Breast Reconstruction Questions

Types of reconstruction

Which type of reconstruction (implants vs. autologous) which you recommend for me and my body type? Why?


Do you use 3-D programs or any other tool (like consultation kits with temporary implants) to understand what I will look like post-surgery?


How do we decide what size I’ll be?


How do cc’s correspond with typical size?


If Implants:

  • How do we decide what type of implant I get? 
  • How long will my implants last?
  • How do you deal with risks of them rupturing or leaking?
  • What is your rate of implant failure?
  • How do you deal with implants flipping?


If Autologous Tissue

  • Will I lose sensation at the donor site? 
  • How do you minimize complications, like: infected seromas, necrosis, fat reabsorption?
  • Do you offer ReSensation?
  • Is alloderm used in DIEP?
  • How large will my donor site scars be? Do you have any photos?
  • Are my risks of complication higher with one particular type of reconstruction vs. another?
  • How many phases of surgery will there be (most autologous reconstruction includes one major surgery, and one to two touch up surgeries afterwards)?
  • If autologous reconstruction, how much tissue is available to rebuild the breasts? Will the the new breasts be the same size, or different?

Timing of Reconstruction

What is the best reconstruction timing for me? Am I a candidate for DTI or expanders?


If Expanders

  • How long after surgery will I get my first fill?
  • How many rounds of fills will I get?
  • What cc’s will I try to get filled up to?
  • Can the expanders be deflated if I decide they’re too big?
  • How long after my last expansion do I have to wait before exchange?
  • How painful will fills be? 
  • What’s the difference in size between expanders and implants?
  • How much exercise can I do in between mastectomy and exchange surgery?
  • How soon after my mastectomy will I start getting my fills?
  • How can I protect against the risk of infection during this interim period with expanders?
  • How can we protect against nipple and skin necrosis?

Surgery

How long is the surgery?


Who will be in the room for the surgery? Will anyone else besides the main surgeon be a hands-on part of the operation?


Will you use alloderm? Why or why not?


What type of anesthesia will I get?


Will I get a nerve block?


How long do I stay in the hospital?


Will I be in the ICU?


What can I expect from the moment I arrive at the hospital to the moment I leave the hospital (e.g. time in waiting room and recovery room, bringing family, updating family on results)

Immediate Recovery

When can I shower?


When do I get my bandages off?


How often will I come see you after surgery?


When can I put my arms over my head?


What are my physical activity restrictions?


What are my day-to-day restrictions? When can I start:

  • Showering
  • Taking baths
  • Lifting things
  • Driving
  • Working out (Lifting and Running)

How long will I be out of work?


How long will I need help from friends/family?


What types of supplies will I need when I get home?


What kinds of bras will I need to wear and for how long?


When should I start PT? Do you have a list of PTs you recommend?


Pain

How long will I be in pain, and how will it change with time?


Where can I expect the most pain? 


What kind of medication will I be on, and for how long?

Drains

How long will I have drains in?


How can I minimize pain/annoyance from drains?


How do I take care of my drains?


What kind of wound cleaning will I need to do after the drains are removed?


How many drains will I have?


Where on the body (sides, armpits, etc.) will the drains be located? 

Complications

How do you protect against nipple necrosis? 


What kind of post-op bleeding is normal vs. what should concern me?


What will happen in the event that a hematoma develops? 


How do you minimize risk of infection?


How do you minimize risk of losing an implant?


How do you minimize risk of a flap failing? 

Scars & Sensation

Scars

  • Where will my scars be? Can I see photos?
  • Do you do the hidden scar procedure?
  • How will my scars change with time?
  • How big will my scars be?
  • Will you recommend products or other things I can do to help with scarring?


Sensation:

  • Do you do any sensation preserving techniques?
  • Where can I expect to be numb?
  • What will my nipples feel like?

Preparing for Surgery

How should I prepare for surgery? 


Physically are there specific areas I should focus on strengthening?


Do you have a psycho-oncologist that you refer patients to? 


What foods/vitamins/supplements should I be taking pre-surgery?


What foods/vitamins/supplements should I stop taking pre-surgery, and how long pre-surgery?


Are there any specification preparation rituals I need to undergo (such as sanitation washes, drinking gatorade for hydration, etc.)?

Long Term Effects

How will future weight gain/loss impact my reconstruction?


How does breast tissue removal impact my hormones?


What can I expect regarding weight fluctuations, acne, or hair changes?


Are there any effects on my balance?


How will this affect muscles in my chest and back?


Are there any activities that I won’t be allowed to do after this surgery?


When can I wear a “normal” bra? (NOTE: Nordstrom offers bra fitting for women who have had breast surgery, and insurance often covers bras post-breast surgery!


WIll I need future mammograms, ultrasounds, MRIs?

Surgeon Expertise

How many breast surgeries have you performed? How many of this particular type of reconstruction have you performed?


What type of reconstruction are you most experienced in?


What is your success rate? 


How many patients have had complications and why? How have you treated?


If something goes wrong, how do I contact you?


Can I see photos of previous surgeries of this type that you’ve completed?


Can I speak to any of your previous patients about their experience?


(If breast surgeon and reconstructive surgeon are separate people): How many times have you performed this surgery in partnership with my other surgeon? What is the nature of your relationship?

Follow-Up Surgeries

How often do you find yourself doing revision surgeries on patients who you reconstructed? Is a revision surgery built automatically built into the timeline (ex. for DIEP)?


Revision surgery (including fat grafting):

Is this outpatient?


How long is recovery, and what are my restrictions?


How long after my reconstruction can I have my revision surgery?


What will you be fixing? 


What can I expect my results to look like?


Will I need drains again?


How long will I be in a compression bra?


Fat Grafting:

  • How much of the fat sticks, in your experience?
  • Will it be an injection or surgery?
  • Where will my donor site be?
  • Will this fix indentations as well as ripples?