How long after a double mastectomy can you get implants

11 Things No One Tells You About Getting a Double Mastectomy

...and then getting reconstruction.

Branislava Zivic / Stocksy

I didn’t crumble when I received a breast cancer diagnosis. I felt brave, confident, and determined to be well. It was detected early—a blessing—but after removing the small tumor, my surgeon said the cancer was invasive and had distinct characteristics that made it likely to return in five years, if not in the same breast, then in the other one. She recommended removal of that breast and informed me that I could opt for a double mastectomy. If I did not want a mastectomy, she said at the very least I would need radiation therapy and very close monitoring after that. I made the decision for aggressive treatment quickly and without hesitating. “Why wait?” I thought, and took the same headstrong route as ordering a drink in a busy bar after a hard day: “Make it a double!”

Since I elected to undergo a bilateral mastectomy with immediate reconstruction, the surgeon inserted expanders (inflatable implants that stretch the skin and muscle to prepare for permanent implants) as soon as my breasts were removed. Before that procedure and the operations that would follow to complete the reconstruction, my doctor went through all the necessary disclaimers and outlined what the surgery and recovery would entail. She was great, and prepared me as best she could. But it’s one thing to read a pamphlet and another thing to put that pamphlet into practice. I learned a lot on my journey—knowing these things ahead of time would have made it easier.

1. After a mastectomy you can’t really use your arms.

Doctors warned me that after the initial mastectomy surgery your arms need to remain in Tyrannosaurus rex position (elbows at your sides) for several days. I didn’t quite realize how limiting that would be until I got home and tried doing normal things. You’re really not supposed to do anything, not even lift your purse. Some physicians will not let you shower at first, limiting your bathing to a tub. Even if you can shower, you can’t lift your arms to wash your hair.

2. So you’re going to have to get used to accepting help.

Being a temporary T-rex means there’s a lot you won’t be able to do for yourself and you’re going to have to call in backup. Surely, upon news of your diagnosis, people you know very well, and not so well, will ask you what they can do to help. It’s a little nerve racking to be expected to know what help you’ll need. Here’s where you can put them to use. I started with the chores at home. Some things can be absorbed by your family members, but not all. Sharing carpool commitments, cleaning the house, doing the laundry and preparing meals are easy ways your friends can help, even if they aren’t your best friends in the world. There will be people who are overzealous in their attempts to be helpful. Be honest with a well-meaning friend if what she is offering makes you uncomfortable. Don’t feel guilty for saying thanks, but no thanks.

Oh, and about not being able to wash your own hair: Someone taking you to get your hair washed at a salon is a huge help and will make you feel better. A compassionate hair stylist who will massage your head and neck is a welcome luxury—and a ride to the appointment is a great task to assign a friend who wants to help.

The writer after reconstruction.Photo by Bonnie McCarthy

3. Breast reconstruction is not a boob job.

Reconstruction is a more complicated procedure than a standard augmentation and tends to require several surgeries. Picture a pillow in a pillowcase. Breast augmentation is like adding an extra pillow, filling the pillowcase until the seams are stretching. Reconstruction is like taking the pillow out of the case, possibly changing the size of the case, then putting in a new pillow and adjusting the fit further. It’s major surgery, which entails drains (small plastic bulbs hanging from tubes inserted where your breast tissue was to collect fluid—these are temporary so don’t worry), expanders, and a nip here and a tuck there to get the size and shape right. I’m happy with my new ones and think they look pretty good, but it was far from a one and done operation.

4. And expanders are not implants.

Though they seem similar, expanders and implants serve different functions and look and feel different. Expanders, which are put in place temporarily (for me, it was three months, but it varies), are like balloons that are periodically inflated with fluid to stretch your skin and muscles to get them ready for your final implants. They are hard and stiff compared to implants, which will feel and appear more natural.

5. Your armpits will change, temporarily.

As the expanders in my chest were being filled weekly to prepare the space for the implants, the once gentle arcs between my arms and my torso began to recess into deep canyons. The surface area of my armpits had changed in a way that a razor no longer fit nicely against my skin. More than once while applying deodorant or wearing a tank top out in public, I discovered I had a wayward hair that had dodged the razor seemingly forever. As the weeks became months, the implants settled in, my armpits slowly returned to their old formation, and the ease of regular shaving returned. Simple solution: Have your armpits waxed pre-surgery.

