Plastic Surgery Questions
- About the practice
- Implant Breast Reconstruction
- Postoperative Care
- Endoscopic Breast Reconstruction
- Abdominal Tissue Flap Breast Reconstruction (DIEP, TRAM, SEIA)
About The Practice
How can I contact NSPS?
You can call our office during normal business hours (8-4:30 M-F) at 312-266-6240. After hours, this number will forward to an answering service which will know how to reach Dr. Fine, Dr. Schierle, or the resident on call. You can also email us at firstname.lastname@example.org or fill out our Chicago Plastic Surgery Contact Form.
Where do the doctors at Northwestern Specialists in Plastic Surgery, S.C. (NSPS) perform surgery?
Our doctors perform surgery at a number of locations throughout Chicago including Northwestern Memorial Hospital, Northwestern Lake Forest Hospital, St. Joseph Hospital, Illinois Masonic, Mercy Hospital and Medical Center, the 900 North Michigan Surgery Center, and River North Same Day Surgery. Northwestern Memorial Hospital includes operating rooms at Prentice Women’s Hospital, the Feinberg Pavilion, and Olson Pavilion.
Where is the office located and how do I get there?
The office is located at 676 North Saint Clair Street directly west of the main Northwestern Memorial Hospital Pavilion. Parking is available at multiple garages nearby. The main garage with covered parking and covered walkway to the office is accessed via Superior Street eastbound or Huron street westbound (between Saint Clair and Fairbanks Court). You may use the second floor pedestrian bridge to access the hospital and on the right will see another bridge to cross Saint Clair Street and enter the 676 Building. The elevators to the 15th floor are on the right. If you enter 676 North Saint Clair at the street level, take the elevators to the right of the security desk to the 15th floor. We are in suite 1575.
We will want to know your previous medical history, planned surgeries, and, most importantly, your individual desires for cosmetic or reconstructive surgery. We place significant emphasis on a patient’s particular wishes and feelings towards the pros and cons of surgery, and are careful to discuss all options available to you. After an initial discussion, our doctors will perform a physical exam of the areas for surgery. This will help them to fully understand all available options for your cosmetic or reconstructive surgery. The meeting will finish with a discussion to answer questions and address any concerns you may have.
What is the focus of your practice?
Through extensive experience in both cosmetic and reconstructive surgery, we have focused our practice primarily on surgery of the head, neck, breast and body. This includes both reconstructive and cosmetic surgery in these areas. Breast reconstruction includes free tissue transfer and implant reconstruction. Cosmetic surgery of the breast and face is also a focus, including breast augmentation, breast reduction, breast lift, facelift, nose reshaping, eyelid surgery. Other procedures, such as liposuction, tummy tuck, body contouring, and wrinkle reduction with BOTOX® or dermal fillers are also offered.
How do I schedule an appointment to see an NSPS physician?
You can call our office anytime during business hours to make an
appointment to see Dr. Fine or Dr. Schierle. Depending on our
schedule, we anticipate we will be able to offer you an appointment
within 2-4 weeks.
For those patients desiring to have surgery within the next 4-6 weeks, we will do our best to accommodate your scheduling needs. Alternatively, if you are still simply gathering information and have not yet decided to have surgery, you may also try contacting our office through the website, and Michelle, our Physician Assistant, or Alex, our Nurse Practitioner, can be of assistance in answering any general questions you may have.
If I decide to have surgery, how long must I wait?
Depending on the surgery you desire, we expect to be able to accommodate you within 4-6 weeks. Every effort is made to accommodate Breast reconstruction after mastectomy or lumpectomy as quickly as possible and can often be scheduled within 2-3 weeks.
Breast Reconstruction (Tissue Expander / Implant)
What timeline can I expect my reconstruction to follow?
The duration of your reconstruction varies, depending on two variables. First and most importantly, it depends upon your post-operative treatment course (radiation, chemotherapy, etc.). Any additional surgery following your mastectomy and tissue expander will not be performed until this is completed and you have healed. Secondly, the length also depends upon the number of expansions necessary to get you to your desired size. Typically, it is best to wait at least three months from your initial mastectomy before any additional surgery occurs.
