After the operation

Wednesday 30 November, 2011

On this page: Concerns after surgery ι Cancer check-ups ι Pregnancy ι Costs ι Information reviewed by

How quickly you recover from a breast reconstruction depends on the type you've chosen, how many operations you need, and your body's ability to cope with the surgery. Some women find that they get back to normal quite quickly while others find that they need several weeks to recover at home.

The main operation for a breast reconstruction usually requires you to spend 2-10 days in hospital. A general anaesthetic will be used and you will probably feel some pain or discomfort afterwards. If you have had a flap reconstruction, you will be sore in the area where the muscle and other tissue were taken, as well as in the breast area. You will be given pain relievers to control your discomfort. You will probably have small tubes inserted into the operation site so fluid can drain away.

You may need to be careful when moving around immediately after the operation, to help the healing process and because of any pain. It's usually advisable not to do housework for 4-6 weeks. This is because you need to avoid repetitive arm movements such as hanging out washing or vacuum cleaning.

After a TRAM flap reconstruction, you should also avoid heavy lifting - including lifting small children - for about six weeks. The surgery will also cause a tightening of the abdomen similar to a ‘tummy tuck' operation. You may have some weakness in your abdomen, which you may notice when getting up from a low chair or sitting up in bed. Ask your surgeon for advice about getting back to your regular activities. 

Your surgeon will continue to care for you until your body has healed properly. Then your usual checkups with your breast specialist will continue - see the next page for more information.

Once healed, your reconstructed breast will not need any special care.

Concerns after surgery

As with all operations, recovery will take longer if problems occur. These might be related to the anaesthetic, to infection or to healing. You should discuss possible problems with your surgeon or breast care nurse before the operation so that you understand the risks of the procedure and you can make the necessary arrangements for your work, home help or childcare.

Differences between your breasts

Most women are happy with the results of their reconstruction. Remember, however, that it is not possible to make an exact copy of your remaining breast. Sometimes there will be differences in the size, shape or position of the two breasts.

If your weight changes, you may find that one of your breasts changes in size while the other one stays the same. This is more common with an implant.

You may also find differences in the feeling of your breasts. Your reconstructed breast may feel either numb or extremely sensitive. You may also suffer some loss of feeling if you have had surgery to your remaining breast (for example, a breast reduction). If you have a nipple reconstruction, the nipple won't have any feeling. 

Healing problems

Sometimes there may be healing problems within the first week or so after surgery. This can be caused by infection, poor blood supply or problems with an implant. Any infection must be treated to reduce the possibility of further complications. If an implant has been used, it might need to be taken out. However, it may be possible to have a new implant put in later on.

Bleeding

Sometimes, shortly after the operation, extra blood collects in or under the wound. This is called a haematoma. It causes swelling and pain and may need to be surgically removed.

Scars

All people heal differently and the final appearance of a scar will vary from person to person, even if the surgery is the same. Most scars have a thickened, red appearance early on. This peaks about three months later, then settles down over time. Sometimes the scar stays thick for a long time and can become itchy and uncomfortable. Your surgeon or breast care nurse can advise you about treatments to reduce the discomfort. You may be able to have surgery later on to improve the scar's appearance.

Cancer checkups

Many women are concerned that their breast reconstruction will hide cancer that has returned (a recurrence). This is not likely to happen because most recurrences of breast cancer occur in the skin or in the tissue just under the skin. 

If a flap reconstruction is done, any recurrence would usually only occur in the skin that belonged to the original breast. The flap used to make the reconstructed breast would not hide this.

If a breast implant is used, it is placed underneath the chest muscle. Again it should not be difficult to detect a recurrence. Having a reconstruction does not affect your chances of long-term survival. After reconstruction, it is a good idea to examine both your breasts every month. Your surgeon will arrange to see you regularly to examine the reconstructed breast and will advise you on how often you need to have a mammogram. You will have the mammogram at a hospital breast clinic or radiological practice.

Mammography is sometimes done on the reconstructed breast. Discuss any concerns with your general practitioner or surgeon. 

Pregnancy

Whether or not to become pregnant after breast cancer and if so, when, is an issue for many women. You should discuss this with your oncologist and breast surgeon.

Pregnancy after a breast reconstruction is possible, regardless of the type of reconstruction. Mesh put into the abdominal wall during a TRAM flap operation supports the abdominal muscles and will help decrease the risk of a hernia during pregnancy.

Breastfeeding is not possible with the reconstructed breast.

Most women can successfully breastfeed with their other breast, although this may be difficult if you have had a reduction. A breast care nurse or lactation consultant can advise you on any concerns you have about breastfeeding after a reconstruction.

Costs

Make sure you know how much it will cost to have a breast reconstruction. Check with your surgeon, the hospital, Medicare and your private health fund before deciding to go ahead.

Financial assistance may be available for transport costs to medical appointments and prescription medicines. Ask the social worker at your hospital if you are eligible for assistance.

Public hospital

Reconstruction after a mastectomy is a medical procedure, not a cosmetic one. This means that the cost is covered through Medicare for a public patient in a public hospital. However there may be some extra charges if an implant is used. There may also be some charges for private patients in a public hospital. Because of the demand for public hospital beds, public patients may need to wait many months for their operation. Check the likely waiting period with your surgeon. 

Private hospital

If you don’t want to wait so long or you want to choose your own plastic surgeon, you can have the procedure privately if you have private health cover or are prepared to pay the extra costs.

If you have insurance, check what your policy covers before agreeing to surgery. Your insurance may not cover the total cost. In a private hospital, Medicare will cover some of the surgeon’s and anaesthetist’s fees. Your health fund will cover some or all of the remaining costs, but sometimes you will need to pay your specialists a gap fee or a hospital admission fee. Part or the entire cost of an inflatable tissue expander and any permanent implant may also be covered by your insurance.

If you don’t belong to a health fund but decide to join one before your operation, remember that you are having a breast reconstruction as a result of a ‘pre-existing illness’. You will therefore need to wait the qualifying period before you can make a claim. This may be up to 12 months. Check with different health funds before deciding which one to join.

Other costs

Check what costs you can expect before agreeing to surgery. You may need to pay for extras such as pain medication, post-surgical bras and checkups with your surgeon. Some women have their nipples tattooed. If a doctors does the tattooing, it is covered by Medicare. If a professional tattooist does the work, it is not covered and you will have to pay yourself.

 

Reviewed by: Staff from Westmead Breast Cancer Institute - Dr Thomas Lam, Plastic Surgeon; Dr Meagan Brennan, Breast Physician; Elisabeth Black, Jenny Cooper, Kim Kerin-Ayres and Mary Sweeney, Breast Care Nurses. Also Bronwyn Chalmers, Cancer Information Consultant, Helpline, Cancer Council NSW; Tracy Cosgrove, Breast Care Nurse, Royal North Shore Hospital; Marie Harland and Pauline Campbell, Breast Prostheses Fitters, Leila O'Toole Corsetry Salon; Lesley Jakes, Viviane Rubinstein and Kathryn Rutkowski, Consumers; and the Oncoplastic Subgroup of the Breast Surgeons Society of Australia and New Zealand (BreastSurgANZ).
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