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How Painful is Mastectomy and Implant Reconstruction? Article

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summerangel
summerangel Member Posts: 182

I was just reading a new Medscape article titled "Breast Surgery May Be a Gateway to Addictive Medication Use" about women becoming addicted to medication after breast surgery. A quote from that article: "'I wonder if perhaps we should not be giving opioids at all to certain patients. For example, a mastectomy and implant reconstruction, oftentimes, surprisingly, that's not a terribly painful procedure. But a TRAM [transverse rectus abdominis] flap or abdominal flap, that really is,' commented press conference comoderator C. Kent Osborne, MD, of Baylor College of Medicine in Houston."

I was in a lot of pain after my mastectomy, I think mostly from the sub-pec tissue expanders. I was on opioids for three weeks, and can't imagine how I would have felt without them. I just wanted to post here and ask others about their pain levels from mastectomy and implant reconstruction.

Link to the article: https://www.medscape.com/viewarticle/942461?src=wn...

Comments

  • beesie.is.out-of-office
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    My pain level was manageable, at least after the first night. My facility keeps MX patients overnight, and I had a morphine drip. The nurse was very attentive and any time she checked she would ask if I had any pain, and if I said "yes", she would add another dose. Once I headed home the next morning, I stayed on opioids for about 24 hours and then felt comfortable moving to OTC paid meds after that. So I didn't need the opioids for long but I would not have been happy to not have them "in my pocket" in case I needed them.


  • mountainmia
    mountainmia Member Posts: 857
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    I wonder how many procedures C. Kent Osborne, MD has had, to be able to evaluate what is really painful and what isn't!

  • minustwo
    minustwo Member Posts: 13,153
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    Funny Mountain. I've actually met that doc & had a good opinion of him.

    Like Beesie, I had a pain med drip in the hospital. I don't react well to codeine or hydrocodone so my drip was morphine. Once I got home I took Tramadol for 24/36 hours, then went OTC. But I was soooo glad I had the Tramadol available.

  • debal
    debal Member Posts: 600
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    i had a fair amount of pain for about a week. In addition to the percocet I had an Rx for flexeril but I didn't start taking it until about day 5. Not really sure why I didn't. Had I alternated it from the start I think I would have faired better. I had a great deal back pain especially between my shoulder blades.

  • leesad
    leesad Member Posts: 100
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    I thought my bilateral mastectomy was very painful. Especially day after. I was kept overnight in hospital too and was sent home with prescription pain meds but I felt high dose Tylenol worked better. I also had issues with muscle spasms in the chest area which were painful so I remember being also sent home with Valium or a muscle relaxer which helped with that. The spasms would come out of nowhere for a week or so. I had immediate tissue expander placement and I think that did add to the pain. I hated the tissue expanders. It was 10 months of hell with those in. My exchange surgery not painful and I had a revision also not painful.

    Yes Mountain Mia I wonder that also how he can relate 🙄. I still wonder why after having my boobs amputated I was basically pushed out of the hospital with drains and left to my own accord. I ‘joke’ sort of with my husband that if men had parts taken off they’d be in hospital for weeks and they’d let them stay with as many meds as they’d like.

  • minustwo
    minustwo Member Posts: 13,153
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    Leesa - yup I too HATED the expanders.

    SummerAngel- not really to the point of your question, but if you stick with the expanders you might look up the "Exchange" thread.

  • debal
    debal Member Posts: 600
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    leesa, exactly. Thanks for reminding me of those terrible spasms!

    I'm in the story telling mood so this is a good thread to share. I'm a pre-op nurse and worked extra yesterday for few hours just starting IVs. First patient of the day had been through 18 weeks of chemo and having her bilateral MX with TEs. We can't use her port for surgery so she was nervous about the IV. Got it in no problem. Dimmed the lights, got her a warm blanket and asked if there was anything else she needed. She sat up and totally broke down crying. First time ever but it felt right to share. I said can you keep a secret? Held her hand looked her in the eye. Firmly said " I've had dmx, with your very surgeon. I've had chemo- I was bald too. You hang in there. You will get through this". She cried even harder and said oh my gosh you look wonderful. And she will again too!. Such an honor to know I comforted her because it just plain sucks. We were meant to meet. I just know it.

