Knowing What to Ask and Planning in Advance Before Breast Reconstruction Surgery

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Plastic Surgeon and Breast Specialist Dr. Constance Chen Offers Practical Tips for Women Considering Post Mastectomy Breast Reconstruction.

Dr. Constance Chen

Whichever surgical option a woman chooses, she should have a thorough understanding of what to expect after surgery, when she goes home, and how her new breast will look and feel.

A diagnosis of breast cancer upends a woman's life, and forces her to make many personal, medical, and financial decisions. If a woman must undergo mastectomy, the predicament is further complicated by the decisions she must make about whether, when and how to have breast reconstruction. Many women undergoing breast reconstruction see implants as the quickest and simplest reconstructive option. Controversy about the long-term safety of implants, however, has driven more and more women to choose “autologous reconstruction,” which uses a woman’s own tissue to create a soft, warm breast that looks and feels like her original breast. “Whichever surgical option a woman chooses, she should have a thorough understanding of what to expect after surgery, when she goes home, and how her new breast will look and feel,” says plastic surgeon and breast reconstruction specialist Dr. Constance M. Chen. “Knowing what to ask and planning in advance with her surgeon before surgery should reduce the risk of surprises later.”

“I'm going home! Yay! But with drains?”
Going home after surgery is an important step emotionally as well as medically. Each woman has a different sense of what is important to her sense of self. She should know in advance that she will probably leave the hospital with surgical drains still in place, and she will need to know how to manage the drains and accommodate them in her clothing as she resumes daily activities. She may be surprised that it is the mundane things, like being able to get in and out of clothes easily, going to the bathroom, and looking normal, that loom large.

“One or more surgical drains are usually required following mastectomy and reconstructive surgery,” says Dr. Chen. “Drains perform the important function of preventing the build-up of fluid in a surgical space.” The drain is a flexible tube that connects from the surgical incision to a small plastic bulb that collects fluid and must be periodically measured and emptied. Drains might be removed in the hospital but are more likely to be removed in the doctor's office after surgery. Your nurse or doctor will instruct you on how to manage the drains and keep them secure and discreet. “Some patients find a post-surgical camisole with pockets for the drains to be convenient,” says Dr. Chen. ”Others prefer an oversized sweater or blouse and loose-fitting pants with roomy pockets to hold the bulb.”

“What if my new breast isn't what I expected?”
Autologous reconstruction, nipple preservation, and techniques that reduce scarring try to recreate a soft, warm, natural breast that is similar to a woman's original breast. However, she may find that the natural “look and feel” of her restored breast refers to how the breast will look and feel to someone else. The breast may not feel at all natural to the woman herself, because her reconstructed breast usually lacks feeling and may be completely numb to touch and sexual arousal. “While results vary, advanced microsurgical techniques now make it possible to reconnect nerves and restore some measure of sensation to the breast,” says Dr. Chen. The importance of breast sensation is different for every woman and should be discussed in the initial surgical consultation so she knows what to expect - especially since not all surgeons are trained in techniques to restore breast sensation.

The goal of breast reconstruction, whether with implants or a woman's own tissue, is to restore symmetry – to create a breast with the shape of the original that is in proportion with her other breast and with the rest of her body. Matching a reconstructed breast to an existing natural breast may not be possible in a single surgical procedure, however. Follow-up modifications may be necessary to achieve the desired symmetric result. “For many women, breast reconstruction is a process rather than a single procedure,” says Dr. Chen. “Lack of symmetry in mastectomy patients after reconstruction can be corrected with adjustments to the reconstructed breast or to its unaffected 'sister.' This possibility should be discussed in the initial surgical consultation.”

“Our goal is to help every woman make informed decisions so that she can better understand her treatment and recovery,” Dr. Chen concludes. “Comprehensive, accurate information about what to expect is helpful to optimize physical and emotional outcomes.”

Constance M. Chen, MD, is a board-certified plastic surgeon with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine. http://www.constancechenmd.com

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Melissa Chefec
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