After all the information and preparation for your surgery it is very normal to expect some insecurity anxiety and emotional swings. Relax, this is completely normal. Most other patients have similar feelings. Talking to either of the surgeons involved will allow you to verbalise this and to be re-assured about what are perfectly reasonable concerns.
After preliminary tests and perhaps a visit to the Physician in order to make sure any medical conditions you may have are optimally controlled a date will be set for theatre. Prepare yourself for a stay of 3 – 5 days if no flap surgery is to be done and 5 – 7 days with flaps.
On the day of admission most of our patients will go to the x ray department for some form of imaging to ensure optimal surgical outcome. These may include mammogram type hook wire localization of the tumour, sonar, plan x rays and scans of the armpit to identify potential lymph glands which we may need to sample during the operation. After this you will be returned to the ward and be prepared for theatre.
The Anaesthetist will come and see you and make sure you are ready for the operation and give you a pre-med and I may need to mark certain anatomical points on your skin depending on the operation to be done.
After the operation all patients who have had flap surgery will go to the high care ward for observation of blood pressure and the flap. The next morning they get transferred back to the ward. You will have drains and drips up and a blood pressure cuff as well as special stocking to aid blood circulation of the legs. This is to prevent the type of problems seen on long distance airline flights (DVT).
Apart from some pain and discomfort you should feel okay if somewhat tired after the surgery and anesthetic. This day is one of evaluation and stabilization after surgery.
On the second day you should be more mobile and the drips will be removed. Between days 3 – 7 depending how you have fared and what your circumstances are at home you will be discharged.
At this stage the drainage tubes will still be in position and will remain so until the drainage has diminished between 8 – 12 days. This may be longer in the case of flap surgery. Whilst this is sometimes uncomfortable it serves to prevent build up of fluid in the wounds.
Psychologically my patients tend to have several periods of depression related to surgery and anaesthesia. This is normal and related to pre operative anxiety, anesthetic and pain killers, sleep pattern disturbances and sometimes sheer emotional release that the procedure is over. This might also happen to you. If you are depressed or concerned about a specific issue contact one of us to share these issues. We do not routinely prescribe medication for this as it is transient and does not require treatment.
You will be seen by your Surgeons in the post op period and your progress will be checked. Stitch removal is between days 12 – 14.
During this period the final histology will be reported to us along with the receptor status of your tumour. This will enable us to discuss the non –surgical treatment with you so a decision can be made about the best options with regards chemotherapy, radiotherapy and/or hormone therapy and also the timing of such interventions.
Do not expect a normal breast mound at this stage. Just as when your breast developed during puberty it will change over the next 6 – 8 months. Wound healing, scar maturing, tissue expansion and gravity all help to mould the new breast mould. This is not an instant process but if you are unsure please check with me.
Challenges you might face during this period may include any number of combinations, which may vary from minor irritations like difficulties in finding bras to major relationship crises.
General comments that we hear are that clothing does change during the period of reconstruction until symmetry has improved to allow the wearing of v necks. Bra wearing is also difficult, but options to exist.