Your patient journey

If you have private health insurance, please contact the company in the first instance to check that the proposed treatment is covered by your health insurance policy, they will provide you with an authorisation number. Your insurance company may offer a choice of consultants who are covered by your policy. Sometimes, the initial appointment is arranged with a consultant through your insurer. If it is not, you can contact the consultant’s secretary directly in order to arrange an appointment.

If you are self-funding, you can contact the private hospital or consultant / secretary directly yourself to arrange an appointment.

During your initial consultation, your consultant will discuss your treatment options including any risks and benefits, listen to your concerns and discuss what you wish to achieve. Together you will formulate a treatment plan tailored to your needs. Your treatment plan may be discussed with health professionals from other disciplines if you have any pre-existing medical conditions to ensure you receive the best care (e.g. breast surgeon / oncologist / cardiologist / haematologist).

With your consent, your consultant will take some pre-operative clinical photographs to form part of your medical records. Photos will be taken post-operatively for comparison.

Investigations such as blood tests and a Computerised Tomography Angiogram (CTA) or a Magnetic Resonance Angiogram (MRA) may be required depending on the type of reconstruction. This will be requested by your consultant.

A second consultation may be required to review any necessary investigations, answer any questions you may have, and go through the consent forms for the surgery together with your consultant. A second consultation allows you more time to be certain you have made the right choice about the surgery you wish to have and enable you to feel fully informed about the procedure.

The hospital will contact you to arrange a pre-operative assessment appointment where you will be medically assessed for your suitability for a general anaesthetic and lengthy surgery. You will meet an anaesthetist, discuss your current medication, any allergies you may have and information will be provided on your planned treatment and the hospital services. Your general health and fitness will be assessed by carrying out various tests and investigations, including blood pressure, blood tests and an ECG (electrocardiogram or heart tracing). Allow plenty of time as these appointments may take a few hours to complete. If you have any further questions, write them down and discuss them with the team.

Taking Tamoxifen may increase the risk of deep vein thrombosis (DVT) or pulmonary embolism (PE). If you have been prescribed Tamoxifen and are having a free-flap reconstruction (MS TRAM, DIEP or TUG/DUG/LUG flap) you will be asked to stop taking it 3 weeks before surgery and start taking it again 2 weeks after surgery. This will not affect your cancer treatment.

The hospital stay is approximately 1- 3 days. You will be discharged as soon as you are medically fit to go home.

You need to bring any medicines that you are currently taking (prescribed, over-the-counter, vitamin/mineral supplements or herbal remedies) on admission to the hospital. If you can, please bring the medication in the original packaging.

Any valuables are brought into the hospital at your own risk.

Please bring a dressing gown and slippers, as you will be asked to walk to theatres for your operation.

Free flap surgery using microsurgical techniques is complicated, and usually means you will be away from the ward for a considerable period of time (often most of the day). Your consultant can advise you on this as the timing will vary depending on the type of surgery performed.

Wound drains may be inserted into the breast and donor site at the time of surgery to allow any fluid collecting to drain away. The drainage tube is attached to a vacuum bottle where the fluid is measured.

You will usually have an indwelling urinary catheter inserted during the operation which will be removed the next day once you are mobile.

If you are having a DIEP/MS-TRAM or TUG/DUG/LUG flap reconstruction, it may be necessary during your procedure for hair close to your bikini line / lower abdomen / upper thigh to be shaved for hygiene purposes as it is close to the donor-site and wound drains may be placed here. You may want to consider your own hair removal prior to admission, we would suggest a depilatory cream or wax in advance of the surgery, do not shave.

You may be given a foil blanket to wrap around you before you go to the theatre. This is to ensure that your body temperature is maintained.

When you wake up after the surgery, you will be in the recovery area where you will stay until the nursing staff feel you are able to return to the ward. The recovery team are very experienced and they will ensure that your recovery is as comfortable as possible. After review by the team you will return to the ward, where you will be monitored closely overnight to observe your newly reconstructed breast(s).

The nurses will look at and touch your breast reconstruction / flap every 30-60 mins for the first night to monitor the warmth, colour, sensation, and blood flow. First, it is important to keep your new breast warm. You may have a heated blanket over your body for this purpose.

The nurses will remove the wound drains on the consultant’s instruction, usually on day 1-2 after surgery, depending on the amount and colour of the fluid drained. Following removal, a small amount of leakage from the wound is not unusual and a light gauze pad can absorb this. Wound dressings will be in place and changed according to daily assessment by the consultants.

