Glossary

Dressings

  1. In general, 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.
  2. The incisions may look bumpy after surgery. This is normal and will reduce over time.
  3. If you do not have steri-strips in place, your incisions were likely covered with glue. This glue can appear purple in color and will begin to peel off over time. Similar to the steri-strips, this glue can get wet in the shower.
  4. If you had a clear plastic tape dressing placed, please keep this dressing in place until your first post operative appointment.

Clothing

  1. Wearing a soft support bra (or ace wrap), even at night, may help ease any discomfort associated with breast surgery, but is not required. Do not wear anything that is tight or uncomfortable. A garment that leaves marks on the skin is too tight.
  2. It can be helpful to bring comfortable clothes to the hospital prior to surgery. 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.

Drains

  1. 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 per drain, please call our office to arrange a time for removal of the drains. Drains are usually removed within 1-2 weeks.
  2. 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.
  3. The drains can get wet in the shower, but should be supported while showering. To secure JP drains, use a ribbon, shoestring, or lanyard around the neck or waist.
  4. While clothed, drains can be secured in a post mastectomy garment of your choice, or can be secured to your clothing using safety pins. You may pin your drains to your shirt or pants as preferred.
  5. Some patients experience discomfort at the drain sites. This can usually be reduced by eliminating motion at the drain entry site. Use of the ace wrap and/or placing a gauze under and over the drain and securing with a small piece of tape can often help. If you are still having considerable discomfort due to drains, please call our office. We can help find a strategy that works for you.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. It is normal to have some redness, about the size of a dime, at the drain sites.

Showering and Wound Care

  1. You may shower 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 or around the area of incisions until 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. Deodorant is okay.
  2. It is okay to shower while the drains and pain pump are still in place. Managing the drains and pain pump in the shower, however, can be challenging. Many patients have found using a lanyard or shoestring is helpful; loop the lanyard or shoe string around your neck and attach the drains to the lanyard using safety pins. Remove the pain pump from it’s waist pack prior to showering. The pain pump can be difficult to stabilize while showering, and it can be helpful to ask someone for help with this. If you find you cannot stabilize the pain pump while showering, it may be easier to wait until the pain pump is ready to be removed, usually around 48-72 hours after surgery. For instructions on how to remove the pain pump, visit our pain pump page.
  3. If you had a clear plastic tape dressing (tegaderm) placed at the time of surgery, it is okay to shower with this in place. The dressing can get wet and does not need to be changed after showering.

Pain Pump

  1. 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.
  2. 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.
  3. After removal of the pain pump, you can cover the area with a small bandaid as needed to keep your clothing clean. Any dressing placed can be removed 24 hours later.

Medications

  1. 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 narcotics (Norco, Tylenol with Codeine) are 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.
  2. It is recommended you take a stool softener after surgery while using narcotic pain relievers. Colace is a good option. If you are still experiencing constipation despite stool softener use, one dose of Milk of Magnesia is usually a good option. For continued constipation, try a suppository. All of these medications can be purchased at your local pharmacy and are over the counter.
  3. Antibiotics will be prescribed to you after surgery. These should be taken for the entire time your drains are in place. If you still have drains in place and run out of antibiotics, please call our office for a refill. If you did not have an implant or tissue expander placed at the time of surgery, complete the course of antibiotics provided to you at discharge; you do not need to take additional antibiotics if you still have drains in place when that prescription is complete.

Activity / Exercise

  1. You may resume normal daily activities the day after surgery; this includes activities that encourage range of motion of the shoulder such as washing or brushing your hair. As soon as you are able, you may begin the exercises included in this packet as stretching positions; this will help keep mobility without increasing drainage. Reach out in the direction of the exercise and hold the position for 5-10 seconds and then move to the next one. You may repeat this 3-4 times per day. You may begin arm exercises once the drains have been removed. Perform the exercises 3-4 times a day and gradually increase your range of motion and repetitions – ideally you should be working to reach a point at which you can fully raise your arms over your head. This will take time and repetition, so do not become frustrated.
  2. If you would like additional support in increasing arm and shoulder mobility, Northwestern Memorial Hospital offers multiple fitness and wellness classes that may be of help. To learn more about current offerings or to register, visit the website at classes.nmh.org/listing/all, or call 312-926-8400. Most classes meet in Streeterville on the Northwestern Memorial Hospital campus unless otherwise noted. Be sure to check with your surgeon/doctor before starting an exercise program.
  3. Walking is encouraged immediately post-operatively. Exercise that raises your heart rate and blood pressure should be avoided for 2 weeks post-operatively. You may resume aerobic exercise (bike riding, aerobics, etc) two to three weeks after surgery. Common sense and good judgment are essential in avoiding injury at this point; start light and build up slowly. Avoid chest specific exercises and running or jumping; for DIEP and TRAM patients, also avoid sit-ups and abdominal exercises. All types of exercise are permitted after 6 weeks.
  4. Do not lift anything that requires straining for six 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.
  5. You may resume driving when you are no longer taking narcotic pain medication during the day and you are able to sit comfortably behind the wheel and perform all motions necessary for safe driving. Always wear a seatbelt while in a car; use a pad or pillow on your chest if necessary for comfort.
  6. It is okay for you to swim with the expanders in place.

Expected versus concerning symptoms after surgery

  1. Patients experience a wide variety of sensations after surgery. Sensation can vary from complete numbness to pressure, tingling, zingers, burning, or itching. In most cases, these sensations are normal and are not an indication of any problem occuring at the surgical sites. Of the many sensations you may experience post-operatively, the symptoms we are generally concerned about include temperature over 101.5F, spreading redness at the surgical site(s), drainage from the incision(s), or a breast that appears to have changed significantly in size. If you notice any of these changes, please call our office at 312-266-6240.

