When will I be discharged?
- For both unilateral and bilateral reconstructions, most patients will be ready for home between day 6-10 post surgery. This will be dependent on how well you are mobilizing, your pain control and whether all the surgical drains have been removed.
- Dr Teh generally will keep you in hospital until all drains are out but in exceptional cases, you can be discharged home with a drain. A nurse from the hospital will check on the drain daily when you are home.
What are my discharge instructions?
- Have someone drive you home after surgery and help you at home for a minimum of 2-3 days. If you normally reside more than 2 hours drive outside of Perth metropolitan area, you will generally be advised to stay in Perth for the first week after discharge.
- Get plenty of rest.
- Follow a balanced diet. Decreased activity may promote constipation, so you may want to add more raw fruit to your diet and be sure to increase fluid intake.
- Take pain medication as prescribed. Do not drink alcohol when taking pain medications. Even when not taking pain medications, avoid alcohol for 3 weeks as it causes fluid retention. If you are taking vitamins with iron, resume these as tolerated as well as all your usual medications.
- DO NOT SMOKE. Smoking delays healing and increases the risk of infection.
- Avoid caffeine (coffee and chocolates) as there is some evidence that this reduces wound healing, causes dehydration and increases blood pressure.
- Wear breast and abdomen compression garments from the time you begin to start getting up in hospitals. You will need to wear the garments every time you are up and about, for 6 weeks after the surgery.
- It is preferable to also wear TED stockings from the hospital after discharge for 2-3 weeks after your surgery
- Look for any signs of swelling in your upper limb especially in you had a mastectomy and lymph node surgery at the same time as the reconstructions. This may indicate that you are developing lymphoedema. Contact Dr Teh’s or your breast oncology surgeon for urgent referral to a lymphoedema physiotherapist.
What should my activity level be?
- To prevent over-stretching the abdominal closure, you will walk bent over and will slowly rise over the next few days post-op as tolerated.
- Pain in the chest and abdomen soon after surgery will cause you to want to avoid taking deep breaths. However it is important to take deep breaths after your surgery to prevent parts of your lungs from collapsing.
- Avoid staying in bed for prolonged periods. This will help to reduce swelling and lowers the chance of blood clots.
- You may use your arms for activities of daily living for the first three weeks, but do not do any overhead activity until 3 weeks post-op.
- Do not drive for 3-4 weeks. When your abdominal and chest areas are sufficiently healed and symptom free to allow for sudden braking, you may resume driving. Do not drive while taking narcotic pain medications.
- Discuss time off work with your surgeon but generally most patients will not return to work for 6 weeks unless they are performing purely home-based administrative duties
- Refrain from swimming, heavy lifting, sit-ups and sexual activity for 6- 8 weeks. During this time, you will be limited only to light walking.
How do I take care of my incisions?
- You will in most cases be discharged with waterproofed dressings. Do not to soak in a bath or spa as the dressings will soak off. A not so lengthy shower is much preferred until the sutures have been removed. This usually occurs 2 weeks after surgery.
- Avoid exposing scars to sun for at least one year and always use a strong sunblock if sun exposure is unavoidable.
- Keep your dressings intact (ie steri-strip or tegaderm). However if you begin to develop an allergy to the glue (itching, redness, blistering), please remove the tape and contact the practice.
- Keep incisions clean and inspect daily for signs of infection.
- Sleep with pillows under knees for 2 weeks (some patients choose to sleep in recliner or lounge chair).
- for more information on wound care, click here.
What can I expect?
- Maximum discomfort will occur the first few days following surgery. Most patients complain of a generalised ache in the chest and stomach muscles especially centrally over the rectus muscle. Some will experience a more sharp and stabbing pain particularly in the breast, armpits, arm or abdomen. This may indicate nerve related pain (neuralgia) and can be treated if troublesome with medications (ie Lyrica).
- Some oozing from the wounds can be expected during this period. Over time, some dissolvable sutures may extrude through the wound edge. These usually have a pimple like appearance which then bursts to extrude suture material.
- Seromas are fluid collection in surgical pockets (ie breast or abdomen). These may occur over a course of a few weeks and will lead to increasing swelling in the affected area. The diagnosis is confirmed by ultrasound. If small and asymptomatic, these can be managed by observation. Treatment otherwise is by drainage either by ultrasound guided aspiration or for recalcitrant seromas, surgical drainage.
What will it look like?
- A new breast mound will be constructed with sutures around the outer edges. It is not unusual to find hard nodules in the breast during the first few months after surgery. This is due to hardening of some of the transferred abdominal flap and these usually will soften up over the course of a few months. They can be tender to the touch.
- Expect a degree of bruising which will tend to be worse in the more dependant areas of the breast (ie lower and outer parts of the breast)
- The abdomen will be tighter and flatter in appearance.
- The majority of swelling will subside in 3-4 weeks, but some swelling may persist for up to 3 months.
What follow-up care will I receive?
- Your 1st post-operative visit will be scheduled approximately 14 days after surgery, sutures will be removed during this visit. Please phone Dr Teh’s Secretary to schedule a post-op appointment when you are discharged from hospital if you do not already have one scheduled.
- Your 2nd post-operative visit will be scheduled somewhere between 4-6 weeks from the initial surgery date.
When should I call Dr Teh?
- If swelling and redness persists after a few days.
- If you develop increased redness along the incisions.
- If you have severe or increased pain not relieved by medication.
- If you have any side effects to medications; such as, rash, nausea, headache, vomiting.
- If you have an oral temperature over 38 degrees.
- If you have any yellowish or greenish drainage from the incisions or notice a foul odour.
- If you have bleeding from the incisions that is difficult to control with light pressure.
- If you have loss of feeling or motion.