All patients will attend the pre-admission clinic. You will be seen by a nurse. Preadmission paper work will be done and any required blood tests and investigations will be carried out. Be prepared to spend 2-3 hours at preadmission.
Through a partnership with the world-renowned Xiaolan Health Centre in Toronto, patients have the option of alternative health support pre and post operation. Your surgeon will consult with Dr. Xiaolan Zhao's team for unified care. You can find more information on the services provided by Xiaolan here. UHN Breast Reconstruction patients receive a preferred rate.
If you are taking a blood thinner, i.e. Aspirin, Ibuprofen, Plavix or Coumadin (Warfarin), you will be required to stop taking it prior to the date of your scheduled surgery. If you have any questions regarding the safety of stopping the blood thinner, then you must contact the original physician who prescribed the medication to you.
If you are having a DIEP flap breast reconstruction you will need a special CT scan of the abdomen to look at the blood vessels that supply the skin. This will help the surgeon in decision-making during the operation.
All patients who are undergoing any type of breast reconstruction should purchase a bra in advance. We suggest bras that are made by Marena who specialize in comfort-wear in supportive garments. The bras that we recommend are catalogue numbers BNVL or B/ISB. They come in a variety of sizes and cost between $60-80. You can speak with one of the consultants at Marena to find the right bra size for you. You can place your online, by phone at 1-888-710-4697 or by email firstname.lastname@example.org.
If you are undergoing tissue expander insertion, then you should bring in your newly purchased bra the day of surgery so that your reconstructed breasts can be supported immediately. If you are undergoing any type of flap surgery, then you will be allowed to wear your bra after the initial swelling subsides which can take between 1-2 weeks. You will not need to bring in your bra at the time of your surgery.
If you have any concerns of questions before surgery, contact your surgeon's office or the Plastic Surgery Clinic at PMH or TGH, and they will direct your questions to the appropriate personnel.
Generally a home care nurse will be assigned to you before your discharge from hospital. She will help manage your drains (if in place) and dressings. She will be an important contact person if you have any questions about your wounds.
Generally all sutures are dissolving and do not need to be removed. Occasionally a deeper dissolving suture may come up through the skin. A small pair of clean nail scissors can be used to trim the end flush with the skin.
If you have been sent home with an abdominal binder after your DIEP surgery you will be required to wear for 3 weeks, 24 hours a day. After this time, you will need to wear the binder only during the day for another 3 weeks.
Generally loose, soft clothing for the first 2-3 weeks is best. Avoid tight waistbands after a DIEP or TRAM flap.
A soft cup bra may be worn for support from the first few days. You must remove the underwire from any bra that you wear for the first 3 months following surgery and during the entire tissue expansion process. We suggest a front fastening soft spots bra to begin with. If the other breast needs a bit more support, then the underwire should be taken out of the operated side and worn as normal on the unoperated side.
Expected Outcomes and Recovery
Your abdomen and waist will be slightly swollen at first following a DIEP or TRAM procedure. It is natural to feel some numbness in the abdomen following the procedure. The sensation will return and may take up to a few months. As incisions heal, they will become harder and tighter especially in the first three months. It may take up to a year for the incisions to become completely pliable, soft, and fade in colour.
Nipple Reconstruction Care
Your new nipple will be twice as large as the final result. Do not be afraid! It WILL settle down!
You will have received a bulky 'hat' dressing taped to the skin immediately post surgery. This should be left intact for the first 24 hours and can then be removed and the nipple can get wet in the shower.
You will have received supplies and advice on redressing the nipple, using a non-stick layer, gauze and the 'hat'. This can be replaced daily after your shower.
The stitches will be removed at 1 week.
A light pad and dressing will have been applied. This can stay in place for 5 days and then be removed (in clinic if you have an appointment, or at home).
Some staining on the pad is normal. The dressing is light- waterproof but not soak-proof. If it gets wet, it can be replaced with a simple cotton wool pad and tape. The tattoo may be slightly patchy on the first dressing change. This is normal, and will mature with time. Occasionally a 'touch-up' is required 6 weeks after the first tattoo. Generally it will need a touch up every 2-3 years, as they do tend to fade over time.