You may have a PCA (patient controlled analgesia) pump inserted into a vein that will allow you to self-administer medicine for pain relief. You will not be able to overdose on this as it locks after each dose for a controlled period of time. The pain from these operations is not usually severe, although different people require varying amounts of pain relief (analgesia). You may feel some mild pain for the first few days/weeks, such as bruising and twinging.

Your blood pressure and blood oxygen levels will be monitored regularly.

You may be wearing “flotron boots” that massage your calves and/or anti-embolism stockings to help prevent DVT or PE.

Due to the slight increased risk of blood clots, if you are having a reconstruction using your abdomen or thigh (MS-TRAM, SIEA/DIEP or TUG/DUG/LUG), you will receive an injection of Dalteparin every night in hospital and be provided with a supply on discharge to self-administer at home. Instructions on administering the injections will be given by the pre-assessment team and ward nurses during admission.

You may also be instructed to wear your anti-embolism stockings for three weeks after you are discharged.

You may have intravenous (IV) fluids to hydrate you after your operation, and you can usually eat and drink normally.

Support garments are required for all types of breast reconstruction surgery. You will need to buy 1-2 supportive, non-wired bras. A sports-type bra or post-surgery bra is perfectly acceptable. The bra should be front fastening, and will be worn for 6 weeks for 23 hours a day (including night time), taken off for showering/washing only. This is to help support the underlying tissue and suture (stitch) lines while healing and prevent

After surgery there will be swelling and your reconstructed breast may seem high and sometimes firmer which may feel unnatural. However, after a while the swelling will reduce, you will feel more comfortable and your breasts will begin to look more natural. After a settling in period it is advisable to have your breasts measured to determine what new bra size you may need. This period can vary from patient to patient, but usually getting re-measured at 3-4 months is acceptable.

If you are having a MS TRAM/DIEP procedure you will need to buy medium support ‘body-shaper’ knickers to support your abdomen. Make sure they are high-waisted and extend up to just under your bra. This is to prevent them rolling down over your scar and to provide compression to your abdomen to prevent fluid collecting.

If you are having a TUG/DUG/LUG procedure you will need to buy medium support ‘body-shaper’ shorts, cycling shorts or leggings to support your inner thigh following surgery. As the scar with a DUG/LUG flap extends down your inner thigh, if you are having either of these procedures you will need to ensure your shorts / leggings are long in the leg and come down past your knee. Sports/yoga leggings may be preferable in this instance.

The physiotherapist may visit you the day after surgery and provide you with some gentle exercises to follow.

As you start to walk around more, you will be able to use the bathroom to have a shower. The nursing staff will be able to advise you depending on the type of dressing used, how you are feeling and provide assistance where necessary.

Hospital staff can provide you with a fit note (‘statement of fitness for work’ – formally known as a sick certificate). Depending on your job, it is advisable to organise 6-12 weeks off work. After this, you may want to consider a phased return to work / reduced hours, please discuss this with your employer.

Some sports can be resumed within 6 – 8 weeks, but we suggest that you check with your consultant. If the sport involves strenuous movements, for example pilates, weight lifting, and racquet sports, then it is advisable to wait 12 weeks then return gradually to these activities and ensure you wear a supportive sports bra during the activity.

You should only consider driving after surgery when sufficient healing has taken place to allow you to wear a seatbelt without pain and you are able to perform an emergency stop (practice in a car park first). Before you drive, we suggest that you check with your insurance company to ensure that you have the appropriate cover. Some companies ban driving for a specific period following surgery. Failure to comply with that condition would mean that you were driving without insurance, which the law regards as a serious offence.

Once you are at home after surgery, it is important to check your wounds. If your wounds become hot, red, swollen and painful or there is a discharge, please contact your consultant directly or the hospital where you were treated for advice.

If you have had a mastectomy at the time of reconstruction you should have an appointment with your breast / oncoplastic breast surgeon approximately 2-3 weeks after your surgery. This is when you will be given the results of the mastectomy and any further treatment that may be necessary will be discussed.

You will be given instructions by your consultant regarding an appointment for review of your wounds to check the healing progress, this will usually be around 7-10 days and may be in a nurse-led clinic. You will also receive a follow up appointment with your consultant around 4-6 weeks after your surgery.

As appropriate, follow-up appointments will be organised to discuss any further procedures that may be necessary, possible or wanted. Further procedures may include symmetrising or revision breast procedures such as breast reduction, mastopexy (uplift), lipomodelling, nipple reconstruction or micropigmentation treatment (tattooing).