Outpatient bilateral mastectomy w/recon?????

I did not have any reconstructive procedures, but I have had bilateral mastectomy surgery. I think it was three hours after the start of surgery that I left the Hospital..

Your Doctor is absolutely right -- you should get out of the Hospital as soon as you can. There are dreadful infections in there that could seriously complicate your recovery, even make you very sick. [Sorry, it just came out that way.]

My very experienced BS/PS team does do outpatient (23 hour observation - no admission) mastectomy, with TE placement, if all conditions are appropriate. You would need to have adequately controlled pain, no post-anesthesia complications like vomiting or lethargy, have good home support, etc. Most of us don't hit all those marks, so have at least an overnight admission, but both the BS and PS said their patients who do outpatient have as good recoveries as those who are admitted. My insurance company does not permit outpatient mastectomy, so I did stay, but I had a paravertebral pain block so actually did not require much additional pain med or attention from the nursing staff. My husband spent the night with me and got me up to go to the bathroom, walk around the hall, etc. Because my block apparatus was removed late the following day (my surgery had been at 3pm the day before) I actually spent a second night because we needed to see what pain control was like without the block, and my 21-year old daughter stayed the second night so my husband could get a decent night's sleep. I was released early the next morning and really did not need to have spent the second night, but glad I did rather than find in the middle of the night that oral pain meds were not enough. I think you will find that most of the members here spend at least one night if they are complication free.

I had bilateral nipple sparing mastectomy with tissue expanders placement back in 2013. The surgery was scheduled in the afternoon and lasted for 8.5 hours, then I spent about 30 minutes in the recovery room and was moved to 'regular' room at around 9:30 PM. They obviously had to keep me overnight but an attempt was made to discharge me the next morning, i.e. less than 24 hours after the operation. We didn't agree and they kept me for one more night.

I think you should insist on staying overnight even if you feel fine and this is just for observation. They will check on you frequently, give you antibiotics via IV which is much more efficient than oral administration and you will learn how to control the pain and take care of yourself. For example, the oxycodone they gave me at the hospital didn't go well with me at all. The surgeon was glad I took it while in the hospital instead of being at home.

I had bilateral mast with TE placement. My surgery lasted almost 9 hours. I stayed overnight and was on morphine. I am soooo glad that I was because I was in a lot of pain even with that.

My best friend had a BMX, without reconstruction, and was told it would be an overnight stay. Turns out she needed enough IV pain control that she got a second night--which was valuable, because it also gave her the opportunity to meet with the nurse-navigator (who gave her books & supplies) and the social worker (who was able to come up with a list of visiting-nurse/home health aide services to help her with dressing changes and drain management after I had to go back to my family). Yes, there are hospital-acquired infections, but they are the exception to the rule there are common-sense precautions--like insisting everyone washes their hands before coming into the room, personnel wear fresh gloves, and using antibacterial wipes for the bedside table, call button/bed control/TV remote, and bedside phone (not everyone will be calling your cell). Not having to deal with getting your own meals while you are fatigued and in pain is invaluable. Getting a private room also reduces the odds of infection.

“Same-day surgery” isn’t always the same as “go home the same day.” The “23-hour admit,” which includes an overnight stay, is often done to maximize insurance reimbursement for the hospital; you’re still technically an outpatient because you have not been “admitted” as in inpatient. If you get one additional night, the hospital can bill and be reimbursed for both a “new patient visit” and a “hospital stay.” (Also, “23-hr-admits” don’t count toward their inpatient-incident statistics). If you have very good insurance and have met your deductible (even better, Medicare Part B and its supplement) there’s no financial impact to you--otherwise, watch your statements and bills like a hawk.

Mine wasn't with reconstruction (other than 'reconstruction' to leave me flat instead of concave and to graft my nipples back on as I was too large for a traditional nipple sparing mastectomy to look what I'd consider normal, but no expanders or implants or anything; my surgery was about 4.5 hours total) and was done on an outpatient basis.

What that meant, for the Marshfield system, is that I wasn't admitted to the hospital, not that the surgery was any less of a major surgery; it's that I wasn't what they considered high risk for having complications during surgery, so it could be done at their outpatient surgery center + a stay in the recovery suites rather than needing a hospital admission (which was more expensive). If I had been determined to be high risk for having complications during surgery, they would have done it on an inpatient basis over at the actual hospital, which was about a mile down the road.

I did stay overnight in one of their recovery suites and was out by 8:30 the next morning.

JennJ99738, talk to your surgeon about it and call your insurance company to see what their policy is on outpatient/overnight/etc. Also find out what the discharge guidelines are for your particular surgery at your hospital. (for example does the patient have to demonstrate the ability to walk before being discharged?- my hospital didn't care that I hadn't walked one step before discharging me. The hospital nurses transferred me from my bed to a wheelchair to my car. It was horrible because once I did try to walk for the very first time since coming out of surgery (when I got home to my driveway!!) I kept blacking out every time I stood up. I absolutely wish I would have talked more with my surgeon, insurance company and outpatient hospital before I had my BMX with TE surgery. I assumed I would be fine with an outpatient surgery because I had a friend who had a BMX with NO recon that was done outpatient by the same surgeon as mine and she did great having it as an outpatient procedure. I won't bore you with the details but if I had to go back and do it over again there is absolutely no way would I have agreed to do it outpatient--or at the very least I would make sure that the place I was having surgery was a 24 hour outpatient center. That was a big part of all my problems--dumb outpatient surgical center was part of a hospital but across the street and past a large parking garage from the actual hospital--and the center's hours were only 8am-5pm. So when I came out of surgery at 5:30pm those nurses were chomping at the bit to get me out of there so they could go home. You may do just fine with outpatient but I would have a plan in place in case you don't and you feel the need to be kept overnight.

23 hours for me too. Surgery was as 2 pm released before noon the next day. I only realized it must have been outpatient from info on these boards. I had a pain ball around my neckthat dissolved over five days so my pain was very well controlled.

I stayed one night as required. My feeling is that one night after major surgery is the minimum. I was in pretty good shape after my surgery physically but it is a big deal. And is was good to have nurses emptying my drains so that I could watch the process.

Best of luck

It is major surgery! I can't believe she said that. Geez

I would cancel that. I had my first surgery at sloan kettering. awful place. since I only had 1 removed I wasnt eligible for PCA patient controlled analgesia. I was informed of this in recovery. the PS told hubby I would be in awful pain and to expect a 2 night stay. unfortunately the BS was in charge. I pitched a fit. it took hours to get a PCA. Threw up. Nurses were too busy to help me up.

If your BS is acting like this now, your likely not going to get adequate pain control. this is crazy

I only had  one side removed.  I'm glad they kept me overnight because I crashed with a bleeding artery and had to have emergency surgery about 1 in the morning!  If I'd gone home, I would've been 20 minutes from the hospital.  Just tell them you have no help at home and need to stay overnight!  Good Luck!

I can not believe a PS would tell you that this is no big deal. It is a very big deal!!! This is a very important decision you are making and it sounds like you are having concerns. I would definitely stay overnight at the very least.

I was allowed to stay one night.  I wanted to stay a second night but they would not allow it.  I had home health care come in daily too, it helped a lot.