Breast Reconstruction - Following Breast Removal
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A tissue expander is inserted following the mastectomy to prepare for reconstruction.

Breast reconstruction is the procedure following removal of the breast due to cancer or other disease. Breast reconstruction replaces the breast, as well as femininity and self esteem. There are different approaches which vary according to the type of mastectomy and the condition of the breast skin.

With every surgery there are possible risks and complications:  
Dr. Yaker performs many breast reconstruction procedures successfully each year. However; there are risks associated with this surgery. Possible complications following surgery include infection, bleeding, poor healing, and reaction to anesthesia. Smokers need to stop smoking prior to surgery. Smoking increases the risk of complications during the healing process.

The expander filled with saline through an integrated or separate tube to stretch the skin enough to accept an implant beneath the chest muscle.

About the Surgery: 
Generally reconstruction procedures are performed at the hospital under general anesthesia, and require 1-5 overnight stays, depending on the procedure.

There are many options available and during consultation Dr. Yaker will discuss your options. A common technique is skin expansion. Following removal of the breast a tissue expander, a balloon style implant, is placed beneath the skin and chest muscle. There is a small valve in the implant which will be inflated with saline over several months in order to stretch the skin. In a second procedure, the expander is removed and a implants is inserted. The final stage of reconstruction consist of the nipple and areola reconstruction. Flap reconstruction is another approach involving creation of a skin flap using tissue from another area of the body, generally the abdomen. The flap consists of the donor sites skin, fat, muscle and blood supply. This flap is tunneled beneath the skin to the chest creating a pocket for an implant, or if enough tissue is available a complete breast mound. In some cases the abdominal contour is improved. There is also a flap technique using tissue from the back and transplanting to the chest by reconnecting the blood vessels to new ones in that region. Scars will be left at both the donor and reconstructed areas. Often and additional surgery is needed to enlarge, reduce or lift the opposite breast to balance the breast.

After surgery, the breast mound is restored. Scars are permanent, but will fade with time. The nipple and areola are reconstructed at a later date.	With flap surgery, tissue is taken from the back and tunneled to the front of the chest wall to support the reconstructed breast.	The transported tissue forms a flap for a breast implant, or it may provide enough bulk to form the breast mound without an implant.
Tissue may be taken from the abdomen and tunneled to the breast or surgically transplanted to form a new breast mound.	After surgery, the breast mound, nipple, and areola are restored.	Scars at the breast, nipple, and abdomen will fade substantially with time, but may never disappear entirely.

Illustrations  above are courtesy of
ASPS (The American Society of Plastic Surgeons)  
(The American Society for Aesthetic Plastic Surgery, Inc.)

Pre-Operative Instructions For Breast Reconstruction

2 Weeks Before Surgery:

• Do not take aspirin or ibuprofen products (You may take Tylenol)
• Do not take any diet pills or similar appetite suppressant medications, (i.e. Metabolife)
• Do not take any herbal preparations, (i.e. St. Johns Wart)
• Do not take Vitamin E
• Do not smoke - This will interfere with the circulation and healing process causing major complications

Fill you prescriptions given to you during your pre-op visit:

• Percocet, Lortab, or Dilaudid is for the pain
• Keflex is an antibiotic (you will need to take all of these as directed)
• Diazepam is a muscle relaxer
• Extras-strength Tylenol

• If you are having abdominal flap reconstruction - A Fleets enema
• Eat a bland meal - Nothing Spicy
• Before going to bed take a Pepcid AC
• If needed a Diazepam to help you rest

• Wear loose clothing, if you will be staying at the hospital over night, be sure to bring loose and easy clothes to wear home. (Do not wear jeans or tight clothing)
• Do not wear make-up.
• Leave all jewelry and valuables at home
• The person caring for you after surgery will need to stay with you for at least 48 hours once you arrive home.

Post-Operative Instructions For Breast Reconstruction

Medications:

• Take your pain medications for the pain. Do not take it on an empty stomach
• Take the antibiotics as directed until they are all gone
• Sometimes patients will develop a yeast infection from the antibiotics, if this occurs call the office
• Should you become constipated, you may use an over the counter stool softener. If you do not have relief from your stool softener, call the office.
• Should you experience itching, take Benadryl 25 mg: one capsule every 6 hours as needed
• Should you have nausea, a prescribed Phenergan suppository should help.
• Remember no aspirin products until 2 weeks after surgery

Other Things to Remember:

• If you feel you are in an emergency situation, please call the office at any time. Our phones are answered 24 hours a day. These calls include: abnormal bleeding, abnormal swelling, or a temperature over 101 degrees. Other calls should be made during business hours Monday - Friday 9:00 a.m. - 5:00 p.m.
• You may have a drain to collect excess fluid and blood which is removed approximately 2-5 days after surgery, depending on amount of drainage
• Should the incisions have drainage, place gauze bandages over the incision. Should drainage continue, call the office.
• Sutures are generally removed at 7 and 14 days post operatively.
• We ask that you not drive 7-10 days after surgery, if a flap procedure is performed it may be 2-4 weeks.
• Most patients take 10-14 days off from work.
• Do Not raise your arms over you head for 2 weeks.
• Patients are encouraged to massage lotions containing Aloe Vera or Vitamin E on the scars to help during the healing process, once all of the sutures or staples have been removed.
• Try to keep activities to a moderate level for the first 4 weeks. After 4 weeks you may ride a life cycle, and take walks. If a flap procedure is performed it may be 8-12 weeks before exercise is recommended. After 6-8 weeks you may resume normal activities as tolerated.

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