Information - Consultation
The Doctor will discuss with you the operative
procedure, provide written information about the possible
risks and complications of the operation, and the results
that have been obtained, both good and bad. A physical
exam is done. Dr Capuano can evaluate the tissues, previous
scars if present, presence of significant masses, and
so forth. Your family doctor is usually notified of
your situation. If you should decide on surgery then
correspondence with your family doctor along with your
insurance carrier would be needed to indicate the
reasons for surgery and the plans. Pre-certification
will be needed in most cases. Many times weeks are needed
to clear the procedure with insurance companies. Insurance
companies, if presented a clear enough picture of the
probability of developing cancer, do pre-certify and
payment for the removal of the tissue and the reconstruction
is available. If you are under the care of an oncologist
or radiation therapist for treatment of prior breast
cancer then the assistance of your oncologist or radiation
therapist can be helpful.
Preparation for Surgery
Prior to surgery, we ask that you refrain
from taking aspirin or products containing aspirin for
at least two weeks before your surgery. Do not eat apples,
as they contain an aspirin-like substance. Avoid omega
fish oils as they have properties similar to aspirin.
Avoid eating large amounts of garlic as it too thins
the blood. Shower for three evenings including the night
before surgery. Use Dial or Safeguard soap. Please do
not apply lotions, creams or powders before surgery.
Surgery usually requires admission to the hospital,
usually on the morning of surgery. Before coming to the
hospital, you should again shower with Dial or Safeguard
soap (unless you are allergic to such soaps, in which
case please ask the Doctor which soap to use). Also
brush your teeth and use a mouth wash. Do not eat or
drink anything after midnight for anesthesia safety
reasons. In certain cases, the surgery can be accomplished
as an out-patient surgery or an overnight stay. Usually
at least an overnight stay is warranted if not a few
days in the hospital.
You will be in the pre-anesthesia area Here
you will be seen by the hospital staff, Doctor Capuano
and the anesthesiologist. Doctor Capuano may outline
the areas of incision. You will have an opportunity
to ask questions before surgery. After your chart is
checked medication to decrease nervousness is usually
The operation involves using incisions beneath the
nipple and in the lower portions of the breast. The
central part of the nipple which has milk ducts in
it will usually be removed.
Blood is rarely if ever needed during the procedure.
If there is a history of easy bleeding then donating
blood prior to surgery may be considered.
The tissue removed is then sent to the pathologist
for examination. If cancer should be detected (rare)
then a decision has to be made about further surgery
but usually nothing further needs be done. You must
have confidence in Doctor Capuano that he will use
his best judgment if such a rare situation should
Rebuilding the Breast
The methods of rebuilding the breast are
many. The current methods are described below.
SALINE OR SILICONE GEL IMPLANT: A saline or silicone gel prosthesis
can be used for immediate reconstruction. This method
can give a very acceptable final result. Sometimes
no other surgery is necessary, however in some cases
another operation is indicated to replace the prosthesis
for a larger prosthesis. This is done as an out patient
TISSUE EXPANDER: A tissue expander is like a balloon
made of SILICONE and is filled with sterile water.
More sterile water may be added after the operation
to make the balloon bigger. The expander will be replaced
with a PROSTHESIS. This is done as an outpatient procedure.
EXPANDABLE PERMANENT PROSTHESIS: There are hopes that
such prostheses will prevent the need for two or more
surgery. However as with any prosthesis, leakage can
occur and it would be necessary to replace it.
REPLACEMENT WITH SKIN AND FAT: Skin and fat from the
abdomen can be used as replacement tissue. This can
be carried out in several ways. If you have excessive
skin of the abdominal area, you might be interested
in such surgery. It is sometimes difficult to fashion
both breasts from abdominal tissue however.
Which method will be used ? Doctor Capuano will need
to evaluate and discuss the options that seem best.
Factors such as previous operations, size requests
and your tissue quality, among other factors, are
considered. The amount of bleeding, condition of the
skin, type of breast disease, presence of infected
material, scars, and so forth, will influence decisions
during the operation. Thus the final method of reconstruction
is determined during the operation.
After surgery a bulky dressing in put in place. Tubes
(drains) may or may not be present to drain fluid.
They are usually in place for a day or two.
