Step by Step
Patients very often have concerns that go beyond the information given by the surgeon. This is a step by step guide of what to expect. Whilst every case is different, if there are no complications the steps involved from beginning to end tend to follow a pattern.
This is a summary of what you might expect, step by step.
- After diagnosis your breast surgeon will discuss with you your options.
If immediate reconstruction is
an option then an appointment will be made to see a plastic surgeon.
- At the initial consultation with the plastic surgeon your options as to
the type of reconstruction will be discussed at some length. This is the
case with both immediate and delayed
- A second consultation, a week or so later is usually very helpful. It
allows you to have had a period of time in which to assimilate all the information
you have received. You are bound to feel overwhelmed at this stage and a
further meeting with the surgeon is generally beneficial.
- Once the type of reconstruction is decided upon the wheels are put into
motion to prepare you for the operation. This will include:
i) A date – the two surgeons involved will generally decide this in discussion with you.
ii) Anaesthetic assessment – generally the week before the operation
iii) Pre admission tests i.e. bloods tests, ECG etc – a week to ten days before admission.
iv) Doppler Scan – a simple ultra sound test, or CT scan is used to visualize the flow patterns of arteries and veins. This is sometimes required with a DIEP reconstruction and is usually carried out a week or so before admission.
v) If you are an insured patient then you will need to inform and liaise with your insurance company to keep them fully informed.
- When the day of the operation arrives admission is usually an hour or
so before the scheduled start time in a private hospital. Possibly the night
before in an NHS hospital. The surgeon will draw markings on you to guide
him during the surgery.
- During the surgery you will have a Bladder Catheter (a
tube passed up into the bladder) inserted. This will allow you to pass water
without having to get out of bed for the first few days after your operation.
As soon as you are up and about the catheter can be removed. Many women
worry about the catheter but it causes very little discomfort and is simply
and easily removed by the nurse on the ward at the doctors request.
- You can expect to be in hospital for around seven days depending on the
type of reconstruction. In the case of reconstructions using a flap it is
usual to spend some time on the High Dependency Unit. This allows the flap
area to be constantly observed in those vital first few days. Very occasionally
after surgery there may be some bleeding or a lack of blood supply to the
flap. In this instance it could be necessary to return you to theatre to
investigate the cause.
- You will have surgical drains either side of your donor site wound and
one at the side of your new breast mound. This is simply a tube used to
remove blood or other fluids from a wound. These are usually removed the
day before or the day you go home.
- Physiotherapy is often required to help with breathing exercises and initially
gentle arm movements. This may commence whilst you are in hospital or be
arranged for after you come home.
- Visits to the hospital to have dressings changed will be made.
- A follow-up appointment to see your plastic surgeon will be made for about
two weeks after you are discharged from hospital.
- Depending on the advice of your oncologist regarding any chemotherapy
and/or radiotherapy that you may need to have and your type of reconstruction
a timetable for nipple reconstruction
and nipple tattooing can be
- You will continue to see your breast surgeon and your plastic surgeon at extending intervals over several months until the reconstruction is complete.