Self-Care Following Breast Reconstruction Using a Tissue Expander

This packet will help you learn about breast reconstruction with a tissue expander and how to care for yourself after its insertion. The tissue expander is placed during surgery. It is an empty balloon that will be filled with sterile salt water over 4 to 6 weeks. This process slowly stretches your skin and muscle. When your new breast mound reaches the right size, the tissue expander will be replaced with a permanent breast implant.

This information is meant to be used in addition to talks with your physicians and nurses. Some of the information may not apply to you. Be sure to ask your plastic surgeon or nurse about what might be different in your situation.

Topics included are:

What to expect after surgery

After your surgery, you will have a large dressing over your incision. The dressing will be put on while you are in the operating room.

One or 2 small plastic drains may be placed near your incision line. These drains collect fluid that normally develops under your skin after surgery. They will usually remain in place for 1 to 2 weeks. You will be taught how to care for your drain(s) before leaving the hospital.

The drain(s) will be removed by your physician when the amount of your drainage is less than 30 cc (about 1 fluid ounce) in 24 hours. Most patients describe the drain removal as a slight pulling or stinging sensation that lasts only a few minutes. You will not need pain medicine for the drain removal. After your drain(s) are removed, some fluid may continue to leak from the site.

Cover the area with a gauze pad and change the pad if it becomes damp. This drainage is normal and can be expected for 24 to 48 hours, after which time the site is usually healed.

Some discomfort is normal after surgery. You may have a stinging sensation along the incision line and your drain site(s) may itch. You may also notice some tenderness along your lower rib cage. These sensations gradually decrease after surgery. You may take pain medication when you need it. Be sure to ask for it so you will be as comfortable and active as soon as possible.

Other common sensations after your surgery include:

These sensations are caused by the nerves being cut or moved during the mastectomy. They will gradually lessen as the months go by, but some degree of numbness may be permanent.

Caring for your incision

While you are in the hospital, your physician or nurse will examine your reconstructed breast every day and change the dressing as needed. We encourage you to look at your chest during the dressing changes so you are familiar with how it looks. When you are ready, you can care for your incision with help from your nurse. This will help prepare you to care for yourself at home.

At first, the size of your reconstructed breast may be much smaller than your natural breast. This is because the tissue expander is not completely filled when it is inserted. Before you go home and with your nurse present, we would like you to gently touch the new breast mound. You may be able to feel the port under your skin. It is used to fill the expander. The incision line across the breast mound is closed with stitches (sutures). You may see some redness and some slight bloodstains on the gauze pad. You may also feel tenderness around the incision. These are normal signs after surgery. After examining the area, the nurse may place a fresh gauze pad over your suture line.

When you leave the hospital, your stitches will still be in place. They may be covered with a gauze pad. You may leave the hospital in a surgical bra. If not, after 2 to 3 days, you may wear any support bra that does not have an underwire and does not press on the tissue expander.

You should replace the dressings daily after surgery as long as needed because of drainage from the incisions or drain sites. You may shower 48 hours after surgery. We recommend daily showers to help keep the suture line clean. Do not take tub baths until your incision is fully healed. Soaking the area may increase your risk of infection. Before entering the shower, remove your bra and the gauze pad. Wash with lukewarm water and a plain non-perfumed soap. Gently clean your incision line and skin. Rinse well. The shower stream should not be directed at your reconstructed breast. Pat the incision line dry with a clean towel, but do not rub it.

Only use an electric razor to shave under your arm on the side of the surgery. Also, deodorant could cause an infection, so do not use it until after you put your bra on. Do not use deodorant on the side of the surgery if you have any break in your skin. After your shower, inspect the incision line and drain site carefully. To do this, stand in front of a mirror in a room with good lighting.

Call your plastic surgeon or nurse immediately if you have any of these symptoms:

When you have finished the inspection, place a clean gauze pad over the incision line.

The tissue expansion process

Your first post-operative visit will be 1 to 2 weeks after your surgery. Call your surgeon’s office to make an appointment as soon as you can. Your plastic surgeon and nurse will examine the incision to ensure that it is healing well. The stitches are the kind that dissolve on their own, so they do not need to be removed. This first visit is a good time to bring up any questions you may have.

