Information on Breast Care

“Over the past year, we have changed our pain management protocols at The Reinsch Pierce Family Center for Breast Health to reduce the amount of narcotic pain medication for breast cancer surgery patients. What has been the real game-changer in our pain protocols is the type of numbing medication we are using, EXPAREL®. A new, non-narcotic, long-acting injection, EXPAREL provides pain relief for up to 24 hours— a significant improvement over previous medications, which lasted only about 8 to 10 hours. Virginia Hospital Center is the only hospital in Northern Virginia to have this medication available to breast cancer patients—and it is making a big difference. More and more, patients tell me that they have zero pain after surgery. Once they go home, we’ve found that they require less, or for some patients no, narcotic medication during their recovery.

In our new approach, we give patients non-narcotic pain pills in the preoperative holding area, which helps relieve pain through different mechanisms. During surgery, I inject a long-lasting numbing medication every place I touch. This, combined with the non-narcotic pills given pre-surgery, enables the anesthesiologist to use less systemic narcotic pain medication overall.

All narcotics have the potential to be abused and the Surgeon General has asked all physicians to reduce the amount of narcotics prescribed. Treating pain with nonnarcotic medication is better—as long as we are able to keep our patients comfortable. Our outcomes consistently show that we can reduce the use of narcotics, while still effectively managing pain. In fact, we have been able to cut our use of narcotic pain medication in half. We are in the process of tracking our results to share with other breast health centers in the U.S.”
— Molly Sebastian, MD, FACS, Medical Director, The Reinsch Pierce Family Center for Breast Health, VHC Physician Group.

“....The primary consideration is which type of reconstruction is medically feasible and whether it will be safe for her to undergo reconstruction. Then I ask, ‘What is going on in your family life? What about your work life? Do you have to travel a lot? Do you exercise? What do you like to do?’ The social aspects of the patient’s life play a significant role in her decision.

For example, for a 35-year-old woman undergoing mastectomy who has very young children, implant reconstruction may be a better option than DIEP-Flap surgery because the recovery time is shorter. However, for a 35-year-old woman without children, DIEP-Flap may be preferable over implant reconstruction because she won’t have to worry about having implants replaced every 10 years. I consider what is happening in the patient’s personal life, in addition to overall medical condition and type of cancer surgery, in recommending surgical options. Usually patients, with my assistance, are able to decide which surgery is right for them after a detailed conversation about their options.

When patients consider having breast reconstruction, they are often worried about pain. Although they think it will be very painful, often it’s not. We do everything possible to make their experience very tolerable. And, by decreasing the amount of narcotic pain medication we give our patients, they bounce back much faster. Almost unanimously, they say it was not as bad as they thought it would be.

I truly enjoy getting to know my patients. It’s incredibly rewarding to do this kind of work.”
— Sarosh Zafar, MD, VHC Physician Group–Plastic & Reconstructive Surgery.