Patient reported sensations after breast reconstruction

The following are patient reported sensations after breast reconstruction surgery. This list is meant to give patients insight into what others have experienced; it is not meant to concern you that you will feel all of these sensations. The sensations listed below are normal and do not indicate you are having a problem. Sensations from your surgical sites are not reliable indicators of what is actually happening in that area. If you are concerned about something you are feeling, it is recommended you rely instead on the way that the area appears when looking in a mirror, and how it feels when you touch it with your hand. If you feel you are experiencing a problem after using these methods, please call our office.

  1. numbness
  2. pressure
  3. heat
  4. spasms
  5. armpit numbness
  6. porcupine feeling under my arms
  7. the feeling of plastic inside my body when I move
  8. the feeling of wearing a tight bra even when I’m not wearing anything
  9. the feeling of wearing a metal bra
  10. tighter at night or when I wake up
  11. itching
  12. burning
  13. my breasts feel bumpy
  14. my breasts look flatter in the front
  15. tightness that extends down my arm toward my elbow
  16. tingling
  17. cold

What to expect after first stage breast reconstruction- TE or latissimus flap

  1. Expansion of your implants will begin around 2-3 weeks after surgery once the drains have been removed and the skin appears healed. If you plan to undergo additional treatment after surgery, we will continue expansions through chemotherapy but not during radiation therapy. Future surgeries take place after chemotherapy and radiation therapy are completed and you have reached your desired size.
  2. After expansions are completed, the expander or implant will be exchanged for your permanent implant, which can be either silicone or saline. This procedure usually occurs, at minimum, 3 months after your mastectomy. Exchange surgery is a same day surgery procedure, is usually accomplished under sedation, and is generally very well tolerated; recovery time is usually around 2-3 days. If you are undergoing chemotherapy or radiation therapy, surgery will occur after the completion of these therapies. This surgical procedure is carried out through the previous mastectomy scar, so no additional scars will be created.
  3. If you have an adjustable implant, exchange surgery is not always necessary if you are happy with your initial cosmetic outcome; instead of exchange, your ports can simply be removed, either in the office or in the operating room. Oftentimes, this can be combined with nipple reconstruction (if applicable).
  4. Nipple reconstruction is carried out with local skin from the breast usually around 3 months after your last surgery. An area of skin is elevated and sutured together to create a nipple mound. This can be done in the office or the operating room depending on your wishes and your desire for any additional procedures. Reconstructed nipples tend to flatten over time. Three months after nipple reconstruction, the areola and nipple tattoo can be placed. This is an in office procedure. Tattoos start out darker and gradually fade; touch ups are sometimes required.

What to expect after TRAM flap breast reconstruction

  1. At your first post-operative appointment, we will remove any drains that are under 30 cc/24 hours and will remove steri-strips. Once all drains have been removed, we will likely not ask you to follow up for another 3 months. At this time, our focus will be on discussing any changes you feel you would like made to the reconstruction. We will also begin to plan nipple reconstruction. Nipple reconstruction is carried out with local skin from the breast usually around 3 months after your last surgery. An area of skin is elevated and sutured together to create a nipple mound. This can be done in the office or the operating room depending on your wishes and your desire for any additional procedures. Reconstructed nipples tend to flatten over time. Three months after nipple reconstruction, the areola and nipple tattoo can be placed. This is an in office procedure. Tattoos start out darker and gradually fade; touch ups are sometimes required.

Expansions

  1. Once you begin expansions, you can continue with expansions weekly until you reach your desired size. The number of expansions needed depends on how much volume we are able to add at the time of your initial reconstruction and how large you desire to be; at each visit, we will add 50-60 ml of fluid. We will continue expansions until you reach a size you are comfortable with. Ideally, we “overexpand” one time past your ideal size. In some cases, limitations due to skin may dictate your ability to continue with expansion, and we will discuss that as the process proceeds.
  2. At each expansion visit, the port will be located and saline will be injected into the implant using a small needle. Most commonly, the area is numb and you will not feel the needle stick. You may feel a sensation of stretching or pressure after expansion, but this usually lasts only a few days. If you do have pain, over the counter pain medication, such as Ibuprofen (Advil), can be used. Expansions generally take around 2 months to complete.
  3. Expansion visits will usually be with one of our mid-level providers (Alex or Michelle). If you would like to see Dr. Fine or Dr. Schierle, please make sure to tell Barb or Julie when scheduling.
  4. Expansions can happen before and after radiation, but not during radiation therapy. Once you have had your planning visit for radiation, we can no longer change the volume of your expander. Ideally, we recommend completing as much expansion as possible prior to beginning radiation therapy.
  5. Some patients will require removal of some of the fluid from their expander prior to radiation therapy. This recommendation will be determined by your radiation oncologist. If you need fluid removed from your expander, please call our office to make an appointment at 312-266-6240

Nipple Reconstruction

  1. Nipple reconstruction generally takes place 3 months after your exchange surgery. It is an outpatient procedure or can be completed in the office.
  2. Your surgeon will use your own skin on your breast to create a prominence. This skin will be sutured into place. The sutures used are typically dissolvable and do not need to be removed.
  3. Nipple reconstructions tend to flatten over time, and, therefore, are unlikely to show through clothes. If you would like your nipple reconstruction to show through clothing, please let your surgeon know.
  4. Nipple/areola pigmentation generally occurs approximately 3 months after nipple reconstruction. We currently offer tattooing with a tattoo artist, Jeff Paetzold. Jeff offers tattoos generally twice per week in our office. This procedure may not be covered by insurance depending on your specific history. Please ask our clinicians about insurance coverage. Learn more about Jeff and view before and after pictures.

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312.266.6240 Chicago, IL