Breast Reconstruction Surgery: 16 Pre-Op Q&As from Our Physician Assistant

Breast reconstruction surgery can be scary. And we know that you’re bound to have questions about what to expect when it comes to the surgery itself and the healing process afterwards.

Thankfully, we have a handful of reconstruction surgery experts at The Center for Natural Breast Reconstruction. We’re thrilled that one of our very own Physician Assistant, Audrey Rowen, PA-C, takes special care to personally answer reconstruction surgery questions asked by our patients. We were particularly impressed by this group of them and wanted to share with you!

If you’re about to have breast reconstruction surgery, or are considering the option, please keep reading! We think you’ll find comfort in the answers below.

1. Where will the scars on my breasts be and will I be able to wear low-cut tops like I did before?

We try to use previous implant scars if we can, but sometimes we need to do things a little differently in order to access the blood vessels behind your breasts.

The incisions we make are generally below the nipple line and should be covered by most clothing. The shape and overall appearance of the breasts after stage 1 is not the final result so things won’t look as you are hoping until after the second stage. But, every person is different, and we will be better able to answer this question at your pre-op marking appointment and after your first surgery has been completed.

2. How long will I be in the surgical bra?

We typically keep our patients in the surgical bra for a minimum of 6-8 weeks and during any strenuous activity after that. After most healing is complete, we can switch you to a front-closing sports bra or other similar bra that provides support without being too tight. Most women wind up wearing a surgical bra through the first 2 stages and may be able to go without a surgical bra after that.

3. I think you said you could make me a C cup. I’d like you to make me as big as you can with what I have to work with.

We will do our best to give you the biggest flaps we can at the first stage. After that we can do fat grafting to increase the size of your breast. 

4. Does more fat in my tummy area make bigger, better breasts?

It can. This doesn’t mean we want you to go out and try to gain a bunch of weight before surgery because you can’t target where you want to store fat. In fact, sometimes the fat goes around your intestines or below your abdominal muscles, and we can’t get to that fat. Women who have larger tummies often have larger flaps, but we can always use liposuction to gather fat from other areas (buttocks, thighs, inner knees, waist area) at subsequent stages to add volume to the breast mounds later.

5. I understand they will not be pretty at first, but will they be lumpy or smooth, or what should I expect about how they are going to look in the beginning?

Every patient is different so the outcomes are not always standard. At the first stage, you will have what we call a “window” where the donor site flap skin is visible on your new breast. This does not mean it is an opening, but rather imagine that a piece of your skin is donor skin while the rest of your breast has your original breast skin.

This is not always permanent as we can sometimes completely close the breast skin on top of the flap, but in some patients who could not have skin-sparing mastectomies, they may always have that section of tummy skin showing.

Things stay pretty swollen for up to 2-3 months so there may be hard or squishy areas that may change throughout your recovery. We try to create a semi-smooth transition from your breast/chest skin to your donor site flap, but our main priority at stage one is to get the blood vessels attached and keep them working.

Things may look a little deformed, asymmetrical, or strange after the first stage, but we fix these issues at stage 2. You are also likely going to have what we call “dog ears” on either side of your abdominal incision from pulling the skin together. This will also be fixed at stage 2.

6. I think you said I wouldn’t need to have mammograms anymore. Is that correct?

Usually, you will not need any mammograms after having a mastectomy with reconstruction. Your oncologist often makes the definitive decision if you are at any increased risk of recurrence or need any routine monitoring. We still highly recommend doing monthly self-breast exams to monitor for any changes. If it does, please notify us or your oncologist/breast surgeon if you find anything of concern.

7. I would like to see some before and after pictures of the different stages and final result. How can I accomplish this? Can you send some to me?

We have some pictures on our website that show you the before and after photos. We do not have any designated photos of the in-between stages to show you, unfortunately. Dr. Kline may have a few extra pictures to show you at your pre-op marking appointment if you wish.

Click here to view our image gallery. 

8. Will you be lifting my left breast to make it match the right one that doesn’t sag because of the radiation?

We always take radiated breasts into consideration when making the flaps. We sometimes make a radiated breast flap a little larger to account for this, or we lift the non-radiated breast more. Most of this tweaking is done at stage 2 or 3, and there is no hard-and-fast guarantee of how the radiated tissue will do. But, we try our best to give you a symmetrical result.

9. How is the fat grafting accomplished? With needles or what?

Fat grafting is done just like traditional liposuction, but instead of throwing away the fat, it gets strained of any debris, blood vessels, etc., and gets injected back into your body, just below the skin, wherever it is needed.

We only make a small incision through which we insert a cannula that gets shifted around under your skin to collect the fat cells. We make a few incisions in the donor sites that are discussed with you before your surgery and those incisions are closed with a few stitches and a little Dermabond glue on top. The strained fat is then inserted with a special bendable needle that can be shaped to follow around a breast mound or however we need it to go to inject the fat.

10. After the fat grafting, will that fat continue to replenish itself? Like if I gain weight, will my breasts get bigger?

After liposuction, fat accumulation tends to appear in areas other than sites that you have had the fat grafting from. This doesn’t mean you will never get fat in those areas again, but it often finds its way to a few different places. Your breasts will be your own tissue and fat, so if you did gain weight, you could possibly gain weight in your breasts and the same goes for losing weight. 

11. Will my C-section ledge be gone?

We try to take other abdominal scars into consideration when finding the best placement of your new “abdominoplasty” scar. By removing the tissue located on your abdomen, there is a good chance your C-section ledge will resolve, but we cannot guarantee this. It’s another one of those things that depends on the patient, and we will have a better answer for you when we do your pre-op marking.

12. When can I drive?

We don’t want you driving as long as you have drains in (breast or abdominal), which is typically 2-3 weeks. Also, if you are taking any prescription pain medication (Percocet, Dilaudid, Valium), we don’t want you driving until you have switched to taking over-the-counter medications.

We also want to ensure that you feel you can be a defensive driver and not worry that if you had to swerve out of the way, you’d hurt something. Most women sit in the back seat away from the airbag for about 2 weeks and often place a pillow between their chest and the seatbelt to help cushion the pressure from the belt itself.

13. When can I have sex?

We don’t recommend any strenuous activity for several weeks following surgery. I would plan to wait at least 2 weeks and then see what may be tolerated. You don’t want to be using your abdominal muscles for up to 6-8 weeks so you have to be mindful of your limitations. As things heal and you progress in your recovery, you may increase activity as tolerated.

14. Can you also remove the lump of scar tissue from the four drains that were put in my rib area by the other doctors? It makes my bra roll up, and it’s uncomfortable.

Depending on the exact location, we may be able to remove it at the first stage, but it is more likely that we will look into that at second stage as the process of harvesting and grafting the blood vessels is very time-consuming and is the main priority at that time.

15. When will I know if my nipples have to be removed?

This is really a question for your breast surgeon. If you are able to have a nipple sparing mastectomy, we cannot guarantee that your nipples will live as they can sometimes scab over and become necrotic. But, there is also a good chance they will survive. In the event that one or both of your nipples needed to be removed or did not survive, we have multiple options for nipple reconstruction.

16. Can I go ahead and get my flu shot before I have my surgery?

As I am answering this, I don’t believe it is currently flu season, and we would rather not introduce anything into your body this close to surgery. I would wait until 1-2 months after surgery.

Do you have a question about breast reconstruction or post-surgery that you’d like answered from our surgical team? Ask the doctor now 

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