Ask the Doctor: Breast Surgery and Reconstruction

Dr. Christine Hannaway is a General Surgeon located in Seaford, DE.  She is a member of the Nanticoke Physician Network and practices at Nanticoke Memorial Hospital.  Dr. Hannaway also serves as the Physician Liaison for the Committee on Cancer at Nanticoke Memorial.

Q: How do I make the decision with my doctor to have a mastectomy or lumpectomy?

Many variables come into play when making this decision.  The primary factor will be your cancer diagnosis and predicted aggressiveness of the tumor.  For most early stage breast cancers, mastectomy or lumpectomy can provide equivalent outcomes for prognosis and lifetime risk of recurrence.  However, lumpectomy will require the addition of radiation therapy for invasive cancer diagnoses.  Other factors that may influence your final decision are your lymph node status, your age, your breast size, your desire for reconstruction, and what regimen of adjuvant therapy you will require after surgery.

Understanding each of these variables and discussing them with your surgeon, oncologists and plastic surgeon is the best way to make a decision you are comfortable with.   
Q: What can I expect as recovery time after a lumpectomy vs. mastectomy? How long will I be out of work? How long before I can shower? Drive? Exercise?

On average total recovery time is two to three months with either procedure. If you have an axillary dissection instead of sentinel node, your recovery may be on the longer side. Depending on the type of work you do, expect to be out a minimum of two weeks, more if you need to use your upper body a lot. Driving is restricted at any time you are still using narcotic pain medication. Your ability to fully move your arm on the side of your surgery will also restrict your driving. You may shower as soon as 48 hours after your surgery.If your surgeon placed drains under your skin, you will have to wait until these are removed before showering. Exercising is encouraged immediately after surgery but should be tailored to where you are in your healing stage. Walking, climbing stairs, doing simple activities of daily living can be started right away. You want to avoid high impact exercise for the first few weeks to minimize trauma to your breast or mastectomy site. After two weeks, you will be given special exercise instructions to follow which help you recover range of motion and strength in your arm and chest. 

Q: How long after surgery until I can start chemotherapy or radiation?

The determining factor for starting adjuvant therapy is the healing of your incisions and which order of treatment your oncologist has recommended. With normal wound healing, you may start chemo between 2 and 4 weeks post-op. If you will be treated with hormone receptor antagonists only, your therapy can start even sooner. Radiation therapy usually starts 4-6 weeks post-op. If you have any problems with your wound, treatment will be delayed until these have resolved. Your oncologist and radiation oncologist will be able to outline your treatment schedule in more detail.

Q: What can I do to make myself more comfortable after surgery?

You want to invest in a comfortable post-mastectomy garment regardless if you are having a lumpectomy or mastectomy. These tend to fit like camisoles but open full length in the front. They may have special pockets for your drains. And many will come with different size inserts to pad and fill the area where you had your surgery. These garments are expensive, ranging between $50 and $100; however a portion of the cost may be covered by your insurance. Ask them and be sure to get a prescription for the garment from your surgeon. Area specialty lingerie shops offer these garments for sale. Other good alternatives are zipper front athletic bras or soft full-coverage wireless bras with front closures. Bring your garment and soft slip on clothes to the hospital. Your nurses can help you get dressed that first time. 

One of the most difficult times for any woman with breast cancer is that first time you see yourself after surgery. I encourage my patients to have a good support network in place ahead of time. A close friend, sister, daughter or mother who can be available for you at this time. In addition to your loved ones, reach out to your community through your church, hospital cancer support groups, and the community. Many of these people want to help you. And some may even be women who have already conquered the many challenges you will face, such as the Peer Mentors available through the DBCC.
Q: Should I have surgery and breast reconstruction at the same time?

Whether a woman chooses breast reconstruction depends on the type of surgery she is having as well as her personal preferences. Most commonly, a woman elects reconstruction following a mastectomy, either immediately or delayed. Sometimes a woman may have smaller sized breasts and if choosing a lumpectomy, she may find her breasts to be asymmetrical after healing. In this case, reconstruction might be desired to correct the size difference. This too can be done immediately or in a delayed fashion.  Your choice of when to have the reconstruction will depend on whether you need radiation therapy and your plastic surgeon’s preference for timing of reconstruction relative to your cancer treatment. The type of reconstruction, implant versus tissue transfer, will also influence the timing thus it is important to discuss your reconstruction options with a plastic surgeon early while you are discussing surgical and medical treatment options with your cancer care team.    

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