This depends on the severity of the wounds.

Mild wound healing issues are usually treated with local wound care which includes dressing changes several times a day.

Larger wounds can be treated with a special dressing called a "VAC". This is a sponge dressing that is replaced every few days (typically 3 times per week). The sponge encourages healing by applying mild suction pressure to the wound. The pressure is generated by a small purse-like device that the patient carries around with them.

More severe wounds can require hyperbaric therapy. This essentially pushes more oxygen in to the wounds to encourage healing.

Surgery can also be required to ensure any unhealthy tissue that is preventing healing is removed from the the wound. Surgery is often performed prior to VAC or hyperbaric therapy.

Any identifiable contributing factors must also be addressed e.g. smoking, malnutrition, uncontrolled diabetes.

Smoking of course is an absolute "no-no". Regardless of the severity of the wound, it is important the patient's diet is optimized to ensure the patient is eating enough of the nutrients required for normal healing (like protein, zinc, vitamins A and C). Diabetic patients must also be re-evaluated to ensure their blood sugar levels are under good control.

Here's a blog post that may also be helpful:
http://breast-cancer-reconstruction.blogspot.com/2010/11/how-to-boost-healing-after-surgery.html

I hope this info helps.

Dr C
http://www.PRMA-enhance.com

I think patients should hear and be able to consider all reconstructive options. Most plastic surgeons perform breast reconstruction but not all offer the whole spectrum of reconstructive options. It is important to establish what kind of procedures your surgeon performs routinely to ensure you will be able to undergo the reconstruction you feel most comfortable pursuing.

Dr C
http://www.PRMA-enhance.com

Two factors...

The first is the type of procedure. Immediate breast reconstruction, at the same time as a skin-sparing or nipple-sparing mastectomy, is associated with the least amount of scarring. These types of mastectomies preserve all the natural breast skin envelope and minimize the amount of scarring. Nipple-sparing mastectomies also preserve the nipple and areola.

The second factor is the patient. Some patients simply heal with nicer scars than others. This is due to factors such as age, genetics and other medical conditions.

I hope this info helps.

Dr C
www.PRMA-enhance.com

Most flap procedures require similar recovery time (4-6 weeks) in terms of resuming most activities and returning to work. In terms of the initial hospital stay after surgery, microsurgical procedures (eg perforator flap) typically need a couple of days longer compared to non-microsurgical procedures (eg lat flap).

Dr C
www.PRMA-enhance.com

At PRMA, GAP flap patients typically stay in the hospital for 3 or 4 days after their initial reconstructive surgery. Recovery is 4-6 weeks in terms of returning to most activities.

Three months later, a second surgery is performed known as "stage 2" or the "revision stage". This includes optimizing breast symmetry and buttock contour, scar revision and nipple-areola reconstruction (if needed). Stage 2 is performed as an outpatient procedure for local patients. Out of town patients usually stay overnight. Recovery is a few days.

The final stage involves tattooing of the reconstructed nipple-areola. This is an office procedure which requires an hour or so out of your day.

All stages are performed 3 months apart.

I hope this info helps.

Dr C
http://www.PRMA-enhance.com

We typically have patients wear a surgical bra for 3 weeks after surgery.

Dr C
http://www.PRMA-enhance.com

No, breast reconstruction does not typically interfere with breast cancer treatment. Patients that are candidates for immediate reconstruction (reconstruction at the same time as mastectomy) proceed with the remaining recommended cancer treatment once they have healed from the mastectomy and reconstruction (usually about 4 weeks). That healing time is generally the same whether you have mastectomy alone or mastectomy and reconstruction.

A small percentage of patients develop wound healing problems after surgery and need slightly longer to heal. In these situations, it can take a little longer to start chemotherapy (if chemo is needed). Again, this situation can arise regardless of whether the patient is having reconstruction.

Patients that have delayed breast reconstruction (ie reconstruction some time after the mastectomy), complete all their breast cancer treatment prior to the reconstruction.

I hope this info helps.

Dr C
http://www.PRMA-enhance.com

This depends on the severity of the wounds.

Mild wound healing issues are usually treated with local wound care which includes dressing changes several times a day.

Larger wounds can be treated with a special dressing called a "VAC". This is a sponge dressing that is replaced every few days (typically 3 times per week). The sponge encourages healing by applying mild suction pressure to the wound. The pressure is generated by a small purse-like device that the patient carries around with them.

More severe wounds can require hyperbaric therapy. This essentially pushes more oxygen in to the wounds to encourage healing.

Surgery can also be required to ensure any unhealthy tissue that is preventing healing is removed from the the wound. Surgery is often performed prior to VAC or hyperbaric therapy.

Any identifiable contributing factors must also be addressed e.g. smoking, malnutrition, uncontrolled diabetes.

Smoking of course is an absolute "no-no". Regardless of the severity of the wound, it is important the patient's diet is optimized to ensure the patient is eating enough of the nutrients required for normal healing (like protein, zinc, vitamins A and C). Diabetic patients must also be re-evaluated to ensure their blood sugar levels are under good control.

