Hormonal Therapy
Hormonal Therapy

Side Effects

The side effects may vary depending upon which technique is used for the breast reconstruction. The side effects range from swelling, pain, infection to breasts of different sizes, shapes, and nipples in different locations. Positive side effect of the abdominal flap is that the woman also experiences a "tummy tuck"

How You Can Help the Cancer Patient Before the Breast Reconstruction Surgery

  • Breast cancer survivors vary greatly in their desire for breast reconstruction. Many of the younger patients prefer to have reconstruction. Indian Health Service (IHS) contracted health services is unlikely to cover reconstruction and alternative sources of financial aid for such surgery need to be pursued– ideally by someone other than herself (to reduce the likelihood of her becoming overly stressed and concerned).

So the breast was removed and I had the immediate reconstruction following that, it was a very long surgery... It was eight hours under anesthesia, it was difficult. . . . but I am very happy with the results. Candi Miller (Haida)

... as we started with part of my reconstruction, it was incredible... I had an infection in my chest and it was making me heal deformed. And I had a staph infection that was just all over my chest from the mastectomy ... it was just sucking my chest in and it made me feel really distorted... But they were still able to do the implants and that was fine. I questioned that, because ... I feel bad that I have to ever question my identity as a woman and what it is that makes me feel like a woman shouldn’t be on the outside, it should be on the inside. I did get the implants and I healed, it took along time but, uhm. I stayed in bed, I took care of myself. I had a lot of help... by this point ... they were doing my surgeries in stages because they couldn’t do it all at once. (The areola and nipple reconstruction) In some states, they don’t think that’s allowable, or necessary for a woman to have this finished. And I, I was so outraged, because (the State) declined me. They started my procedure and then they said that it wasn’t necessary and that I wouldn’t be able to be finished. And I couldn’t believe this. I was so outraged, but I wasn’t going to give up. I mean ... the government ...(was) ... deciding what’s right for me. And I sent them my pictures, and I called, and I’m like "This is crazy... I’m a thirty-two year old woman. How can you tell me that this isn’t necessary? This is necessary." And it was a matter of communicating and not giving up hope. Alisa Gilbert (Tewa Pueblo)

  • Be available to discuss her thoughts about reconstruction and how it may or may not affect your personal or intimate relationship.

Questions to Ask Your Plastic Surgeon Before You Have Breast Reconstruction

  • What are the different choices of reconstruction surgery? What type do you think is best for me? Why?
  • Should I have the reconstruction at the time of my mastectomy or should I wait until later? How much later can I have it done? If I need to have chemotherapy, should I wait until I have finished that treatment?
  • What are the advantages and disadvantages of having reconstruction at the time of my mastectomy? Of waiting to have it until later?
  • What are the side effects and risks that I should consider?
  • Will you be using tissue expanders? A saline-filled implant? Can you use my own tissue?
  • Will you explain how the surgery will be done? What kind of anesthesia will you use?
  • What will I look like after the surgery? What kind of scars will I have and where will they be?
  • What will my new breasts look like? Will it match my other breast? Will it change over time? Will I have to have anything done to my other breast?
  • Can I have my nipple reconstructed? How will it be done?
  • What is your experience with this operation?
  • Do you have any before-and-after pictures you can show me?
  • May I talk with someone who has had the operation?
  • How many operations will I have to have? Will I need to be in the hospital each time? For how long? How long will I need for recovery?
  • Will I be in much pain?
  • Will I need to wear a special bra after my operation?
  • How much will it cost? Will my insurance cover any part of it?
  • What can be done if the surgery is not successful?

(Printed with permission, Morra and Potts, Choices, Avon Books, 1994, p. 330.)

Operation Choices for Breast Reconstruction

Expander Can be of several types. Empty silicone sack or double envelope with silicone layer and empty sack implanted under skin and muscle, gradually filled with saline (saltwater) solution through a valve over a period of weeks, stretching skin. Local or general anesthesia. Inpatient or outpatient. Surgery takes 1 to 2 hours.

Most common type of reconstruction. Provides greatest flexibility in breast size. Requires additional office visits (15 to 30 minutes) to add saltwater solution to stretch skin. May be uncomfortable for some women. Can have problems with valve. Another operation often needed to convert expander to permanent implant.

Implant, also called fixed-volume implant Sack, filled with silicone gel or saline fluid, implanted under the skin and chest muscle. General or local anesthesia used. Can be outpatient or inpatient. Surgery takes 1 to 2 hours. Short recovery time. Low rate of complications. Implants filled with silicone gel can be used only if a woman is enrolled in a clinical trial. Saline filled have silicone layer or envelope that contains filling.

Latissimus flap, also called back flap. Muscle called latissimus dorsi, and eye-shaped wedge of skin moved from back to chest wall and sewn in place, leaving tissue attached to original blood supply. Inpatient with general anesthesia. Surgery takes 2 to 4 hours. May need blood transfusion. Major surgery that can be painful. Need to stay in hospital 3 to 6 days. Scar left on back or side. May have drain in for several weeks. May have fluid buildup in back area. May have slight bulge under arm that will shrink in time.

