Preparing for Breast Reconstruction

Breast cancer surgery and reconstruction can be daunting, confusing and fraught with a sense of urgency. Take time to think through your decisions, which you will live with for a life-time. Condensed from “Breast Cancer Surgery and Reconstruction: What’s Right for You” by Patricia Anstett (June, 2016; Rowman and Littlefield). More information at http://bcsurgerystories.com.

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. Bring questions you have with you. Don’t be afraid to ask to have information repeated or explained further.
3. 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.
4. 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, thepinkfund.org.
5. 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.
6. What kind of incisions does the doctor use and what scars will they create?
7. Does the plastic surgeon mostly perform reconstruction with implants, as most do?
8. Does the plastic surgeon perform autologous breast reconstruction with your own tissue, and if so, the more preferred, advance DIEP flap and related procedures?
9. 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?
10. Lose weight if possible; obesity is associated with a higher rate of surgery problems. Stop smoking; it increases the risk of complications.
11. Find a person or team you can rely on to get you to appointments and 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. 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.
12. Follow instructions carefully about the surgery drains you may have. Keep track of the fluid drainage and avoid getting them 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.
13. It will take weeks, even months, to get back to normal activities. It may be wise to schedule more recovery time from work or normal activities than you think you need.
14. 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. Your breasts may feel tight or too high up on your chest, which should resolve over a few months. Your nipple, if you have one, may develop a scab, change color or shape. See your plastic surgeon if problems persist. Gentle breast massages may help, beginning about two weeks after surgery, to increase blood flow and reduce swelling. Don’t use heat pads or ice packs; both can damage the skin. With time, sometimes weeks or even months, swelling should resolve.
15. 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. Walking, running and using exercise machines that don’t require much arm movement should be fine, in moderation.
16. If you are in severe pain, have lots of swelling or running a high temperature, call your doctor’s office.