How large will I be after the first stage tissue expander reconstruction?
We add fluid to the expander at the time of surgery that takes up the excess skin without putting any tension on the skin. This usually results in a breast slightly smaller than you were prior to surgery.
How many expansions will I need? How often can they be done?
The number of expansions you will needs depends on your desired size and the size you are immediately after surgery. If you want to be the same size as you were prior to surgery, this usually takes 1-3 expansions. If you want to be larger than you were prior to surgery, this may require 3-6 expansions. Each expansion takes place in the office and can be done once a week. If you want to take more time in between expansions, that is okay.
Can expansions be done during my other treatments?
Expansions can be done during chemotherapy, but not during radiation therapy.
When can I start expanding?
Expansions typically begin 2-4 weeks following your mastectomy, given that your skin has healed as expected.
Does expanding hurt?
Most women do not have sensation in the area where the expansion occurs. It is possible to feel pressure, but rare that it is painful.
Is it okay to swim with an expander in place?
Yes, you may swim with an expander or implant 3 weeks following your surgery (or when the incision is healed).
How do I know what size is best?
We will continue to expand until you reach a size that you are comfortable with. We usually recommend trying on different types of clothes to determine which size is best for you. Ideally, we overexpand one time past your desired size in preparation for your second stage surgery.
Breast reconstruction post-op concerns:
How do I care for the surgical sites? When can I remove the dressings?
You may remove the gauze dressing 24 hours after surgery and then shower. Keep the steri-strips in place; they have been applied with a skin adhesive, so you can wash over them without loosening them. Steri-strips will gradually loosen along the edges, and usually fall off within 7-10 days after surgery. If your steri-strips fall off earlier than 7 days after surgery, it is okay; if they are still in place after 10 days, you can remove them yourself or they will be removed in the office at your first post-operative appointment. You may continue to cover the incisions with gauze if you want to, but it is not necessary.
How do I care for drains?
You may have one or more bulb suction-type drains (JP drain) in place when you are sent home. Please strip and empty the JP drain 2-3 times daily, or more often if the bulb fills up. To strip the drain, firmly grasp the tubing closer to your body, and use your other hand to squeeze and slowly slide your thumb and index finger down the tube. Always stabilize the tube with one hand while stripping the tube with the other. After emptying the drains, squeeze the bottle to create suction and replace the cap while squeezing to maintain the vacuum.
Make sure to measure and record drain output for each drain during every 24 hour period, and bring your record to your post-operative appointment. After the drainage has decreased to 30 mL or less in a 24-hour period, please call our office to arrange a time for removal of the drains. Drains are usually removed within 1-2 weeks.
You will be on antibiotics while the drains are in place. If you run out of antibiotics and still have your drains, please call our office for a refill. PLEASE NOTE: If you had a TRAM, you only need to finish the antibiotics given to you; if drains are in longer than your antibiotic coverage, that is okay.
Can I shower with the drains in place?
The drains can get wet in the shower, but should be supported while showering. To secure JP drains, used a ribbon, shoestring, or lanyard around the neck.
Is leakage around the drain sites okay?
Some patients experience leakage around the site of their drains. This is okay. Reinforce the area with gauze to protect your clothing and continue to strip and empty the drains as instructed.
What color should the drainage fluid be?
Drain fluid usually starts out red in color and slowly changes to lighter red, then pink, or even yellow. These colors are all normal and expected. Drainage fluid may also have noticeable particles and strands in it; this is also normal.
What amount of drainage is normal?
Drainage varies from patient to patient and can also vary from side to side. If you notice a difference in output between your drains, this is okay. In general, you should note a decrease in your drain output over time.
Activity can increase your drain output slightly; this is okay. It is important to keep active range of motion in your arms after surgery by doing the exercises we provide you as stretches. Limiting arm mobility can result in frozen shoulder, so it is important that you continue to use your arms. Avoid exercise while the drains are in place, but continue stretches.
How do I care for my pain pump?
