Preoperative Planning

It is beneficial to be in good physical condition prior to having breast reconstructive surgery. If you are involved in exercise regularly, please continue to exercise frequently. If you are not getting any or adequate exercise, please understand that any physical activity prior to surgery will serve you very well in your recovery. Even if you were only able to walk 20 minutes a day or take the stairs in your building, you will find that your recovery may be quicker and less painful.

Do Not Smoke. Avoid smoking for at least 6 months before and 6 weeks after surgery. This includes exposure to “second hand smoke”. Cigarette smoking causes blood vessel spasm and can diminish blood flow to your reconstruction.

Admission

You will normally be admitted in the afternoon, the day before your breast reconstruction and reviewed by Consultant Anaesthetist. You will also see Mr Kosutic who will double-check information obtained with CT-angiogram against Doppler ultrasound and perform matings on your chest wall and abdomen, in preparation for your reconstructive surgery the next day. You will have the opportunity to ask any questions and receive any additional information, if required. Mr Kosutic will make sure you are fully reassured and well prepared for your procedure. You will be nil by mouth from past midnight.

The Day of Surgery

The next morning, you may be reviewed by Consultant Anaesthetist (if they have not reviewed yourself the day before). The nursing staff will transfer you to Theatres where you will see Mr Kosutic who will double check markings from day before and answer your final questions. You will then be transferred to anaesthetic room where general anaesthetic will be administered by Consultant anaesthetist. Mr Kosutic works with some of the best and most experienced team of Consultant Anaesthetists in UK, with expertise in critical care and pain management. They have decades of experience with thousands of general anaesthetise procedures in far more medically complex and elderly patients then yourselves. They also have special knowledge in anaesthetising patients requiring microvascular free tissue transfers. Their expertise provides extra reassurance and its very important for success of your surgery.

After Surgery

Following Your successful Breast Reconstruction, you will wake up in the recovery area and be transferred either to ward or Critical care unit, depending on the length of your surgery. Mr Kosutic will notify your family about successful outcome and reassure them you are recovering well. There will be intense monitoring following your breast reconstruction, to make sure flap receives good blood supply. In the event of any concern, patient may be taken to Theatre for re-exploration. This happens in extremely rarely as Mr Kosutic has 100% success rate in free DIEP flap breast reconstruction, which not many surgeons around the world have achieved. Monitoring will get less intense on day 4 after surgery and it is expected for you to be ready for home but the day 7 or 8 following your successful breast reconstruction. There will be a weekly wound check up in dedicated plastic surgery dressing clinic monitored by Mr Kosutic until your wounds are fully healed. Further instructions will be given throughout the wound heeling process which usually takes 2-3 weeks.

Symmetrisation Procedures

6 months following successful natural tissue breast reconstruction patients is assessed for symmetrisation procedures. These are ‘touch-up’ smaller surgeries that are organised either as a day case or overnight stay. Touch-up surgeries may include flap reduction, breast-uplift on the opposite side, breast reduction, liposuction and lipofilling. Often these are performed in several stages.

Nipple and Areola Reconstruction

Once both Mr Kosutic and patient are happy with the volume and shape achieved, your nipple will be reconstructed at a day-case local anaesthetic procedure. You are able to go home immediately after and your wound is managed weekly until fully healed. Once new nipple has stabilised, areola can be tattooed to complete breast reconstruction journey. This is usually done 8-12 months following successful 1st stage natural tissue reconstruction.