A double mastectomy involves the surgical removal of all breast tissue from both breasts, often performed as a preventative measure or as treatment for breast cancer. When combined with immediate reconstruction, this complex procedure includes the placement of temporary medical devices called tissue expanders (TE). These expanders are essentially balloon-like implants inserted beneath the chest muscle or skin to gradually stretch the remaining skin and tissue. The timeline for a double mastectomy with expanders is not a single period but a multi-phased journey that begins with the initial surgery and extends through a months-long process of tissue preparation.
Surgical Duration: Mastectomy and Expander Placement
The time a patient spends in the operating room for a double mastectomy with immediate tissue expander placement is typically between four and six hours. This duration covers the period from the initial incision to the final closure. The procedure requires two surgical teams: the breast surgeon performs the mastectomy, and the plastic surgeon manages the reconstruction and expander placement.
The active surgical time is longer than a mastectomy alone because it includes creating a pocket for the expander and its initial partial inflation. The total time spent in the operating room suite is longer, as this includes the preparation phase, the administration of general anesthesia, and the monitoring period immediately following the procedure.
Variables That Influence Operative Length
The actual operative length can fluctuate significantly based on several patient and procedural specifics. One of the most significant variables is the need for lymph node evaluation, such as a sentinel lymph node biopsy or a full axillary lymph node dissection. If cancer is present, the surgeon must remove and analyze lymph nodes from the armpit area, which adds substantial time to the procedure.
The specific type of mastectomy chosen also impacts duration; a nipple-sparing procedure requires more delicate dissection and greater effort to preserve the skin envelope compared to a simple skin-sparing mastectomy. A patient’s body mass index (BMI) and the overall size of the breasts being removed can also influence the time required for tissue removal. Furthermore, the experience level of both the breast and plastic surgery teams can contribute to the operative time.
Immediate Post-Surgical Recovery and Hospital Stay
Immediately following the procedure, the patient is transferred to the Post-Anesthesia Care Unit (PACU) for close monitoring as they wake up from general anesthesia. This initial monitoring period typically lasts about one to two hours, ensuring that the patient’s vital signs are stable and initial pain is adequately managed.
The total length of the initial hospital stay commonly ranges from one to three nights. During this time, the medical team manages pain, monitors for early complications like bleeding or infection, and provides education on post-operative care. Patients are discharged with surgical drains, known as Jackson-Pratt drains, which are small tubes placed beneath the skin to remove excess fluid. These drains usually remain in place for one to two weeks until the fluid output decreases to a minimal level.
The Complete Timeline for Tissue Expansion and Exchange
The initial surgery is only the first phase of the implant-based reconstruction, with the complete process often taking an average of three to six months to complete. This extended timeline is necessary for the tissue expanders to prepare the skin and muscle for the permanent implants. The process begins a few weeks after the initial surgery once the surgical incisions have adequately healed.
The expansion phase involves a series of outpatient appointments for “fills,” where sterile saline solution is injected into a magnetic port on the tissue expander. These appointments are typically scheduled weekly or every other week. Each injection slowly stretches the surrounding chest tissue, creating the necessary space for the final breast implant.
The expansion continues until the desired volume has been achieved. A resting period of at least four weeks is then usually recommended after the final fill before proceeding to the second operation. The final stage is the expander-to-implant exchange surgery, which is a shorter procedure, often lasting only one to two hours, and is frequently performed on an outpatient basis.