Latest / Healthy Vitals / Breast Surgery and Reconstruction - What to Expect at Every Step, Part 3: Recovery [Podcast]

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Breast Surgery and Reconstruction - What to Expect at Every Step, Part 3: Recovery [Podcast] · Healthy Vitals

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  Scott Webb (Host): Today, we are wrapping up a three-part series on
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  breast surgery and reconstruction by focusing on what happens after surgery.
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  I'm joined again today by a couple of expert surgeons from Summa Health.
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  Plastic surgeon Dr.
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  Mike Tran is here again, as is Dr.
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  Eve Klenotic.
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  She's a specialist in breast surgery and breast surgical oncology.
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  This is Healthy Vitals, a podcast from Summa Health.
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  I'm Scott Webb.
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  It's really nice to have you both back here.
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  This is the third part in our three-part series, so we do encourage folks to
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  listen to part one, where we talked about breast surgery and reconstruction.
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  Part two was more focused on the surgery and the reconstruction, more
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  specifically surgical approaches and reconstruction choices.
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  And today, we're going to talk recovery, prevention, and long-term
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  wellness, you know, life after surgery here in part three.
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  So, Dr.
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  Tran, you're up first.
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  What does recovery look like beyond, let's say, the first few weeks?
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  Dr. Mike Tran:
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  I want people to know that recovery is much longer than just skin healing.
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  A lot of people think that, "Okay, my incision's closed.
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  I should feel normal now."
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  But the tissue is still changing from months to year, right?
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  The swelling goes down, scar is going to soften, breast is going to start settling,
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  tightness improves, the nerve starts to wake up, or sometimes if they stay
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  numb, your strength starts to come back.
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  The fatigue you feel after major surgery, that can stay around for a
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  little bit longer than what you expect.
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  And of course, there's always the emotional side to it, right?
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  You may physically be doing well, but you still have to process the diagnosis, the
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  surgery you underwent, your body changing, and the fear about recurrence, right?
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  So, my post-op schedule is usually one week after surgery, then three
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  weeks, then three months, then a year.
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  So, I always tell patients, "Don't judge where you are."
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  Like, "Don't judge where you're going to end up based on how
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  you feel at three weeks."
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  Three weeks is very, very
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  Host: Right.
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  In the big picture, three weeks is not a long time and sounds more
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  analogy-wise, little bit more like a marathon than a sprint, right?
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  Dr. Mike Tran:
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  That's exactly right.
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  Host: Yeah.
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  And staying with you, Dr.
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  Tran, and you've established for us, you benefited from your expertise in
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  these podcasts that there's a lot of reconstruction choices and options.
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  So when we think about those choices, how do they affect mobility,
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  healing, and quality of life?
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  Dr. Mike Tran:
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  Well, there are trade-offs to every reconstruction, and this
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  is why the reconstruction has to be individualized, right?
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  For instance, with an implant, we're not operating on another
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  part of the body, so the initial recovery is going to be simpler.
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  But you do have an implant in your body, and the implant can
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  develop scar tissue around them.
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  They move, they rupture, get infected.
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  They may even require another operation later on.
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  There's a maintenance cost to it, right?
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  Whereas when you're using your own tissue, there's a bigger cost up front.
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  For instance, if I take tissue from the abdomen, now you're recovering from
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  the breast operation, but you're also recovering from the abdominal operation.
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  But once that heals, it's your own tissue.
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  It gains the weight, it lose weight the same as you, and it
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  behaves more naturally over time.
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  So, higher cost up front.
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  You can see how with all these reconstructive iteration, neither
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  is universally better, right?
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  It's more individualized.
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  What's better for a young, healthy woman who wants to avoid implants?
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  That may be completely different than what's better for a
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  70-year-old grandmother who wants the shortest reasonable operation.
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  Host: Yeah, it definitely sounds like it's not one-size-fits-all.
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  And as we've learned and benefited from your expertise, both of you, over
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  these podcasts, it's a team approach at Summa Health, shared decision-making
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  with the patients, sometimes even on the table during surgery.
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  And Dr.
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  Klenotic, what's one thing patients can do to reduce their risk of lymphedema?
