Delayed Breast Reconstruction
When a woman is first diagnosed with breast cancer, her only concern is beating it and getting better. It is a frightening and overwhelming time. Once she has a mastectomy to remove the breast(s) and feels more confident about her survival, thoughts may turn to preserving her femininity. Women who decide to have reconstructive surgery need to consider whether to have it at the same time as the mastectomy or to delay it. Neither option is right or wrong. It is only a matter of what works best for each individual woman and what her surgeon recommends.
The surgeon will have a good idea of the extent of the patient’s breast cancer based on the results of her biopsy, mammograms and other imaging modalities. However, it is impossible to know the full impact of the cancer until after the mastectomy has been completed. The surgeon will also evaluate the patient’s lymph nodes before surgery. Some patients with more advance cancer may have a mass felt in her axilla or those lymph nodes may look prominent on her preoperative imagery. For these advanced cancers a delayed approach may be the best option. Also other body shapes may be better treated with a delayed reconstruction.
Other Pros and Cons to Consider
One advantage of delaying breast reconstruction is that it gives patients the chance to just focus on treatment. It also provides time to research the various reconstructive options available. The obvious downside is living without breasts in the interim. If this is a major concern, patients should ask about the possibility of receiving temporary prosthetics.
While immediate reconstruction can lessen the emotional impact of a mastectomy, it is not without risks. The biggest one is that the woman may need radiation later and this is likely to damage the new breasts. Immediate reconstruction also requires a longer surgery and recovery period. Even when a patient opts for immediate reconstruction, it may require several surgical procedures to achieve the desired results.
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Western Maryland Medical Arts Center
12052 Willowbrook Road, Suite 460
Cumberland, MD 21502
Hours of Operation:
Tuesday and Thursday 8 am – 5:30 pm
Friday 8 am – 12 pm
Recovery from Delayed Breast Reconstruction Surgery
It is normal to feel sore and tired for up to two weeks after implant surgery to reconstruct the breasts. It is longer after a flap surgery due to two surgical sites on the body that need to recover. Upon discharge, the surgeon will provide the patient with a prescription for narcotic painkillers. Additionally, she will learn how to empty her own surgical drain. This is a small tube located inside of the wound that catches extra fluid while the body heals.
The recovery expectation for flap surgery is six to eight weeks. This is usually shorter for implant surgery. Bruising and swelling may remain for this entire time. Women should not feel alarmed when they do not feel normal sensations in the reconstructed breasts. This is normal, and it can take years for these feelings to return or may never completely return. Wearing a surgical bra 24 hours a day helps to support the new breasts and ultimately allows healing to progress faster. It is best to avoid underwire bras after recovery since they can aggravate the skin and scars.
Breast reconstruction patients should avoid intense physical activities for up to six weeks as well as overhead lifting. Most women are ready to return to work eight weeks after surgery or a bit earlier.
Recovery from the Double Surgery
Most patients spend a day or two in the hospital after a mastectomy and simultaneous breast reconstruction. This is usually with a drainage tube in place that pulls blood and body fluids from the surgical site and pushes them to an external collection device. The nurse will show the patient how to empty it before she leaves the hospital. The greatest amount of discharge takes place during the first 24 hours and will continue to decrease until stopping altogether after about a week or two.
Incisions from the surgery must be kept dry for at least three days. That means patients need to avoid showers and baths for the first three days. A surgical wrap holds the reconstruction in place, which patients should wear continuously until Dr. Jackson directs them to stop. Patients will learn how to change their own dressings and should do this once a day during this time frame. Preferably, another person, such as a loved one, can help with this.
The surgeon will send the patient home with prescription-strength medication for pain. It is important to take this medication and avoid anything with aspirin or aspirin products for at least the first three days since this increases the risk of bleeding. Bruising, numbness, tingling, and general discomfort should disappear after several days.
Performing arm exercises and getting up to walk around can start the day after surgery. However, strenuous workouts must wait several weeks. Patients vary considerably on the amount of time needed to recover. Some are able to return to work within two weeks and others need six weeks or longer at home to recover from a mastectomy and immediate breast reconstruction.