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Pain After Breast Reconstruction | Breast Reconstruction Associates

Pain After Breast Reconstruction

Written by Breast Reconstruction Associates on . Posted in Breast Reconstruction, Womens Health.

Most surgical interventions come with some degree of postoperative pain or discomfort. This can be a source of fear and anxiety for many patients facing mastectomy and breast reconstruction surgery. At Breast Reconstruction Associates, we use a specific pain control protocol that has proven efficacy, and we work together with patients to achieve the optimal degree of pain control. Most of our patients have been pleasantly surprised that their pain was less than expected. Here is some insight into the way we approach pain control.

While it is not feasible to guarantee a pain score of 0/10, even with adequate pain medications, we are committed to helping you remain as comfortable as is safely possible after surgery. Our goals are to reduce your discomfort to a degree that is tolerable so regular activities of daily living can be performed, to avoid over-sedation, and to avoid adverse medication side effects.

There are many different types of pain that are experienced after mastectomy and breast reconstruction—general post-operative pain of incision sites, neuropathy (nerve-related pain) and musculoskeletal pain. In our pain control protocol, we prescribe medications that target each type of pain to yield better overall pain control.

The post-operative pain medication regimen used at Breast Reconstruction Associates is aligned with the ERAS (Enhanced Recovery After Surgery) protocol.  This protocol was developed to be a perioperative strategy that promotes quicker recovery after surgery and helps patients avoid opioid-based pain medications. The medication regimen associated with this protocol is supported by evidence-based research and is used worldwide.  Our practice takes a patient-centered approach to the use of this regimen and we have had great success with our patients’ post-operative recovery.

Our patients are our priority. Your post-operative comfort and care are important to us. If you are considering DIEP flap breast reconstruction and have questions about post-operative pain, reach out to our plastic surgeons at Breast Reconstruction Associates.

FAQs

Most patients are pleasantly surprised to find their pain is less than expected. While a pain score of 0/10 cannot be guaranteed, the goal is to reduce discomfort to a tolerable level that still allows you to perform regular daily activities.

There are three main types of post-operative pain: general incision site pain, neuropathy (nerve-related pain), and musculoskeletal pain. Each type is addressed with targeted medications for better overall pain control.

The practice follows the ERAS (Enhanced Recovery After Surgery) protocol — an evidence-based, globally recognized perioperative strategy designed to promote quicker recovery and reduce reliance on opioid-based pain medications.

The ERAS protocol is specifically designed to help patients avoid opioid-based pain medications wherever possible. A multi-medication approach is used to target different pain types, minimizing the need for opioids.

The three main goals are: reducing discomfort to a tolerable level so daily activities can be performed, avoiding over-sedation, and preventing adverse medication side effects.

Yes. Breast Reconstruction Associates takes a patient-centered approach to the ERAS regimen, working with each patient individually to achieve the optimal degree of safe and effective pain control.

You can reach out directly to the plastic surgeons at Breast Reconstruction Associates with any questions about post-operative pain and recovery. They are committed to making your comfort and care a top priority throughout the process.

Common Plastic Surgery Risks | Breast Reconstruction Dallas Forth Worth, Austin & Oklahoma City, OK

Surgical Risks of Breast Surgery and Reconstruction

Written by Breast Reconstruction Associates on . Posted in Breast Cancer, Breast Reconstruction, Womens Health.

Making the decision to undergo surgery, regardless of the operation, can be overwhelming. At Breast Reconstruction Associates, we understand that discussing the surgical details in plain English as well as reviewing the potential risks involved imparts the needed information that leaves patients feeling informed and confident.

