days After Surgery

First of all, congratulations. You're a breast cancer survivor.

Some people consider breast reconstruction as building something new, but Dr. Fosnot thinks of it differently: "Reconstruction creates volume to reproduce or mimic a breast."

The length of time you'll spend in a hospital after surgery depends on what kind of breast reconstruction you choose. You have two options:

1. An Implant
2. Free Flap Reconstruction

Implant Surgery

Implant surgery typically takes place after a mastectomy is performed to remove the breast tumor and surrounding tissue. Those who have implant surgery are usually discharged within two days.

Free Flap Reconstruction

A free flap reconstruction is a little bit more complex of an operation than the implant surgery is. With this procedure, the tissue is taken from other parts of your body, like the abdomen. Patients are usually discharged within five days after the procedure.

While free flap reconstruction surgeries may be more complex, they are nothing to be afraid of, especially at Penn Medicine, the largest free frap reconstruction center in the United States by volume. Here at Penn Medicine we specialize in this type of breast reconstruction and we've recently performed our 5,000th free flap reconstructive surgery.

Both reconstructive surgeries have their pros and cons, so it's important to talk with your surgical team about which option is best for you.

Post-Op Pain Management

Some degree of short-term pain is universal after surgery, but your doctors will work with you to ensure you are comfortable and the pain is tolerable. The emotional pain may not be as tolerable: Many women find it hard to look at their new appearance for a few days.

"It's a very emotional journey for women," Dr. Fosnot explains. "One universal thing I can tell you is everyone goes through that process differently."

One Month After Surgery

Physical therapy is usually recommended for women after either type of reconstructive surgery.

Physical therapy exercises allow women to:

• Regain strength
• Adjust to new physical limitations
• Find safe ways to perform daily activities

It typically takes about two to four weeks for women to learn the exercise techniques they need for rehabilitation.

Six Weeks After Surgery

Most women can return to work after six weeks and do things they did before surgery.

In the six weeks after surgery, chances are you'll be completely focused on recovering physically. Yet, the act of returning to work and going back to your normal life may trigger new emotions — like when you're shopping for new clothes or thinking about dating or intimacy.

At this point, you may feel lots of emotions, including anxiety or depression. Those actions can lead to you thinking more deeply about the changes to your body and who you are as a woman post-surgery. You may find it helpful to talk to a counselor or other women who have had breast reconstruction.

Three Months After Surgery

Now that your breasts have had time to heal, nipple reconstruction is usually the final phase of breast reconstruction. Not everyone chooses to have this procedure, since it's mostly for cosmetic purposes; however, Dr. Fosnot and Dr. Kanchwala both strongly recommended the procedure because it makes the reconstructed breast look more like the original breast.

When it comes to nipple reconstruction, women have two different options:

1. They can have a new nipple built by a plastic surgeon
2. They can opt to just receive a nipple tattoo

Women that go with the first option will have their new nipple built using tissue from their body or donor skin. In contrast, the nipple tattoo is a less invasive procedure in which case the skin will match the same nipple color as their original breast and, therefore, look three-dimensional.

"Fine-tuning" your original surgery is usually also done at the same time as nipple reconstruction. The purpose of this second procedure is to make small adjustments to the reconstructed breasts to improve the overall cosmetic appearance. What that will entail depends on the type of breast reconstruction done three months ago. This surgery, like nipple reconstruction, is an outpatient procedure.

One Year After Surgery

A year out is usually when you can stop seeing a plastic surgeon for regular checkups.

As recovery continues, your breasts will continue to change over the course of a year from what they look like now. Some of these changes may include:

1. Fading of scars (although they may always be noticeable)
2. Loss of breast sensation after a mastectomy due to delicate nerves getting severed when the breast tissue is removed
3. Regaining sensation in your breasts, which Dr. Kanchwala says usually takes about a year and will vary from patient to patient

"The whole point of breast reconstruction is to get to a point," he says, "and sometimes it takes up to a year — where you are able to move beyond this period of your life."

Learn more about Breast Reconstruction at Penn