  • leesad
    leesad Member Posts: 100
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    Yes DebAL, you were meant to be her nurse!!! What a lovely way to support her and I’m sure it meant the world to your patient. Thank You for sharing! You are a special nurse!
  • OnTarget
    OnTarget Member Posts: 124
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    I had a BMX. I went to Tylenol and Ibuprofen after the first 2 days. It hurt but only when I moved, so it was totally bearable for me.

  • jaybird627
    jaybird627 Member Posts: 1,227
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    Every time I've had a breast-related surgery my doctor's have prescribed a finite amount of opoids. Oxycodone type. They all stated that I needed to wean myself off before the script was done. I always did. I really like opioids (who doesn't like a loosey goosy feeling?) but my job has random drug testing so I knew I had to self wean. I only ever used the codones for a few days. I can't even remember the total number of BC related surgeries I've had. UGH.

  • JFBCADVOCATE
    JFBCADVOCATE Member Posts: 12
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    Check out my podcast with an honest discussion of drains and expanders

    https://www.buzzsprout.com/1473595/episodes/677588...

  • rah2464
    rah2464 Member Posts: 1,192
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    DebAl God bless you for lifting that poor woman up just when she needed it the most. I can imagine just how impactful hearing about your experience was (and with the same surgeon no less!) And thank you for your courage and commitment to caring for others during the pandemic. Heart


    I had quite a bit of nerve pain and intense spasms after my direct to implant double. I went off percocet maybe 5 days after surgery then popped tylenol and ibuprofen like crazy for the next 5 weeks or so. I also used a few valium when the spasms were causing too much pain.

    I am three weeks out from a revision surgery now and the pain profile is non existent compared to the first go round. I was sent home with oxy and gabapentin, which I only took for 2 days then stopped. I would definitely rather have access to the medicine in case I truly need it.

  • DiveCat
    DiveCat Member Posts: 290
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    I *really* dislike how I feel on opioids, and while I take them to manage my pain initially I always am trying to get off them as soon as I can, within a day or two to OTCs.

    My PBMX/direct to implant was considered out patient so I spent some a few hours on day surgery unit where they got my pain (and nausea, as that is when I found out I get PONV) under control and discharged me with a finite # of Percocet. I took them as prescribed (writing down times on my schedule I made) for about 2 days but I really hated how I felt on them - first time taking opioids - so switched to Extra-Strength Tylenol & Ibuprofen after that.

    All my surgeries have similarly been “day surgeries”. Both my implant swaps they sent me home within 1-2 hours of leaving recovery with a finite # oxycodone (I think once with Percocet but after that it has been Tramadol or something) but again I rather hated how I felt on them so only took them first day before switching to Tylenol & Ibuprofen. Mostly I needed them to manage me getting home (2 1/2 hour car ride) and sleeping that first night.

    My fat grafting - I was pretty sore at midsection so I took my oxycodone (Tramadol again) for 2-2 1/2 days before switching to Tylenol and Ibuprofen. Most time I have taken them but I was incredibly uncomfortable in midsection - fairly thin so I felt pretty scraped up and bruised!


  • summerangel
    summerangel Member Posts: 182
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    Thank you for the responses! It seems that I'm unusual in that I took opioids for 3 weeks, but it does seem like most would need at least a few days worth. The opioid issue really is a problem, but I don't think the solution is to completely deny people pain medication that they need. Personally, the medication just put me to sleep, but that worked to alleviate the pain so it was worth it. I had no trouble quitting and still have most of a bottle sitting around the house that I need to dispose of.

    This makes me wonder why my pain was so bad, as I've been told quite a few times by healthcare providers that I'm "tough". I did have very well-developed pecs, my PS said they were very tight, so that may have had something to do with it. Also, my TEs were filled with 100ccs during surgery and I had additional fills every 5-7 days after. That wasn't exactly pleasant, either. Not sure.

  • beesie.is.out-of-office
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    I think you answered your question as to why you had so much pain. I did get a fill during surgery - can't remember how much - but my PS was clear in advance that she would only do this if she felt there was room and it wouldn't add to my pain. If you have well-developed pecs that were very tight, the 100ccs at surgery would hurt! And fills every 5-7 days? Yikes. It was every 2 weeks for me, and the amount of the fill was based on when I said "okay, I can feel that now". As soon as I felt any pressure, the fill stopped. So early on the fills were larger, and towards the end, smaller. My PS believed in low and slow and that certainly worked well for me.