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  Dr. Eveline Klenotic:
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  I don't know if there's just one thing, Scott.
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  It's multiple things.
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  But with lymphedema, it is very important to detect it early,
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  and prevention is key, right?
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  So, depending on what type of procedure they had, if they only
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  had a few lymph nodes out, and no radiation, the risk of lymphedema is
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  actually quite small, like 2% to 5%.
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  But it is a possibility.
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  So, arms exercises, routine screening and follow-up, and that's part of
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  the national guideline to make sure that they keep up with the screening.
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  And we have this fancy machine called L-Dex that kind of detects the fluid
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  pressure in the arm before patient has symptoms, so that if we detect
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  a major change, even before they notice it themselves, we can intervene
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  and prescribe an arm sleeve or send them to the physical therapist that
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  specializes in lymphedema prevention.
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  And hopefully, we can get ahead of the lymphedema.
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  And maybe Dr.
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  Tran can chime in later.
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  Lymphedema has different stages.
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  And in the early stages, it's still very much treatable.
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  However, in the later stages, it's, non-reversible.
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  And there are also some myths associated with lymphedema risk.
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  I think, most people would be so afraid to do IV and blood pressure
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  cuff on the side of surgery.
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  And while it is true, if we have two arms and the other one had no
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  surgery, then it's okay to use that arm, you know, if it's available.
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  But in general, if they've had minimal axillary surgery or lymph
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  node removal, and especially if they didn't have radiation and no lymphedema
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  symptoms, it is okay to use that same arm for IV, for vaccine, for
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  blood draw, for blood pressure cuff.
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  And especially, if it's an emergency situation, we often see it when we do
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  trauma care, you know, and a patient comes from a car accident, and they're
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  really sick, but they write in the headboard, "Do not use this arm for IV."
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  In that situation, please save her life.
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  You know, you can use the arm.
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  But yeah, those are kind of myths.
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  In general, it can be used.
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  But of course, if the other arm is available, you know, it
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  doesn't hurt to use the other arm.
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  Host: Right.
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  Yeah, Dr.
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  Tran, I wanted to ask you, staying with lymphedema, what are some of the warning
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  signs that patients should never ignore?
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  Dr. Mike Tran:
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  The early lymphedema signs, it may not look dramatic.
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  It might just be, "Hey, my arm feels heavy today," or, "My watch feels tighter.
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  My ring suddenly doesn't fit too well."
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  Right?
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  It's very subtle.
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  Host: Yeah.
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  Dr. Mike Tran:
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  Right.
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  And so, it's something, you know, if it's persistently different
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  between the two arms, I would rather just hear about it, bring it up.
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  And that way, we can identify it early.
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  And having identified it early, there are more options that we can
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  have to manage it and keep it from progressing, and that's really the
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  name of the game with lymphedema.
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  Host: Yeah.
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  As Dr.
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  Klonotich was saying, early diagnosis is key.
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  And Dr.
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  Klonotich, when we think about, you know, just recovery in general, like what are
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  some common surprises, I guess, maybe that patients experience during recovery?
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  Dr. Eveline Klenotic:
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  Yes.
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  I think most of my patients would say, "Oh, the pain is not as bad
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  as I thought," you know, because it is a big surgery sometimes.
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  But actually, most people would have more numbness than pain, and
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  that is a surprising thing for them, too, that the areola or the breast
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  can be numb or decreased sensation.
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  And a lot of patients now that we are doing more and more what we call
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  oncoplastic surgery, which is removing the cancer but reshaping the breast at
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  the same time to decrease deformity, and it provides like breast lift and better
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  appearance than if we didn't do anything.
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  I think patients are usually very happy with the outcome after oncoplastic
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  reduction and symmetry surgery.
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  And they often say, "I should have done this a long time ago even without cancer,"
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  Host: Yeah,
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  Dr. Eveline Klenotic:
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  So Yeah.
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  Host: Yeah.
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  So, Dr.
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  Tran, let's talk long-term outcomes.
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  I think you've said along the way here about just being sort of
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  realistic and honest with patients.
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  So, what can they realistically expect after breast surgery and reconstruction?
