What To Expect
Here you will find information on what to expect on your breast reconstruction journey.
Here you will find information on what to expect on your breast reconstruction journey.
Our Plastic Surgeons accept referrals for patients throughout Ontario or from other provinces across Canada as well as from abroad. We accept referrals from any medical doctor, who may be a general practitioner or family doctor, or an oncologist, or a breast surgeon. You may download our Referral Intake Form on this page to provide your referring doctor with the type of information that we require in order to book a surgical consultation appointment with one of our plastic surgeons. Download the referral form here.
The wait time for a clinic appointment depends on the urgency of your situation and whether or not you have active breast cancer or in situ breast disease. Generally, if you have active breast cancer, then your wait time from referral to consultation with a plastic surgeon will be within only one to two weeks. If you have in situ breast disease without an invasive breast cancer, then your wait time may be up to 3-4 weeks. Our goal in these situations is to see the patient as soon as possible. If you are a gene carrier seeking to see our plastic surgeon for prophylactic mastectomy and reconstruction, then we will do our best to coordinate your appointments with the breast surgeon to be on the same day as the plastic surgeon. The wait time from referral to consultation may be up to several months.
Many of our patients perform their own research using the internet, information booklets, consultation with doctors, family and friends prior to attending their Plastic Surgery consultation appointment. We have prepared a patient education booklet on all of the available breast reconstruction options that may be downloaded and reviewed prior to your clinic appointment or will be provided at the time of your appointment.
All of the Plastic Surgeons in the UHN Breast Reconstruction Program are also specially trained microsurgeons so that we may provide all of the different types of breast reconstruction at our hospitals including using your own tissue to reconstruct your breast.
We only succeed because of the excellent contribution from the members of our multi-disciplinary team. We work very closely with the Breast Surgical Oncology Group at University Health Network. Our close collaboration allows for timely access to immediate breast reconstruction (at the same time as the mastectomy). Our breast team is composed of the Breast Surgical Oncology Group led by Dr. David McCready. In addition, Dr.’s Leong, Escallon, Easson, Reedjik and Cil perform the latest techniques of nipple-sparing and skin-sparing mastectomy and sentinel node mapping. Their offices are located adjacent to our Breast Reconstruction Clinic at Princess Margaret Hospital, and coordinated timely consultations can be arranged. In addition, our interdisciplinary team includes one clinical nurse specialist at each of our UHN clinics (Princess Margaret Hospital and Toronto General Hospital), floor nurses, physiotherapists specializing in post-breast surgery rehabilitation, and other health care workers.
This team approach provides coordinated treatment and comprehensive care. Our Clinical Nurse Specialists, Sarah Rotstein RN, BSc, BScN, MN (Breast Surgery) and Agnes Wisniewski RN, BScN, MN (Breast Reconstruction) are Registered Nurses that have extensive knowledge, skills and expertise in breast and breast reconstructive surgery. We have recently recruited Amanda Perrotta, CCPA, BHSc (PA), BSc who is a Physician Assistant (Breast Reconstruction) who assists the surgeons and patients in developing and implementing the surgical plan. These are the primary people who will provide guidance throughout your surgical journey from diagnosis to survivorship. They offer extensive pre and post-operative teaching and education, support and counseling, and troubleshoot any concerns that may arise to ensure positive patient experience and outcomes. In addition to being patient advocates, they are highly involved in program planning and program initiatives. Furthermore, in addition to the complete array of surgical procedures offered by our program, research efforts to analyze our current surgical methods with the goal of providing the top level of care to our patients is a major focus of The UHN Breast Reconstruction Program.
Once you meet the team and your Plastic Surgeon they will have a more specific idea of which breast reconstruction options are available to you. They will review all of the risks and benefits of each of the techniques and explain why they would or would not recommend an option, for example, if you do not have enough excess abdominal tissue to use for a breast reconstruction of your desired size and shape.
Depending on the timing of your breast reconstruction surgery, the team will help you to make a personalized decision regarding the type of breast reconstruction surgery that is best for you. Perhaps you require an immediate reconstruction at the same time as your mastectomy but are not able to manage the extended recovery time of 6 weeks to 3 months required for a reconstruction using your own tissue. The team may suggest an implant-based breast reconstruction that may be performed in stages to minimize the post-operative recovery time. All these factors are taken into consideration prior to signing the surgical consent form. You may also need some time to consider all of the information provided on your first clinic visit and we will arrange another clinic visit to answer any additional questions to help you make the best decision for your situation.
In patients with breast cancer we comply with the Cancer Care Ontario wait time guidelines that require all breast cancer surgery be provided within 4 weeks from the time the patient signs the surgical consent form.
In all cases you will be provided with a personalized breast reconstruction plan from beginning to end that may include preoperative optimization with possible use of alternative supportive treatment, social worker for emotional support, physiotherapy, and/or bra fitting in selected patients. This will be followed by a personalized post-operative optimization with possible use of a physiotherapist, massage therapist, and scar care in carefully selected patients in addition to completion of the reconstructive journey with the final aesthetics touches such as nipple reconstruction with aerolar tattooing. The cost of all of these steps is typically covered by your provincial health insurance plan.
You may be required to attend a pre-admission appointment prior to your surgery. This appointment will be arranged by your surgeon’s office. You will be either seen in person by a nurse in the clinic or a telephone interview may be conducted. If needed, you may be required to see other healthcare professionals like an Anesthesiologist, Pharmacist and/or Clinical Nurse Coordinator. Pre-admission paper work will be done and any required blood tests and investigations will be carried out. Be prepared to spend 2-3 hours at pre-admission. Please bring a list of your medications with you to your pre-admission appointment for review. If you are seeing any other specialists for your heart or lungs, you may be asked to bring recent documents to your appointment as well.
You may be asked to stop some of your medications before your surgery. This will be reviewed with you by your Surgeon and Surgical Team prior to your surgery.
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.
In some cases, your surgeon may ask you to wear a supportive bra after your surgery. You will need to bring this supportive bra with you on the day of your surgery.
If you have any concerns or questions before surgery, contact your surgeon’s office or Agnes, and they will direct your questions to the appropriate personnel.
Prior to your discharge home from the hospital after your surgery, we will arrange for a nurse within your community through the Local Health Integration Network (LHIN) from the hospital if you require drain care or dressing changes after your surgery. Recently, the delivery of the LHIN services across Ontario has been changed and you may be required to travel to a clinic to receive nursing care for your drains or dressings. The frequency of visits from your nurse and specific instructions for your drains and dressings will be provided to you before you leave the hospital.
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.
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 sports 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.
For some patients after abdominal surgery, you may be sent home with an abdominal binder. If you have been given an abdominal binder following 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.
Know where to buy bras and breast prostheses after breast surgery booklet – Download
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.
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 7 to 10 days and can then be removed and the nipple can get wet in the shower. There are times when the dressing needs to be changed more often. 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.
Going Home after Nipple Reconstruction – Download
Light pad and dressing will have been applied. This can stay in place for 7 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.
Going Home after Areola Tattoo – Download