Reconstruction of a breast removed due to cancer or other disease is one of the most rewarding surgical procedures for surgical expert Dr. BYUN. New medical techniques and technology makes it possible to create a breast that is almost indistinguishable from a natural breast. Reconstruction is often possible immediately following mastectomy (breast removal), so a patient may never have the experience of being without a breast.
Reconstruction may require two or more surgeries depending on the extent of the procedures required and how well the reconstructed breast will match the other. The nipple and areola must be replaced for full reconstruction, but some patients opt to simply have the general breast contour restored.
Surgery takes between one and six hours and is performed under local or general anesthesia but may need a hospital stay of one to five days following operation. Discomfort upon conclusion varies between patients. Sutures dissolve internally, and dressings are removed in a week.
The most common complication is the formation of scar tissue around the implant which may make the breast feel hard. This is because scar tissue may envelop the implant, compressing the implant. Infection is also a possibility and could result in the patient’s body rejecting the implant or the transferred tissue. In addition, there is a small possibility that the surgical procedure may prevent a recurrence of the original tumor from being detected.
Do bear in mind that post-mastectomy breast reconstruction is no simple procedure. Dr. BYUN will explore the many options available to you as you consider the procedure.
Breast Reconstruction FAQs
Will I Be In Pain?
You will not feel anything during the procedure, since anesthesia will be used. However, after the anesthesia wears off, you will feel some pain and discomfort. It is highly recommended that you start off taking Extra Strength Tylenol, every six (6) to eight (8) hours, alternating with Motrin. Please DO NOT MIX pain relief medications together at the same time. If you are experiencing a higher level of pain, please take the prescribed pain medication (Norco, or other prescribed pain medication).
How Long Does The Recovery Take? When Can I Go Back To Work & Exercise?
Depending on both the surgery and your own physiology (your body’s healing), most patients have a downtime of two (2) to three (3) weeks before returning to daily activities such as exercising. During the first ten (10) days, we ask that you do not do any activity that increases your heart rate. This is to help the healing process, since the blood clot that has stopped the bleeding from the surgery dissolves in about seven (7) days. After ten (10) days, increase activity by ten percent (10%) each week as tolerated. Stop activity if you see a dramatic increase in swelling when you wake up the following day. At the one (1) week post-op visit you will be provided with healing instructions and what specific activities are allowed. Patients can usually return to work after one (1) week.
What To Do If I Become Constipated?
Reduce Norco usage, walk around, and take an over-the-counter medication like Colace or MiraLAX. It is recommended that you start using an over-the-counter stool softening medication one (1) day before surgery and continue taking it until you no longer need to be taking Norco for pain.
What Does The Healing Process Look Like?
Bruising, Swelling, and Stitches (which can pucker) are all NORMAL. Tissue firmness is NORMAL. Your body may not heal symmetrically, meaning one side may take longer to heal than the other, this is NORMAL. Any previous asymmetry may remain.
Why Are My Results Uneven?
Post-op asymmetry is NORMAL. Pre-existing asymmetry will continue since the human anatomy of left vs. right does not always match. Human tissue is naturally asymmetric. This applies to Breasts, Face, Eyes, and even the Nose.
Why Is My Swelling Lasting Longer On One Side?
This is very common. The function of your Lymphatic System (which acts as a highway of Arteries, Veins, and Lymphatic Channels) is to filter out fluid from particular areas of the body. Lymph Nodes, Bone Structure & Tissue Shape are different from right to left, so when it comes to draining, the “clearance rate” of the swelling is also entirely different on each side. The heart is located on the left side of the body and distributes blood throughout the body using different paths & pressures. The drainage of the heart is not completely linear; thus, another reason why Lymphatic Clearance is different on each side.
How Soon Can I Take A Shower?
We recommend waiting forty-eight (48) hours to shower. Make sure you are steady on your feet. Do not soak the incisions and pat them dry when done.
Can I Get My Sutures Wet?
After forty-eight (48) hours, stitches can get wet. It is highly recommended, however, that only normal saline (over-the-counter medical cleaning solution) is used to clean the stitches. DO NOT use any cleansers or alcohol products on the suture site. Picking or pulling at the sutures is not approved and can cause damage. Pat the sutures dry if need be.
