What Does a Reconstructed Breast Look Like?

This is an impossible question to answer as there are so many variables that need taken into account.  Implant reconstructions look very different to tissue reconstructions.  Delayed reconstructions have totally different scars to immediate reconstructions.  Delayed reconstructions, however, almost never need to be subjected to radiotherapy.  Some immediate reconstructions do then get given radiotherapy.  The effects of radiotherapy are not usually severe, but are very variable.  Tissue based reconstructions tend to withstand the effects of radiotherapy a little better, but this again is not absolute.  There are all sorts of procedures that can be done to the other normal unaffected breast to patients having a single breast reconstruction to try and improve the overall appearance.  Some people will be having double mastectomies anyway and then have similar procedures on each side.  Some people are appropriate for nipple sparing mastectomies and reconstructions, some are not.  The decision making here is really very complicated and depends on a combination of your anatomy, whether you have cancer or are having mastectomies for risk reduction, your own personal preferences and those of the surgeon you see.  If you are considering reconstruction having either had your cancer treated or for a risk reducing procedure you have plenty of time to do your research thoroughly and get as much advice as you need to make the right decision.  If you have cancer and are having a mastectomy as the initial treatment for this with an immediate reconstruction it is worth canvassing opinion on who to see initially from someone you trust (like your breast cancer surgeon) and then making your decision within a time frame that avoids delaying your cancer treatment.  You should be reassured that there are always options if you are not happy with what you have chosen later on once all your cancer treatment has finished.  This is a very emotional time for any woman to go through so consider taking the people close to you to these appointments to help you to talk through all the information you are given afterwards.  They will also help you to remember bits you might otherwise forget.  Any surgeon will make time to see you as many times as you need to help make your decisions and provide you with all the support you need.  Good luck with it all!

The appearance of breasts after mastectomy and reconstruction will depend on several things including the type of mastectomy performed, whether or not lymph nodes were taken, whether or not radiation was performed, whether or not there were complications after any procedures, and of course, what reconstructive technique was employed.
Nipple sparing mastectomy has the best aesthetic results, however, not every patient is a candidate for nipple sparing. Whether or not you are a candidate will depend on your breast cancer type, location in relation to the nipple/areola, the size of your breast, the degree of breast ptosis, and several other factors. This is an important conversation to have with your general/breast surgeon, as well as your plastic surgeon.
If you are not a candidate for nipple sparing due to having large/ptotic breasts, then a wise pattern/skin reducing mastectomy can be a great option to improve the aesthetics/shape of the breast following reconstruction. A standard skin sparing mastectomy, which is sometimes the best option given the circumstances, will result in a transverse scar across the front of the breast. There is flattening of the anterior breast post reconstruction due to the horizontal pattern of skin removal, and sometimes dog ears on either side of the closure that need to be removed.
If lymph nodes are taken, then this often leaves a divot below the armpit area that can be noticeable. This is not often correctable at the initial stages of reconstruction. However, this is an area that can benefit from fat grafting in order to add volume to the area where tissue was previously removed. If radiation was performed to the axilla after lymph node removal though, it can be very difficult to correct the resulting contour irregularity and sometimes flaps may need to be employed if it becomes a major issue.
If radiation is required after breast reconstruction it will change the position and shape of the reconstructed breast. Radiation will cause the skin and tissues to contract, shrinking the overall breast envelope/shape. The position of the breast will typically move superiorly on the chest wall, especially in comparison to the non-radiated side. This may result in the need to perform procedures to correct asymmetries after radiation.
Certainly while the task of breast reconstruction is to recreate the form, shape and appearance of a breast after a mastectomy, the ultimate goal is to reconstruct breasts that will appear normal in clothes. It is definitely possible to achieve outstanding aesthetic results that make it seem as if one never went through mastectomy even when unclothed. When this is not possible, which is most of the time, it usually has to do with many of the factors listed above which are necessary to treat the breast cancer. As plastic surgeons caring for the whole patient, we must prioritize the cancer treatment first and optimize the aesthetics of the reconstruction wherever we are able within that process. The importance of a multi-disciplinary team in which the oncologic breast surgeon and reconstructive plastic surgeon work closely together, cannot be overstated.

Reconstructed breasts depend on a few factors. A couple of them are if the breast have been previously radiated or need radiation and how much skin needs to be excised. These two factors will determine scars and also the quality of your tissue and your surgical options. The main goal for breast reconstruction is to make a breast that looks and feels as good or better than before you had the diagnosis of cancer.