A few of the general risks associated with any surgery are bleeding, infection of the surgical site, blood clots, and adverse reactions to general anesthesia. During your consultation with your plastic surgeon, you will review these general risks as well as the risks specific to breast surgery and/or reconstruction in detail. Although most women do not experience the following complications, here is a brief preview of the risks that will be covered in your discussion:

Fluid collections

Fluid or blood (seroma or hematoma) may accumulate between the skin and underlying tissues following surgery. Drains may be left in place after surgery to prevent this accumulation. Should this problem occur after drain removal, it may require additional procedures for drainage of the fluid.

Changes in sensation

The surgery will alter the sensation to the nipple, areola and surrounding breast skin. It’s important to discuss the possible extent of these changes with your surgeon, as it will depend on what type of surgery has been recommended for you.

Potential loss of the nipple-areola complex

If you are having a procedure that spares the nipple and areola, there is a risk of decreased vascular supply to these structures which can lead to necrosis (or death). This can either be self-limiting or require intervention.

Mastectomy flap necrosis

The breast skin remaining after mastectomy can have trouble healing from a lack of blood supply. When the blood supply is low enough, breast skin can die.  This is more common in larger breasted women.  Tobacco use and previous radiation history can also increase the risk of mastectomy flap necrosis.

Delayed wound healing

Wounds may separate after surgery. This may require daily home wound care or further surgery to correct the defect.

Microvascular thrombosis

Autologous breast reconstruction is associated with the risk of clot formation within the artery or vein providing circulation to the flap. This most commonly occurs during surgery but can happen afterwards, usually within the first 24-48 hours after surgery. This requires a second operation to attempt salvage of the tissue. The risk of this occurring is low and will be discussed in further detail with your surgeon.

Failure of the reconstruction –

Regardless of the method selected (implants, DIEP flap, or other flap), the reconstruction can fail which leaves the patient with a flat chest wall.  Alternative methods would be considered if the patient elects to proceed with secondary reconstruction. In general, in properly selected patients, failure is uncommon.

At Breast Reconstruction Associates, we are committed to helping you navigate your surgical options, weigh the risks and benefits of surgery, and make the best decision specific to your care.  Reach out to our plastic surgery office in Fort Worth, Austin or Oklahoma City if you have questions. We are here as a resource for you.

FAQs

The most common risks include fluid collections (seroma or hematoma), changes in sensation, delayed wound healing, and infection. While these risks exist, most women do not experience serious complications when surgery is performed by a qualified plastic surgeon.

A seroma is a buildup of fluid, while a hematoma is a collection of blood that accumulates between the skin and underlying tissues after surgery. Surgeons often place drains after surgery to prevent this. If it occurs after drain removal, additional drainage procedures may be required.

Surgery can alter sensation in the nipple, areola, and surrounding breast skin. The extent of these changes varies depending on the type of procedure performed, so it’s important to discuss this with your surgeon during your consultation.

Mastectomy flap necrosis occurs when the remaining breast skin loses adequate blood supply and begins to die. It is more common in larger-breasted women and in patients with a history of tobacco use or prior radiation therapy.

In the event that a reconstruction fails — whether using implants, a DIEP flap, or another method — the patient may be left with a flat chest wall. Alternative reconstruction methods can be explored if the patient chooses to pursue a secondary procedure. Failure is uncommon in properly selected patients.

Microvascular thrombosis is the formation of a clot in the artery or vein supplying blood to a reconstructed flap. It most commonly occurs during surgery or within the first 24–48 hours afterward and requires a second operation to attempt to save the tissue. While serious, the risk is considered low.

The right reconstruction method depends on several individual factors, including your body type, medical history, cancer treatment plan, and personal goals. A consultation with a board-certified plastic surgeon at Breast Reconstruction Associates will help you weigh the risks and benefits of each option — whether implants, DIEP flap, or another approach — so you can make a confident, informed decision.

Smoking and Breast Reconstruction Surgery | Breast Reconstruction Surgery Specialist in Dallas

Smoking and Breast Reconstruction Surgery

Written by Breast Reconstruction Associates on . Posted in Breast Reconstruction, Womens Health.