6. Your implants could get … chilly.

Even though doctors (and the Internet) say this shouldn’t happen, my replacement breasts don’t always warm up with my body heat. It makes me think of waterbeds that are freezing when their respective heaters aren’t working. They aren’t always cold, but the majority of the time when I get ready for bed my arm brushes against my chest and the feeling of coolness surprises me.

I "ordered a double." (Get it?)Bonnie McCarthy

7. You might have a choice when it come to what to do with the nipples.

Speaking of cold, most surgeons remove the areola and nipple as part of the mastectomy. The advantage of nipple reconstruction with a tattooed areola is that you no longer have to worry about the consequences of drafts while wearing tight t-shirts, nor do you need to continue to invest in plastic shields to camouflage your high beams. I find this an advantage of the surgery and that most women agree.

It is possible to keep your own nipples and areola. Ask your physician whether or not you are a good candidate for a “nipple-sparing mastectomy” (it may depend on your diagnosis). But do note that if you are able to go that route, it is sill likely you will lose sensation.

8. But you may want to wait a bit before you make that choice.

From my own experience, I suggest that you don’t begin nipple reconstruction until you are completely satisfied with the shape, size, and lift of your breast. It can take a while to get them where you want them. I was eager to be done for insurance reasons and needlessly endured a second scar from a revision made after nipple construction.

The doctors tell you this but there is never any way they can completely understand what you envision. For me, I was looking forward to new and improved breasts after pregnancy and nursing two children left them less than perky. Don’t let the results on day one of the new implants scare you! I looked lopsided and was very upset. But they settled in evenly, yet smaller than I thought we had agreed on in the pre-surgery consultation. (Here’s a tip I learned much later: Every 200 cc’s of fluid in the expanders equals a cup size in the final implants you get.) They were not the volume that I had become accustomed to in my bikini that summer; an adjustment in a subsequent surgery helped me accomplish that. Ask a lot of questions when you see your doctor and write down the answers.

10. They can get in the way of a restful night’s sleep.

Long after you’ve healed, you may feel some discomfort when you go to bed. It’s not uncommon for me to toss and turn a bit to find a comfortable position—what once was my preferred sleeping position isn’t anymore. Some women like to wear a sleep bra, which is akin to the most comfortable sports bra you own. It has a medium level of support—similar to a bra for yoga, not for running. Usually made from a nice soft material, they give you just enough support to relieve any soreness that may ensue from the implant moving one way or another.

If the sleep bra is not enough or not comfortable, use a body pillow. When I lie on my right side too long, my sternum hurts. A thin, soft pillow placed just along my side mitigates that pain for better rest.

11. People are going to look.

When you are comfortable enough to talk about your experience, you’ll notice something about the reaction from men that is distinctly different from speaking to women. When I tell women that I had a double mastectomy, they’ll glance at my chest and say, “You can’t even tell,” or “They look great!” Men are not so comfortable. They want to look—it’s natural. But trying to behave like gentlemen, they nervously resist. Or they try to get in a furtive glance. Eyes dart around not knowing if they’ve been caught looking where they shouldn’t and not certain if they were allowed, or supposed, to look. Simply keep moving the conversation along without pause and they will regain composure quickly.

You could understand that it might be awkward for a man, not knowing whether or not he should look at the things you are talking about. It’s helpful to know going in that this awkwardness might arise and giving some thought to how you want to respond. I learned when I mentioned it to male friends to follow the announcement by looking away so they could sneak a peek and not embarrass either one of us. I assumed that when a man goes home and tells his wife that Leslie had a double mastectomy his wife’s first question will be, “How do they look?” I am happy to give them a brief chance to find out the answer.

I would never wish this experience on anyone, but knowing these things ahead of time would have made it easier. Breast cancer treatment is a process that keeps evolving and getting better all the time. I am grateful for the women who went before me and endured far more invasive surgeries and prolonged recoveries. Research has led to incredibly better treatment that continues to improve. Ask for the specific help you need and don’t quit asking until you are satisfied. That’s what your recovery is really all about—being nurtured and putting your health, and yourself, first.

Leslie A.M. Smith ordered her double in 2011 and remains healthy. She is a public relations consultant in Long Beach, CA. Follow her on Twitter @LeslieAMSmith

Watch: The Realities Of Breast Cancer Treatment Nobody Ever Talks About