How Often Can I Apply Heat And Cold Packs?
Hot packs are NOT recommended due to a side effect of increased inflammation which can further delay the healing process. However, cold packs are recommended with frequent usage in fifteen (15) minute intervals.
How Soon Can I Get On A Plane?
Every case is unique. Typically, short distances (short domestic flights) are okay. However, we recommend that you wait until you see Dr. BYUN’s team at the one (1) week follow-up appointment for final approval. Please keep in mind that extra swelling can occur due to pressure changes in the plane.
BYUN Post Operative Information & Care Instructions for Breast Reconstruction
MEDICATIONS TO HELP WITH NAUSEA
ZOFRAN (or OTHER ANTI-NAUSEA MEDICATION): Take one (1) Zofran tablet (or other anti-nausea medication) as prescribed on your way home from surgery.
MEDICATIONS TO HELP WITH INFECTION
KEFLEX (or OTHER ANTIBIOTIC MEDICATION): Start the antibiotics as prescribed (make sure to consume food when taking any antibiotics as it can cause nausea). It is crucial to complete the ENTIRE course of antibiotics.
MEDICATIONS TO HELP WITH PAIN
TYLENOL & MOTRIN: Start with two (2) extra strength Tylenol (take every 6-8 hours). You may take Motrin instead of Tylenol if preferred. Do not take Tylenol and Norco within the same 6-8 hour window. Taper off medications as tolerated.
NORCO (or OTHER PRESCRIBED PAIN MEDICATION: If pain is not controlled with extra strength Tylenol or Motrin, take one-two (1-2) tablets of Norco instead (take every 6-8 hours). DO NOT DRIVE if you’re taking Norco as it can cause drowsiness and other side effects. Norco has Tylenol in its composition – AVOID TAKING NORCO WITH TYLENOL and/or MOTRIN in the same 6-8 hour window.
METHODS & MEDICATIONS TO MINIMIZE BRUISING AND SWELLING
ARNICA TABLETS & BROMELAIN (over the counter): Take one (1) week before and continue for one (1) week after surgery
ICE THERAPY: Fifteen (15) minutes on, fifteen (15) minutes off. Icing is most important in the first forty-eight (48) hours post-surgery. Icing will still be effective after that forty-eight (48) hour period and is still recommended.
COMPRESSION: Firm but gentle wrapping with ace bandages.
METHODS TO ENHANCE RECOVERY
PROTEIN INTAKE: Protein can be ingested in any form; powder, shakes, bars or foods high in protein.
HYDRATION: Increase water intake (i.e., Pedialyte hydration packets to put in water) & Electrolyte drinks (i.e., Vitamin Water).
CLEANING WOUNDS TWO (2) to THREE (3) TIMES A DAY: Not cleaning enough can cause infection while cleaning too much can take away good, healing tissue and prolong recovery.
MINIMIZE STRESS: Stress leads to inflammation and can delay healing.
METHODS TO DECREASE NAUSEA
HYDRATION: Hydrate the day before with clear fluids. NO FOOD or WATER 8 hours prior to surgery, but you may hydrate before the 8 hours.
MEDICATIONS, CHEWS & FOODS
Take anti-nausea medications (Zofran, or other prescribed anti-nausea medication).
Try ginger candy or a flat ginger ale drink.
Avoid strong scents and smells, or food odors.
Eat slowly and in small portions.
Do not lie down flat after your meal for two (2) hours.
Return to normal foods slowly (please refer to the steps below):
- Start with CLEAR LIQUIDS (water)
- Move into a SOFT DIET (applesauce, pudding, etc.)
- Return to a REGULAR DIET
IMPORTANT: A full diet can be introduced ONLY when the others are successfully tolerated.
IMPORTANT: Start with room temp food – the hot temperature of the food may cause nausea.
ACTIONS TO AVOID AFTER SURGERY
AVOID HEAT THERAPY: Heat expands the tissue and can ruin the surgical work.
