When any foreign body, such as an implant, is put into your body, your immune system responds by forming fibrous tissue around it. Over a few months this fibrous tissue can contract as part of the natural healing process. If this contraction is severe then you may have tightening, hardening and changes in the shape of the reconstructed breast. This may be uncomfortable and can spoil the match with your natural breast. Most capsular contractions form in the first year, but some may take up to three years.

In a few cases the implant and capsule may have to be surgically removed, and a replacement implant inserted at the same time. The risk of developing a capsular contracture that needs further surgery is between 10 and 20 per cent and is more likely if you have had radiotherapy before or after the implant was put in.

Your surgeon will try to create a breast shape that matches your own breast as closely as possible. But it is not possible to give a perfect match. If you are not happy with the new reconstruction and feel that it does not match the other breast well enough, it is important to discuss this with your breast care nurse or doctor.

It may be possible to improve the match by having surgery on your other breast, or by replacing the implant with another one that is a different shape, size, or is positioned slightly differently. You may also need to have a further operation with a different type of reconstruction: for example if you have had a tissue expander reconstruction then you may need to have a flap created as well.

Abdominal hernia is a rare complication following a TRAM flap or a free TRAM flap. This is due to the removal of the abdominal muscle, which may weaken the abdominal wall. If this is a risk, your surgeon may put in a protective gauze mesh to replace the muscle and give a lower risk of this happening.

Using a flap from your back (latissimus dorsi) may reduce your shoulder movement, because of the loss of muscle. This can sometimes make it difficult to do everyday activities like getting into and out of the bath, or can affect your ability to do some sporting activities, such as skiing.

Some women find that they have some stiffness in the shoulder and this is more likely after mastectomy than lumpectomy. It is important to do exercises to help maintain the movement in the shoulder. Cancerbackup or Breast Cancer Care can send you a leaflet about the exercises. You will normally be seen by a physiotherapist who can teach you how to do them.