Post-operatively, you will have a local anesthesia pump (“pain pump”) in place to help control pain. This consists of a small tube with a bottle at the end containing marcaine. You may shower with the pump in place; just remove the cloth bag prior to showering. The pain pump usually lasts 48-72 hours after surgery. When the inner balloon appears empty, the medication is finished. You may remove and throw away the bottle. Remove the clear tape and steri-strips from your skin and gently pull the tubes out. This will not be painful as the skin is numb. Be aware that the tubes are long.
My pain pump is leaking; is this okay?
Leaking around the site of the pain pump is not uncommon. Fluid may appear clear to pink or light red in color. If your pain pump is leaking, you can reinforce the area with a gauze to protect your clothing or may remove the pain pump if you desire. Leaking, in and of itself, is not a problem, but can be a nuisance.
Will I be prescribed pain medication?
Pain medication prescribed post-operatively should be taken as directed to relieve pain as it is important to be comfortable enough to keep moving. This medication should be gradually tapered or reduced to a point at which the narcotic you are prescribed (Norco, or Tylenol with Codeine) will be used only at night time by two weeks post-surgery. If you feel the medication prescribed is too strong, pain pills may be cut in half or try plain Tylenol (Acetaminophen) or Advil (Ibuprofen). If taking Acetaminophen, do not exceed 4,000 mg per day; please keep in mind that many narcotic pain medications prescribed also contain acetaminophen. We also recommend that you use a stool softener while taking pain medication as constipation after surgery and while taking narcotic pain medication is very common.
Constipation is common after surgery. It is caused by general anesthesia and the pain relievers used after surgery. This can be treated by taking a stool softener. We recommend you take a stool softener consistently, such as Colace, while taking pain medications. If you do not find the stool softener is working, you may try a suppository or enema. These can be purchased at your local pharmacy and are over the counter. If you are constipated and begin to feel worsening abdominal pain or vomiting, please contact our office.
I am nauseous, is there anything that can help?
Nausea is common after surgery. This can be related to the medications you are taking or to constipation. Make sure to eat something prior to taking any pain relievers or antibiotics as this can often help avoid nausea associated with these medications.
Do I need to adjust my diet after surgery?
You may resume your normal diet after surgery. Eating a healthy diet can aid in healing and improve energy levels after surgery. Multivitamins may also help.
When can I shower after surgery?
You may shower beginning 24-48 hours after surgery. Clean incisions gently with soap and water and pat dry. Do not swim, bathe, use hot tubs, or use lotions or creams on the breast for 2 weeks after surgery or until the incisions have healed. Do not shave the affected underarm with a razor as your risk for injuring yourself is significantly higher due to numbness. Electric razors are okay.
Can I move my arms after breast reconstruction surgery?
Immediately after surgery, arm range of motion stretches are encouraged. Although arm exercises can increase drain output, maintaining range of motion is extremely important. For this reason, you should do arm exercises as stretches while the drains are in place. Once the drains are removed, you may progress to shoulder exercises.
When can I resume exercise after surgery?
After breast reconstruction surgery, it is recommended you avoid exercise that raises your heart rate and blood pressure for 2 weeks. Walking is encouraged immediately after surgery. After two weeks, you can return to aerobic exercise slowly. Avoid running or jumping and chest specific exercises (chest press, push ups, etc) for 6 weeks. All types of exercise are permitted after 6 weeks.
Listen to your body. Start out slowly and gradually increase as tolerated. If you experience pain or discomfort, decrease the amount of exercising.
Is there a lifting restriction after surgery?
Do not lift anything that requires straining for 6 weeks. You may lift anything that does not require straining or struggling after discharge, but heavy lifting should be avoided for six weeks post-operatively.
When can I drive after surgery?
You may not drive while taking narcotic pain relievers during the day. It is okay to drive while drains are in place as long as you are not taking narcotics during the day. You may drive whenever you are capable and confident of the movements of driving and are no longer taking narcotics during the day. Always wear a seatbelt while in a car. Use a pad or pillow on your chest if necessary for comfort. A seatbelt is a life-saving device.
When can I expect I will be ready to return to work?
Average return to work time after tissue expander reconstruction is 2 weeks; after latissimus flap, average return to work is 4 weeks; and after abdominal tissue reconstruction, 6-8 weeks. We will work with you on helping you return to work when you feel ready.
