Delayed Post-mastectomy Prosthetic Breast Reconstruction

WHAT YOU SHOULD KNOW:

• Post-mastectomy breast reconstruction is surgery to remodel the shape of the breast after having a mastectomy. A mastectomy is surgery where part or all of the breast is removed to treat breast cancer (tumor). This may include removing one or both breasts, with or without the skin which covers them. Reconstruction surgery is done to make a breast that comes close in form and appearance to a natural breast.
  
  
• Delayed post-mastectomy prosthetic breast reconstruction is surgery done weeks after mastectomy. An implant may be placed after recovery from the mastectomy is complete. This surgery may also be done weeks after a tissue expander (balloon-like sac) was placed after the mastectomy. This allows the tissue expander to first stretch tight chest skin and tissues before placing the implant. It may also give time for you to think thoroughly about which type of implant you will get and type of surgery to have. You and your caregiver will decide which type of breast reconstruction is right for you.
  
  
• For this surgery, caregivers use a permanent implant filled with saline (salt water). You may also be offered an implant filled with silicone gel instead of saline. The tissue expander, if present, will be removed and replaced with the permanent implant. The permanent implant will give a fuller look to the shape of the breast. Sometimes, surgery to reshape the other breast may also be needed after reconstruction to match the new breast. Surgery to create a nipple and areola may also be performed at a later date.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

There are always risks with having surgery, including reconstruction. You may bleed more than usual, get an infection, have trouble breathing, or get blood clots. If an implant is used for reconstruction, it may become less attractive over time. Scar tissue may form around the implant or the implant may wear out, burst, or leak. You may need to have more surgeries later on. The reconstructed breast may have more scars and not be as sensitive as it was before. Women who are obese, who smoke, or who have had or will have radiation are at a higher risk of problems. Call your caregiver if you are worried or have questions about your surgery, medicine, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• Monitoring:
  
  
  • Heart monitor: This is also called an ECG. Sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen. This shows caregivers a tracing of the electrical activity of your heart.
    
    
  • Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
    
    
  • Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.
  
  
• General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.

During your surgery:

• Caregivers will clean your chest area with soap and water. This soap may make your skin yellow, but it will be cleaned off later. Sheets will be put over you to keep the surgery area clean.
  
  
• Caregivers will make a wide incision (cut) in your breast area. The tissue expander, if present, is removed and replaced with the permanent implant. The implant is placed in the pocket or space that was formed by the tissue expander. Thin rubber tubes may be put into your skin to drain blood from your incision. The incisions will be closed with stitches and covered with bandages.

After surgery: You are taken to a room where you can rest. Caregivers will check on you. When they see that you are ready, you may also be allowed to go home. If you are staying in the hospital, you will be taken to your hospital room. Do not get out of bed until your caregiver says it is OK. A bandage is used to cover your stitches or staples. This bandage keeps the area clean and dry to help prevent infection. A caregiver may remove the bandage soon after your procedure or surgery to check the area.

• Activity: Caregivers may help you get out of bed to walk on the same day of surgery, or the day after. Ask caregivers if there are exercises that you may do while in bed. Exercise helps blood move through your body and may help prevent blood clots from forming. Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you feel weak or dizzy while standing up, sit or lie down right away and call your caregiver.
  
  
• Deep breathing and coughing: This breathing exercise helps to keep you from getting a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum (mucus) from your lungs for you to spit out. You should deep breathe and cough every hour while you are awake even if you wake up during the night.
  
  
  • Hold a pillow tightly against your incision (cut) when you cough to help decrease the pain. Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with a deep, strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
    
    
  • You may be asked to use an incentive spirometer. This helps you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Then let out your breath. Use your incentive spirometer 10 times in a row every hour while awake.
  
  
• Diet: You may be able to eat when bowel sounds are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope. You may be given ice chips at first, and then liquids such as water, broth, juice, or soda pop. If you do not have problems after drinking liquids, caregivers may then give you soft foods. Some examples of soft foods are ice cream, applesauce, or custard. Once you can eat soft food easily, you may begin eating your usual diet.
  
  
• Drains: These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.
  
  
• Intake and output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Certain foods also contain liquid. You may need more or less liquid each day. Ask your caregiver how much liquid you should have each day. Ask caregivers if they need to measure or collect your urine before you dispose of it.
  
  
• Medicines: Your caregiver may give you the following kinds of medicines:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.
  
  
• Pneumatic boots: These are plastic boots or leggings put on your feet or legs over pressure stockings or ace wraps. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the pneumatic boots. This helps push the blood back up to the heart to keep clots from forming.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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