Breast Reconstruction

Breast Reconstruction

What is breast reconstruction?
Following a mastectomy or lumpectomy for breast cancer, many women choose to look into options for breast reconstruction. Most aspects of this surgery are covered by the benefits of OHIP.

There are three main categories of breast reconstruction:
• Using breast implants
• Using your own tissue (transferring tissue from the lower abdomen or the back)
• Combining your own tissue and breast implants

Breast reconstruction is a process that often takes 6-12 months from consultation to completion. There are often multiple stages to surgery including revisions, nipple creation, and tattooing an areola. Dr. Eckhaus will discuss with you whether you are a candidate to undergo breast reconstruction at the time of mastectomy (immediate reconstruction). Breast reconstruction can also be done following a mastectomy or lumpectomy. If you have had or are having radiation, it is best to wait at least 6 months following the end of your radiation to consider breast reconstruction.

When breast reconstruction is done on one side, some patients will be candidates to have surgery on the other side to improve symmetry of size and shape. This is referred to as a balancing surgical procedure and may involve a breast lift, breast reduction, or breast augmentation to the opposite breast.

Your initial consultation will focus on the many factors involved in this decision and determine what available options best meet your individual objectives.

Pre Surgery Instructions

Before the procedure
No aspirin or blood thinning medications for two weeks prior to surgery. Fasting begins at midnight the night before surgery. Any medications that you take in the AM may be taken with a sip of water (except for blood thinning medications). If you get ill prior to surgery please notify us.

The Surgery

During the procedure
Because there are so many options for breast reconstruction surgery, it is difficult to make generalizations regarding all the surgical details. Below is a brief surgical overview for two common options.
1Tissue expander/breast implant surgery:
This is usually completed in two stages. The first stage involves placing a balloon-like empty tissue expander under the chest wall muscles. One to two weeks after surgery we begin slowly filling the tissue expander with saline. This is done in the outpatient clinic at the hospital weekly in small amounts over 4 or 8 visits) to allow slow stretching of the tissue. It is done using by injecting the saline through the skin into the self-sealing port. This stretching of the tissue creates enough room for the final breast implant.

The second surgery is performed four to five months after the first procedure, and involves the exchange of the initial tissue expander for a permanent breast implant. Each surgical procedure is performed under a general anesthetic (you are asleep) and takes 1.5-2 hours and is a day surgery (no overnight stay is needed). If the first surgery is done at the same time as the mastectomy, then your general surgeon may want you to stay overnight in hospital.
2Breast reconstruction involving a patient’s own tissue:
This may be achieved in one or two stages, depending on the specifics of the individual case. The details of this procedure are reviewed at length in your consultation. These procedures are done under general anesthetic and take between 3-5 hours and may require a stay in hospital.

While Dr. Eckhaus does perform breast reconstruction with the use of tissue from the back (latissimus dorsi muscle-skin flap with the use of an implant), he does not perform abdominal tissue reconstruction (DIEP or TRAM flap).

Fat grafting involves the use of your own fat (removed by gentle liposuction) to improve contour and increase symmetry but is not used often as a sole means for breast reconstruction. It is typically used after the initial breast reconstruction surgery to improve minor shape and size asymmetries.

After Your Surgery

Post procedure
Tissue expander/breast implant surgery:
You will be in the recovery room anywhere from 1-3 hours where the team will ensure you are comfortable, eating and drinking, walking and able to urinate.
On discharge home
Immediately upon discharge from the hospital, you are encouraged to rest under supervision and start a light diet as tolerated.

You will have been given a prescription for antibiotics that is started when you return home from surgery and is taken for 1 week.

You should be up and walking, drinking fluids, taking your antibiotics and pain medication as described below. Increase activity as tolerated, but there is no heavy lifting for 4 weeks. Do not change the dressings until your first post op appointment.
What do I take for pain?
If you have pain, you are encouraged to start with:
• two Tylenol extra strength (total of 1000 mg of Tylenol) and one Advil extra strength (400 mg of Advil) to be taken at the same time as they work by different mechanisms and work very well together.
• You can take the above three pills (two Tylenol extra strength and one Advil extra strength) every 8 hours around the clock for the first day or two. This is often sufficient for pain medication and can avoid the need for stronger medications such as narcotics (Percocet, Tylenol #3 etc.).
• However, you will also have a prescription for a stronger pain medication that can be taken as needed if the Tylenol and Advil combination mentioned above does not suffice. This stronger pain medication may be taken on top of the above regimen. Please ensure the maximum dose of Tylenol in 24 hours does not exceed 4000 mg.

** Please be aware that with any medication and particularly Advil (a type of non-steroidal anti-inflammatory) there are risks of allergy, severe allergy, gastro-intestinal bleeding and stomach ulcers. Taking your medication with food can sometimes help with some of the stomach symptoms.

An initial wrap and post-operative compression bra are left in place for 2-5 days. During this period of time, you may use a hand held shower or sponge bath but the dressings must stay dry.
First post-operative appointment
The initial dressing change is done on day 2-4 after surgery. The dressings are removed and the white steri strip tapes are left on. Dry gauze or padding is used daily to protect the tapes from the compression bra band.

In the first two weeks following surgery, the post-operative compression bra is worn 24 hours a day (day and night, except for the shower).

The subsequent two weeks (week 3 and week 4 following surgery), the compression bra is worn during the day only.
Second post-operative appointment
The second appointment is close to 2 weeks after surgery and the white steri strip tapes will be removed. Dry gauze once daily is used for the next week and then you will start the silicone gel sheeting for scar management (given to you at this appointment).

Post-operative swelling and bruising begins to subside after 7 days but can take up to 2-3 weeks. Though most of the swelling will have subsided by week 3, you are advised to wait 1-2 months to be re-sized for a new bra. Patients usually require 1 week of downtime and should avoid strenuous exercise for 4 weeks.
Breast reconstruction involving a patient’s own tissue
You will be in the recovery room anywhere from 1-3 hours where the team will ensure you are comfortable, eating and drinking, walking and able to urinate. You will then be transferred up to one of the inpatient rooms.

Drains will be put in place to remove excess fluid.

Following a 1-2 night stay in hospital, the nursing staff will teach you dressing and drain care for the first few days you are at home. Patients typically require 4 weeks of downtime.

**The remaining details of the post-operative care will vary depending on the procedure and therefore will be discussed in detail at the time of your consultation.
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