|FAQ: Mastectomy and TRAM Flap Reconstruction|
1. How long will I be in the hospital? Approximately 3-5 days
During your hospital stay
2. Will it be painful? As with any major surgery it can be very uncomfortable. It varies by individual; i.e., how much surgery was needed, was there lymph node involvement and what is your tolerance for pain. Look at your recovery in phases:
a. Phase I is the hospital stay where you will be out of bed the next day to a chair then walking slowly with help.
Your decision to choose the TRAM flap option means that the reconstruction will be about 90 percent complete after one surgery and only one follow-up surgery will be needed. The follow-up procedure to construct a nipple and 'landscape' (touch up any uneven scarring from the first surgery) is not nearly as intense, done as an outpatient, and the recovery time is very short.
b. Phase II is the first week or two at home where you will sleep with pillows under your knees or in a recliner, move around your home on your own or with the help of a walker, and work your way toward standing straight.
c. Phase III is when the drains will be removed (if they hadn't been removed by this point already) and you will be able to lie flat in a bed and drive a vehicle. The drains, by the way, are extremely helpful in your recovery because they minimize internal draining, possible internal bleeding and infection. Some women experience anxiety about going home with drains, but it is only for a week or two and the discomfort is very mild. Phase III is usually during the third week following surgery. If chemotherapy will be needed, many women begin as early as four weeks following the surgery.
3. What will my treatment for pain be like? The operation is done under general anesthesia. The anesthesiologist may recommend an epidural to minimize the discomfort in the torso area for the first few days after surgery. This is the same procedure many women have for child birth. This is done in the prep and holding area prior to surgery. If you have an epidural, it will be removed around the third day. Another option for pain relief is the On-Q pain device and a PCA (patient controlled analgesia) machine. The On-Q pain system releases numbing medicine into the zone of surgery through tiny catheters. It is removed in 2-3 days. The PCA allows you to give yourself small increments of morphine in your I.V. as needed. In Phase II of your recovery (once you go home), someone will need to fill a prescription for you at your pharmacy. We usually prescribe Percocet (depending upon your unique needs). By Phase III your abdominal incision will still be numb to the touch, as will your reconstructed breast and belly button. The swelling in your breast and abdomen will be minimal. Many women experience tenderness in two places at this point; on the abdomen above the belly button (where the synthetic muscle is sutured-in) and just below the reconstructed breast (where the muscle was turned in order to bring the abdominal tissue to your reconstructed breast).
4. I have a weak stomach and usually experience nausea and vomiting with anesthesia. Is there anything that can be done? Yes. Vomiting would not only be painful following a TRAM reconstruction, it could stress the sutures. There are highly effective anti-emetics available that work in combination. They can be taken orally pre-surgery, intravenously during surgery and for a few days post-surgery. Please let me know if you have experienced nausea and vomiting with previous surgeries.
1. When will I walk? The nursing staff at the hospital will tell you when you should get out of bed. Do not do this alone. Be sure to ask for, or bring, a few large safety pins to pin the drains to your gown. Doing this will enable you to keep your hands free to support yourself and will avoid discomfort of the drains pulling at the sites (they are stitched in, they won't fall out, but pulling on them can be uncomfortable).
When you go home
2. What foods and liquids will I be able to have? For the first day following surgery, you will not be hungry and nourishment will be handled through your IV. Then, you will be started on a light diet. By day 3 or 4, many patients are ready for regular meals (within reason of course). It is recommended not to eat heavy meals or large portions at first and to introduce them gradually.
3. Will I be able to have visitors? Seeing a few members of your immediate family or extended family as soon as you arrive from Recovery is important to your emotional well-being. Receiving visitors during your hospital stay is important too, however, people who are curious and want to hang around for long periods of time are not helpful. A close family member or friend who is willing to sit quietly with you, rub your back or keep you company when you are awake is encouraged, especially if you are the type of person who prefers to have someone near. That person can also serve as your gatekeeper by diplomatically suggesting that long period visitors leave so you can rest. All other family members and friends who visit should be supportive and upbeat, willing to stay for very short periods of time and able to understand that you will most likely drift off to sleep during their visits.
