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I. Initial consultation
A. Immediate reconstruction (reconstruction at time of mastectomy)
can be scheduled within 72 hours if:
- Patient recently diagnosed with breast cancer
- Patient has need for mastectomy as soon as possible
- 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:
- Patient has previously had mastectomy
- Patient has congenital chest wall deformity (Poland’s
syndrome)
- Patient has suffered breast implant failure and needs augmentation
with her body’s own tissue
C. Visit usually ~90 minutes
- Obtain patient history and discuss options
- Physical examination
- Clinical photography Initiate plans for scheduling surgery
(as noted above)
- Instruction packet given
- Need for lab tests determined
II. Pre-op visit
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
- Nothing to eat or drink after midnight
- Time to arrive and directions to check-in
- Instructions for family members
III. First Stage Reconstruction
A. Soft tissue restoration and transfer
- First night in SICU
- Following 3 nights in regular hospital room
B. Post-op visit
- One week after surgery
- Usually ~15 minutes
- Check reconstructive sites
- Removal of drains if indicated
- Instruction for wound care and activity
- Review of care instructions for out-of-town patients
C. Follow-up visits
- Usually ~15 minutes
- Check reconstructive sites
- Suture removal if indicated
- Initiate planning for Second Stage Reconstruction
IV. Second Stage Reconstruction
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
- Nipple reconstruction
- Breast contouring and refinement
- Donor site scar revision or contouring if required
- Reduction, augmentation, or breast lift on opposite side if
required for symmetry
D. Pre-op visit Usually ~30 minutes
- Discuss plan and patient wishes, concerns
- Apply pre-surgical markings
- Clinical photography
- Review consent forms
- Instructions for patient and family
1. Nothing to eat after midnight
2. Time to arrive and directions to check-in
E. Post-op visit
- May be arranged with local physician for out-of-town patients
- One week after surgery
- Usually ~15 minutes
- Check reconstructive sites
- Removal of drains if indicated
- Instruction for wound care and activity
- Initiate planning for Third Stage Reconstruction
V. Third Stage Reconstruction
A. 8 weeks or beyond Second Stage Reconstruction
B. Pigment application (medical tattooing)
to nipple areol
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 |
