Breast cancer surgery and reconstruction can be daunting, confusing and fraught with a sense of urgency. Most women just want it to be over. Yet they will live with surgery decisions for a life-time. Take time to think through your decision. 

Condensed from Chapter 23, Wrapping It Up, “Breast Cancer Surgery and Reconstruction: What’s Right for You.”  By Patricia Anstett, author, “Breast Cancer Surgery and Reconstruction: What’s Right for You,” (June, 2016; Rowman and Littlefield). More information at http://bcsurgerystories.com

ASSEMBLING YOUR MEDICAL TEAM

1.  For the best results, seek out a breast cancer surgeon and plastic surgeon who do reconstruction all the time. Ones good at facelifts, nose jobs and wrinkle removal often don’t have the skills you are looking for and the best results. Ask your doctor, family and friends for names of breast surgeons and plastic surgeons. Visit the doctor’s or hospital’s Web sites. The best teams have extensive information online about their practices, the surgery options they perform, and pictures of patients with breast reconstruction. Ask for names of patients you can talk to.
2. Find someone who is a good listener to accompany you to your first appointment. If no one is available, bring a small tape recorder to the appointment and ask to use it.
3. Bring questions you have with you. Don’t be afraid to ask to have information repeated or explained further.
4. Take time to see how the doctor reacts to your questions. Is she comfortable with you asking for information? Does she explain issues clearly? If you don’t like how the doctor responds, find another doctor or hospital where options may be different.
5. Ask the doctor, hospital or your insurance plan what doctors you can see and what out-of-pocket costs you face. If your health plan doesn’t cover all costs and you have a limited income, you may be eligible for help from non-profit organizations such as the Pink Fund, www.thepinkfund.org.
6. Find out if you are eligible for surgery advances, such as direct-to-implant, one-step reconstruction or a nipple-sparing mastectomy. Your weight and body size can rule out some procedures.
7. What kind of incisions does the doctor use and what scars will they create?
8. Does the plastic surgeon mostly perform reconstruction with implants, as most do?
9. Does the plastic surgeon perform autologous breast reconstruction with your own tissue, and if so, the more preferred, advance DIEP flap and related procedures.
10. Are you at higher risk of surgery complications, such as lymphedema, a common swollen chest and arm problem, or heart problems, after radiation? What tests do you need to find out if you have a higher risk?

  PRE-SURGERY ISSUES

11. Stop smoking; it increases the risk of complication.

12. Lose weight if possible; obesity is associated with a higher rate of surgery problems.

13. Find a caregiver or team you can rely on to get you to appointments, help with household tasks and pets. Some women create Internet pages that allow family and friends to get medical updates or to bring you meals or help with other tasks.

14.  Assemble items you need to take to the hospital such as a robe; a comfortable surgery bra or abdominal binder if you have breast reconstruction with abdominal tissue; and a pillow to place on your chest or tummy under a seat belt for your ride home.

15. Take care of items you may not be able to tend to for a while, like a haircut or other health-related and other appointments.

16. Pet owners may want to consider arrangements, even elsewhere, for their animals, if they jump on your chest or expose you to bacteria while you recover.

POST-SURGERY ISSUES

17. The first few weeks after surgery may be challenging. It’s wise to schedule more recovery time from work or normal activities than you think you may need. Many women feel they underestimated recovery issues.

18. Follow instructions carefully about the surgery drains you may have. Keep track of the fluid drainage and avoid getting the drains wet. Some doctors say no showering until the drains are removed; others allow showering with precautions, such as showering backwards for a few weeks. Some doctors and women recommend purchasing a new or used shower chair to help caregivers help you shower.

19. Wear the post-surgery bra you purchased or the hospital provided for you until your drains are removed.

20. Rest and sleep on your back, propped up to be comfortable.

21. If you are in severe pain, have lots of swelling or running a high temperature, call your doctor’s office for help.

22. It will take weeks, even months, to get back to normal activities or feel comfortable with your new body. You may feel weird sensations, such as a pulling sensation, or be unable to lift your arm, even to take a half-gallon container of milk out of the refrigerator in the week or two after surgery.

22. Your breasts also may feel tight or too high up on your chest, which should resolve over the next few months. Your skin may swell or look an orange peel with larger pores, a common problem caused by swelling. Your nipple, if you have one, may develop a scab, change color or shape. See your plastic surgeon if problems persist.

23. Gentle breast massages may help, beginning about two weeks after surgery, to increase blood flow and reduce swelling. Dab lotion on your fingers once or twice a day and gently massage your breasts. Don’t use heat pads or ice packs; both can damage the skin. With time, sometimes weeks or even months, swelling should resolve.

24. Resume exercising gradually. Begin walking, even around the house for a few minutes. Two weeks after surgery, most women can begin light exercises once or twice a day to increase the range of motion in their arms. These exercises are simple movements, such as walking your hands up a wall as if you were washing it. Walking, running and using exercise machines that don’t require much arm movement should be fine, in moderation. If you still are having problems, you may need physical therapy, which your doctor has to prescribe.