The following tips and information are intended to provide a general idea of what to expect from the days before breast reconstruction surgery and in the hospital afterward. At The Breast Center Park Meadows Cosmetic Surgery, we want you to feel comfortable and prepared in advance of your reconstructive surgery appointment. You may also consider providing your family members with these guidelines so they know what to expect and how they can help you prepare. If you have any questions about preoperative guidelines, please call us at (720) 457-4461.
First Steps to Prepare for Surgery
Here are things to be aware of in the first few weeks before the surgery:
- If you smoke or use nicotine gum/lozenges or other tobacco products, you must stop at least 3 weeks prior to surgery. These products significantly increase the risk of post-surgical complications, including delayed wound healing and autologous tissue flap failure.
- Our experienced staff will let you know what time you can have the last meal prior to your surgery. A light meal is sometimes preferable because some patients experience mild constipation following surgery.
- Pajamas, a robe and slippers are all things you may want to bring to your surgical appointment. You will wear a hospital gown during and immediately after surgery, but you may want to change into your own comfy pajamas at some point. Do not be alarmed if you never use the robe and slippers. Some people like to have these while others are fine without them.
These first steps apply to any reconstructive surgery, whether implant-based or flap-based. Below, we will take a look at tips for each type of procedure.
Initial Preparation for DIEP Flap and Other Flap Reconstructions
One type of breast reconstruction uses a flap of your own tissue – harvested from a donor area such as the abdomen – to reconstruct a breast. For some women, the reconstruction can be performed at the same time as mastectomy. If you are having an immediate reconstruction, you should expect the operation itself to take 3-6 hours per side to complete. The surgeon will check in with your family members in between the mastectomy surgery and the reconstruction. Afterward, you will spend 1-3 hours recovering in the hospital or our surgery center, depending on where your procedure is performed. A family member or other guest will be allowed to come stay with you once you are recovering in a private room.
For guests and family members: For those loved ones waiting for you while you are in surgery, there is a hospital cafeteria, as well as grocery store nearby. There are also several hotels in the area, recommended by our staff. If you and your family are from out of town, our Patient Coordinator is happy to assist you with hotel bookings and other matters related to your stay.
What to expect as you recover from surgery: After your time in the recovery area, you will be transferred to a private room on the floor. You will have a pain pump and a Foley catheter. That catheter is usually removed on the first day. You will wear special stockings and compression boots for improved blood flow in your legs. The hospital bed will be flexed as not to stress your incisions.
There will be multiple drains, 1 in the reconstructed breast and 1 or 2 in the donor site. You may also have the blue Doppler wire in the breast area. The drains are the thickness of a pencil and have a bulb at the end to collect the excess fluid from the surgery sites. You may have some drainage from around the site where they enter the skin, which is normal.
Use gauze to keep the area dry. You will leave the hospital with drains, and they will instruct you on drain care prior to discharge. You may also have a visiting nurse who can assist with drain care.
The Day After Your Flap-Based Reconstruction
You'll be able to get out of bed the day after your procedure, but you may need to stay seated most of the time. The next day, you should be able to get up and walk around. It may be most comfortable to walk slightly bent forward. You will begin taking an oral pain medication before you leave the hospital, and you will have prescriptions for certain pain meds and antibiotics to take at home. Most patients fill these prescriptions prior to surgery so they don't have to worry about it when they get home.
You will wear special stockings and compression boots for improved blood flow in your legs. There will be a drain in the reconstructed breast. The drains are the thickness of a pencil and have a bulb at the end to collect the fluid. They collect the excess fluid from the surgery sites. You may have some drainage from around the site where they enter the skin, and this is normal; however, you should use gauze to keep the area dry.
Post-operative surgical bras: You will be provided with a special bra to wear after surgery. You can expect to be fitted and sized for one of these bras before your surgery day. If you wish to purchase more bras for after your procedure, we recommend the Nordstrom breast prosthesis program. This department store has multiple locations across the Front Range and the entire country, and their Breast Prosthesis Program features certified fitters trained to fit and size women who have undergone breast reconstruction, as well as women who have undergone mastectomy or lumpectomy without reconstruction.
Nordstrom carries a full line of garments that include postoperative garments and camisoles which also has the option to hold drains. Bring that binder/girdle to your first post-operative appointment. They have many options and are well versed in helping our patients find garments that will be comfortable and meet each need postoperatively. They will work directly with your insurance company, too.
Returning Home After Surgery
Typically, most patients go home on the second or third day after surgery. When you go home, you may still be walking slightly bent over and will still have surgical drains attached to your body. You may want to prepare by having a recliner or first floor bedroom with lots of pillows for comfort. It is recommended to sleep in a flexed position.
You may shower 48 hours after surgery. You will still have the drains, and these can be supported using a long necklace/bathrobe tie or string. There is no real care for the incisions as they will all have surgical glue or steri-strips on them. You may notice a little oozing along the incision if the glue wears off. This is normal and you may place some Neosporin and gauze over the area.
The worst is over, and you will be feeling better after a shower and especially after your drains are removed. It is not painful to remove the drains, but instead a funny feeling/sensation; however, most patients are relieved after removal. Once the drains are removed you can sleep on your side.
It is important that you follow the drain care instructions making sure to record the amounts in “cc’s” and keep the bulb flat which keeps it in suction. Make sure to bring the drain record to all of your postoperative appointments.
If you have stairs in your home, you may go up and down once a day. After the first week, you will be able to do that a little more frequently. Try not to nap during the day as it will be harder to sleep at night. Eating small meals with your pain medication will usually be more tolerable at first.
Many patients are prone to constipation or feel they cannot move their bowels. Patients may need to take both a stool softener, such as Colace, or a motility agent, like Senekot if this develops. The anesthesia and pain medication as well as lack of activity can all lead to constipation.
Nausea may also be a problem for some people following surgery. It is important to have food with pain medication if you start to feel nauseous. In addition, there are specific medications that can be prescribed if you continue to struggle with nausea. The nausea is usually from the pain medication which you will need, so sometimes adding a nausea medication is very helpful.
If you need chemotherapy, usually this may begin about 1 month after surgery.
Park Meadows Cosmetic Surgeons Perform DIEP Flap at Sky Ridge Medical Center
Preparing For Breast Reconstruction with Breast Implants
The preoperative guidelines for an implant-based surgery are really quite the same as those listed above. Therefore, please see the guidelines listed above while keeping these implant-specific details in mind:
- Tissue expanders are placed in the first operation. This takes about 50 minutes for each side of the chest. The tissue expanders increase the space beneath the skin so that breast implants can be placed at a later date.
- Patients who have implant reconstruction feel stronger day by day. You will feel the expander in your chest most of the time for the first 3 weeks. It is normal to feel sharp corners where the expander is folded in the midline and armpit area. You will be able to do most things by 6 weeks. You may be able to drive by 2-3 weeks if you are comfortable and are no longer taking pain medication. Heavy lifting, heavy exercise, and swimming are not recommended for 6-8 weeks. Most people take 4 weeks off work.
- The procedure to place the implants varies depending on the details, such as type of implant used and whether both breasts are receiving breast implants. Our experienced plastic surgeons will make sure you know what to expect from that procedure.
Dr. Christopher Williams, Dr. Jeremy Williams and our entire staff want to make sure you feel fully prepared for your procedure. We encourage you to ask us about anything you have on your mind. We will be here with you every step of the way, from your very first consultation through your successful recovery.
To schedule a consultation in Lone Tree, near the greater Denver area, please call The Breast Center Park Meadows Cosmetic Surgery at (720) 457-4461.