Implant-based reconstruction is done in two stages. The first stage is inserting the tissue expander either above or under the pectoral muscle (chest muscle). Please discuss where your tissue expander will be placed with your respective plastic surgeon. The tissue expander is used to stretch the skin and muscle to create a pocket for the permanent implant. After two weeks, once your incisions are healed, your plastic surgeon will start inflating the tissue expander with normal saline (salt water). The expansion process will take place every one to two weeks in the clinic.
Using a needle and syringe, normal saline is injected into the tissue expander to stretch the skin and muscle to create space for the permanent implant.
Permanent implant-based submuscular (beneath the muscle) breast reconstruction. After the last expansion, there is a healing phase of approximately 3 months before the tissue expander is removed and a permanent implant is put in place.
Planning for your operation
If you were given a prescription, and asked by your plastic surgeon to wash your skin with antibiotic soap, please wash your chest area (from the collar bone down to your belly button) every day starting 7 days before your operation.
Your surgeon will discuss with you if you need to purchase a supportive surgical bra. You will be asked to bring this with you to your operation.
How long will I stay in the hospital?
- For tissue expander insertion at the same time as mastectomy (immediate breast reconstruction) – overnight hospital stay.
- For tissue expander exchange to permanent implant – day surgery (you will go home the same day of your surgery).
- For tissue expander insertion after having a previous mastectomy (delayed breast reconstruction) – day surgery (you will go home the same day as your surgery).
How long will it take to recover?
The average recovery for tissue expander insertion is 3 to 4 weeks. You will be unable to do any heavy lifting of more than 10 lbs for 4 to 6 weeks after your operation. As well, you will be unable to lift anything over 10 lbs for the first 24 hours after your tissue expander inflation.
The recovery for implant insertion is 2 to 3 weeks. You will be unable to do any heavy lifting of more than 10 lbs for 4 to 6 weeks after your operation.
Most people having this operation do not require a pre-admission appointment.
If you do, you will be notified by your surgeon's office. Depending on your needs, this visit may take
2 to 5 hours and takes place a week or so before your operation date.
Pre-Admission Clinic
Toronto General Hospital
Eaton Building – Ground Floor, Room 400
Phone: 416 340 3529
Fax: 416 340 5191
TGH Maps & Directions
- Your health card (OHIP card). If you do not have an OHIP card, please bring another form of government-issued photo ID, such as a driver's license or passport.
- Your health card and any other insurance cards. You will need the policy number of your extended health insurance, if you have any.
- Your spouse/partner, a trusted friend or a family member to offer you support and be a second set of ears.
- All the medications you take in their original containers. This includes prescription medications, over-the-counter medicines, vitamins, supplements and herbal or natural products.
- A copy of your power of attorney for personal care and/or advanced directives.
- A list of any questions that you may have about the operation and recovery.
- The name or phone number of your pharmacy, as well as any medical specialists that you have seen in the past 3 years. If you have had a cardiac stress test, echocardiogram and/or a pulmonary function test in the past 3 years, it would be helpful to bring a copy of the final report with you to this appointment.
- You will have blood tests and routine skin swabs. The swabs are taken from your nose and other areas of your body to check for germs that can cause infections.
- You may also need an
ECG to check your heart and a chest
x-ray to check your lungs.
- You will meet many health care providers during your pre-admission visit. Please feel free to ask them any questions that you may have:
A pre-admission nurse will review your health history and give you information to prepare you for your operation, including directions for
cleaning your skin, eating before operation, taking your medications, and pain management.
A pharmacist will review your medications.
- Depending on your needs, you may also meet:
An anesthetist who will review your health history, discuss your anesthetic plan and pain relief after operation.
A member of the medicine team, if you have other complex health problems.
Stop eating food by midnight on the night before your operation. Your stomach needs to be empty.
-
STOP eating food by midnight on the night before your operation.
- You may drink clear fluids up to 5 hours before your operation.
- Examples of clear fluids you can drink:
- Apple juice
- Beef or chicken broth (no noodles or vegetables)
- Orange juice (without pulp)
- Grape juice
- Jell-O or popsicles
- Cranberry juice
- Pop (such as ginger ale, 7-Up, Coke)
- Lemonade
- Water
- Coffee or Tea (no milk)
Arrive
2 hours before your scheduled operation time:
Surgical Admission Unit (SAU)
Toronto General Hospital
Peter Munk Building – 2nd Floor, Room 310
TGH Maps & Directions
All hospital entrances are open by 6 am. However, Elizabeth St. and University Ave. are easiest to access.
