After tissue expander breast reconstruction, my primary concern is keeping your skin alive. The most common complication following tissue expander breast reconstruction is mastectomy skin necrosis (death of the mastectomy skin). The early postoperative period is when the skin left behind after the mastectomies, which is your breast skin, can die. The reason it could die is because the blood flow to that skin is disrupted from the mastectomy. Most of the blood vessels that keep the skin alive travel through your breast tissue. And those vessels are cut when the breast tissue is removed. So, the blood flow to the overlying skin or the mastectomy skin is severely disrupted and reduced following a mastectomy. Therefore, our initial goal is to keep all that skin alive, long enough for your body to grow new blood vessels.
Wound care: I will start by putting an ointment all over the surgical site that helps keep the skin alive. The other thing of course is to stay well hydrated and to avoid any and all nicotine-containing substances. You will have a gauze dressing over the mastectomy site. The incisions on your chest will be closed with sutures (stitches) which dissolve on their own and so they don’t need to be removed. It’s not unusual to notice some slight redness or bloodstains on the gauze pad and have some tenderness in the area. These are normal signs after mastectomy surgery. Do NOT put a heating pad or cold compression on the surgical sites as this can damage the fragile skin.
Supportive Bra: The next thing I need you to do is not put any pressure on it. Don’t let any of the nurses or anybody put you into a bra right away. Just no pressure on your skin. Leave it uncompressed. So, no bra. You can obviously wear a shirt and gown. But don’t wear a bra or anything tight that would crush the skin right after the mastectomies. Once I tell you it’s okay, you can start wearing a bra for some gentle compression, which will help those drains come out faster and expedite the internal healing. But we can’t do that too soon because we would risk hurting the overlying fragile mastectomy skin on top.
Showering: Following tissue expander breast reconstruction, you can shower after 48 hours. You can let your drains just dangle in the shower. After you shower, check your incisions and drain sites in front of a mirror in a well-lit room. If you notice redness, swelling, or new drainage from the incisions, or if you have a fever of 101 degrees Fahrenheit or higher, you should call me.
Drains: Jackson-Pratt (JP) drains are small plastic drains that I put in near your incisions to collect fluid after your mastectomy surgery. They are secured in place with a stitch. In my experience, the drains that stay in the longest in all of plastic surgery are drains around a tissue expander following a mastectomy. The mastectomies tend to create a ton of fluid, and so we need the drains to remove that fluid. And then you have a tissue expander in there as well, which tends to contribute to fluid production. So, the drains that are in place following a mastectomy with tissue expander placement may be in for 2-3 weeks. They may stay in for quite a while, so be prepared for that. I found that starting with 2 drains on each breast, which seems like a lot, actually helps all the drains come out faster. So, you’ll start out with 2 drains on each side, and then we’ll take one of those drains out probably within a week and then the second one hopefully within another week, but sometimes it takes a little bit longer.
Exercise: You can exercise 1 week after your last drain comes out in a gentle compression bra. I ask my patients to avoid forceful exercises that involve jogging, jumping, or running for the first few weeks.
Swimming: You can swim and go under water 3 weeks after surgery assuming everything has healed up, but we may need to wait longer than that because it is possible that the drains may have just come out around 3 weeks.
Followup: I will be seeing you in clinic about once a week. We will start adding fluid to the tissue expander using the filling port. We will be pumping it up almost every time that I see you. We will keep adding fluid to the expander, initially to fill up that space. We need to at least meet the skin to fill up that empty skin envelope. After that, we can continue adding more fluid until we reach your reconstructive goal.
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