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Breast Reconstruction With Expander or Implant: Before Your Surgery

Picture of a tissue expander and breast implant after mastectomy

What is breast reconstruction with an expander or implant?

Breast reconstruction is surgery to rebuild the shape of your breast after you have had part or all of your breast removed because of cancer. It may also be done for women who have problems with breast development. Your doctor may create a breast form with an implant that is put under the skin and often under the chest muscle in your breast area. You and your doctor will plan your surgery based on your wishes, your overall health, and how much surgery and treatment were done for the cancer. Every woman's treatment plan and breast surgery are different.

Breast reconstruction usually takes more than one surgery. The nipple and the brown area around it, called the areola, are usually recreated at a later time. Your doctor may also use a balloon (tissue expander) to stretch your skin and muscle for several months before the final implant is put in. The balloon is gradually expanded with a saltwater solution every 1 to 2 weeks until the tissue is ready. This happens in your doctor's office.

You will likely be asleep during your surgery, and you may be given a medicine that numbs the breast area. After your surgery, you will probably be able to go home the same day or the next day. Depending on the type of work you do, you should be able to go back to work or your normal routine in 3 to 6 weeks. The cuts (incisions) leave scars that will fade with time. Your doctor may try to use the same incisions that were used to remove your cancer. Your doctor will try to make incisions that leave as few visible scars as possible.

It is important to know that your breasts will look different after surgery. Your new breast may feel firmer and look rounder or flatter than your other breast. The new breast may not have the same shape as your breast did before it was removed. Some women have surgery on the other breast to make them look as much alike as possible.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

What happens before surgery?

Preparing for surgery

    Bring a list of questions to ask your doctors. It is important that you understand exactly what surgery is planned, the risks, benefits, and other options before your surgery.
  • Tell your doctors ALL the medicines and natural health products you take. Some of these can increase the risk of bleeding or interact with anesthesia. Your doctor will tell you which medicines to take or stop before your surgery.
    If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if you should stop taking these medicines before your surgery. Make sure that you understand exactly what your doctor wants you to do.
    You may need to stop taking certain medicines a week or more before surgery, so talk to your doctor as soon as you can.
    Before your surgery, you will speak with an anesthesia provider to discuss your anesthetic options, including the risks, benefits, and alternatives to each. This may be on the phone or in person.

Taking care of yourself before surgery

  • Build healthy habits into your life. Changes are best made several weeks before surgery, since your body may react to sudden changes in your habits.
    • Stay as active as you can.
    • Eat a healthy diet.
    • Cut back or quit alcohol and tobacco.
  • If you have an advance care plan, let your doctor know. If you do not have one, you may want to prepare one so your doctor and loved ones know your health care wishes. Doctors recommend that everyone prepare these papers before surgery, regardless of the type of surgery or condition.

Having surgery can be stressful. This information will help you understand what you can expect and how to safely prepare for surgery.

What happens on the day of surgery?

  • Follow the instructions exactly about when to stop eating and drinking, or your surgery may be cancelled. If your doctor has instructed you to take your medicines on the day of surgery, please do so using only a sip of water.
  • Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
  • Do NOT shave the surgical site yourself.
  • Remove all jewellery, piercings, and contact lenses.
  • Leave your valuables at home.

At the hospital or surgery centre

  • Bring a picture ID.
    Before surgery you will be asked to repeat your full name, what surgery you are having, and what part of your body is being operated on. Your doctor will use a marker to draw lines on your breast. He or she will use these lines during surgery to rebuild your breast.
    Tell your doctor if you or anyone in your family has a history of blood clots. If so, you may get a blood thinner before surgery and have special stockings on your legs after surgery.
    A small tube (IV) will be placed in a vein, to give you fluids and medicine to help you relax. Because of the combination of medicines given to keep you comfortable, you may not remember much about the operating room.
    You will be kept comfortable and safe by your anesthesia provider. The anesthesia may range from making you fully asleep, to simply numbing the area being worked on. This will depend on the procedure you are having, as well as a discussion between your doctor, the anesthesia provider, and you.
    The surgery will take 1 to 2 hours.
    As you wake up in the recovery room, the nurse will check to be sure you are stable and comfortable. It is important for you to tell your doctor and nurse how you feel and ask questions about any concerns you may have.

Going home

  • Be sure you have someone to drive you home.
    For your safety, you should not drive until you are no longer taking pain medicines and you can move and react easily.
    Arrange for extra help at home after surgery, especially if you live alone or provide care for another person.
    You will be given more specific instructions about recovering from your surgery, including activity and when you may return to work.

When should you call your doctor?

  • You have questions or concerns.
  • You don't understand how to prepare for your surgery.
  • You become ill before the surgery (such as fever, flu, or a cold).
  • You need to reschedule or have changed your mind about having the surgery.

Where can you learn more?

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