Here's a blog post that may also be helpful:
http://breast-cancer-reconstruction.blogspot.com/2010/11/how-to-boost-healing-after-surgery.html

I hope this info helps.

Dr C
http://www.PRMA-enhance.com

Two factors...

The first is the type of procedure. Immediate breast reconstruction, at the same time as a skin-sparing or nipple-sparing mastectomy, is associated with the least amount of scarring. These types of mastectomies preserve all the natural breast skin envelope and minimize the amount of scarring. Nipple-sparing mastectomies also preserve the nipple and areola.

The second factor is the patient. Some patients simply heal with nicer scars than others. This is due to factors such as age, genetics and other medical conditions.

I hope this info helps.

Dr C
www.PRMA-enhance.com

Most flap procedures require similar recovery time (4-6 weeks) in terms of resuming most activities and returning to work. In terms of the initial hospital stay after surgery, microsurgical procedures (eg perforator flap) typically need a couple of days longer compared to non-microsurgical procedures (eg lat flap).

Dr C
www.PRMA-enhance.com

At PRMA, GAP flap patients typically stay in the hospital for 3 or 4 days after their initial reconstructive surgery. Recovery is 4-6 weeks in terms of returning to most activities.

Three months later, a second surgery is performed known as "stage 2" or the "revision stage". This includes optimizing breast symmetry and buttock contour, scar revision and nipple-areola reconstruction (if needed). Stage 2 is performed as an outpatient procedure for local patients. Out of town patients usually stay overnight. Recovery is a few days.

The final stage involves tattooing of the reconstructed nipple-areola. This is an office procedure which requires an hour or so out of your day.

All stages are performed 3 months apart.

I hope this info helps.

Dr C
http://www.PRMA-enhance.com

We typically have patients wear a surgical bra for 3 weeks after surgery.

Dr C
http://www.PRMA-enhance.com

Most plastic surgeons agree the safest time is AFTER completion of the radiation therapy. Radiation after a tissue reconstruction (eg diep flap, tram flap) can cause the reconstructed breast to shrink and harden. Unfortunately, this is a fairly common scenario. Less frequently (more so with with heavy radiation doses), new wounds can develop in the reconstructed breast which need wound care. Patients facing radiation after flap breast reconstruction should know that there is a risk of needing further reconstructive surgery to correct changes caused by the radiation therapy. One study found a re-operation rate of almost 30% in patients receiving radiation after TRAM flap reconstruction.

Some surgeons will offer immediate DIEP flap reconstruction (i.e. DIEP at the same time as the mastectomy) even though radiation is planned after the mastectomy. I would only consider this if your surgeon has a very good working relationship with a radiation oncologist experienced with radiating flaps. Even though radiation protocols are the same throughout the country, some radiation oncologists have more experience with radiating flaps than others and can deliver the radiation in a more "flap friendly" way to decrease the risk of complications without compromising cancer treatment.

I hope this info helps.

Dr C
http://www.PRMA-enhance.com

The medication Gabapentin can help some patients with persistent hypersensitivity after breast surgery. I would look into that if you haven't tried that already.

Dr C
http://www.PRMA-enhance.com

Preferably immediately after diagnosis. I feel it is very important for patients to learn about all their breast cancer treatment options, including breast reconstruction, at the very beginning of their journey. This is the only way to ensure they are truly involved in their treatment plan. It also allows those patients interested in immediate breast reconstruction to pursue it if they are candidates. For those that may not be candidates, knowing they will have the option once all their other breast cancer treatment is completed is often a huge source of strength.

Dr C
http://www.PRMA-enhance.com

Please research all your options yourself, not just the ones presented to you by your physician(s). Just because your surgeon doesn't offer you a certain procedure, doesn't mean you're not a candidate. Unfortunately, some patients will have to travel for the procedure they feel most comfortable pursuing.

Dr C
http://www.PRMA-enhance.com

Women that have had a previous TRAM flap, tummy tuck or very extensive abdominal wall surgeries (like complex repairs of huge hernias) cannot have a DIEP or SIEA flap reconstruction because the lower tummy tissue that is needed has already been removed, disconnected or moved around.

Having said that, most of the time previous abdominal surgery really isn't an issue.

Many women these days have had a previous c-section or hysterectomy. It is possible for these procedures to cause damage to the blood vessels needed for DIEP flap surgery but this is rare. A previous c-section, hysterectomy, or tubal ligation is not a contra-indication to having the procedure.

If your surgeon is worried about potential damage from previous surgery then certain tests can be performed to examine the anatomy more closely. This can include a simple doppler ultrasound exam in the office or a more involved test like a CT angiogram.

While previous abdominal surgeries may not prevent DIEP flap reconstruction, women that have had multiple previous abdominal procedures are at increased risk of abdominal complications like bulging and even hernia after DIEP flap surgery when compared to women that have never had prior abdominal surgery.

Some medical issues can make any form of microsurgical breast reconstruction (including the DIEP flap) more difficult and also increase the risk of complications like flap loss. These include disorders that make the blood clot more easily (eg Factor V Leiden).

I hope this info helps.

Dr C
http://www.PRMA-enhance.com