For tissue expander-to-implant reconstruction following bi-lateral nipple sparing mastectomy for breast cancer, what is a typical follow up schedule starting right after the surgery for exchange to final silicon implants? I understand that healing issues could change the timing and number of post-op visits, but barring serious problems, what is the ideal number and timing over the following weeks and months? Or even years? What might it be for later revision later surgery, if necessary?
What is a Typical Post-op Visit Schedule After Implant Reconstruction?
Doctor Answers (3)
Postoperative visit schedule for two-stage implant reconstruction.
Every surgeon differs in their postoperative routine. I perform a large number of breast reconstructions with expanders and implants and my schedule is the following:
- Week 1: 1-2 visits in the first week post-surgery for first drain removal, mastectomy flap check, and monitoring.
- Week 2: Second drain removal and first fill of the expander.
- Weeks 3-?: Weekly fills of the expander until desired volume is achieved. Overfill the following week then wait for 4-6 weeks for pocket maturation.
- Earliest exchange is ~12 weeks, later for longer fill times or chemo/radiation.
After the exchange, the visits certainly space out more:
- Postoperative day 1 - Evaluate for early complication (hematoma). Assess symmetry, position, patient questions.
- Week 2 - Wound check, evaluate for contour issues, fluid, etc.
- 1 month postop, 3 month postop, 6 month postop, then yearly follow up.
- MRI (if gel implants) at 3 years, then f/u every two years afterwards.
As always, every surgeon is different and complications lead to more frequent visits. I probably see my patients more than most surgeons, but I find it leads to a better educated patient and a better result at the end. Hope this helps!
Followup for 2nd stage implant breast reconstruction
Based on your question, i gather that you have tissue expanders and are about to undergo exchange to silicone implants.
Since this is outpatient surgery, I prefer to see you back the next day to evaluate for any fluid collection or bleeding and to review postop incision care instructions. In most cases, a drain is not necessary during the exchange procedure. I then see you back at 1 week postop to evaluate your incision and ensure there are no signs of infection. At this point, we discuss implant massage techniques, scar treatment, and activity level for the next month. I then see you at 1 month postop to assess the shape, size, symmetry. At this visit, we again review the signs of capsular contracture and discuss preventive measures. I will then see you every 4-6 months for 2 years.
If a nipple reconstruction is desired, I perform these at 3 months after the exchange procedure.
I like to see patients the day after surgery
whenever possible then every 2-3 days until drains are out, then weekly depending upon chemo and radiation. I wait at least 2-3 months after chemo before performing surgery. Radiation can mean 6 month delays before revisional surgery. I overexpand as much as possible prior to final implant and then plan on revisions at six months to one year after final expansion/chemo/radiation.