Breast reconstruction recreates the shape of a breast after mastectomy, injury or a congenital difference, and for many women it is an important part of feeling whole again. At her practice on Harley Street in London, Ms Anna De Leo, a consultant plastic surgeon with advanced training in reconstructive microsurgery, offers both implant-based and natural-tissue (autologous) reconstruction, performed at the time of mastectomy or months or years later.
There is no single right way to reconstruct a breast, and no obligation to have reconstruction at all. Some women choose it immediately, others wait until treatment is complete, and some decide it is not for them. Ms De Leo's role is to explain every option clearly and honestly, to work alongside your breast surgeon and oncology team, and to help you reach the decision that fits your body, your treatment and your life.
01What Is Breast Reconstruction?
Breast reconstruction is surgery to rebuild a breast mound that matches the remaining breast as closely as possible, or to create a balanced pair after a double mastectomy. It is most often undertaken after mastectomy for breast cancer, or after risk-reducing mastectomy for women with an inherited gene variant such as BRCA1 or BRCA2. It is also used to correct breasts affected by trauma, previous surgery or congenital conditions such as Poland syndrome or tuberous breasts.
Reconstruction usually takes place in stages. The first operation creates the breast shape; later, smaller procedures may refine contour with fat grafting, adjust the other breast for symmetry, and reconstruct the nipple and areola. Reconstruction restores form and proportion, and can make clothes, swimwear and everyday life feel more comfortable. It is important to know from the outset that the reconstructed breast will not have the same sensation as a natural breast, although some feeling may gradually return over time.
02Immediate or Delayed Breast Reconstruction
One of the first decisions in planning breast reconstruction is timing.
Immediate reconstruction
Breast reconstruction performed during the same operation as the mastectomy allows you to wake up with a breast shape, often preserves more of the natural breast skin, and can mean fewer operations overall. It is not always the best choice, particularly if radiotherapy is likely after surgery, as radiotherapy can affect both implants and transferred tissue.
Delayed reconstruction
Delayed breast reconstruction, carried out months or years after mastectomy allows cancer treatment to be completed first and gives you time to recover and reflect. Many women across London seek delayed reconstruction long after their treatment ended, and it is never too late to ask about it.
Suitability depends on your general health, cancer treatment plan, body shape, previous radiotherapy, smoking status and personal preference. Ms De Leo coordinates closely with your breast surgeon and oncologist so that reconstruction never compromises cancer treatment. Some women prefer not to have reconstruction and choose an external prosthesis or to remain flat; this is an equally valid choice, and you will be supported whatever you decide.
03Your Consultation on Harley Street
Your consultation at 64 Harley Street, Marylebone, is an unhurried conversation with Ms Anna De Leo. Many women value discussing breast reconstruction with a female surgeon, and you can take all the time you need. She will take time to understand your diagnosis and treatment, previous surgery, general health and, importantly, what matters to you, whether that is a natural feel, the fewest operations, a quicker recovery or avoiding implants. She will examine the chest and potential donor sites such as the abdomen, thighs and back, and review relevant scans and reports from your cancer team.
You will then discuss the reconstruction options realistically available to you, the number of stages likely to be needed, the scars at the breast and donor site, and recovery. A partner, friend or family member is welcome to join you. You will be given written information and time to decide; there is no pressure, and many women find a second appointment helpful before committing.
In the UK, the NHS offers breast reconstruction to women undergoing mastectomy, in line with national guidance, and this remains a valuable option. Some women choose to see a plastic surgeon privately for a second opinion, for delayed reconstruction, for revision of an earlier reconstruction, or for greater flexibility of timing. Factors affecting the cost of a private personalised plan include the technique, the number of stages, the length of surgery and hospital stay at an accredited London hospital, and aftercare.
04Breast Reconstruction Techniques: Implant and Autologous Options
Implant-based reconstruction
A silicone implant, sometimes preceded by a tissue expander that is gradually inflated to stretch the skin, creates the breast shape. Implants may be placed beneath or above the chest muscle, often with a supportive mesh or tissue matrix. Implant-based breast reconstruction involves a shorter initial operation and recovery and no donor-site scar, but implants may need future replacement and can be affected by radiotherapy.