TRAM flap (transverse rectus abdominous myocutaneous), also called tummy tuck. Fat, skin and muscle taken from stomach area and moved up to form breast. Tissue usually remains connected to abdominal blood supply, although in some cases microsurgery used. Inpatient, with general anesthesia. Surgery takes 3 to 5 hours, with general anesthesia. Surgery takes 3 to 8 hours. May need blood transfusion. Major surgery that can be painful. Hospital stay of several days. Recovery period may take several weeks, including inability of patient to stand straight for days or even weeks. Healing problems may occur, including thick tissue on flap. Scar in abdominal area.

Microsurgery, also called free flap. Muscle and fat from other parts of body, such as buttock or thigh, are cut free from blood supply, moved to breast and reattached to breast blood supply by microsurgery. Inpatient with general anesthesia. Surgery takes 3 to 8 hours. May need blood transfusion. Major surgery that can be painful. Hospital stay of several days. Recovery period may take several weeks, including inability of patient to stand straight for days or even weeks. Healing problems may occur, including thick tissue on flap. Scar in abdominal area.

Nipple Can be made from existing skin, pinched and tacked to make nipple, or created from tissue from other nipple or groin and attache to breast mound. Areola reconstruction may also be done. May need tattoo to match color of other breast. If created from other nipple or groin, that area will feel tender for about 2 weeks.

(Printed with permission, Morra and Potts, Choices, Avon Books, 1994, p. 357.)

  • Fatigue (e.g., lethargy); Feeling very weak or tired
  • Dry, itchy skin; sunburned
  • Loss of appetite
  • Soreness and swelling
  • Constipation
  • Cough
  • Fever
  • Pain

How You Can Help the Cancer Patient Before the Radiation Therapy Begins

  • Radiation will interfere with the healing from the surgery. The cancer patient must wait until her surgery has healed before beginning the radiation therapy.
  • Work with a healer or story teller to help the patient prepare for how she will deal with uncomfortable feelings during the therapy. For example, the patient may be strapped down to help her stay in one position so that the radiation goes where it is supposed to go, and not affect other parts of the body. Then the machine may move to focus on different angle of the tumor (or place where the tumor was removed). The sound and the closeness of the equipment frightens some patients. Help the patient prepare for how she can deal with hearing the sounds, or the sudden movement of the equipment.

I got scared when the big machine came down on me cause I never experienced nothing like that in my life, so I got scared so I started praying in my own prayers. I asked the machine, whatever you are, believe and get me well. That’s what I said to the machine, get me well. Mary Lou Calabaza (Santo Domingo Pueblo)

  • One healer prepared special prayers for the patient to say while she was going through the radiation therapy. She brought her token bag with her into the radiation treatment room so that she could hold the bag with the special "gifts" the healer prepared for her while she said her personalized prayers.
  • You can go with the patient when she is fitted for a cast or any other preparation to help her stay in one position. There are different techniques that are used to help her stay in a single position.
  • The radiation oncologist will mark the area on her skin where the radiation is to be directed. They will use India ink or another relatively permanent marker. She needs to avoid scrubbing off the mark. Once the mark is made, some women have had traditional healers do ceremonies over the marked area. Nothing should be placed directly on the marked area prior to or during treatment (such as a poultice)

Family members are sometimes concerned that the patient is radioactive following radiation therapy. Talk with the provider about your feelings and your concerns. If very high dosages of radiation are used, the provider may recommend that the woman not hold infants or very small children for a short period of time. For most patients, the dosage is focused on a local area and such concerns do not exist.

How You can Help the Cancer Patient During the Radiation Therapy

  • Radiation is given in different ways. If the patient has an implant, you may only need to help her get to and from her appointments and to help her deal with side effects, if any.
  • If she is receiving radiation at the health care facility, you cannot be in the same room with the cancer patient while the treatment is being done (because the providers do not want you to be exposed to unnecessary radiation).
  • Some radiation rooms have speakers or intercoms to outside waiting areas. If an intercom system or something similar exists, you can talk with the patient as long as talking does not result in her moving her body.
  • Some patients have severe reactions to radiation which results in having to take additional medical prescriptive drugs, like cortisone (e.g., Prednisone). You can help by picking up the medications and making certain that any and all medications are taken as directed by the provider.

How You can Help the Cancer Patient After the Radiation Therapy

  • Most patients do not feel too badly after the first few treatments and she may require little assistance initially (e.g., help walking to the car). However, she can suddenly begin to experience side effects. The most common are feeling very weak and tired, and experiencing red, tender dry skin on the area where the radiation is being focused. Be prepared to help her when she feels tired. See the Section on "How to Help the Patient When she is Feeling Weak." For the skin problems, ask the provider for a lotion. They are likely to provide a sulfa cream.
  • The patients who are going through radiation therapy are usually extra sensitive to sunlight and heat. They are likely to have no tolerance to heat.
  • If the vehicle you use to transport the patient to and from the radiation therapy is not air conditioned, borrow a car or truck that is.
  • If the patient must walk in the sunshine for daily activities (such as walking to the mail box to pick up mail, or to feed and water animals), have other members of the family help with these duties, or provide an umbrella or a wrap to help shield her from the heat of the sun.

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