Post # 38 – Preparing for Breast Reconstruction Surgery

Dear Family and Friends

 In my last post I talked a little bit about if you should or should not have breast reconstruction. In today’s post I want to share information with you about preparing to have the surgery itself and the recovery process as it has been explained in this article from the Cancer Society:

https://www.cancer.org/cancer/breast-cancer/reconstruction-surgery/preparing-for-breast-reconstruction-surgery.html

Preparing for Breast Reconstruction Surgery

Your surgeon can help you know what to expect from your breast reconstruction surgery and be as prepared as possible. You should have realistic expectations of how your body will look and feel after surgery and understand the benefits and risks of the type of reconstruction you are having. Ask questions and follow your surgeon’s instructions carefully. this is a pretty comprehensive list of questions you need to know the answers to before your surgery. Some questions that may help you include:

• What should I do to get ready for surgery?
• How much discomfort or pain will I feel after surgery?
• How long will I be in the hospital?
• Will I need blood transfusions?
• How long will it take me to recover?
• What will I need to do at home to care for my incisions (surgical scars)?
• Will I have a drain (tube that lets fluid out of the wound) when I go home?
• How much help will I need at home to take care of my drain and wound?
• Will I be taught exercises to do after surgery? When can I start them?
• How much activity can I do at home?
• What do I do if my arm swells?
• When will I be able to go back to normal activities such as driving and working?

Knowing what to expect

As you prepare for breast reconstruction surgery, ask your surgeon what to expect. Breast reconstruction can make you feel better about how you look and renew your self-confidence, but keep in mind that the reconstructed breast will not be a perfect match or substitute for your natural breast. If tissue from your tummy, shoulder, or buttocks will be used, those areas will also look different after surgery. Talk with your surgeon about surgical scars and changes in shape or contour. Ask where they will be, and how they will look and feel after they heal.

Geez, there is so much to learn, to know, and to ask – every step of the way. If I am finally able to have breast reconstruction surgery I will know enough to ask the right questions😊

Your surgeon (or other doctors involved) should explain the details of your surgery, including:

• The drugs (anesthesia) that will be used to make you sleep and not feel pain during the surgery
• Where the surgery will be done
• How long the surgery will take
• Possible complications of surgery
• What to expect after surgery
• The plan for follow-up
• Costs

Understanding your surgery costs

Health insurance policies often cover most or all of the cost of reconstruction after a mastectomy, but this might not always be the case if you have reconstruction after breast-conserving surgery (lumpectomy). Check your policy to make sure you are covered, and find out what portion of the bill you’ll be expected to pay. Also, see if there are any limits on what types of reconstruction are covered.

One of my younger sisters just had a lumpectomy and a breast reduction on the other side. She is doing well, they got all of her cancer and they did not need to remove any of her lymph nodes so that is great news. She is still recovering today, but says she is doing well after the procedure.

Before surgery, make sure your insurance company will not deny breast reconstruction costs (for mastectomy or lumpectomy). Your surgeon may be able to help you with this if your insurance plan wants to deny coverage, so be sure to ask. It may take some time and effort. In the past, health plans have denied coverage for certain reconstruction procedures despite federal laws that require coverage in most cases. They often reverse such decisions on appeal.

It is so important to check with the insurance company before you have any surgeries, some things that you think should be covered may indeed not be covered at all or only partially covered, so be sure to check in with them if you ever have any questions – then you wont be in the same boat as I am in right now trying to figure out a bill from 2015 ☹

Getting ready for surgery

Your breast surgeon and your plastic surgeon should give you clear instructions on how to prepare for surgery. These will probably include:

• Help with quitting smoking if you’re a smoker
• Instructions to take or avoid certain vitamins, medicines, and dietary or herbal supplements for a period of time before your surgery
• Instructions on eating and drinking before surgery

I am so very glad that I do not have these vices to worry about any more. When I had my knee replacement surgeries I did have to stop taking all of my vitamins six weeks before surgery until six weeks after the surgery,but that was all I needed to do. If you have any of these vices please get help and give them up! You can do it!! If I can, I know that you can --- just trust the Lord, ask Him for the help that you need. You can always contact the local missionaries serving in your area. I know they have a program that can help you to give up these things that aren’t good for you anyway – right?

