My name is Dr. Haritha Veeramachaneni. I’m a plastic surgeon at Long Island Plastic Surgical Group, and I specialize in breast reconstruction. A patient can best prepare for their reconstructive surgery by asking lots of questions. We’re more than happy to talk to you about all of these concerns and put your mind at ease before surgery.
Patients, after their breast cancer surgery, will have some degree of postoperative pain. After surgery, I have patients that require pain medicine for a few weeks after surgery, which is certainly okay to take them for postsurgical pain, whereas I have other patients that don’t experience the exact same surgery with pain requiring a narcotic. They always tell me, “Oh, I didn’t even use the prescription that you gave me. I just took Tylenol.” That’s okay, too.
We have a great medicine that we use nowadays called Exparel, which is a long-acting injectable medication similar to the medicine that a dentist might give you to, say, numb your mouth. It’s a medicine that numbs your chest wall for up to three days, and the use of that medicine has really helped us control patients’ postoperative pain to where they’re using much less narcotic medicine and making them comfortable.
Patients will be able to wear a bra after surgery, but the type of bra may vary depending on the type of surgery that you have. One typical feature of bras after surgery is that they are front-close bras, so the hooks are in the front, allowing a patient not to have to lift their hands up in the air or stretch behind their back to hook or close the bra. That makes it much easier. Another feature of postsurgical bras are that they don’t have any underwire and that they’re quite comfortable, and these come in a variety of sizes. Often after the surgery, we’ll select the best size for the patient and provide them with one. We like to provide them with one because sometimes the first bra after their surgery could get messy or dirty or stained, because it’s right after we put on the surgical dressing, and it’s okay for the patient to search for more like these so they have a few extra on hand after the surgery.
Patients always want to know if they can shower after surgery, which is very important. Patients are very anxious that they won’t be able to maintain their normal personal hygiene after the surgery. I always reassure them that because breast surgery happens from the waist up, it’s perfectly okay to shower from the waist down without any restrictions. I always have my patients sponge bathe from the waist up so that they can feel clean and that not to soak or saturate their dressings with water. Often times, I use waterproof dressings as a way where they can still get in the shower.
Breast cancer surgery can often require the use of drains after surgery, and most commonly is when a patient has a complete mastectomy. With the removal of all of the breast tissue, the body can generate lots of inflammatory fluid that needs to be collected and emptied. For us, a drain is simply the best way to do this, and a drain looks like this. It has an internal component which has some type of holes or slats or perforations, depending on the model. This collects the fluid, and through suction, draws the fluid into this reservoir, and it’s able to generate its own suction through negative vacuum pressure. Up to once or twice a day, as the fluid collects into this reservoir, the patient is required to simply empty the fluid out and then recompress this reservoir to recreate that suction. Drains often are required to be kept in place after surgery for one week, possibly two, maybe slightly longer, depending on how much fluid is being created, and they’re simply removed in the office itself without requiring another procedure.
Patients often ask when after their breast reconstruction surgery they can get back to their normal day-to-day activities. Typically, we ask that patients don’t do any heavy lifting, so usually defined as something greater than 20 pounds, and also avoid repetitive motions of their arms and shoulders. For example, cleaning their house after surgery is not a good idea… Mopping, vacuuming, reaching, and trying to dust their blinds. We have patients that just can’t sit still after surgery. They feel they have to be active, and it’s really important to remind them that having the appropriate restrictions is very important after surgery.
Now, a return to work is something that is very individualized based on the type of surgery that they’ve had, but also on a patient’s job description. We have some patients who have a desk job where they’re not engaged in any heavy lifting at all, and maybe doing some typing or answering the phones or writing, and we absolutely clear those patients much sooner to return to work, maybe even at the two to three week mark, compared to someone who is, say, a factory worker or a baggage handler at JFK. We would have them have a much longer period of restrictions where they would not be allowed to return to work or engage in any heavy lifting.
Patients often ask, “Are there ways to help their scars fade after surgery?” We take great pride as plastic surgeons in closing our scars very neatly so that long-term, the scar is as imperceptible as possible. One of the best ways to let a scar improve is simply time. Scars can take up to six months to a year to fully fade and take on their final appearance, but in that first year after the surgery, especially in the first six months, we do have a couple of techniques to help the scar have its best final appearance. One is simply moisturization of the scar with any type of lotion or oil and scar massage. Often times for any type of scar, massage is a great way to soften scars and help improve their appearance long-term. You should ask your surgeon when is the appropriate time to start massage directly on the scar. That is something that’s individually tailored to the type of surgery and reconstruction that was done.
One of the best evidence-based therapies for scars is silicone treatment. That can be in the form of silicone gel, of which there are many brands on the market. Some are medical-grade companies, such as Silagen, BioCorneum, and NewGel, which can be found at doctor’s offices. There are other brands of silicone scar gels in drugstore retail as well.
A more effective way to deliver silicone therapy to a scar is in the form of silicone sheeting. It looks like this. It’s a sticker of silicone which has a peel-and-stick backing. Something large like this is intended for a long, large scar, such as a tummy tuck, but there are examples of this which are precut and sized for breast incisions. They can go around the nipple/areola complex, they can go in a vertical pattern, and they’re specifically designed for breast reconstruction scars. They’re simply peel-and-stick, and they’re meant to be left on the entire day and simply removed when the patient is in the shower. Long-term, they can help reduce the redness and thickness of scars.