Enhanced Recovery Protocols Reduce Pain Downtime After Breast Reconstruction Surgery

Enhanced Recovery Protocols Reduce Pain, Downtime After Breast Reconstruction Surgery.

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Choosing whether to have breast reconstruction surgery—and whether to get implants or autologous reconstruction—is one of many decisions patients with breast cancer face. 

Though the majority of patients choose implants, more women are choosing autologous reconstruction, which uses tissues transplanted from the abdomen to shape breasts that look and feel more natural.

Five to 10 years ago, patients who chose autologous reconstruction spent several days in the hospital and were prescribed narcotic medication for post-surgical pain, which could last up to a month. 

Now, our patients who receive autologous reconstruction leave the hospital two or three days after surgery—and sometimes even drive themselves home. Many of them are going back to work or on long walks around the neighborhood just a week later because of:

  • Muscle-sparing surgical techniques
  • Precise pain targeting
  • Collaborative decision-making between patients and care providers

By consistently listening to patients’ concerns about breast surgery, we have developed protocols to reduce patients’ pain and discomfort during recovery and help them feel more like themselves again faster.

Minimally invasive technique spares muscles.

MedStar Washington Hospital Center is one of only a few treatment centers that specializes in deep inferior epigastric perforator (DIEP) flap breast reconstruction. In these microsurgery procedures, a specialized plastic surgeon transfers abdominal fat, skin, and blood vessels to a patient’s chest, reattaches these tissues, and artfully shapes a new, natural breast. 

In nearly every DIEP flap, nerves from the abdomen are also reconnected to the chest to enhance sensation in the new breast. 

The surgeon does not remove a patient’s muscle during a DIEP flap procedure. This technique not only prevents the pain associated with removing muscle but also helps patients retain their core strength to resume physical activity faster. For some patients, this means getting back into triathlon training. For others, it means being able to lift their grandchildren again.

Timing of the surgery.

Plastic surgeons partner closely with breast surgery colleagues to determine the best time to perform the reconstruction, based on each patient’s cancer treatment plan. For example, radiation can increase the risk of surgical complications such as infection or wound healing issues. If a patient doesn’t need radiation therapy after mastectomy, we often recommend immediate DIEP flap reconstruction, which is performed at the same time as the breast cancer surgery. 

For patients who need radiation therapy after their mastectomy, we’ll perform a delayed reconstruction. During the mastectomy, we place a temporary tissue expander in the chest to maintain the shape of the breast. After radiation is complete, we remove the expander and perform the surgery. 

A DIEP flap procedure can take 6-10 hours, compared to a few hours for implant reconstruction. However, the results will last the rest of your life.

Surgical procedures at @MedStarWHC help #BreastCancer patients recover from #BreastReconstruction faster and with less pain. Some patients even drive themselves home a few days after surgery: https://bit.ly/3B526V0.
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Precise pain management improves recovery.

The narcotic pain medication typically prescribed after autologous reconstruction can cause drowsiness and lethargy in addition to the physical pain and discomfort that follow surgery. 

By reducing patients’ pain overall, we reduce their need for narcotics and help them get back to everyday life, from work to child care, faster—without sacrificing pain relief.

We accomplish this through:

  • Nerve blocks: We inject numbing medication into nerves within the chest and abdomen that signal pain. The numbing effect lasts a few days after the surgery, lessening the patient’s pain—and the need to treat pain.
  • Over-the-counter medicine: Days before and after surgery, the patient takes a combination of non-narcotic medications, including Tylenol and anti-inflammatories, to lower their pain. 
  • Movement: Physical therapists help patients get up and moving as soon as possible to regain strength and mobility and reduce stiffness and swelling. The sooner you can get back to your normal activities, the better you’ll feel.

Patient comfort is our priority.

The last thing we want is for recovery to cause feelings of fear and anxiety. Our goal is to continually advocate for our patients and provide the highest level of comfort. My plastic surgery colleagues and I collaborate with breast surgeons, anesthesiologists, and physical therapists to ensure we’re listening and responding to each patient’s unique needs.

Every step of the way, we’ll partner with you to help you make the best choice of all the options that might work for your body and lifestyle. In every discussion with patients, we explain the risks and benefits of all available reconstruction procedures. 

Many patients don’t know what autologous reconstruction is until they meet with us. It’s not the best option for everyone, but you can’t make an informed decision without being properly educated.

We encourage you to ask every question you have and are happy to share several resources, including pictures and videos. The more transparent we can be, the more confident you can feel in your decision. We’re here to guide you on your journey to a fulfilling life after cancer treatment.

Breast reconstruction surgery is an important, personal decision.

Meet with a team of surgeons and pain management specialists to learn all of your options.

Call 202-877-DOCS (3627) or Request an Appointment

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