Plan to have someone take you home after your surgery or your stay in the hospital. You may also need them to stay and help you out for a few days or longer.

I am so very blessed to live fairly close to where I would need to go for surgery when the time comes for me to have it. It is only about 3 hours away, but my kids make it a mini vacation whenever they have needed to take me out to the city for my surgeries. Make sure you have a good support system in place before you do this thing.

Where your surgery will be done

Breast reconstruction often means having more than one operation. The first creates the breast mound. This may be done at the same time as the mastectomy or later on. It’s usually done in a hospital.

If follow-up procedures such as filling expanders or creating the nipple and areola are needed, they may also be done in the hospital, or they may be done in an outpatient facility. This decision depends on how much surgery is needed and what your surgeon prefers, so you’ll need to ask about this.

Hopefully your surgery center will be relatively close for you and your family, so as not to make it a hardship for any of you. Good luck and God bless you all!

What anesthesia will be used

The first stage of reconstruction is almost always done using general anesthesia. This means you’ll be given drugs to make you sleep and not feel pain during the surgery.

Follow-up procedures may only need local anesthesia. This means that only the area the doctor is working on will be numbed. A sedative drug may also be used to make you feel relaxed but awake. You might feel some discomfort.

Be aware of the possible risks

Certain risks go along with any type of surgery, and breast reconstruction may pose certain unique problems for some women. Your surgeon will go over the possible risks of reconstruction surgery with you. Be sure to ask questions if there’s anything you’re not sure about. For more on the possible risks after surgery

What to Expect After Breast Reconstruction Surgery

It’s important to have an idea of what to expect after surgery to rebuild your breast, including the possible risks and side effects. The time it takes you to recover from surgery will depend on the type of reconstruction you have. Most women begin to feel better in a couple of weeks and can return to usual activities in a couple of months. Talk to your doctor about what you can expect. Be sure you understand how to take care of your surgery sites and how to follow up with your breast care, including regular mammograms and when they are needed depending on the surgery you have had.​

Possible risks during and after reconstruction surgery

Any type of surgery has risks, and breast reconstruction may pose certain unique problems for some women. Even though many of these are not common, it’s important to have an idea of the possible risks and side effects.

Some of the risks during or soon after surgery include:

• Problems with the anesthesia
• Bleeding
• Blood clots
• Fluid build-up in the breast or the donor site (for a tissue flap), with swelling and pain
• Infection at the surgery site(s)
• Wound healing problems
• Extreme tiredness (fatigue)

Problems that can occur later on include:

• Tissue death (necrosis) of all or part of a tissue flap, skin, or fat
• Loss of or changes in nipple and breast sensation
• Problems at the donor site, such as loss of muscle strength
• The need for more surgery to fix problems that come up
• Changes in the arm on the same side as the reconstructed breast
• Problems with a breast implant, such as movement, leakage, rupture, or scar tissue formation (capsular contracture)
• Uneven breasts

Risks of infection

Infection can happen with any surgery, most often in the first couple of weeks after surgery. If an implant has been placed, it might have to be removed until the infection clears. A new implant can be put in later. If you have a tissue flap, surgery may be needed to clean the wound.

Risks of capsular contracture

The most common problem with breast implants is capsular contracture. A scar (or capsule) can form around the soft implant. As it tightens, it can start to squeeze the implant, making the breast feel hard. Capsular contracture can be treated. Sometimes surgery can remove the scar tissue, or the implant can be removed or replaced.

Additional risks for smokers

Using tobacco narrows blood vessels and reduces the supply of nutrients and oxygen to tissues. As with any surgery, smoking can delay healing. This can cause more noticeable scars and a longer recovery time. Sometimes these problems are bad enough that a second operation is needed to fix them. You may be asked to quit smoking a few weeks or months before surgery to reduce these risks. This can be hard to do, so ask your doctor for help.

Recovering after reconstruction surgery

You’re likely to feel tired and sore for a week or 2 after implant surgery, or longer after a flap procedure (which will leave you with 2 surgical wounds). Your doctor will give you medicines to help control pain and other discomfort.

