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Breast Reconstruction Surgery and Post Operative Care

Breast reconstruction offers hope to women who have lost or face the possibility of losing their breast(s) to cancer or other diseases. Breast reconstruction is typically performed using either implants or your own abdominal tissue. In a majority of cases however, plastic surgeons use tissue expanders and implants to restore the size and shape of the breast. Tissue expanders are devices much like a breast implant, which are inserted underneath the chest wall muscle (pectoralis muscle) immediately following mastectomy. After a short period of healing, saline is injected periodically into the tissue expanders using a small needle. Once the volume and shape of the breast is achieved with the tissue expander, a second surgery is performed to remove the tissue expander and insert the breast implant. This second surgery is often done on an outpatient basis.

You may ask, why not just insert an implant immediately after the mastectomy. In a mastectomy, an ellipse of skin around the nipple and areola (the pigmented area surrouding the nipple) is typically taken along with the breast tissue. This creates a deficit of skin which needs to be replaced. A tissue expander allows for the growth of this replacement skin as the expanding implant stretches the overlying skin. Once the replacement of skin is adequate for the shape and size of the new breast, a breast implant is inserted

After a period of healing, a new nipple can be reconstructed out of the skin overlying the implant and a new areola can be tattooed some time after that.

Your breasts are wrapped with an ACE wrap. Leave the wrap on until you are seen again in follow-up at the office. If the wrap is too tight, you can undo the ACE bandage and rewrap it more loosely. But, the ACE bandage should be snug and provide support. Also, the ACE bandage should cover the entire upper, middle, and lower breast. DO not wear it like a tube-top with cleavage showing up top. No showering until your drains are out. You can sponge bathe everywhere else, but keep your ACE wrap clean and dry.

Take medications as directed. Do not take aspirin, anti-inflammatory medications (Motrin, Ibuprofen, Alleve) or Vitamin E supplements for 2 weeks after surgery.

No driving while under narcotic medications for pain.

Empty and record your drain output daily.

Ask your plastic surgeon in your first follow-up visit regarding going back to work.

You should sleep on your back for 2 weeks following surgery.

Avoid alcohol or cigarette smoking for at least 3 weeks following surgery.

Call and make a follow-up appointment for 7 days following surgery.

Do not raise your arms over the level of your shoulder for 3 weeks. Do not pick up objects heavier than a phone book.

Do not apply a heating pad over your breasts. Portions of your breasts will be numb and you may get a burn from the heating pad. Cold packs in the first 48 hours following surgery is OK and may help to keep the swelling down. Apply cold packs over the ACE wrap, not directly over the breasts and nipples.

Scar therapy for your incisions will start at 2 weeks following surgery. Your plastic surgeon will instruct you regarding scar creams.

You may return to normal activity and exercise at 3 weeks following surgery.

If you are constipated, take over-the-counter laxatives. You do not want to strain over the toilet. This may lead to your blood pressure rising and cause bleeding.

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