AVOID TOO MUCH ACTIVITY: Increasing heart rate and blood pressure can worsen swelling and fluid build-up.
AVOID MASSAGING THE SURGICAL SITE unless told to do so by our medical team.
AVOID TAKING BANDAGES / ACE WRAP(S) OFF: DO NOT remove bandages until after forty-eight (48) hours, or as instructed by our medical team. If ACE wraps are not worn correctly, original surgical results may not be maintained.
AVOID LAYING ON ONE SIDE: Laying on one particular side can cause an increase in swelling on one side of the body, can worsen asymmetrical appearances, and delay the healing process.
ON THE WAY HOME: Take anti-nausea medication.
UNTIL ONE (1) WEEK FOLLOW UP: Start antibiotics (take with food like yogurt, applesauce, or crackers) and start pain management.
PAIN MANAGEMENT OPTIONS:
Tylenol Extra-Strength & Motrin: one (1) to two (2) tablets / capsules, alternating every six (6) to eight (8) hours.
For Intolerable Pain: Norco, or other prescribed pain medication (take with food and as directed).
DO NOT drive and DO NOT mix Norco with Tylenol and Motrin.
If taking Norco, take with stool softener, as Norco can slow down digestion.
AFTER SURGERY: Start stool softener as directed: Colace, Miralax, or fiber supplements. Apply Ice to and around the surgical area.
MONITOR SWELLING: The first three (3) days are the worst, the majority of swelling subsides in three (3) weeks.
Elevate legs above heart level.
Start foot exercises – ten (10) times every hour (60 min), this helps to prevent clots.
Start breathing exercises – ten (10) times every hour (60 min), take a deep breath in, hold for ten (10) seconds and exhale.
Perform these exercises at your own pace, helps prevent lung collapse and pneumonia from general anesthesia.
WOUND CARE: To be done two (2) days after surgery – at your forty-eight (48) hour postoperative visit.
BANDAGES & DRESSING
- Remove gauze and ACE band – DO NOT remove anything directly on the skin.
- Apply Bacitracin / Neosporin to incisions three (3) to (4) times daily to prevent infection and scar depression.
- Once bleeding or oozing has stopped, stop application of ointment.
- Keep the incision clean and dry – use saline and gauze to clean, NO RUBBING.
It is OK to touch the dressing and adjust if it causes any discomfort.
If the dressing is soiled before the two (2) day mark, replace it with a new, clean gauze / ACE bandage.
IMPORTANT: If you have the urge to vomit, sneeze, or cough let it out.
IMPORTANT: If you’re continuously vomiting, call the office.
WHAT TO AVOID AFTER SURGERY
AVOID Lifting Arms Above Head or Behind Back
AVOID Sleeping on your Stomach
AVOID Chest or Arm Exercises
AVOID Strenuous Activity for at least two (2) weeks
DO NOT Lift Objects over 10lbs
Be Kind to Yourself and Trust the Healing Process
BE PATIENT – swelling can take a few weeks to months to decrease.
SORE THROAT feeling from the Endotracheal Tube placed by the Anesthesiologist, resolves within in one (1) to two (2) days, using ice chips or hot tea will help to soothe sore throat.
PLEASE NOTE – If surgery is more than five (5) hours, the anesthesia team may insert a catheter to monitor your body fluid during surgery, the catheter is removed at the end of surgery, discomfort is normal and present for twenty-four (24) hours.
SENSATION, NUMBNESS and TINGLING is NORMAL – new nerves awaken and grow after muscle repair, it may take up to six (6) months to one (1) full year for normal sensation to return.
BLEEDING within the first twenty-four (24) to forty-eight (48) hours is NORMAL.
BRUISING can appear away from the incision, this is NORMAL – bruising will change colors as it heals.
PUCKERING after surgery is NORMAL and a great sign – this shows that your muscles are adhering to the tissues, do NOT massage the puckered areas.
In The Media
Six things to be aware of before going under the knife.
Dr. Michael BYUN is a serious doctor with seriously comprehensive experience unlike many of his peers, setting him heads and shoulders above the rest.
Chicago magazine profile of Dr. BYUN.