You’ll wake up in the recovery room. Expect discomfort, both from the operation itself, and from the anesthesia. You’ll be given anti-pain drugs, and may be given drugs to deal with any nausea, as well.
You may not want to—for some women, this is very hard—but look at your chest. You’ll see a bandage, probably blood, and perhaps a flat place where your breast used to be (if you didn’t have reconstruction). It’s an odd sensation. Take a deep breath, and move on; you’ll get used to this “new you” in time.
Q. I have to decide right away if I want reconstruction done, is that right?
A. Not necessarily. You can always go back and have reconstruction done later. And sometimes your surgeon and oncologist will recommend that you do wait till later, if they feel it’s important for you to start chemotherapy quickly, without waiting for a reconstruction to heal. Or if you’re going to need radiation, which can sometimes negatively affect a reconstruction. In either of those cases, you’d probably be advised to have reconstruction down the road sometime.
If you do decide to have reconstruction done immediately, you also have to decide whether you want implants (saline or silicone); or an autologous reconstruction, which means your breast is rebuilt using another part of your body, usually tissue from your belly or back.
Q. I heard the term “skin-sparing mastectomy” mentioned. What’s that?
A. If you’re having an immediate reconstruction, you may be offered a skin-sparing mastectomy, which means that the surgeon removes your nipple and breast tissue, but leaves the skin of your breast intact. This kind of surgery makes reconstruction easier, as there’s already a natural pouch there to hold the new breast. It also gives you a better cosmetic result, as the scar is limited to a small circle around your areola.
Unfortunately, some women aren’t eligible for skin-sparing mastectomies. If the tumor was very close to your skin, or you have inflammatory breast cancer, you probably won’t be offered a skin-sparing mastectomy.
Q. How long will I be in the hospital?
A. Hopefully, at least overnight. The Breast Cancer Patient Protection Act, currently working its way through Congress, would outlaw so-called “drive-through mastectomies,” a cost-limiting practice some insurance companies use that categorizes mastectomy as same-day surgery, forcing mastectomy patients to go home in very bad shape: bleeding, woozy, sore, and shaky.
A typical hospital stay for a mastectomy without reconstruction is 2 to 3 days. With reconstruction, it’s more like 4 to 6 days, depending on what type of reconstruction you have.
Q. What’s the recovery like? How long will it take me to get back to normal?
A. Again, it depends on your exact surgery—as well as your definition of normal. Even the simplest type of mastectomy, one without reconstruction, is still a fairly serious surgery.