What follow up can I expect after breast reconstruction surgery?
Please follow up with our office 1 week after surgery for your routine post-operative appointment. After drains have been removed, you will need to follow up with our office to begin expansions if you had a tissue expander or latissimus flap breast reconstruction. These usually begin between 2 and 4 weeks post-operatively, and may happen once per week. The number of expansions vary between patients. If you had a TRAM, once drains are removed, we usually ask you to follow up between 3 and 6 months to discuss any desired revisions and/or nipple reconstruction.
I have bunching along my incision, is this normal?
Bunching at the incisions is normal and often resolves as you heal. If fullness or folding along the incision persists, this can be revised at your second surgery.
Is it normal for the reconstructed breast to seem flatter on the front? Will this change?
Your reconstructed breast will appear flatter in the front than your natural breast; this is normal.
Will this flatness change?
This can be improved at your second stage surgery, but will not completely resolve.
After surgery, I feel many lumps and bumps on my breasts; is this okay?
It is normal to find lumps and bumps on the breast after surgery. These are due to nature of the mastectomy and scar tissue. If you find a lump or bump on your breast, continue to watch and feel the area. If you feel the lump increases in size, please alert either your plastic surgeon or breast surgeon.
Is it normal to have asymmetry after surgery? Will this persist?
A small degree of asymmetry is normal after surgery. Asymmetry can be due to the placement of the implants on your chest, or may be due to asymmetries in your anatomy. It is important to note that asymmetries you have before surgery will likely still be present after surgery. Some degree of asymmetry is expected and sometimes unavoidable, and can be improved at your second surgery.
After surgery, my breasts appeared bruised; is this okay?
Bruising after surgery is normal. This can appear anywhere from purple to green or yellow in color. Bruising may also spread downwards due to gravity. This is normal and does not mean your bruising is worsening.
Discoloration of the incision can sometimes be seen after surgery due to change in blood supply associated with mastectomy. Sometimes, this color change will appear similar to a bruise, slightly purple in color. These areas may blister or ooze slightly. These areas may also turn into a scab. If you notice any of these findings along your incision, this is not an emergency. We will continue to watch it over time. In many cases, you will be able to heal this area on your own. In some cases, we will aid your healing by removing the scab and reclosing the area. This can happen in the office.
I have new feelings in my breast that just started; is there something wrong?
You cannot rely on your feelings in the operative area; feelings alone are not an indication of a problem. When you have a change in sensation, it is important to look at the breast and feel with your hands; feelings with findings you can also see with your eyes or feel with your hand are important. Zingers, itching, burning, cold, lightning bolts, and numbness are all very common sensations felt after breast surgery. They do not indicate there is a problem, and are all normal parts of healing and recovering after mastectomy. These sensations can be felt on the chest, the armpit, and along the inside of the arm.
What findings should I be sure to report to my surgeon after surgery?
You may have many strange sensations after surgery in the surgical site, most of which are very normal and do not need to be reported to your surgeon. The following list describes findings that are concerning and should be reported to your surgeon:
- fever of 101 degrees F or greater
- whole breast is red, or redness on the breast that is spreading
- one side is much larger than the other and painful
Can I sleep on my sides or stomach after surgery?
It is okay to sleep on your sides once the drains have been removed. Sleeping on your stomach is not recommended for the first 6 weeks. A good tip to help you sleep on your back after surgery: place a pillow under your knees and on each of your sides. Putting a few pillows under your head and shoulders to prop yourself up can also help with sensations of tightness across the chest.
What is cording? How do I know if I have cording, and what can be done?
Many women experience a sensation of tightness in the armpit after mastectomy and reconstruction. In some women, this sensation may persist after the initial post-op period. This is called cording. It is usually felt in the armpit and front of the chest, and can extend down the arm, possibly all the way to the wrist. Continuing shoulder range of motion exercises can improve this. Physical therapy may be indicated if exercise alone is not able to resolve the symptoms.
What can I expect for my second stage implant reconstruction surgery?
