Pre-op Bilateral Mastectomy Instructions

Before I dive in to the post-op risks, wound care and meds, it is important to note that these instructions were particular to MY surgery, MY medical history and are not intended to be advice for anyone.  MY Procedures immediately after bilateral mastectomy:

Left  Breast Reconstruction with Expander (1st stage) – First stage reconstruction of left breast with insertion of an expander under the left chest wall skin and muscles. RNFA.  I-Flow Pain Pump. O/N.

Right Breast (this is the breast that has breast cancer) Reconstruction with Expander (1st stage) – First stage reconstruction of right breast with insertion of an expander under the left chest wall skin and muscles. RNFA.  I-Flow Pain Pump. O/N.

Prior to Surgery:

• NO  SMOKING!!  No respectable Plastic Surgeon will commence with plastic surgery of this type (perhaps of any type) if you are a smoker.  Smoking restricts blood flow and could cause necrosis of the tissue at the healing site.  — I stopped smoking one month before my surgery.  Oh, this includes kicking the habit of any nicotine replacement therapy too since nicotine has the same constrictive effect on the blood vessels and could cause necrosis.  I used Chantix for 5 days then went cold turkey.
• Multivitamins and Vitamin C – take your vitamins twice per day to improve your general health.  Take Vitamin C, 500mg, twice daily to promote healing.
• DO  NOT  TAKE  ASPIRIN  OR  IBUPROFEN for two weeks prior to surgery, review the list of drugs containing aspirin and ibuprofen carefully.  Such drugs can cause bleeding problems during and after surgery.  Use medication containing acetaminophen instead.
• LIMIT  VITAMIN  E: Stop taking two weeks prior to surgery.
• Fill the Prescriptions you have been prescribed BEFORE the day of surgery.
• Cleansing:  Three nights before surgery and each following night prior to surgery, shower and wash the surgical areas (from collar bone to below breast crease with Betadine Scrub for FIVE  MINUTES.)  Repeat this cleansing on morning of surgery.
• No eating or drinking anything after 12:00 midnight, this includes water!
• Do Not Wear any moisturizers, creams, lotions, deodorant or makeup the day of surgery.
• Clothing:  Wear comfortable, loose-fitting clothing,DO  NOT  WEAR  ANYTHING  THAT  YOU  NEED  TO  PULL  OVER  YOUR  HEAD.  Leave hairpins, wigs and jewelry at home.

Plastic Surgeon Orientation

During the visit, we discussed whether or not insurance would cover reconstruction of the left breast which does not have cancer.  This whole insurance situation has been very stressful, one has to be their own advocate and stay aware.  Anyway, she described to me the process, a 3-step reconstruction which will take nearly a year for completion.

Step 1:
Immediately at the mastectomy operation, the plastic surgeon comes in to begin reconstruction, and in lay terms, to me, that means that she inserts “tissue expanders” which will “grow” as she fills them with saline solution in future visits.  These “fillings” will cause the tissue to expand so that permanent silicone gel implants may be placed in the future.

The tissue expanders are placed under the pectoral muscles to give a smooth appearance.

After the expanders are filled to the appropriate size, we wait FIVE  MONTHS before the actual, permanent implants can be placed.

Step 2:
Permanent implant placement will require another surgery, but not as long, just a matter of removing the temporary expanders and replacing with the permanent implants.  I do not recall how long of recovery time is required before Step 3 – Nipple reconstruction.

Step 3:
Nipple reconstruction will take place at some point after recovery from the permanent implant procedure.  I am not sure how long the surgery will take, nor do I know the recovery time.

Tatooing:
After the Nipple is reconstructed, tattooing takes place to give the appearance of the areola.  Here, breastreconstruction.org is a site that gives in-depth information on reconstruction in general as well as the nipple tatooing procedure.  Photos of prior patients’ results are stunning! Unbelievable and beautiful!