Tag Archives: breast reconstruction

Preparing for surgery

I have seen many different lists outlining what you should do before surgery, what to take to the hospital, and how to make your life easier through recovery. Check out the Mastectomy Surgery Checklist from FORCE, a prep guide and a checklist from MyDestiny.

Here’s the list I kept for myself (after-surgery updates included) .

Preparing your body:

Get in the best physical shape you can manage before the surgery. The healthier the body, the more tolerant it is to trauma and the faster it recovers. ¤ YES! But lay off the push-ups and focus on core and legs. Note: I chose reconstruction via tissue expanders/implants, which directly impacts the pectoralis major muscle. Your doctor may offer different advice based on type of recon (or no recon).
Constipation can be an issue after pain medication and anesthesia. Two weeks pre-surgery start getting more fluids (avoid caffeine), fiber, flax seed, prunes, or prune juice in your diet. You can also purchase an over-the-counter stool softener. ¤ Colace was the only medication that made me nauseous. I stopped taking it. Sunsweet prune juice did the trick. I went #2 on day five.

Preparing your home:

Rent a recliner or a hospital bed. Alternatively use lots of pillows, buy a wedge pillow or get yourself a BedLounge. Because of drains you will not be able to sleep on your side and obviously can’t sleep on your stomach. Pillows are crucial if you don’t normally sleep flat on your back. Most women report that sleeping at a 45 degree angle seems to be most comfortable. Buy one of those c-shaped travel pillows to help support your neck. ¤ I borrowed an electric recliner from a friend. Covered it with a vinyl sheet and a sterile white one. BEST THING EVER.
Buy or borrow a TV tray type of table on wheels. Have it next to your recliner or bed.
Get a Tiddy Bear or a travel-size pillow for the car to keep the seat belt off your chest. ¤ Tiddy Bears are great! The key is to have two of them – one up high on the shoulder and one under the boobs.
Have a set of clean sheets ready for the day the you return from the hospital.
Move everything you will need during the day to waist level.
Buy paper plates, plastic cups, straws, food in/on smaller and lighter containers. ¤ Yes on the straws, but all the other stuff I didn’t really use.
Prepare and freeze meals ahead of time or have someone as the designated cook while you recover.
Buy or rent a shower chair or have a cooler handy. ¤ I sat on a small cooler.
Get a back brush for showering. ¤ YES!
Place bottles of hand sanitizer everywhere.
Buy a personal digital thermometer if you don’t already have one. Monitor your body temp (keeping infection in mind). ¤ Yup, this is important. Take temp daily.
Things for the nightstand:
- Medications (track when and how much taken) ¤ Set an alarm clock/cell phone to wake up at night and take on a schedule, rather than wait for the pain to hit.
- Gauze, tape, scissors
- Rubber gloves
- Hand sanitizer
- Tissues
- Chapstick
- Snacks
- Water
- Note pad and pen
- Books and magazines
- Tablet/eReader and charger
- Phone and charger
- Camera ¤ This is important. I took photos every single day from multiple angles. They helped me keep track of the necrosis and were my go-to when I thought I developed a seroma.

Other handy items to buy before surgery:

Lanyard or a special bra with drain pockets (insurance may cover) or make your own drain pockets if you have a sewing machine (see vid below) ¤ A lanyard worked well for me.
Button down shirts
Dry shampoo
Alcohol wipes
Non-child-proof medication bottles
Tylenol

For the hospital (if staying overnight):

Button down top
Lanyard/drain pockets
Head band and ties
Toothbrush and paste
Face wipes
Throat lozenges
Chapstick
Eye mask, ear plugs
Back scratcher (meds will make you itchy)
eReader/tablet and charger (check if hospital has wi-fi)
Headphones
Tiddy Bears or small pillow for the seat belt during the ride home

Speed bump

2 Replies

I have been seeing the breast surgeon since the spots showed up on the ultrasound in March. I expected to work with him and the plastic surgeon I chose. Well, that will not be so. During a recent screening appointment he threw a wrench into it. He doesn’t have regular operating privileges at the hospital the plastic surgeon operates in and vice versa. He thought he would, but with his current patient load, there just aren’t enough weeks in a month for him to do whatever has to be done in order for a hospital to grant those privileges to an “outside” surgeon.

That’s just peachy! Now what? Do I pick one of the other two plastic surgeons or do I find another breast surgeon? He suggested that I stick with the plastic surgeon and meet with another breast surgeon – one he highly recommends. So off to another appointment!

I met with Dr. K and discussed most of the specifics of what has been going on with me and where I stand now. He’s available to do the mastectomy on the 22nd, he seems like he knows what he’s doing, he does think that this is a good idea, we got along just fine, and he’s originally from Jersey (good or bad – you decide). I feel like I don’t have much choice at this point, as it doesn’t look like the other surgeon can do it, but I know I don’t have to “settle,” so I’ll think about it and see if I’m good with this arrangement or not.