- We will prepare you for the operation.
- If you did not see the anesthetist in the Pre-Admission Clinic, you will meet them before your operation.
- We will mark the area where we are doing your operation.
- We will give you a small needle with Heparin, a medication to help lower the chance of developing blood clots.
- We will give you an intravenous (IV) drip. This is a small needle that we put in a vein in your arm. We use it to give you one or all of the following: fluids; antibiotics; pain medications.
On this page, you can read all about what to expect during your hospital stay. Or, just click on one of the links below, to get the answer you want right now.
- You will wake up in the
Post Anesthesia Care Unit (PACU) and stay there for
1 to 2 hours.
- Once you are ready to leave the PACU, you will be moved to the
Breast Restoration and Plastic Surgery Inpatient Unit at Toronto General Hospital or
Short Term Care Unit – 18B at Princess Margaret Cancer Centre.
- You will be attached to some or all of these tubes:
-
IV – We usually take the IV out as soon as you can tolerate an oral diet.
-
Oxygen – Oxygen helps you breathe. This will be delivered through nasal prongs.
-
Jackson Pratt drain(s) (JP) – Placed at your surgical site to drain fluid.
- The nurses will give you a medication through the IV (antibiotics, anti-nausea).
- You will have dressings on your surgical incisions.
- Initially after your operation, you may feel drowsy and tired.
- You may experience some pain at your surgical sites and/or nausea; we will manage your symptoms with medications.
- You may feel some tightness in your chest.
- After breast reconstruction surgery, it is normal to feel stiff in your back, chest, shoulders and arms.
- It is important to do range of motion exercises and walk post-operatively to encourage circulation.
- At home, you will be able to do light activities of daily living (e.g., walking, toileting, getting dressed, personal hygiene)
- We will send a referral to the Local Health Integration Network (LHIN) to arrange for a nurse within your community to help you to take care of the drain.
You can expect to be discharged the same day of your operation or the next day. Your health care team will talk to you about your stay once you're out of the PACU.
Please monitor the surgical sites for signs of infection (increasing redness, pain, fever). If you are concerned about the surgical site, please contact your surgeon's office or return to the emergency department at the hospital where your operation was performed.
- There are no dietary restrictions; you may eat what you can tolerate.
- If you have a clear dressing on your surgical site, you will be asked to leave this on until your follow-up appointment.
- If you have a fabric type of dressing, this can be removed 48 hours after your operation. Leave the Steri-Strips (paper tapes) along your incision until your follow-up appointment.
- You will not be unable to do any heavy lifting of more than 10 lbs for 4 to 6 weeks after the operation. This includes pushing heavy objects.
- You will be given a prescription upon discharge from hospital; please take your medications as directed.
- If you were given a prescription for antibiotics, please take them until your drains have been removed.
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DO NOT drive when you are still taking pain medications.
- You may start driving once you are able to check your blind spot safely and you must feel comfortable to make a sudden jerky movement in case of an emergency.
Go to your nearest emergency department if you see these signs of infection:
- Your temperature goes higher than 38°C (100°F) and lasts longer than 24 hours.
- If you feel chills.
- If your incisions or the skin around you incisions is bright red, hot and swollen.
- Your incisions are leaking white fluid or pus.
- Your incisions have pus that smells bad.
The Nurse Coordinator is your first place to call for post-operative questions:
Agnes Wisniewski RN, BScN, MN
Phone: 416 340 4800 ext. 5161
You can also
call your surgeon's office for more information.
Before you leave the hospital you will be reminded to call your surgeon's office to schedule a follow-up appointment:
When
About 2 weeks after the operation.
Where
There are two clinics associated with the Breast Reconstruction Program.
Princess Margaret Cancer Centre |
Maps & Directions
2nd Floor, M. Lau Breast Centre.
Toronto General Hospital |
Maps & Directions
7th Floor, Plastics Clinic
What to Expect
- Your surgeon will assess your surgical sites for their healing progress and speak to you about your recovery.
- If you had a tissue expander inserted, you most likely will have your first inflation at this clinic visit.
- Your surgeon will let you know when you should return for a second follow-up during this appointment. You will be required to call the office to schedule this.
What to Bring
You will need to bring your health card to your appointment.
