It’s shocking, yet possible. Thanks to special techniques that enhance a patient’s recovery after surgery, women can now undergo major surgeries – such as a mastectomy and immediate implant breast reconstruction – and return home the same day.
Dr. Claire Temple-Oberle, surgeon at the Tom Baker Cancer Centre in Calgary, is a leader in this emerging field and has so far offered this approach to 60 women who have had reconstructions over the past year. “We noticed women struggling with recovery from traditional perioperative management, so we began looking at options,” she says. “The enhanced recovery after surgery model is about giving patients a better recovery journey, with less time in the hospital and better outcomes with fewer complications.”
The procedure used by Temple-Oberle and her team is based on a model used for colorectal surgeries, which was adapted for breast reconstruction. “Most of the women we approached were quite keen about the idea,” she says. Patients who undergo the enhanced recovery method with same day discharge must be in good health and live within an hour of Calgary, should complications arise.
There are three major areas of focus for the procedure: pre-operative, operative and post-operative care. As Temple-Oberle notes, counselling is a large part of pre-operative care. “Staying in hospital after surgery often has a sense of security,” she says. “But, there are advantages to getting home sooner, and these can include patients being with their families, getting better sleep and having lower risk of infection – all of which can reduce recovery times.”
In addition to counselling, pre-operative care includes medications like antibiotics, pain and anti-nausea drugs. “Another aspect is keeping patients warm, both before and during the procedure,” says Temple-Oberle. “If a person’s body temperature drops by one degree, there’s an increased risk of complications.”
During the operation, an anaesthesiologist (like Dr. Jeremy Hamming, who works with Temple-Oberle) may use a combination of medications like intravenous anaesthetic, epidurals and local anaesthetics.
Using these agents helps limit the patient’s pain response and avoid the use of volatile gas, which can increase post-operative nausea.
Post-operative care includes pain and anti-inflammatory medications, as well as hydrating and staying mobile. When patients return home, having a responsible adult with them is essential. “Both the patient and the adult will learn about the drains and wound sites related to the surgery,” Temple-Oberle explains. “And the caregiver will also wake the patient up and ensure that they take their pain meds regularly.”
At-home support is provided by a medical team, as patients receive phone calls and answer recovery questions on the days following the surgery. “We followed our first 30 women rigorously to study their experiences, and they scored better than people who were in the hospital. It’s incredible how well they did.”
Having witnessed the success of this implant reconstruction procedure, Temple-Oberle and her colleague, Dr. Christiaan Schrag, began using the procedure for more extensive reconstructions. “We’ve started using enhanced recovery for abdominal flap breast reconstructions, which are often used for delayed reconstructions after a person has had radiation, for example,” she says. “The method has been positive for these procedures, as well, and women are often able to return home in three to four days, instead of the traditional five to six.”
With the positive results they’ve seen, Temple-Oberle and her team have been asked to be the international leads, developing guidelines on the procedure for the Enhanced Recovery After Surgery Society. “We’ve established a team of plastic surgeons and anaesthesiologists from around the world to provide expertise on the method,” she says. “From this, we’ll publish what we suggest are the best practices and recommendations for these types of reconstructive surgeries.
“We were so fortunate to be able to pursue enhanced recovery, and we could do this thanks, in part, to support from the Surgery Strategic Clinical Network, CancerControl Alberta and the Alberta Cancer Foundation,” she adds. “There’s a lot you can do to help the body and soul recover, and enhanced recovery may provide a great option for people.”
Breast Reconstruction Awareness (BRA) Day
On October 21, breast cancer patients and their supporters are invited to learn more about breast reconstruction and other available options. In Calgary, the event will take place at the Alberta Children’s Hospital from 5:30 to 8:30 p.m., providing a wide variety of learning opportunities.
This year’s activities will include a show and tell, where peer volunteers provide mastectomy patients and their support people the opportunity to see and talk about reconstruction. Other activities will include a mock operating room, a body casting area, lectures and exercise options.
“People need information to make choices,” says Dr. Claire Temple-Oberle. “Many women may feel reconstruction isn’t for them, and that is perfectly fine. At BRA Day, our biggest goal is to educate women and to empower them to make their own personal choices.”