If you’re considering reconstruction after mastectomy, you may be thinking about the look and feel of your new breasts. Will the breast look like real breasts? Will it match the natural breast? Will it look good? There may be a million questions milling around in your head. We’ve tried to answer a few of those in this article.

Here’s an overview of the four characteristics—shape, size, symmetry and scarring—that most determine how reconstructed breasts look:

Shape:
Breast Implants - Your reconstructed breast may be flatter, more round, or have less projection than your natural breast, depending on whether it is rebuilt with implants or your own tissue. If your surgeon uses round saline implants, your breast will look round with minimal to moderate projection. If the implants used are contoured or tear-shaped, the breast will have a natural slope and projection, but not everyone has the chest structure to accommodate them. Implants used for reconstruction are always placed under the chest muscle, so even contoured implants may appear round and flat.

Tissue Flap Reconstruction – This requires a lengthier surgery and recovery period than implants. Tissue flaps are a better reconstructive method after radiation; women who have implant reconstruction after radiation more frequently develop capsular contracture, a tightening of scar tissue around the implant that can harden the breast and distort its shape.

Size:
Reconstructed breasts can approximate the size of your natural breasts or can be made somewhat smaller or larger. If your new breasts are built with implants, your surgeon will select a model of appropriate volume to create the size you want. If you have muscle-sparing flap reconstruction, your new breast will be created from excess fat in your abdomen or buttocks. Slender or athletic women who lack sufficient fat may have to settle for a smaller breast.

Over time, a breast created with an implant (if unaffected by capsular contracture) retains its original size, while a flap reconstruction loses and gains weight along with the rest of your body.

Symmetry:
From a surgical perspective, bilateral reconstruction presents a better chance for symmetry, because the surgeon is starting with a clean slate. Unilateral reconstruction is a bit trickier, because it’s more difficult to match the natural droop of the opposite breast.

Scarring:
This is an unavoidable side of surgery. Initially after surgery, the scars are red and prominent, but fade over a period of time. Keeping the healed scar moist, massaging the scar line, and using a scar management product, can smooth and flatten scars, making them less noticeable.

Sensation:
Lost sensation is an unfortunate byproduct of mastectomy, caused when delicate nerves are severed as breast tissue is removed. Just how much sensation is regained, and to what degree, varies greatly between individuals. In most cases, women remain numb in the front of the breast and retain sensation in the outer perimeters of the breast. Even the new, cosmetically constructed nipple and areola remain numb after mastectomy because it lacks nerve endings and muscle fibers needed to receive sensation.