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  Dr. Mike Tran:
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  Yeah, I think most patients can expect to get back to a very normal life.
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  That means work, exercise, travel, swimming, wearing normal clothes,
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  all that is usually achievable, okay?
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  But I also don't like pretending that reconstruction makes the
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  cancer experience disappear.
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  You're going to have scar, you may have area that's numb.
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  You may need to have another procedure somewhere down the road.
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  If you have an implant, you have to remember that it's not
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  necessarily a lifetime device.
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  If you're using your own tissue, the reconstruction will change
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  and age with your body, right?
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  So to me, a happy ending is when the reconstruction stops occupying so
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  much space in the patient's life.
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  They're not waking up every morning thinking about
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  their breast reconstruction.
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  It just becomes a part of their body and they go on to live their life.
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  Host: Right.
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  They go on and play pickleball and go to work and as you say, travel, wear
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  a bathing suit, whatever it might be.
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  It's been great stuff over these three episodes, very, educational.
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  I hear the expertise, the compassion in your voices, all of it, which I'm
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  sure is very meaningful to patients, prospective patients, their families.
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  Dr.
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  Klenotic, I want to finish up with you here in this last part of part three.
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  What message would you most like newly diagnosed patients to hear as they begin
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  what is, I've learned from you all over these podcasts, is really a journey?
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  Dr. Eveline Klenotic:
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  I really think that all of us who are in this profession, we're very
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  passionate about breast cancer care because breast cancer is very common.
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  We know somebody in our circle that has it.
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  And likewise, we are here for you every step of the way for every patient.
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  We are a great team.
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  And Summa is very lucky to have seven plastic surgeons who are here to
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  help, one piece of the reconstruction or recovery journey for the breast
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  cancer a little bit more manageable
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  Dr. Mike Tran:
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  Just to add to what Dr.
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  Klenotic is saying, and to you, Scott, yes, indeed, it is a journey,
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  and I want patients to understand that they don't have to understand
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  everything on day one, right?
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  Because I imagine a patient going in there, they get told that they have breast
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  cancer, and then immediately we start throwing enormous amount of information
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  at them, like surgery, lymph nodes, radiation, chemo, reconstruction, and then
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  we ask them to make a decision about it.
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  Dr. Eveline Klenotic:
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  Correct.
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  Dr. Mike Tran:
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  And then, they're probably not having heard some of the
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  words that we're saying, right?
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  And so, I always tell patients, ask a bunch of questions.
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  Ask the same question twice if you need to, bring somebody with you.
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  Write things down, Understand there's several medically reasonable paths, right?
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  And so as long as you understand the overall bird's eye view, you know,
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  our job is not trying to push you into one operation or the other.
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  My only job is to explain the options and explain the trade-offs, make sure
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  the cancer is treated appropriately, and then help you choose the path
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  that makes the most sense for you.
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  Dr. Eveline Klenotic:
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  Yes, I think that is the key.
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  That our job is to give the best options and education so that our
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  patients and their family can make the best decisions for themselves
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  Host: Right.
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  Yeah, that's perfect.
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  And my job now is to put a period at the end of this sentence.
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  I've really appreciated your time and expertise, throughout
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  these three podcasts.
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  We hope folks, of course, will listen to all three parts and
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  listen to them in order, but it's their dime, their dance floor.
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  We hope they listen, you know, at least to the parts that are relevant to them.
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  I want to thank you both for your time
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  of this works.
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  And as I said, you know, before that first one, you know, yes, breast
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  surgery and reconstruction, but what can we expect every step way?
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  And I think we've done that.
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  We've talked through it all.
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  We provided that to listeners.
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  So, thank you so much.
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  Dr. Eveline Klenotic:
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  Thank you, Scott.
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  This has been so much fun.
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  Dr. Mike Tran:
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  Absolutely.
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  Great pleasure.
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  Host: And for more information, go to summahealth.org/breast.
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  And if you enjoyed this episode of Healthy Vitals, we'd love
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  it if you'd leave us a review.
• 12:38
  Your review helps others find our educational content.
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  I'm Scott Webb.
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  Thanks for listening, and we'll talk again next time.