Going under the knife

So what’s actually going to happen? How does this work?

The prophylactic bilateral mastectomy is serious business. The operation can range from four to over 12 hours – depends on what type of mastectomy (skin-sparing, nipple-sparing) and reconstruction (direct, delayed, implant, DIEP, TRAM, other flap, fat transfer) are planned. It requires at least one night’s stay in the hospital and has a lengthy recovery (multiple-week’s-worth, not just a few days). During a mastectomy the surgeon removes all of the breast tissue leaving little or none behind. The breast reconstruction can happen or begin at the same time the breast tissue is removed: the breast surgeon removes the tissue and hands off the scalpel to the plastic surgeon who does his magic.

After consulting with both surgeons, I chose to have a skin-sparing mastectomy and go the two-stage implant route for reconstruction. Sadly (or not – depends on how you look at it) I do not have enough extra tissue and fat to spare for some new boobies. I’m still undecided on whether or not I want to keep my own nipples, but more on that later.

This whole procedure scares the crap out of me. Even though I’m still two months out, I’m already nervous! There are so many things that need to be considered and so many unknowns. A few things are still up for discussion with the surgeons. I have another list going and will be meeting with both of them again to get some more info to help me decide (updated a couple of answers post-appointment).

Do we need to biopsy the sentinel node to see what’s going on there? Original verdict was no, but to be re-discussed with new surgeon (see Speed Bump). The answer is still no.
Should I keep my nipples? Eventually decided that I’m going to keep them.
Do we really need to snip the pec nerves? It is done to create the pocket, but also for optimal projection. If the pec major remains completely intact, this can cause “jumping boob” when you shake hands, reach for things, or even have a conversation, if you talk with your hands.
When do we do insurance pre-authorization? Breast surgeon does it first about a month before surgery. Plastic surgeon submits after that is granted.
How long will I be unable to shower, open my own water bottles, high-five, do the nasty, drive, work, etc.? Timetable for Healing is one of the sections in the Breast Reconstruction Guidebook and details the first four weeks post-mastectomy. You are back to most of your normal routine during week four.

Breast Reconstruction Guidebook Table 14.1

Source: Steligo, Kathy. Breast Reconstruction Guidebook: Issues and Answers from Research to Recovery. Maryland: The Johns Hopkins University Press, 2012. Print, third edition.

Aside from worrying about infections and other surgery complications, the thing that bugs me most is long-term limitations on physical activity. During the procedure, the surgeons snip some of the nerves that are attached to the pectoralis major to create a pocket for the implant. Because of this, the pec major atrophies and loses some of it’s function. The pec minor learns to pick up the slack, but doesn’t fill the shoes. Does this mean that I won’t be able to go rock climbing again? How about wake boarding? Eek! Anyway, another topic to research and discuss.

Need to know basis

Now what?

But why?

4 Replies

I never really worried or thought much about cancer until my sister was diagnosed with breast cancer when she was 28 (10+ years ago). She died a year later. So … annual mammograms began in my mid 20s and mid-year ultrasounds were added a few years later. The topic of a prophylactic bilateral mastectomy came up on a couple of occasions, but I didn’t think I had enough reason to seriously consider it. So far, so good.

In March 2012 an ultrasound spotted some issues. Three separate masses were present – two on the left breast, one on the right. They developed in the six months since the last mammogram. Based on quantity and consistency, the oncologist thought they were cysts. Rather than doing a biopsy to draw fluid for testing, he recommended that I first undergo an MRI screening. At this time I started doing some casual research on prophylactic bilateral mastectomies. Waiting for test results was hell, but when they eventually arrived, they were good – no cancer. Whew! High five!

Fast forward to June 2012. I felt something unusual during one of my monthly self-exams. The lump I felt was in one of the three spots where the ultrasound found issues. Another ultrasound confirmed that two of the three spots had increased in size and were now palpable. Fine-needle aspiration biopsies were done and results sent for testing. I got names of a few plastic surgeons in my area and left with a plan to start the conversations, no matter the results. The biopsy results were negative for cancer, but there were abnormal cells detected. I already knew I have “extremely” dense breast tissue/fibrocystic disease (which can make diagnosis of cancerous tumors more difficult). I was told to continue my self-exams and keep regular screening appointments as I had in the past.

You’re doing WHAT?

1 Reply

January 22, 2013. Seems so far away, but I know it’ll be here before I know it. That’s the day I’m having a prophylactic bilateral mastectomy (PBM) and start the breast reconstruction process. A PBM is an elective, preventative procedure which surgically removes breast tissue (see more details under WHAT IS A PBM?). You’re doing what with WHAT? Ya, I am doing it. I have thought long and hard about what this really means. I have discussed this with family, friends, and doctors. I have done hours of research, almost ad nauseam. After considering all of the factors, the risks, the benefits, the uncertainties, the consequences, I know this is the right decision for me.