This surgery is most commonly performed under sedation. This means you will be sleepy and relaxed in the operating room, but may not be completely asleep. Most patients have no recollection of surgery when it is performed under sedation. This type of anesthesia does not require a breathing tube as you will be breathing on your own, and allows for a quicker recovery with less risk for post-operative nausea and vomiting. The surgery itself usually takes 1 to 1.5 hours. You will not be allowed to drive yourself home afterwards, so make sure to arrange a ride. Most patients return to work within 1-3 days. The need for narcotic pain control after this surgery is often extremely minimal. Most patients take narcotic pain relievers for the first night and possibly the next day only. You will most likely not have additional incisions other than the initial mastectomy incision. There are no drains used in this procedure.
There is a hard lump under my arm; what is this?
It is possible that you will have an adjustable implant with a port that comes off of the side of the implant. It is either the size of a dime or a quarter and can be felt beneath the skin. This port may be accessed to add or remove saline. The port is most often removed at the same time as the nipple reconstruction.
When is the nipple reconstruction done?
The nipple reconstruction is performed two to three months following your final implant reconstruction. Should you need or desire any surgical revisions to the actual breast, it will have to be completed prior to the nipple reconstruction. The nipple is done most often in the office, but may also be performed as an outpatient procedure in the operating room under light or no sedation if you desire other revisions. You will need about 24 hours to recover.
How is the nipple reconstruction performed?
Your surgeon will use your own skin on your breast to create a prominence. It will be sutured into place. The sutures are typically dissolvable.
Are the nipple and the tattoo done at the same time?
The nipple and areola are done at two separate times. The areola is the final phase of the reconstruction process and typically done two to three months following the nipple reconstruction. This is done in our office by Jeff Paetzold. The tattoo takes approximately one hour for each side. You may not swim for 2 weeks following the tattoo.
Does breast cancer reconstruction surgery look natural?
Implants are more round and fuller at the top than natural breasts. They appear similar to breasts in a bra. For this reason, they do not necessarily look “natural” but their appearance is usually pleasing to reconstruction patients.
Reconstruction with tissue from you back or your abdomen can have a more natural appearance; these types of reconstruction will feel softer, will change with your weight, and will move more like natural breasts.
Is there a chance of getting cancer in the tissue of the breast reconstruction?
Breast cancer can recur in breast tissue. Ask your breast surgeon or oncologist about your chance for recurrence. Implant reconstruction and tissue based breast reconstruction (latissimus flap or TRAM flap) does not change your risk for recurrence of breast cancer.
What happens if I gain or lose weight?
If you had implant breast reconstruction, gaining or losing weight will not change the size or appearance of your reconstruction. If you had TRAM flap reconstruction, your reconstructed breasts will change weight with you just as your abdomen used to.
Is numbness normal? How long will the area be numb?
Numbness at the site of your mastectomies is normal and to be expected. Most women regain sensation in this area, but it will be about two years until you are able to determine exactly how much sensation you will have. You may experience sharp, shock-like sensations while your nerves are ‘waking up.’ This is normal and will improve for up to two years.
Do I have to have a mammogram following a mastectomy?
No, you do not need to have a mammogram following a mastectomy. You will need to continue yearly mammograms on the unaffected breast, if applicable.
What exercises can I do after surgery to improve or maintain good shoulder range of motion?
You may begin arm exercises after your drains are removed. ‘Wall walking’ is an example of an exercise that will help to improve your range of motion. As soon as you are able you may use the exercise positions as stretching positions, this will help keep mobility without increasing drainage. Just reach out in the direction of the exercise and hold the position for 5-10 seconds and then move on to the next one. You may repeat this 3-4 times per day.
Do I need to get MRI’s if I have silicone implants?
No. MRI is recommended by the Federal government to assess for potential leak of the implant. Because we know that implant leakage does not cause any major health concerns, we only recommend getting imaging to identify rupture if you notice a change in the appearance or feel of the breast that is consistent with rupture.
Will I set off a metal detector at the airport when I have tissue expanders?
Not all expanders will cause a metal detector to alarm, but it is possible. If you are planning on traveling, let our office know so that we can provide a note explaining the nature of the device.
Can I have an MRI when I have a tissue expander?
Please notify our office in the event that you are to have an MRI while you have an expander. This may or may not be possible, depending on the type of device.