Depending on the type of surgery you have, you will most likely be able to go home from the hospital within a few days. You may be discharged with one or more drains in place. A drain is a small tube that’s put in the wound to remove extra fluid from the surgery site while it heals. In most cases, fluid drains into a little hollow ball that you’ll learn how to empty before you leave the hospital. The doctor will decide when the drains can be safely removed depending on how much fluid is collecting each day. Follow your doctor’s instructions on wound and drain care. Also, be sure to ask what kind of support garments you should wear. If you have any concerns or questions, ask someone on your cancer care team.

Getting back to normal

Most women can start to get back to normal activities within about 6 to 8 weeks. If implants are used without flaps, your recovery time may be shorter. Some things to keep in mind:

• Reconstruction does not restore normal feeling to your breast, but some feeling may return over a period of years.
• It may take up to about 8 weeks for bruising and swelling to go away. Try to be patient as you wait to see the final result.
• It may take as long as 1 to 2 years for tissues to heal fully and scars to fade, but the scars never go away completely.
• Ask when you can go back to wearing regular bras. Talk with your surgeon about the type of bra to wear – sometimes it will depend on the type of surgery you had. After you heal, underwires and lace might feel uncomfortable if they press on scars or rub your skin.
• Follow your surgeon’s advice on when to begin stretching exercises and normal activities, because it’s different with different types of reconstruction. As a basic rule, you’ll want to avoid overhead lifting, strenuous sports, and some sexual activities for 4 to 6 weeks after reconstruction. Check with your surgeon for specific guidance.
• Women who have reconstruction months or years after a mastectomy may go through a period of emotional adjustment once they’ve had their breast reconstructed. Just as it takes time to get used to the loss of a breast, it takes time to start thinking of the reconstructed breast as your own. Talking with other women who have had breast reconstruction might be helpful. Talking with a mental health professional might also help you sort out anxiety and other distressing feelings.
• Silicone gel implants can open up or leak inside the breast without causing symptoms. Surgeons usually recommend getting regular magnetic resonance imaging (MRI) of implants to make sure they aren’t leaking. (This isn’t needed with saline implants.) You’ll likely have your first MRI 1 to 3 years after your implant surgery and every 2 years from then on, although it may vary by implant. Your insurance might not cover this. Be sure to talk to your doctor about long-term follow-up.
• Call your doctor right away if you notice any new skin changes, swelling, lumps, pain, or fluid leaking from the breast, armpit, or flap donor site, or if you have other symptoms that concern you.
• This six to eight week needing time off – I would lose my job. I do not have sick leave or anything like that available to me at this time. This is why I don’t see this happening any time in my near future☹

Talk to your doctors about the need for mammograms

Women who have had a mastectomy to treat breast cancer generally do not need routine screening mammograms on the side that was affected by cancer (although they still need them on the other breast). There isn’t enough tissue remaining after a mastectomy to do a mammogram. Cancer can come back in the skin or chest wall on that side, but if this happens it’s more likely to be found on a physical exam.

It’s possible for women with reconstructed breasts to get mammograms, but experts agree that women who have breast reconstruction after a mastectomy don’t need routine mammograms. Still, if an area of concern is found during a physical exam, a diagnostic mammogram may be done. (Ultrasound or MRI may also be used to look at the area closely.)

If you have a breast implant and you need a mammogram, be sure to get it done at a facility with technologists trained in moving the implant to get the best possible images of the rest of the breast. Pictures can sometimes be impaired by implants, more so by silicone than saline. Be sure your technologist knows about your implant before starting the mammogram.

If you’re not sure what type of mastectomy you had or whether you need to get mammograms, ask your doctor.

Do you feel a little bit more informed about your decision to either get breast reconstruction surgery? I hope these last two post have been helpful in helping you to know some of what you may be in for in making your decision. here is another website you can go to for information on breast reconstruction surgery: https://ww5.komen.org/BreastCancer/BreastReconstruction.html there are also articles and more information at the following websites:
http://www.nationalbreastcancer.org/breast-reconstruction
https://www.mayoclinic.org/search/search-results?q=breast%20reconstructive%20plastic%20surgery
https://www.cancer.gov/search/results
https://www.cancer.org/content/cancer/en/search.html?q=breast+reconstruction+surgeryRemember to include the Lord in your decision making process, He is the best partner to have. That is enough for tonight, I have to work really early tomorrow, so I'll say good night all. Everyone make it a wonderful week. Until my next post, good night all😊