During expansion, the breast mound will not have the shape and size of the other breast. The breast will not take its final form until the permanent implant is inserted.

You will return to your physician’s office every week for 6 to 8 weeks to complete the expansion process. Before each expansion, your breast mound and incision line will be examined. The tissue expander is inflated with sterile salt water through the port through a small needle. The expansion takes about 20 minutes each week. You may feel some tightness and fullness in the breast area and some discomfort in your shoulder or back. It generally gets better within 1 or 2 days. After each expansion, you should continue your normal activity. You can return to work or do light housekeeping a few hours later. You can also drive if you have full range of motion in your shoulder on the recovering side. If your job involves lifting 10 pounds or more, you may need to change your work schedule until it is safe for you to lift heavy weights. If you have any questions, ask your physician or nurse.

Comfort measures

Between expansions, there are a few things you can
do at home to feel more comfortable. Warm showers, acetaminophen (Tylenol®), or ibuprofen (Motrin®, taken with food), may help ease the tightness and discomfort. You may notice that your skin becomes dry and flaky as it is expanded. A non-perfumed moisturizer put on once or twice a day can be soothing. Do not put the lotion directly on the incision for the first 6 weeks. Never apply a heating pad or warm compress directly on the breast mound. It is possible to burn the skin because your sensations have changed. Your nurse will also show you stretching exercises you should do at home. During your weekly visits, your nurse will review your progress with these exercises.

Exercise

Regular exercise after your surgery and during expansion is good for you, but there are some exercises you should not do. Do not do high-impact aerobics, jog, lift weights or swim until your physician approves. Avoid exercises that build up your chest muscles (pectoralis). Do the simple exercises at home that are shown in your exercise booklet. These exercises will improve your comfort and flexibility.

Clothing tips

When you leave the hospital, you may be wearing a surgical bra. After the drains are removed, you may choose to wear your own bra.

It should:

To help balance your appearance in clothing, you may fill your bra with a soft breast form. Your physician or nurse can let you know where you can purchase one. This breast form is a lightweight nylon pouch, and its size can be adjusted to match your other breast by adding or removing the cotton fluff inside. This is especially useful as the breast mound becomes larger during expansion. It can be laundered using a mild detergent, such as Woolite® or Ivory®. It should be washed once a week and then air-dried.

Another way to achieve a balanced look is to use shoulder pads, which come in a variety of shapes and sizes. You may also line your bra with a soft gauze, also available at our office. Replace the gauze frequently enough to make sure that it is always clean. As your plastic surgeon told you, the tissue expander will be “overinflated.” As you near the end of your expansion, sometimes your new breast mound may look about one- third larger than your natural breast.

To hide this imbalance, wear:

Completion of breast reconstruction

Once you have finished your tissue expansion, the next stage of breast reconstruction will be scheduled. This stage is the removal of the expander and placement
of the permanent implant. The surgery will be done

6 to 8 weeks after expansion is completed so your
skin can rest. This date may change if you need other treatments such as chemotherapy or radiation. You will not need weekly visits to the office during this time. If
it is indicated, your surgeon will discuss surgery on the other breast to make it match the shape and size of your reconstructed breast. It is done to make the natural and new breasts look alike. This surgery is up to you. You may want to have it, decide whether to have it later or choose not to have it at all.

The exchange of the tissue expander for the permanent implant takes about 1 hour for each side. If a matching procedure is done on the other breast, it takes more time. You will be able to go home 3 to 4 hours after your surgery.

If you decide to have a nipple reconstruction, it is usually done about 2 months after the permanent implant is placed. Surgery on the other breast may also be done at this time.

Nipple reconstruction can be done either in the hospital or in your surgeon’s office. If your reconstructed nipple/ areola needs to be darkened, tattooing of the area can be done in the office.

Do not hesitate to seek help or get support from your plastic surgeon or nurse. If you have questions or concerns, please contact us.

Plastic Surgery

Michael Howard, MD

Phone: (224) 271-4250

Fax: (224) 271-6920

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Plastic Surgery

Chad Teven, MD

Phone: (224) 271-4250

Fax: (224) 271-6920

Learn More