AFTER DISCHARGE FROM THE HOSPITAL
OR THE AMBULATORY CENTER
You will be given medications for swelling,
discomfort and to prevent infection. All medications
should be taken as prescribed. If you have a problem
with a medication, please call the office. "Black
and blue", swelling, localized areas of discomfort
and temporary numbness are expected and usually take
one to two weeks to resolve.
If you experience a sudden onset of discomfort and/or
swelling, and/or fever and/or drainage, please call
the office promptly. You should rest and relax at
home following your surgery. Do not engage in any
stressful activities. You should keep your elbows
generally at your sides. If you are unsure of any
activity, please call the office.
At the time of your first office visit, the dressing
will be removed. You will be advised regarding wound
care. Showers are usually permitted after a few days.
Sutures are removed during the first two weeks sometimes
longer. Secondary surgery is needed in a number of
cases. Most commonly such surgery is to replace the
prosthesis or expander (balloon) and to adjust the
size of the permanent silicone prosthesis. Revision
of scars, release of "capsular contracture", revision
of nipples, changing the position of the nipples or
other surgery may be beneficial.
SCARS are the most frequent complication (actually a
natural consequence of surgery). Usually scars heal
well. At first they may be red, spread, thick and even
painful. Few remain that way. It does take time (months).
CAPSULAR CONTRACTURE: The breast becomes slightly to
very firm around the silicone prosthesis. A capsule
forms in each and every case where a prosthesis is implanted.
Only time can tell how firm a capsule will be.
CAPSULAR CONTRACTURE - WHAT CAN BE DONE?: As we
have noted,a capsule forms around the breast prosthesis.
This happens in each and every case In some cases
the capsule is thicker and/or firmer than in others.
In some it is more bothersome than in others. There
are several ways to try to remedy a firm capsule when
medications fail. One way is to massage the area and
gently squeeze the prosthesis. This causes softening
of the capsule in many instances.
CAPSULAR FRACTURE: This is not done anymore. It is
presented for historical interest only. Historically
it was done by squeezing at the base of the capsule,
pushing the prosthesis through the capsule and thus
tearing open the capsule. This procedure was associated
with problems. Since the capsules torn or burst open
(somewhat like a grape being pushed out of its skin),
there would be tearing of tissue. Upon tearing, bleeding
would occur. Usually it was minimal, however there
have been severe cases reported. In these cases the
patient had to be taken to the operating room to control
bleeding. The prosthesis could usually be put back
in place after removal of the blood. END OF HISTORICAL
OPEN CAPSULAR SURGERY: Surgery is usually done under
a general anesthetic for comfort. Other methods such
as sedation (sleepy-like state) can be used. Capsular
surgery usually involves the original incisions so
that no other scars are produced. The prosthesis is
removed. The capsule is then opened surgically. The
prosthesis is replaced and the wound closed.
We try to minimize hospital stays. Whenever out patient
surgery is possible, it is used.
REMOVAL OF A PROSTHESIS: While this is rare, it has occurred.
As a residual, the scars left from the original surgery
will be present and permanent.
You should request surgery only if you are confident that
the possible benefits of this procedure outweigh potential
risks. No one can predict the exact outcome of surgery.
While good results have been obtained in the past, no
guarantee can be given.
TIME AWAY FROM WORK: The estimated time away from work
is usually three weeks to six weeks and depends to a large
extent upon the prompt healing of the wounds and the absence
It also depends on the nature of your job. Three to four
weeks is needed before moderate activity can be resumed.
Four to six weeks or more may be needed if heavy work
must be done. Those individuals with jobs requiring extensive
and/or repeated use of the arms may require more time
away from work. Please discuss your job activities with
the Doctor so you may obtain a better estimate of time
away from work.
SUBCUTANEOUS MASTECTOMY requires understanding before
surgery. If you have questions, you are encouraged to
ask them. Do not request and consent to surgery unless
you understand the benefits versus the risks of surgery.
This information is provided for
your general information. How such information exactly
applies to an individual would depend on a face to face
history, examination, perhaps laboratory exams and individual
treatment plan. Further, because of the nature of electronic
media and information - there is no doctor-patient relationship
but merely a general information display - THANK YOU.
BREAST SURGERY TO
SAVING THE NIPPLE
AND SKIN OF THE BREAST