After Surgery - Latissimus Dorsi & Tissue Expander/Implant
Generally this is a similar procedure to the tissue expander, although the addition of the flap from the back does make it a slightly more involved procedure from the recovery point of view. You will spend an extra day or two in hospital, and may find it takes a little longer to get back to your normal self.
Generally, the amount of pain after a tissue expander or implant placement is less severe than that following autologous reconstruction.
Whilst in hospital any post-operative pain you have will be carefully monitored and treated. Pain control will be with a combination of injections and tablets. We suggest taking these regularly for the first week, as pain is much easier to control if it is prevented rather than try to control it after it has set in
After the first week the amount of analgesia you require will be decreased. You may only need to take an analgesic first thing in the morning and just before bed while managing on Tylenol and/or Advil alone during the day.
Everyone's pain tolerance is a little bit different. Some people find they don't need tablets after the first couple of weeks, some people use them a bit longer, especially at night or after a more strenuous day. There is no right or wrong length of time to be on pain medication.
You will receive sips of fluid overnight and then will slowly be advanced to a normal diet as tolerated. This may take one to three days and differs from patient to patient.
Generally a normal healthy diet should be fine.
We would recommend adding fibre/bulk (e.g. grains/leafy vegetables and fresh fruit) to the diet for the time you are on additional painkillers as they can sometimes cause constipation. Straining at stool may cause discomfort to the tummy.
A diet rich in protein (low fat meat/fish/nuts) will help with healing.
Drains & Dressings
You will wake up to find one drain in the breast pocket, and two in your back. While in hospital, the nurses will measure the drain output every few hours. Any dramatic increase in drain output or new bright red bleeding may indicate a haematoma in the surgical site and should be assessed by a member of the plastic surgery team. It is important for you to learn how to strip the drain, a maneuver that the nurses should teach you to prevent clot formation in the tubing. You should continue to strip the drains every few hours while awake once you are discharged home.
A home care nurse will be assigned to help care for the drains and change any dressings that are required.
If you are discharged home with drains in place, they generally stay in place until there is minimal output at which time the home care nurse will remove them. You can shower with the drains in place.
Dressings should be minimal over most of the surgical site when you go home and wounds may be exposed in the shower and washed with soap and water. A light dressing to prevent staining of clothes may be needed. This can be provided by homecare.
A fragrance free moisturizer can be massaged into the surgical sites at about 3 weeks with a gentle circular motion to help the scars mature.
Recovery from a latissimus dorsi flap combined with a tissue expander procedure is slower than from a tissue expander only reconstruction. Again, the first week should be mainly spent resting and recovering with short walks around the hospital or the home. We would suggest avoiding lifting anything over 5 pounds for the first 3 weeks, and 10 pounds for weeks 3-6.
Initially avoid lifting your arms above your head (e.g. hair washing, brushing, hanging washing etc) for 2-3 weeks. Then gradually increase the amount you bring your arms out. By the end of 4-6 weeks you should be able to lift your arms with a full range of motion. It is natural to feel some tightness and stiffness.
If you have had a mastectomy at the same time as the placement of the tissue expander(s), then you must contact your breast surgeon's office to inquire about when you may start physiotherapy of your arms and shoulders. Your breast surgeon will have a physiotherapy protocol that he/she prefers that is specific for your needs.
Driving is something that must be assessed with respect to individual healing. You must feel comfortable to perform an emergency stop or avoid a child/pet/accident. You must be physically able to look behind you and to each side and wear a seatbelt for the length of time in the car with comfort. In addition, you are legally not allowed to drive while taking prescription pain medications.
Signs & symptoms of infection
Infection around an expander or implant can occur beneath the latissimus dorsi flap. If it occurs, it can be a devastating event. If caught early in its course, the infection can be well controlled and completely treated using oral or intravenous antibiotics. If the infection is severe or caught too late or unresponsive to antibiotics, the implant will need to be removed. You must be vigilant with looking out for any signs of infection to avoid this disastrous outcome.
A small amount of redness in the skin under tapes may be normal. If the redness spreads, the breast becomes either swollen or tender or you get discharge from the wound, or you develop a fever, you should contact your plastic surgeon's office immediately.
Expansion of the tissue expanders usually begins 2 weeks after surgery. If the wound has been a little bit slow to heal we may delay expansion for 1-2 weeks until we are happy it has healed completely.
Expansion proceeds at a variable rate, depending on many factors such as skin quality, skin amount, desired size, volume of expanders and patient tolerance/preference. Again, there is no correct speed, but most patients have 50-60cc at each weekly or biweekly visit.
Once the desired size has been reached, the next surgery will be booked. Generally there is a gap of 3 months between the final expansion and change to permanent implants.