 a symmetry procedure is performed approximately four to six months after the initial breast reconstruction procedure. The symmetry procedure that is performed is based upon your specific situation, including the breast surgery and breast reconstruction procedure performed, as well as if the reconstruction was bilateral (performed on both breasts) or unilateral (performed on just the affected breast). For bilateral reconstruction, the symmetry procedure, if needed, allows for refinement of the shape and size of the reconstructed breast. For unilateral breast reconstruction, the symmetry procedure, if needed, allows for the reconstructed breast to be refined, and at the same time a procedure is also performed on the other breast (breast lift, breast reduction, etc) to achieve optimal balance between the breasts.
The final stage of breast restoration takes place about two to three months after the second stage/symmetry procedure. Initially the nipple is reconstructed using the flap or mastectomy tissue. After the reconstructed nipple heals, approximately 6 months, medical tattooing can be performed to restore the color of the areola. For more information regarding this please visit the nipple reconstruction page.
The major benefits of breast reconstruction microsurgical procedures are the restoration of a natural appearing breast without losing any muscle from the abdominal or buttock donor site. The short- and long-term results of the procedure are excellent. Patients have a relatively short hospital stay of 3-4 days and can return to normal daily activities in about two to four weeks. Most patients can resume all activities without restrictions, including lifting at three months.
The major benefits of implant based reconstruction is a natural appearing breast with a simpler procedure with less recovery time. The average hospital stay for a direct to implant case, where the implant is placed at the time of the mastectomy, is one night. Typically, most patients can resume their normal activities at four weeks and all activity restrictions are lifted at three months.
All breast reconstruction and breast symmetry procedures, following a mastectomy, are covered by insurance, as legislated in 1998.
The risks of implant based reconstruction include seroma (a collection of fluid within the breast), infection, and capsular contracture. These risks factors are reduced by surgical technique, including the use of an acellular dermal matrix to support the implant, the placement of breast drains, intraoperative antibiotics, patient activity restrictions, and post surgery oral antibiotics that are taken until all drains are removed. On average, two drains are placed per breast and typically all drains are removed by 2-3 weeks post op but may stay longer depending on the specific patient situation.
What bra should I wear post op?
A special surgical bra will be placed post operatively in the operating room that is soft and breathable, allowing for optimal healing after your breast surgery. In the initial post operative period it is important that your breasts are supported, and the surgical bra is to be worn both during the day and at night.
This is very individual and is based on the size of the breasts and your specific post operative recovery. Typically, at your one month post op appointment, pending no recovery complications, you will receive information regarding approved bras that you may purchase. After having a mastectomy, most patients have some degree of sensation change to the breasts. This decrease in breast sensation increases the risk of bras rubbing and causing skin irritation. It is important that you wear a bra that is soft, without underwire, and that does not have thick seams, to reduce the risk of skin irritation and breakdown. Our office has spent a lot of time finding bras that are safe and comfortable and you will be given this information when it safe for you to transition from the initial surgical bra.
We do not recommend wearing an underwire bra. The wire tends to rub in areas that no longer have sensation or have decreased sensation, causing chafing or blistering. If you choose to wear an underwire for a short period of time, check your skin frequently for any breaks in the skin. If you are going to wear an underwire bra (for example for an event), you should wait at least 3 months after your initial surgery or 2 months after your symmetry procedure.
You may shower 48 hours after surgery (postop day 2), with the water to your back. Showering with the water to your back prevents direct contact of water on the incisions. It is ok if water trickles over your shoulders to the incisions. Just pat the incisions/dressings dry after you shower. Please do not wash/scrub your incision sites. A sterile dressing was placed over your incisions in the operating room and this will stay in place and will be changed during your post op appointment. Please do not remove or change your dressings, unless otherwise specified by our office.
Do not wear deodorant on the day of surgery. You may start wearing deodorant after you have been discharged home, unless you had a sentinel node biopsy, in which case you will need to wait until 1 week after surgery. There are no restrictions on the type of deodorant you may use.
Please strip your drains 5-6 times per day and record the output per drain, per day on your drain log. For specific instruction on how to care for and strip your drains please refer to the drain care page.
What wound care do I need to do?
In most cases after surgery you are not required to do any wound care, unless otherwise specified by our office. A sterile dressing will be placed over your incisions that should remain intact and will be changed in the office during your post operative visit.
You will begin simple range of motion exercises after all drains have been removed, typically at the 2-3 week appointment. If at 4 weeks you have not been able to restore full range of motion, you will receive a prescription for physical therapy.
You can begin walking as soon as you return home, but you may not feel like walking long distances at first, and it is important to listen to your body and not push yourself while your body is trying to heal. At 4-6 weeks, we allow you to gradually increase your activity. Most patients can resume light exercise including the stationary bicycle at 4-6 weeks post operatively. More strenuous exercise can typically be resumed at approximately 2-3 months post op. Please discuss with our office before resuming any exercise to ensure it is safe for you to do so in your specific situation.
When can I sleep on my stomach or side?
Please discuss with our office before transitioning to sleeping in a new position, including transitioning from your recliner to bed (if you had a DIEP/SIEA flap procedure), to determine if it is safe for you to do so. All patients are required to sleep on their back for a minimum of 4-6 weeks post operatively. Typically, at 3 months post op, as long as there are no delays in your recovery, you can sleep on your stomach.
Intimacy can be resumed 6 weeks post operatively, as long as there are no recovery complications or delays in healing. Please avoid direct pressure to the breasts until at least 3 months post operatively.
Can I massage my breasts?
Breasts can be lightly massaged at 2-3 months post operatively. Please avoid applying direct heat or cold to the breasts, this can result in burns or damage to the breast due to decreased breast sensation after mastectomy.
Once you no longer have drains, you no longer are taking pain medication, and you feel confident in your ability, you can return to driving.
In the immediate post operative period you are at an increased risk for blood clots and precautions should be taken to avoid this. If you are driving longer than 2 hours, wear TED stockings and take breaks from sitting. You should only wear a lap belt, however if you must wear one that crosses your chest, be sure to place padding between you and the belt.
When do I stop iron, selenium, and zinc after surgery?
You may stop iron 2-4 weeks after surgery if your energy levels have returned to normal (or you may stop if you are experiencing gastrointestinal issues with the iron). You may stop the zinc and selenium 2 weeks after surgery if you do not have wound healing complications.
Friday, October 31, 2003 08:47 a.m.
HAPPY HALLOWEEN
I finally got my cute little laptop. I love it. I took it home, and to my chagrin ended up working in my PJs. Since I was getting my desktop swapped out I had to place all my MP3 on a network drive. I was terrified they were going to delete all of my music. I invested a lot of research time looking for all of that music. I did, however, delete some of the horrendous stuff I had, why I had it....no clue. I had some stupid shit on there and won't embaress myself by listing it in such a public space.
Big news, very big news coming down the pipes. Can't divulge just yet but very soon. Just waiting for the details. Stay Tuned!
All Hallows Eve is tonight. We had plans to go to the Sunset Room with Mo & Ro but we all realized we were to broke to go out. Instead we're all going to meet up at my house and watch scary movies. I'll buy a bag or two of candy just in case we get any ghouls and goblins stopping by.
I was so tierd yesterday. I went to the gym immediatly afterwork, came home did some work, read and fell asleep at approx. 7:45pm. Im in dire need of a nice weekend at home!
Tuesday, October 28, 2003 05:47 a.m.
Its taking for my laptop to actually make it to my lap. Supposedly it was ordered 3-weeks ago, but having to wait is ridiculous