For most women, breast reconstruction is a process that can take several months to complete. Breast reconstruction can be performed and completed in one surgery, but most patients will need more than one procedure to get the best results. To ensure that you are completely healed and ready for your next surgery, insurance companies have a 90 day waiting period that applies to ALL patients between reconstruction stages. This means each stage is performed at least 3 months apart.

It is also important for patients to know that approval is required in writing from your insurance for each reconstructive stage before we can schedule your surgery. It can sometimes take several weeks to obtain this approval after the paperwork is submitted by our office.

STAGE 1

This is your initial reconstruction. This can either be performed at the same time (immediate reconstruction) or following your mastectomy (delayed reconstruction). Once you have recovered from anesthesia you will be transferred to an inpatient hospital room where you will require a short hospital stay (usually 2 days for flap patients and 1 night for implant/tissue expander patients).
Arrangements will be made for you to see us in the clinic 10 – 14 days later. Typical appointments before and after your surgery include:

Initial Consultation

• Usually about one hour in duration
• The physician reviews your medical history, examines you and discusses options
• Clinical photography
• Initiate plans for scheduling surgery

Pre-Op Visit

• Visit with the nurse, usually 1.5 hrs in duration
• Patient sent to lab to complete pre-admission testing
• May be done over the phone if patient is not local
• Surgical plan and remaining questions or concerns are discussed
• Surgical consents reviewed
• Pre-op instructions
• Collection of out-of-pocket expenses (such as deductible and coinsurance)

Post Operative Follow Up List 

• Visit with the nurse, usually 30 minutes in duration
• Reconstructive sites checked and sutures and drains removed if indicated
• Visit with surgeon, usually 30 minutes in duration
• Discuss the next reconstructive stage

STAGE 2

This is called the Revision Stage. This stage will be delayed for patients who require post-mastectomy chemotherapy and/or radiation. This surgery can include refinement of the shape and/or volume of the reconstructed breast, reduction or lift of the other breast for symmetry, scar revision, and body contouring to achieve the best possible cosmetic results. Patients who choose implant reconstruction will have their tissue expanders replaced with permanent implants during stage 2 as well.  Nipple reconstruction is usually also performed as part of this stage although occasionally your surgeon may feel it is best to delay this until a later stage depending on your specific situation. The revision stage is performed under general anesthesia as an outpatient, so does not usually require an overnight stay. Stage 2 is usually the final stage for patients who had nipple-sparing mastectomy and immediate reconstruction.

Pre-Op Visit

• Visit with the nurse, usually about 45 minutes in duration
• Surgical consents reviewed
• Pre-op instructions
• Collection of out-of-pocket expenses (such as deductible and coinsurance)

Post Operative Follow Up List 

• Visit with the nurse, usually 30 minutes in duration
• Reconstructive sites checked, sutures and/or surgical dressing removed if indicated

STAGE 3

Nipple reconstruction is usually performed at stage 2 but in some situations your surgeon may feel it is best to hold off until a later time. When not performed at stage 2, this can usually be performed in the office under local anesthesia. No pre-operative visit is necessary.

FINAL STAGE

This stage (3D medical tattooing or “micropigmentation”) restores pigment to the reconstructed nipple and areola in patients who did not have a nipple-sparing mastectomy. This is a minor office procedure under topical anesthesia.

Micropigmentation Appiontment

• Visit with the nurse, usually one to two hours in duration
• Clinical photography appointment scheduled

Final Clinic Appointment

You will meet with your physician for a final visit about 6 weeks after your last stage.