Breast Reconstruction Forum – Patient to Patient

The following information is provided by Dianne, one of our mastectomy and One-Stage Breast Reconstruction with Implant and AlloDerm patient.

Before surgery

  • Get copies of all your medical records for your own use.
  • You need to have some tests performed before your surgery. Have them done at home and bring the results with you:

EKG (heart test): A technician puts little electrodes all over your body and then does a scan; it’s totally painless and very fast.

Lung scan: You stand in front of a screen while a technician scans you; also totally painless and fast.

Blood tests: A technician takes a routine blood sample, drawing several vials of blood. Remember to drink lots of fluids and avoid caffeine for 24 hours before the test to plump up your veins and make the withdrawal easier.

Breast MRI: This is a standard MRI, but the second part is done with an IV in place. Again, drink lots of water and avoid caffeine 24 hours before. Let the technician know if you have any allergies; they will want you to take a special pill beforehand. You can ask for a mild sedative will help calm you during the procedure. You will be asked to lie in one position for quite a while without moving and the sedative not only calms you, it helps you to lie still and perhaps even dose off.

Depending on the type of MRI machine, it may be very claustrophobic. It helps to keep your eyes shut before you are put into the machine. You may also bring ear plugs or the MRI center may have headphones with music. The MRI machine is loud-it sounds like a jackhammer, so you may or may not be able to hear much of the music, but the headphones do help block out the sound. The MRI takes 40-60 minutes but is painless.

  • Fill your post-op prescriptions before your surgery, so you’ll have them when you leave the hospital.
  • Ask for a mild sedative the night before surgery so you can get a good night’s sleep.
  • If you want a private room (a small additional fee), ask if one is available; your husband/caretaker can stay with you overnight.

Here’s what I thought was essential to bring to the hospital. I know I took WAY too much stuff with me. We looked like the Beverly Hillbillies checking in to the hospital:

  • Two small travel pillows: one for under each arm.
  • You really only need pajama bottoms, slipper socks and a short silky robe. But you will want at least two or three PJ sets for recovery. Silky PJs are the best. You will spend the next few weeks sliding in and out of bed – it is easier to do in silk than in flannel.
  • Baggy button down shirts over sweat bottoms with slip-on shoes are by far the easiest thing to wear with the drains. It’s not elegant, but it is comfy and at this point, that’s all you will care about. Later I wore sweats and baggy zip-up hoodies. Think baggy until the bulky drains are removed.
  • Small travel case with lip balm, a bit of makeup, travel brush, wet wipes and throat lozenges (your throat will be a bit sore after surgery).
  • An IPOD with soothing spa music to help you relax and sleep, and your favorite tunes for during the day.
  • A sippy cup won’t spill when you are in bed.
  • A few small snacks, as hospital food it is not that great: crackers, animal cookies, dried fruit, etc. The nurses keep a small supply of juices.
  • Books or magazines and crossword puzzles, although you may be too uncomfortable to really concentrate.

Day of surgery

  • No eating or drinking after midnight the night before.
  • Check in at Admitting at Dobbs Ferry-they are pretty fast.
  • You will change into a hospital gown. You will need to leave your glasses if you have them (don’t bring contacts to the hospital) with whoever comes with you. (Leave your jewelry, purse and other valuables at home.)
  • A nurse will take your vital signs and put an IV in your arm. Ask for a mild sedative if you need one to help calm your jitters.
  • Ask the anesthesiologist to add an anti-nausea medication to your IV while you’re still in surgery. (Note: this is routinely added for all of Dr. Salzberg’s reconstruction patients.)
  • If you are having a sentinel node biopsy (women having a prophylactic mastectomy will probably not have this procedure) you’ll go to Radiology, where they will inject you with a special dye. When I had this, it burned like fire and was very painful, but it was over quickly.
  • In the OR, the doctors will come over and talk to you. Dr. Salzberg will draw his surgical markings on you. The nice anesthesiologist puts medications in your IV and all of a sudden, you are sound asleep. What seems like literally a minute later you will be awake in the recovery room. I was wired from the drugs they used to bring me back up. I yakked the ears off the recovery room nurse and did not go to sleep until about 1:00 a.m., but I understand others are groggy.

After surgery

Once you’re awake and stable, you’ll be moved to your hospital room. You will have a morphine pain pump that you can control and use when you need it. It will deliver only up to 6 doses per hour so you cannot overdose. A fanny pack around your waist will hold a Marcaine ball that feeds a local anesthetic directly to your breasts for two days. The Marcaine worked so well for me, I only used my morphine pump four times, but use it as often as you feel pain. There are no medals for being a martyr and many women use the full dosage hourly.