    This is advice that I probably shouldn't give, but my recommendation is that you save a few of those extra pills. I bring the extras of old prescriptions into the pharmacy for disposal when I am getting a new prescription, but I always hold on any that are left from the latest prescription. The worst pain I've ever felt was when I cracked a molar (while grinding my teeth at night). I got in to see the dentist quickly, but thank goodness I had some opioids left from my last breast surgery to ease the pain until I was in his chair. To use an expression that my PCP uses, as long as you know that you are not someone who will abuse them (and know that there isn't anyone in your household who will), it's handy to have a few of these pills "in your pocket" in case you ever need them.

  • WC3
    WC3 Member Posts: 658
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    I had a skin sparing mastectomy with immediate pre pec expander placement. My pain was manageable with Tylenol provided I did not move much or try to use my arms in contraindicated ways.

    I think it would have been a different story if cutting muscle were involved.


  • summerangel
    summerangel Member Posts: 182
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    Thanks, Bessie, I think you're right about holding on to the medication. For some reason it's kind of comforting to know they're there if I ever need them. I also think you're right about low and slow being more comfortable. My PS, who really was great overall, just had a standard rate of filling and did everyone's that way. On the one hand I was finished with fills very quickly, but I think I paid for it with pain.

  • hapa
    hapa Member Posts: 613
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    I was like WC3. Mastectomy with immediate pre pec implants and only took OTC pain meds. And I'm not even sure I needed those tbh. My first round of physical therapy was the most painful part of the whole process. I had a lot of cording/webbing in my armpit and the PT tore it up, which was very effective though painful.

  • WC3
    WC3 Member Posts: 658
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    hapa:

    I didn't have any axillary lymph nodes remove so no cording but my shoulder froze and I woke up from my exchange surgery with severe pain under my armpit and feeling like my armpit was stiched together inside. This lasted until I had my port, which was on the same side, removed. While I was still numbed up I extended my arm out as much as I could and I am not sure if there was actually a suture in there that I broke or the port with the implants was just too tight of a fit but in any case the pain was gone when the lidocaine wore off.

  • mountainlover
    mountainlover Member Posts: 59
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    SummerAngel,

    I had severe pain after my UMX nipple sparing with prepec TE placement. I had to undergo surgery twice in 24 hrs due to hematoma, and pain was slightly better after the emergency surgery but still bad.

    I can't take paracetamol so I alternated opioids and ibuprofen up to 3 weeks and a half post-surgery while gradually reducing dosage, then I managed on ibuprofen alone and quickly stopped all painkillers maybe in a week . It infuriates me that anyone should be kept in pain because the medical profession fears we'll get addicted. Pain is pain and noone should be forced to suffer if this can be avoided. I had to endure some comments by a pharmacist and one of the PS assistants but I got what I needed and had no problems at all to wean . But I sure hold on to those leftover tablets for the next round of procedures! Fingers crossed!

  • msphil
    msphil Member Posts: 185
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    hi there i was diagnosed while planning our 2nd marriage so scare but things moved along rather quickly. I found lump in shower. Was diagnosed with idc stage2 0/3 nodes 3 mo chemo before and after Lmast with expander. But after one filling i got a 103_104 temp fiance at time rushed me to ER. went into surgery to remove it my body rejected it as a foreign body it hardened. Then 7wks rads then 5yrs on Tamoxifen and got married between chemo and rads. Praise God a now 26yr Survivor and its also 26yr Anniversary. Hold on with Positive thoughts and lots of Hope.

  • Blue1002
    Blue1002 Member Posts: 6
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    I came here looking to read about pain after mastectomy so this thread is right up my alley, thank you SummerAngel! I am in a similar boat to you, SummerAngel I guess -- I am two weeks postop from a BMX with 15 lymph nodes removed (and tissue exanders under the pectoral muscles) and I'm still in a LOT of pain. And I used to think of myself as a pretty "tough" person with a high pain threshhold. I HATE complaining and I feel like it's all I do now. Sigh.

    I told everything to my doctor and she said it's all normal but I keep reading about people who were fine with advil and tylenol two days post op, and I'm wondering to myself, why do I have so much pain? I have a lot of pain around my incision on the left (where the lymph nodes were removed), tightness/pain around the tissue exanders, a general burning sensation across my chest, super-sensitivity in my left arm... honestly I don't know what's due to the BMX and what's due to the TEs but it's just generally not fun.