Is the dimpling under my breast after my second stage surgery normal?
Yes, as part of your second stage revision, we may place sutures at the bottom of the breast under the skin. This can cause the fold at the bottom of the breast to appear dimpled. As the sutures dissolve, this dimpling will go away and the fold will appear smooth. Increased pain in this area is normal after surgery if sutures were placed.
What is MAC anesthesia?
MAC stands for Monitored Anesthesia Care and is most commonly called “twilight”. It involves sedation of varying levels to keep you comfortable during your procedure. During a MAC procedure you will most likely sleep, but you may be slightly aware that you are in the operating room. Most patients have no recollection of the procedure or their time in the operating room. MAC anesthesia allows for a quicker recovery period, and reduces nausea and vomiting.
What can I put on my scars?
Each patient will scar differently. Scars are unpredictable. You may put anything over-the-counter on your scar, but time is the best healer for all scars. If your scars appear to be red or raised, please notify our office to talk about options for improving their appearance.
Frequently Asked Questions
Endoscopic latissimus dorsi flap reconstruction
How long does the surgery take?
Breast reconstruction with a latissimus dorsi flap takes approximately 3 hours.
Will there be a drain in place after the surgery?
After surgery, you will have three drains per breast; two will drain the back, and one will drain the breast.
What is the expected length of hospital stay?
After surgery, you can expect to be in the hospital 1-2 days.
What is the expected recovery time?
Recovery to normal activity (not including exercise) can be expected within 1-2 weeks. Lifting only what does not require you to strain or struggle is okay after surgery. You may resume exercise 6-8 weeks after surgery.
Will the muscle tissue retain nerve sensation?
The portion of muscle that is moved to your breast will not have any sensation. The muscle will, however, still have nerve innervation. This means it will be able to contract.
Frequently Asked Questions Regarding
Breast Reconstruction -
Abdominal Tissue Flaps, DIEP, TRAM, & SIEA
What exercises may be beneficial prior to an abdominal tissue flap?
Walking is always beneficial from a cardiovascular standpoint. Additionally, exercises which help to strengthen your core muscles are beneficial for this type of surgery.
What items may be helpful during my hospital stay?
Tops that button or that you can step into are better than pull-overs. Bottoms with elastic waistbands and/or a drawstring will be most comfortable. Lip moisturizer and headphones may also be helpful for your own comfort. Many women also find having a pillow over their surgical sites while in the car makes them more comfortable for their trip home.
Will I need to take any medications prior to surgery?
An over the counter iron supplement in combination with a vitamin C tablet will help to build your iron stores with the vitamin C helping to increase absorption.
How many drains will I have?
The number of drains may vary, but typically you will have 2 at each reconstructed breast and 2 at the abdomen. The drains will be removed when the output is less than 30 cc over 24 hours
How should the flap look?
The flap (area inside the circular incision) should be monitored for signs of adequate blood flow. It should be warm to the touch and should not appear ‘mottled,’ purple, or feel cool. Should you experience either of these symptoms, please call the office immediately.
When can I take the steri-strips off?
You may leave the steri-strips, or white tapes, in place until you are seen in the office the week following your surgery. Should a strip fall off, it is acceptable to leave the area open to air.
When can I drive?
You may not drive while taking narcotic pain relievers during the day. It IS okay to drive while drains are in place as long as you are not taking narcotics during the day. You may drive whenever you are capable and confident of the movements of driving and are no longer taking narcotics during the day. Always wear a seatbelt while in a car. Use a pad or pillow on your chest if necessary for comfort. A seatbelt is a life-saving device.
When can I exercise?
See general exercise and activity recommendations. Please refrain from abdominal exercises (i.e. sit-ups or crunches) for about six weeks.
Is numbness normal? How long will the area be numb?
Numbness at the site of your mastectomies is normal and to be expected. It is possible to have temporary numbness around your abdominal incision as well. Most women regain sensation in this area, but it will be about two years until you are able to determine exactly how much sensation you will have.
Do I have to have a mammogram following a mastectomy?
No, you do not need to have a mammogram following a mastectomy. You will need to continue yearly mammograms on the unaffected breast, if applicable.