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Reconstructive Timeline

I. Initial consultation

A. Immediate reconstruction (reconstruction at time of mastectomy) can be scheduled within 72 hours if:

  1. Patient recently diagnosed with breast cancer
  2. Patient has need for mastectomy as soon as possible
  3. Coordinated with our Breast Oncologic Surgeons to be done in conjunction with mastectomy

B. Delayed breast reconstruction is usually scheduled 3 to 4 months or beyond initial consultation if:

  1. Patient has previously had mastectomy
  2. Patient has congenital chest wall deformity (Poland’s syndrome)
  3. Patient has suffered breast implant failure and needs augmentation with her body’s own tissue

C. Visit usually ~90 minutes

  1. Obtain patient history and discuss options
  2. Physical examination
  3. Clinical photography
  4. Initiate plans for scheduling surgery
  5. Instruction packet given
  6. Need for lab tests determined


II.
Pre-op visit - Refer to initial consultation is visits are combined

A. Usually ~30 minutes
B. Review consent forms if not completed at initial visit
C. Review plan and discuss remaining questions or concerns
D. Apply operative markings
E. Pre-surgical instructions reviewed

  1. Nothing to eat or drink after midnight
  2. Time to arrive and directions to check-in
  3. Instructions for family members


III.
First Stage Reconstruction - Inpatient Hospital Stay

A. Soft tissue restoration and transfer

  1. Requires 4 day Inpatient hospital stay

B. Post-op visit

  1. One week after surgery
  2. Usually ~15 minutes
  3. Check reconstructive sites
  4. Removal of drains if indicated
  5. Instruction for wound care and activity
  6. Review of care instructions for out-of-town patients

C. Follow-up visits

  1. Usually ~15 minutes
  2. Check reconstructive sites
  3. Suture removal if indicated
  4. Initiate planning for Second Stage Reconstruction


IV. Second Stage Reconstruction
- Outpatient Hospital Procedure

A. 8 to 12 weeks or beyond First Stage Reconstruction
B. Delayed until chemotherapy or radiation completed if required
C. Procedures done on outpatient basis

  1. Nipple reconstruction
  2. Breast contouring and refinement
  3. Donor site scar revision or contouring if required
  4. Reduction, augmentation, or breast lift on opposite side if required for symmetry

D. Pre-op visit Usually ~30 minutes

  1. Discuss plan and patient wishes, concerns
  2. Apply pre-surgical markings
  3. Clinical photography
  4. Review consent forms
  5. Instructions for patient and family
  6. Nothing to eat after midnight
  7. Time to arrive and directions to check-in


E. Post-op visit

  1. May be arranged with local physician for out-of-town patients
  2. One week after surgery
  3. Usually ~15 minutes
  4. Check reconstructive sites
  5. Removal of drains if indicated
  6. Instruction for wound care and activity
  7. Initiate planning for Third Stage Reconstruction


V. Third Stage Reconstruction
- Dr. Allen’s Office

A. 8 weeks or beyond Second Stage ReconstructionB. Pigment application (medical tattooing) to nipple areola
C. Minor office procedure ~30 minutes to 2 hours
(depending on whether unilateral or bilateral)
D. Care instructions given
E. Return appointment scheduled


VI. Follow-up appointment

A. ~6 weeks after tattooing
B. Final check breast reconstruction
C. Clinical photography
D. Discuss scheduling annual follow-up visits




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