    My doctor recommended Gabapentin 3x daily, Ibuprofen and Tylenol and I'm trying that, but honestly only OxyCodone touches the pain. They gave me some OxyCodone when I left the hospital and refilled it once already, like 4-6 pills at a time. And I'm down to my last OxyCodone. I hate feeling like an addict begging for more but I just want to be able to feel OK. My kids are playing with their Christmas toys and I wish I could go out and play with them.

    SummerAngel when did the pain get better for you?

    To be totally honest I didn't follow the link to read the full article because I can tell from your summary it's just going to make me want to head-butt the author, lol! Sorry!

    DebAL thank you so much for sharing - I teared up just reading your post. You are the sort of nurse we all pray for. Thank you for caring.

  • muska
    muska Member Posts: 224
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    My double mastectomy with sub-pectoral reconstruction (expanders) ended after 9 pm. I had a blockade shot before surgery, so I don't think they gave me anything that first night. For the second night, I was given oxycodone orhydrocodone that gave me a bad reaction (heart palpitation etc) without much effect on pain. My doctor commented it was good it happened while I was still at the hospital. I didn't take anything but Tylenol after discharge. The pain was manageable with tylenol

  • buttonsmachine
    buttonsmachine Member Posts: 339
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    I found opioids to be helpful and necessary after my mastectomy, even if only for the first five days or so. My pectoral muscle was cut, the tissue expander was placed under the muscle, and I had an ALND.

    As an aside, I am concerned that too many cancer patients are not getting adequate pain control because of the policy shifts that have resulted from the opioid epidemic. I have been fortunate to mostly only have temporary pain (after surgeries, for example) for my first four years of having cancer and being in active treatment. But that is not the situation everyone is in, and I think some doctors - who have never done the things we have done, or gone through the things we have gone through - can be very unsympathetic. Not okay.

  • beach2beach
    beach2beach Member Posts: 245
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    i had a bmx with direct implant. They did not give any pain meds other than Ketorolac(heavy duty Tylenol is how it was described to me) through IV. Sent me home next day with 4 pills. Never took them. I was told from the beginning by the BS/PS they try to not rx opiods etc.

    Guess I was lucky.

  • summerangel
    summerangel Member Posts: 182
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    Blue1002, sorry I just saw your post - been off for the holidays!

    I ended up taking opioids for 3 weeks. The 3rd week I was able to use only ibuprofen during the day and then the opioids at night. After the end of the third week I was okay, but I did have one evening, the night of the 4th of July, when I needed another pill. I had been at a 4th of July party and much more active than I had been up until that point post-op and the area at the bottom of my pecs where the surgical mesh had been sewn down was very painful.

    I'm sure there are a lot of factors in the amount of pain, maybe the use of the surgical mesh "sling" was also a factor in mine. I agree that doctors cannot and should not treat every patient the same and they need to be aware of that particular patient's needs.

  • Blue1002
    Blue1002 Member Posts: 6
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    Thank you SummerAngel! I feel like _maybe_ I am getting better? I don't know if that's just optimistic thinking or if my progress is just so incremental that I can't really notice it. I mean, I'm definitely better than the first week. But it's four weeks out and I'm still waking up with pain at a 6-8. Soooo... not great. Hopefully I will turn a corner soon.

  • orangeflower
    orangeflower Member Posts: 95
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    They routinely send mastectomy patients home *the same day of surgery* here...They give you painkilling injections in your chest during the operation and tell you that you probably won't need any opioid painkillers. Well, I was in so much pain they had to admit me to the hospital overnight to help control the pain. I was on opioid painkillers for a couple of weeks afterwards I think, and I was still in so much pain. I couldn't even sit up without help. I can't imagine going through the mastectomy and tissue expander placement surgery without opioid painkillers. It seems like that the medical profession is overreacting to the opioid epidemic and not giving these necessary medications to people who really need it.

  • Molly2006
    Molly2006 Member Posts: 3
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    Hi! How do you like the latissimus dorsi flap? I am about to have this done next week and I’m nervous about the look and what it feels like under the arm pit. Do you like it ? Pros and cons? I’m very nervous about it. Thanks for any feedback! Molly200

  • cardplayer
    cardplayer Member Posts: 2,051
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    I had my exchange surgery Tuesday, took Vicodin for pain Tuesday evening and have since been taking Tylenol for pain, as needed. I’m still taking it easy, but so far the recovery has been much easier than expected.