4. What should I wear for my trip home? Every individual tolerates the discomfort differently. Because most women leave the hospital with one or two drains below their abdominal incision, wearing pants or jeans can be difficult. (Refer to section 2c for explanation of drains.) Some are comfortable in loose-fitting pants with the front closure (zipper, snaps, or buttons) left open, and a loose-fitting button-down blouse. Others find that a button-down robe, no underwear and a lap-blanket works well.
1. Will someone need to stay with me? This is your decision, however it is recommended to have a family member or friend with you most of the time to help with cooking for your family, cleaning and laundry, and your personal care. This is helpful especially since women tend to want to provide for their families, and easily forget that this is a time to rest and heal.
2. When can I take a bath or shower? To reduce the risk of infection it is recommended to avoid baths or hot tubs at least until the drains are out. It is usually okay to shower when you get home even with the drains in but you should ask your surgeon prior to doing this. Sometimes wound healing problems could be developing or Gortex mesh was used inside the abdomen at the time of surgery. In these cases water exposure could increase the chance of infection early on. When you come in to the office for a post-operative follow up exam you will be given an expected date.
3. How do I take care of the drains? There are usually one or two drains in the mastectomy site and two drains in the abdomen. They typically stay in for one to two weeks. The drainage should be recorded in ml or ccs three times per day. A drain is ready to come out if it has put out less than 25 ccs for 1-2 days. Clean gauze around the drain is all that is needed. If the drain is not holding suction it usually means it has come partially out. This is not an emergency but call the office at an appropriate time to discuss it.
4. When will I be able to wear a bra? During the TRAM flap surgery, the abdominal tissue is moved up along the torso and stomach under the skin, and then turned at a 90-degree angle under the breast that was removed. It is then brought out and used to build a new breast. The tissue is never totally disconnected. Tight bras or bras with under-wires can put pressure on the turned muscle just under the reconstructed breast and decrease blood flow to it. For that reason we recommend, and many women prefer to wear shirts with bras built in or close-fitting undershirts to hold both breasts firm, and not be constricted.
5. Where should I sleep? You should sleep in a bed with pillows under your head and knees, or in a recliner (many women prefer the recliner for Phase II). If you have pets or small children who may invite themselves onto your lap and torso while you are sleeping, place a pillow on top of your torso to avoid pain in case they surprise you. If a cat, for example, jumps up on you while you are asleep, there's no risk to the surgical work that was done to your torso, but it will surely cause you immediate and temporary discomfort!
6. How will I get around? Once your leave the hospital (Phase II), walk slowly, and use rails and furniture for support. Many women use a walker to relieve lower back discomfort that sometimes occurs when they inadvertently use their lower backs to accommodate for the bent over position due to the front torso surgery. The important thing is to walk when you are feeling up to it. Walking improves circulation, the respiratory function, and overall healing.
7. Will I be able to go up and down steps? Some women begin using steps the first day they are home. If you choose to go up and down steps, be sure to use the rails and have someone nearby in case you need assistance. Additionally, take frequent breaks, at least every two steps.
8. What shall I do about the blistering under the tapes? If steri-strip tapes were used on the incision leave them alone. Your surgeon will take them off in the office. They tend to stay on for one to two weeks. If blisters form along the tapes apply an antibiotic ointment like Neosporine. Maxi pads are helpful as dressings along the incisions for padding or to collect oozing along the incision.
9. When shall I follow up with each surgeon? The surgeon who did the mastectomy and worked with me during your reconstruction will have his or her own follow up recommendation. What typically occurs is that you will come in for an office visit with me one week after you return home, and you will go in for an office visit to him or her two weeks after you return home. We work together to help you and either of us can remove drains, stitches and assess your incision healing.
10. When will I return to work? This is a decision based on many factors; e.g., your employers policy, whether or not you will begin chemotherapy or radiation, and your health and best interests. If you undergo surgery only, your return may be around 6 weeks. If you will undergo chemotherapy, your oncologist will be part of the decision-making. Together you and your doctors will decide.
Feel free to call the office anytime you have questions; i.e., don't suffer in silence! We are available to help you, and in some cases can provide you with contact information of other women who have had the Mastectomy and TRAM flap reconstruction.
For additional information on Tummy Tuck / Abdominoplasty, visit the
American Society of Plastic Surgeons
for this procedure.
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