I have had reconstruction.

Recovery

Once you have returned home, it may be tempting to go back to your usual activities, but try to take it easy!

  • You may have specific instructions depending on your procedure.

    Walking upright: If you have have reconstruction using your abdominal tissue, you will likely start walking a bit hunched over, or in a flexed position. Within a few days you should be able to start to straighten up, but let your body be your guide. Don’t do anything that doesn’t feel right, but try to get up and move around every day.

    Thoracodorsal Vessels: If you had a flap and the blood vessels were connected to your vessels near your armpit, then the positioning of your arms is important to keep the pressure off the tiny vessels that were sewn together there. Place pillows under your arms when you are sleeping, and don’t lift your arms more than 45 degree away from your body.

    Drain care: you’ll be given instructions on how to empty and care for drains placed in surgery. See the MORE section for specific details on drain care.

Things to watch for at home:

  • Signs of infection

    Bright red, hot, painful areas (not controlled by medication). You may also feel generally unwell or have a fever.

  • Signs of hematoma (blood collection)

    Pain, swelling, redness, and disfiguring bruises (usually will occur within the first day postoperatively)

  • Signs of a blood clot.

    Following any procedure, you are at a slightly increased risk of blood clots. You may be sent home on blood thinners for a period of time following your operation. Signs of a blood clot in your leg (or Deep Vein Thrombosis (DVT) – include: redness, warmth, or swelling, usually just to one calf. If you have any shortness of breath or chest pain, it may be a sign of a blood clot in your lungs (Pulmonary Embolus (PE)). If you have any of the symptoms listed above, do not hesitate to go immediately to an emergency department.

Future Surgeries

If you have spoken to other women who have undergone reconstruction, you have likely heard about the potential need for small, follow-up surgeries, or “revisions.”

This may be necessary if there is still some asymmetry between the breasts – either from the surgery, or because only one side was reconstructed and the other breast does not quite match. Sometimes, it is simply that there is a little bit of extra skin that needs to be removed. And sometimes, it is for nipple reconstruction.

Nipple Reconstruction:

If you have had a mastectomy or lumpectomy which required the resection of your nipple areolar complex (NAC), you can also choose whether you would like nipple and areolar reconstruction. This can be done as an outpatient, typically as a small day procedure or under local anesthetic, and you would not have to be admitted to hospital.

Nipple and areolar reconstruction can be done through a combination of surgical procedure and tattoo, or tattoo alone.  The surgical procedure involves using the skin of the reconstructed breast to make a nipple mound. This is can be done both in the setting of implant based reconstruction or autologous/flap reconstruction, and is usually done at least 3-6 months following surgery.

The surgeon you are working with may choose to tattoo the areola first, prior to nipple reconstruction, or after the nipple reconstruction has healed.

 It is also possible to simply tattoo the nipple areolar complex, without nipple reconstruction. With proper shading and contouring, these are often made to look 3-dimensional and provide the optics of a projecting nipple. They do not however, have sensation or feeling to them.

There are also nipple prostheses available, which are removable devices made to look and feel like nipples.

The Other Breast:

Although some women undergo mastectomy and reconstruction of both breasts, many women only have mastectomy and reconstruction on one side. Depending on the shape of your breasts, it may be difficult to make the reconstructed breast match the contralateral breast. If that is the case, your surgeon may recommend what is sometimes referred to as a “balancing procedure.” This may involve a breast lift (mastopexy), breast reduction, or augmentation with implant.

Revisions and Fat Grafting:

Fat grafting typically involves liposuction of the abdomen, flank or thighs, and then injection of the fat to areas in the breast that are scarred or require volume. This may be in areas of scar from the mastectomy, from a lumpectomy, or even due to irregular contour after implant or tissue based reconstruction.

Not all the fat that in transferred will remain long term - an estimated 50% will remain, although the exact amount is difficult to tell.

Fat grafting often requires a few procedures depending on contour and the amount of fat graft “take.”

Most often, this is done in the main operating room under a general anesthetic. Sometimes, if only small volumes need to be corrected, this can be done using local anesthetic (freezing).

Interesting fact: If you gain weight, the fat cells that have been transferred from your abdomen to your chest will also increase in size!