It’s estimated that there are currently over 30 million active cigarette smokers in the United States. The general health impact of cigarette smoking has been well established, and issues include elevated risk of stroke, cardiovascular disease, lung cancer and COPD. The mass distribution of this information, as well as new smoking-cessation strategies for smokers, has decreased overall cigarette consumption over the last decade. 

It’s important to know that there are multiple issues with cigarette smoking.  There are cancer-causing agents introduced to our lung, and there is also nicotine absorbed into our blood.   Nicotine has a direct impact on the health of our blood vessels.  As reconstructive surgeons, it’s the nicotine absorbed into the blood that concerns us, as this causes issues with healing after surgery.  

The recent trend in smoking behavior is in the form of e-cigarettes or “vaping”.   These e-cigarettes come in multiple forms, some with nicotine and some without.  There is new research emerging that suggests e-cigarettes come with their own spectrum of lung issues.

Its also important to know that nicotine consumption, in any form, whether it be cigarettes, e-cigarettes, gums, patches, or lozenges, still increase the risk of complications with surgery.  For this reason, your plastic surgeon will need to know if you are using any nicotine products.  At your consultation, your plastic surgeon can discuss with you in detail the nicotine-related risks of breast reconstruction, in a way that is tailored specifically to your case. You will be asked to discontinue use of all nicotine products for at least 4-6 weeks prior to your surgery date.  It is possible your surgeon will choose to test your blood or urine for the presence of nicotine.

At Breast Reconstruction Associates, your breast reconstructive specialists in Dallas, Fort Worth, Austin and Oklahoma City, we are here to help you make the best possible decision for your general health and wellbeing, as well as to prepare you for the best possible surgical outcome.

Breast Surgery for Older Women | Breast Reconstruction Associates

Breast Surgery for Older Women

Written by Breast Reconstruction Associates on . Posted in Breast Cancer, Breast Reconstruction, Womens Health.

Breast cancer is the most common malignancy affecting American women with 1 in 8 women diagnosed during their lifetime.  There are several risk factors involved in the development of breast cancer, some of which are modifiable (weight/BMI, hormone use, smoking and alcohol use) while others cannot be changed or controlled (age, genetics).  Increasing age is considered the most significant risk factor for this diagnosis, and it may contribute to the treatment decisions as chronologically advanced women may have other co-morbidities that must be considered.

As we age, our organs experience various changes that can affect surgical healing.  For example, the skin becomes thinner and has less connective tissue like collagen and elastin, all of which can lead to delayed healing.  While we cannot reverse this physiologic process, we can control other components like smoking. All nicotine products cause vasoconstriction, which makes it more difficult for the arteries to deliver necessary oxygen and nutrients to all organs and tissue.  Smoking and the use of nicotine products exponentially increases the risks of surgery and can sometimes disqualify a patient from reconstructive surgery.  We prefer that any patient undergoing reconstructive surgery be off all nicotine products for at least 6 weeks.

General anesthesia is required during breast reconstructive surgery whether using implants or autologous aka tissue-based reconstruction.  At Breast Reconstruction Associates, we use a two-surgeon team on all autologous cases to minimize the length of surgery and therefore the amount of anesthesia, which directly correlates to quicker recovery times.  Age is a consideration for these surgeries as there are increased risks of post-operative delirium and post-operative cognitive dysfunction in patients aged 65 and older.  These patients are at higher risk if they have an established diagnosis of any form of cognitive impairment.

At Breast Reconstruction Associates, we offer various reconstructive options for our patients and always involve the patients in this discussion and decision process.  Each patient is unique due to their age, medical and family history, and tumor profile among many other considerations.  We want to work with you and your breast cancer team to determine the best possible outcome, so please contact us today to set up a consultation.

Sources:
“Preparing for Surgery – Age Risks,” American Society of Anesthesiologists, https://www.asahq.org/whensecondscount/preparing-for-surgery/risks/age/.