GENERALLY SPEAKING THERE ARE THREE MAJOR TYPES OF RECONSTRUCTIVE SURGERY.
- Where an artificial prosthesis “implant” is used, frequently called “breast augmentation”.
- When muscles from your abdomen or chest wall are used to reconstruct the breast (TRAM and Latissimus Dorsi Flaps, DIEP).
- When breast tissue is removed to reduce the size of the breast.
BEFORE YOU GO TO SLEEP
If you haven’t already met your anaesthetist you will meet them either on the ward or in the anaesthetic bay on the day of your surgery. At this stage if you have any concerns or worries about your operation or anaesthetic please let them know.
Once in the anaesthetic bay you will have an intravenous drip placed and often you will be given a sedative “relaxing medication” just before going into the operating theatre. You often will not remember much after being given the sedative. Once inside the operating theatre you will have several monitors placed (these monitor things like your blood pressure, heart rate and breathing patterns). Once these are placed you will be given an oxygen mask and then receive another injection through the drip. This injection will put you “to sleep”. The next thing you will remember is waking up either in the recovery room or in the operating theatre.
For TRAM or latissimus dorsi flaps further monitoring such as temperature and arterial blood pressure measurements will generally be required as they are much larger operations.
The Operation
During the operation your anaesthetist will remain with you monitoring your operation, anaesthetic and all your vital physiological functions. They stay with you until you reach the recovery room where your care will continued by the recovery staff. While you are in recovery if you have any discomfort or feel nauseous or sick it is important that you let the recovery staff know. They can administer pain killers or anti nausea drugs if they are required. Generally speaking, if we get you comfortable by the time you leave recovery you will then have good on going pain control
YOUR STAY IN HOSPITAL
Depending on the extent of your surgery you may be able to go home on the same day as your surgery. In many cases in a fit patient having an elective breast augmentation can go home on the same day of surgery, with oral pain relief.
Breast reduction surgery may require one to two night stay in hospital.
Larger reconstructive surgery such as TRAM/DIEP Flaps or Latissimus Dorsi flaps are more complex and extensive surgeries, and require longer stays in hospital and often more complicated pain relief.
PAIN RELIEF
You will be given pain relief during your operation with the aim of having you comfortable when you wake in recovery. If you have any discomfort please let the nursing staff know, so that they can give you further pain relief if you need it.
For implant surgery and breast reduction surgery you may well be able to go home on the day of your surgery. If this is the case you will go home with prescriptions for your pain relief. Most commonly you will be sent home on a combination of regular paracetamol and a stronger pain medication such as tapentadol, codeine or oxycodone, which you can take on top of the paracetamol when needed. By taking the paracetamol regularly it will decrease the amount of the stronger pain medication that you may need. If you still have significant pain after this then please contact your anaesthetist. Oxycodone and codeine are restricted medications that must be used only for postoperative pain as prescribed specifically for you. Under no circumstances should you give them to friends or family or leave them within the reach of children. We are restricted to how many tablets we are able to prescribe with the maximum being ten.
In the case of more extensive reconstructive surgery, you may require a PCA. PCA stands for Patient Controlled Analgesia. It is a small computer device that delivers pain relief into your drip when you press a button. The best way to make a PCA work well is to start using it whenever you begin to feel pain. This way you can keep your pain under control rather than waiting till the pain is problem then trying to treat it. After 24 -48 hours we will convert your pain relief to oral tablets as above.