Autologous (flap) reconstruction
In autologous breast reconstruction, your own tissue is used to create a warm, soft breast that changes naturally with your weight and ageing. Options include:
- DIEP flap: skin and fat from the lower abdomen, transferred with its blood vessels while sparing the abdominal muscle, and reconnected to vessels in the chest under the operating microscope;
- thigh-based flaps: tissue from the inner or upper thigh, for women with less abdominal tissue;
- latissimus dorsi flap: muscle and skin from the back, sometimes combined with an implant.
Free flap reconstruction relies on microsurgery, the joining of blood vessels only one to three millimetres across. Ms De Leo holds an International Master's Degree in Reconstructive Microsurgery and a Diploma in Microsurgical Techniques, and this precision underpins safe, reliable tissue transfer.
Refinement stages
Later procedures may include fat grafting to smooth contour, symmetrising surgery on the other breast such as a reduction or lift, and nipple reconstruction with areola tattooing. Advanced healing technologies are used to help scars settle and blend.
Reconstruction is not about replacing what was lost, but about giving each woman a real choice in how she feels in her body again.
ADLSynergy · Harley Street
05Breast Reconstruction Recovery Time
Breast reconstruction recovery varies considerably with the technique:
- Implant reconstruction: usually one night in hospital, with a return to light activities and desk work after around two weeks and a fuller recovery at six to eight weeks.
- Flap reconstruction: a longer operation and hospital stay of several days, with close monitoring of the flap; most women need six to eight weeks or more before returning to work and normal activity, as both the breast and donor site heal.
A supportive post-operative bra is worn for around six weeks. Swelling settles over several months, and further refinement stages are spaced to allow the tissues to recover.
Emotional recovery matters as much as physical healing. At ADLSynergy, our team supports you with scar therapy and massage, lymphatic drainage, and breathing, posture and voice work after breast surgery, alongside nutritional and wellbeing support through our longevity service. These therapies are offered in coordination with your oncology team and always respect your wider treatment plan.
06Risks and Realistic Expectations
Breast reconstruction is complex surgery and its risks depend on the technique chosen. General risks include bleeding, haematoma, infection, delayed wound healing, seroma, poor scarring, asymmetry and blood clots. Implant reconstruction carries risks of capsular contracture, rippling, implant exposure or loss, and the likelihood of future implant replacement. Flap reconstruction carries a small risk of partial or complete flap failure due to problems with the blood supply, fat necrosis, and donor-site problems such as abdominal weakness, bulge or hernia. Smoking, radiotherapy, diabetes and a high body mass index all increase risk.
Most reconstructions need more than one operation to achieve the best result, and the reconstructed breast will look and feel different from the natural breast. Results vary between individuals. The aim is a breast that restores balance and confidence, built safely and with honesty about what can be achieved.
07Why Choose Ms Anna De Leo on Harley Street
Ms Anna De Leo is a GMC-registered consultant plastic surgeon and a Fellow of the European Board of Plastic, Reconstructive and Aesthetic Surgery, with a European Master's Degree in Reconstructive Microsurgery and more than twenty years of experience in reconstructive and aesthetic surgery. She has worked within NHS plastic surgery services at Chelsea and Westminster, the Royal Free in London and Oxford University Hospitals, and gained international experience at leading centres in Brazil, Spain and Finland. She is a member of BAPRAS and collaborates with an Oxford University team, teaching medical students and trainees.
As a female plastic surgeon, she brings sensitivity as well as surgical precision to conversations that can be deeply personal. You will see her throughout your journey, supported by her dedicated team at our Harley Street practice in London. Breast reconstruction is also part of her wider work in reconstructive surgery.
If you would like to talk through breast reconstruction on Harley Street, whether immediate, delayed or a revision, contact the practice. The practice is open every day by appointment for patients from London and further afield.
