You should expect to be in hospital for 3-5 days. On the day of your surgery your consultant will draw some markings on you which are used as a guide for surgery. You will also see the anaesthetist who will discuss the anaesthetic and post-operative pain management plan. If you’re having an immediate reconstruction, you will also see your breast surgeon who will be performing the mastectomy.  

Items you should bring into hospital: 

• Slippers or non-slip socks 

• Dressing gown 

• Front-fastening nightwear 

• Post-operative bra and compression underwear 

• Toiletries – all your dressings are shower-proof, so you’ll be able to have a shower during your hospital stay. 

Your bra needs to be front fastening with no underwires. This will need to be worn day and night for at least 6 weeks after your surgery as it gives your reconstructed breast support.  

Please do not bring in any jewellery and remove rings from the operated side. This is because your arm/hand is prone to swelling after the operation.  

Please note that children under 13, plants and flowers are not permitted on the ward. Ward visiting times are 11am-8pm, although visiting is not permitted during mealtimes (usually 12-1pm and 5-6pm).  

What To Expect on the Ward 

Day 0 – The day you have your surgery 

• The operation will take between 6-8 hours. You will likely feel drowsy until the following day so it’s advisable for your next of kin to telephone the ward before visiting.  

• The nursing staff will make If any problems with blood flow to the flap or bleeding occur, it would be necessary to return you to theatre to investigate the cause. 

• You’ll be nursed in bed at a 45⁰ incline with your knees bent. This is to reduce the tension on your abdominal area.  

• Do not be alarmed by the number of drips and drains you may have when you first return from theatre. This is normal for this type of surgery.  

• Bair Hugger – you will have a warming blanket on for the first night after your operation. It’s important to keep the area warm to maintain and good blood supply to the flap. You may want to bring a handheld fan to use to cool your face for the first post-operative night. 

• IV Drip – this is used to give you fluids and keep you hydrated whilst in theatre and immediately afterwards when you’re too drowsy to drink. It can also be used to give you medication if required. The drip is usually discontinued once you’re drinking enough. 

• Urinary Catheter – this will be inserted once you are asleep and allows you to pass urine without getting out of bed. For most people it is removed the morning after your surgery, however if not it will be removed once you’re up and walking around.  

• Drains – you may have drains at the site of your reconstructed breast and abdomen. Unless the drainage output is high, these are removed before you go home.  

• Oxygen – you will have oxygen administered initially via a mask and then through small tubes that sit in the nostrils. This is required until your oxygen levels have returned to normal.  

• Compression Boots & Stockings – you will wear anti-thrombus stockings throughout your admission and for 6 weeks after your surgery. In addition to this, you will have an inflatable cuff on the calves during your operation and for 24 hours afterwards. These inflate and deflate in a cycle and gently massage the calves to help your circulation to continue to flow whilst you’re less mobile.  

Day 1 

• The ward physiotherapists will come see you in the morning. If you have your surgery on a Friday or Saturday, the weekend physiotherapists may have to visit you later in the day. You do not need to wait for the physiotherapists to get out of bed but you must not try and do it alone – the nurses on the ward will help you.  

• The physiotherapists will teach you how to log roll out of bed and will help you to transfer out into a chair. If you’re able, you will go for a short walk with the physiotherapists. It’s really important that you sit out of bed on this day. This is to reduce post-operative complications such as chest infections which may prolong your hospital stay. 

• The physiotherapists will show you circulation and deep breathing exercises and show you how to perform a supported cough. They will also demonstrate your basic shoulder exercises that you’ll be doing for the first 7 days following your surgery.  

• Nausea and vomiting, light-headedness and pain are very normal the first time you get out of bed after surgery. The physiotherapists, occupational therapists and nurses are trained to help you and will monitor you throughout the process. You can help improve this by paddling your feet up and down when sitting and drinking plenty of water.  

• As you start moving there will be pain and pulling at your abdominal wounds but don’t worry, they will not split. You donor site wound will become more comfortable over the next few days.   

Day 2 / 3 

• The physiotherapists will see you again to make sure you’re able to move around and are doing your circulation, deep breathing, and shoulder exercises.  

• You’ll be advised not to try and stand up straight for the first couple of days after your operation. After this, it’s important you try and gradually stand up straighter to gently stretch your abdomen and prevent ongoing back pain. You should aim to be stood upright by 1 week following your surgery.  

Day of discharge (usually day 3 / 4)  

The physiotherapists will perform a stair assessment and ensure you’re safe to return home. They will also review the more advanced exercises that you’ll be doing from day 7 onwards.  

You must not drive yourself home from hospital so you must think about who will take you home after your operation. You must still wear a seatbelt as a passenger in a car. It may be more comfortable for you to use a small pillow to cushion the surgical area from the seatbelt for the journey home.

You may feel more confident to sit in the back of the car initially.

At Home 

There are simple things you can do to make your home environment easier for you to move around in. The occupational therapy team advise you to take the following steps before coming home:  

– ensure you can easily get in and out of bed from the unaffected side. If you’ve had bilateral breast reconstructions, choose the side that is least painful. 

– Bring items down from high shelves and have regularly used items to hand and at waist-level. 

– Have toilet roll in front of you and not behind/to the side. This will stop you from twisting/overreaching following your surgery. 

• You’ll have an appointment in dressings clinic 7-10 days following your operation. At this appointment a nurse will clean the wounds and redress them if required. You may need multiple visits to the dressings clinic until your wounds have healed. If you have any questions regarding your physiotherapy exercises, you can ask the nurse to contact the plastics specialist physiotherapist who can come and review you in dressings clinic. 

• Your plastic surgery consultant will see you between 6-8 weeks following your surgery to check the reconstructed breast and ensure your recovery is going well.  

• If you’ve had an immediate reconstruction, you’ll be seen by your breast surgeon approximately 4-6 weeks after surgery to discuss your results and any additional treatments you may need.  

• A physiotherapy review appointment will be arranged for you between 5-6 weeks following your surgery. You will be told about this a few weeks after your surgery. This will be a telephone appointment. It will then be decided between yourself and your physiotherapist if you need to come in for a face to face appointment.   

Pain

Pain is common after any operation and you will be given a small supply of pain relief to take home with you. If you need additional or stronger pain relief you should contact your GP after your surgery.

• It is very important to take the pain relief that you have been prescribed regularly, especially in the first few weeks after your operation.
• Pain relief will allow you to move more freely and with less discomfort. It will help when you are completing your physiotherapy exercises in the day and can also give you a better night’s sleep.
• Constipation is often a side effect of certain stronger pain relief. If constipation is a problem, drink plenty of fluids, make sure you have enough fibre in your diet, and consider using a gentle laxative available from the chemist.