Mary was a patient on Lynher ward who had been admitted for reconstructive breast surgery.  Sister Penny Thompson led the development of a revised patient pathway for breast care on Lynher ward and Mary was one of the first patients to receive care on this new pathway.

Mary had been diagnosed with breast cancer three years prior to her treatment, for which she had a left mastectomy followed by several months of chemotherapy.  Due to the nature of her tumour, she also had her ovaries removed as there was a high risk of secondary tumours due to the hormonal imbalance caused by her breast cancer.  Her reconstructive surgery had been delayed, due to the ongoing treatment and further surgery that she required.

Although Mary was pleased with the care and treatment she had received over the years, she was not happy with the image of her body, which she was left with following the mastectomy.  Due to her usual breast size, her breast prosthesis was large; this was uncomfortable and awkward to deal with on a day-to-day basis.  As the months passed, Mary became more and more unhappy.

For any woman, reconstructive surgery carries high risks.  With a large breast needed to be built the operation planned would be several hours, with risks of anaesthesia; there were risks of  the flap failing, donor site infection, further scarring, long-term pain and limited movement.   Because of these risks and the fact that Mary had undergone significant surgery and other treatment in recent years, her family were not keen for her to have this reconstructive surgery.

Despite the risks of further surgery and against the wishes of her family, Mary agreed to reconstructive breast surgery and commenced the new breast care pathway.  This involves the patient coming into hospital the day before surgery.  With such major surgery, there is a considerable amount of preparation for the patient, both physiologically and emotionally.  There is much evidence to demonstrate that reducing patient anxiety and stress levels results in improved success of surgery, reduction in complications, reduction in pain and decreases the over-all length of stay in hospital.  The Breast surgery pathway allows the woman to receive all the relevant information and psychological support to fully prepare her for surgery.  Mary commented on how she felt involved and prepared by coming to the ward the day before surgery – and how this allowed her to ask questions, be given information in context and to meet the staff who would be caring for her post-operatively.

Surgery for Mary’s reconstruction lasted ten hours, involving creating a flap of muscle, skin and blood vessels from her abdomen.  She had two large wounds on her breast and abdomen.  Immediately following surgery she was admitted to Critical Care for twelve hours.  Post-operatively, back on Lynher ward Mary was nursed one-to-one in a cubicle; this allowed the intensive nursing she required  - maintaining her physiological status, wound-care, infection prevention, pain control, emotional and psychological support. 

 The care pathway lasts 5- 7 days and progresses patients in their recovery from surgery, wound care, pain control, mobilisation and independence.  Mary appreciated the privacy & dignity the pathway afforded and the fact that her involvement was encouraged in her care decisions.

Discharge planning included follow-up support – both for wound care, breast support and planned breast development (eg nipple reconstruction, areola tattoo).  Mary left hospital six days following her major surgery - feeling happy with her treatment and much more positive about her body image.  The reconstructive surgery had not only given her back her breast, but also corrected some of the scarring from her original mastectomy – it gave back her own body, her image of being feminine and her self- confidence as a woman.