Breast Implants: Part 2, Surgery

Patient Expert

Once you've decided you're going to have a breast implant; as well as what type, and the specific procedure, it's time to prepare for surgery.

Many women choose to begin their implant process at the same time they have their mastectomy surgery. But some women simply aren't ready to make all the necessary implant decisions prior to mastectomy; or there may be trouble coordinating the schedules of the surgeon who'll do the mastectomy, and the plastic surgeon who'll insert the implant or expander.

If this is the case, implant surgery can be delayed for months, or even years. And it's not a problem; if you're not totally sure you even want implants; if other cancer treatment (e.g., chemotherapy) on top of a long implant process doesn't thrill you; or if you're unsure in any way, don't worry; it's fine to delay your implant surgery.

One thing you should make sure of: prior to surgery, get a referral to a physical therapist, either from your oncologist, or from your surgeon. Getting range of motion back in your arm and shoulder on the affected side, as soon as possible, is key to preventing long-term arm and shoulder issues.

Whenever you have your surgery, it helps to be familiar with the process. Let's look at what the surgeon will do, and what happens afterwards.

Once your breast tissue is removed, the mastectomy surgeon will hand you over to a plastic surgeon. This surgeon will either insert an implant directly, or insert an expander.

Direct to implant surgery
If you have "direct to implant" surgery, the implant will be inserted into a pocket created underneath your chest muscle with the use of artificial skin. The surgeon will then close the wound, and you'll start the recovery process.

Occasionally, the surgeon may go back in to make some adjustments for cosmetic reasons; and s/he will also go back several weeks later to create a nipple and areola. But other than that, the process is finished.

Tissue expander surgery
The standard way to create a pocket for a breast implant is with an expander, a device that stretches the skin and tissue around it as it's gradually filled with saline solution, over the course of several months.

Once the general surgeon has completed your mastectomy, the plastic surgeon will place the expander, already partially filled with saline, on your chest wall, behind your chest muscle. S/he then closes the wound, and you'll head to recovery.

As with any major operation requiring general anesthesia, you're likely to feel pretty groggy afterward. Many insurance companies classify mastectomy surgery as same-day surgery, requiring you to leave the hospital without an overnight stay; most women feel better recovering in the hospital overnight, so see if your insurance will allow you to do this.

Once you're home, you'll have at least two drains coming out of your breast, usually close to your underarms. These drains are important; they allow fluid that collects as a result of surgery to drain out, speeding the recovery process.   The nurse will show you how to empty and clean the drains, as well as how to attach them to your underclothing, to keep them out of the way.

Initially, you won't be able to reach your arms overhead; so be prepared to have someone help you with cooking, dressing, and bathing. As long as you have the drains in, things will feel awkward; once each drain is producing less than 20 to 30 ccs fluid in 24 hours, you can have them removed, and you'll feel much better.

And, once the drains are removed, your incisions can heal; you can start physical therapy; and you can begin the tissue expanding process, if that's the road you've chosen.

Next: The Fill Process

Previous: Getting Ready