You will have four drains coming out of your breasts; each drain must be stripped and emptied throughout the day. Make sure the nurses do this at least once each shift! Many times they may not and you have to remind them, because this is important. Before you leave the hospital they will give you lotion and directions on how to manage the drains. My husband did my drains for me, but it is not difficult to do them yourself. You will need to strip, empty and measure the drains three or four times a day until they are removed. I used the clips that came with the surgical bra for the drains and found that fine; others preferred fanny packs or lanyards to carry the drains around.

Once you get out of the hospital you will still want to be elevated as if you were in a hospital bed. Make a nice nest for yourself-put four pillows at an angle under your head and shoulders, one under each arm and one under your knees. As you recover, the pillows will disappear one by one.

Dr. Ashikari will remove the Marcaine ball after a couple of days. I felt just a bit of a pinch; not too bad on the pain scale, but not totally painless either. Most of the time this is done before you leave the hospital, unless you leave the next day as I did. I had to go back to his office for a post op-visit to get it taken out.

For post op, the Summerfield Suites (http://www.hyatt.com/hyatt/summerfield) is a great place to stay, with spacious living/kitchen areas plus separate bedroom and bath. They have a nice breakfast and also dinner buffets. It is less expensive than other not-as-nice alternatives and close to shopping and restaurants. The Marriott Residence Inn in White Plains is a good alternative with suites and is close to everything.

Making things easier

  • You’ll be very weak right after your surgery; have someone unscrew all your medications in advance so you don’t have to struggle to open them.
  • You won’t be able to raise your arms or reach much above shoulder height the first couple of weeks. Have everything you need at counter level.
  • Wear the compression strap OVER your clothes and PJs whenever possible. It is much more comfortable and helps prevent chafing.
  • Have stool softeners handy to counteract the constipation caused by pain medication.
  • When riding in the car for the first week and a half or so, use a travel pillow between you and the shoulder strap and another in your lap to rest your arms on.

The preferred post-op bra is Donna Karan’s Underwire Sports Bra #35137. The  Natori Sport Underwire Sports Bra model # 34439 is more comfortable for sleeping. It is nice to alternate bras so no spot get too sore from wearing just one type. They run a bit small and you will be a bit swollen-I normally wear a 34 but needed a 36. Dr. Salzberg will determine cup size, but it does not hurt to get a couple of sizes, as you can always return one if it doesn’t fit. You may not fill out the cup completely right after surgery, but as a few weeks go by the implants soften to a more natural shape and will fill out the cup.

  • Palmers Scar Guard (available in CVS pharmacies) massaged in several times daily after incisions heal (about five or six weeks post-op) will help the appearance of your scars.

My own personal recovery

Week 1: I didn’t do much but lie around, read, eat and walk the halls of the hotel. I did take some short trips to the hospital to visit another patient and to see a friend nearby, but your stamina will be limited, so only plan an hour or two at most. You really want to take it easy. For some reason I was famished all the time and ate bigger meals than I normally do! I was uncomfortable, but not in any real pain, and just weaker than I had expected. (Be careful when using public restrooms! Most of them have doors that are heavy and push in but pull out. You could get stuck waiting for someone to rescue you like I did!)

Week 2: I felt stronger and my drains came out-oh, happy, happy day!-on the eighth day. They are a nuisance while in, but not really all that bad as long as you make sure not to let anything snag or pull on them. For me, pulling them out was very painful (I cried and screamed a bit), but some say it was not a big deal. Take some pain medication before you go in to have them removed, just in case. We flew home the same day. This is the time to start your stretching exercises to get your mobility back (but don’t start until Dr. Salzberg says it is okay).

Week 3: I started driving and was feeling really good. I could have driven sooner, but I didn’t need to, so I babied myself. New Year’s Eve was my three-week anniversary and we went to the movies and then to a small party. The hard part is not to overdo. I still wasn’t supposed to lift anything, but I began walking an hour a day and trying to get myself in good shape to get through chemotherapy. (I had never walked before or worked out at all so this was new for me!) At this point I finally felt less swollen and like my armpits belonged to me again. It’s not that it hurts exactly; it’s just that you can’t stretch properly and you can tell your arms have been placed in an unnatural position while you were in surgery.)

Week 4: I was stronger and getting most of my mobility back, except for some pesky scar tissue on my left side where they took all my lymph nodes; this should not be a concern for women having prophylactic mastectomies). I had a prescription for a physical therapist to help stretch that out.

Week 5: I was still getting stronger and starting to realize that one day these new boobs would probably feel pretty normal, though it would still take awhile. One of the strangest feelings is every time I got the least bit cold, the muscle contracted over the implant and squeezed. It felt like I had two small boulders attached to my chest; uncomfortable and weird, but not painful. I looked forward to getting the compression strap off; it was a bit uncomfortable as well.

Week 6: Felt more and more normal, but had to leave the compression strap on as my implants were still too high. I had almost full mobility back, but was still just a bit stiff on the left side. I had to stretch every day to maintain mobility, and had to remember not to overdo lifting because I felt good, but if I would have overdone, I would have felt it!