Immediate Post-mastectomy Tissue And Implant 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.
  
  
• Immediate post-mastectomy combined autogenous tissue and implant breast reconstruction is surgery done right after mastectomy. This may help you better cope with the loss of a breast. However, a second operation at a later date will be needed. A combined autogenous tissue and implant breast reconstruction is done if the chest skin and tissues are tight and flat. You and your caregiver will decide if this type of reconstruction after mastectomy is right for you. For this surgery, caregivers use a tissue flap taken from another part of your body to rebuild the shape of the breast. The tissue flap is usually taken from your lower abdomen (stomach), buttocks, thigh, or upper back and is made up of skin, fat, and muscle.
  
  
• A tissue expander (balloon-like device) implant will be used to stretch the skin and tissues of the chest. It will be filled with saline (salt water) by your caregiver regularly. A tissue expander is only temporary and you will need another surgery to replace it with a permanent implant.
  
  
• A permanent implant may be filled with saline or silicone gel. Sometimes, surgery to reshape the other breast may 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. You may bleed more than usual, get an infection, have trouble breathing, or get blood clots. Your heart, lungs, blood vessels, or nerves may get injured while having the surgery. The area where the flap was taken may become weak and you may have big scars. The reconstructed breast will not be as sensitive as it was before. Sometimes, skin death may occur if you have a problem with healing, and you may need another surgery. 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.

GETTING READY:

The week before your surgery:

• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using any of your present medications. These may include aspirin, ibuprofen, or blood thinners.
  
  
• Ask your caregiver before using any over-the-counter or herbal medicine or supplement. If you regularly use these medicines or supplements, tell your caregiver.
  
  
• Caregivers may think you will need a blood transfusion during surgery. You may be able to donate your own blood before surgery. This is called autologous blood donation. This must be done at least three days before your surgery. You may also ask a family member or friend with the same blood type to donate their blood. This is called directed blood donation. Ask your caregiver for more information on autologous or directed blood donation.
  
  
• You may need to have blood and urine tests, mammography, chest x-ray, and other tests. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your surgery:

• Remove any nail polish.
  
  
• You may be given a pill to help you sleep.
  
  
• Ask caregivers about directions for eating and drinking.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• Do not wear contact lenses on the day of your surgery. You may wear glasses.
  
  
• Caregivers will insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your surgery. Tell your caregiver if you or any member of your family has had a problem using anesthesia in the past.
  
  
• You will be asked to sign a legal piece of paper (informed consent). It gives a caregiver permission to do the procedure. If you are unable to give your consent, someone who has permission can sign this form for you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

TREATMENT:

What will happen:

• You will be asked to change into a hospital gown. You may be given medicine to help you relax or make you drowsy. You will be taken on a cart to the operating room. You will get medicine called general anesthesia to keep you completely asleep during surgery. Caregivers will clean your chest and the area where your tissue flap will be taken. Sheets will be put over you to keep the surgery area clean.
  
  
• Caregivers will make a wide incision (cut) in your breast area to do a mastectomy. Other incisions will be done in another part of your body to get the tissue flap. The flap will be moved to the breast area and a tissue expander implant will be inserted under the muscle. Thin rubber tubes may be put into your skin to drain blood from your incision. The incisions are closed with stitches and covered with bandages.

After surgery: You will be taken to a room where you can rest until you wake up. You may be allowed to go home. If you are staying in the hospital, you will be taken back to your 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 prevent infection. A caregiver may remove the bandage soon after surgery to check your incision.

Waiting room: This is a room where your family and friends can wait until you are ready for visitors. If your family leaves the hospital, ask them to leave a phone number where they can be reached.

CONTACT A CAREGIVER IF:

• You cannot make it to your appointment on time.
  
  
• You have a fever (increased body temperature).
  
  
• You feel a new lump in your chest or axilla (armpit), or see or feel other changes in your breasts.
  
  
• You have a skin infection or an infected wound near the area where surgery will be done.
  
  
• You have questions or concerns about your surgery.

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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