The Duchess of York Sarah Ferguson
The Duchess of York Sarah Ferguson. Photo: Getty Images/Jeremy Selwyn-WPA Pool Getty Images/Jeremy Selwyn-WPA Pool

Sarah Ferguson endured eight hours on the operating table for her single mastectomy surgery and reconstructive surgery according to a recent report. She then stayed in the Intensive Care Unit (ICU) for several days for monitoring.

A representative for the Duchess of York revealed last week that she had a successful surgery at King Edward VII Hospital in London and that she was already recovering back home in Royal Lodge with her family by her side. But the operation was "more involved than people think" according to a friend, who told the Daily Mail that it "was very long – getting on for eight hours."

"Today, the message she wants to get out is that she is very grateful to those who saved her and she feels very lucky to be alive," the unnamed pal shared adding that the 63-year-old is specifically thankful to the "two incredible surgeons Christina Choy and Stuart James who carried out the operation and all the medical team who worked tirelessly to help her."

Dr. Choy was the surgeon who carried out the single mastectomy while plastic surgeon Dr. James did the reconstructive surgery afterward. He performed a breast reconstruction with the "DIEP flap" technique, which involves taking fat from the abdomen to form a new breast.

This is believed to be a complex procedure that only highly-skilled surgeons are allowed to perform. Dr. James was once hailed by Tatler magazine as one of the U.K.'s top breast doctors. Experts say this process can take over six hours as it involves microvascular surgery, which requires cutting and then re-joining delicate 2mm blood vessels.

The hours-long combined operations and the length of time she was under general anaesthesia reportedly took its toll on Ferguson. She had to stay in the ICU for four days so doctors can monitor her vital signs. She was said to be in "good spirits" just days after she left the hospital.

The Duchess of York revealed during an episode of her "Tea Talks" podcast last week that she was diagnosed with breast cancer during a routine mammogram in early May. Her result showed a "shadow" and not a lump on the chest area.

"Most people usually associate breast cancer with a lump but that's not always the case. A lump can be detected by the patient, but this was a 'shadow,' which can go undetected because it's a wider spread of cancerous cells that can be picked up through screening," a source told the publication adding that in Fergie's case, "a biopsy was taken from the shadowy area of tissue and a few days later the results came back to confirm the diagnosis – breast cancer."

Doing a lumpectomy was not an option due to the size of the shadow. Instead, Ferguson was highly advised to undergo a single mastectomy which would remove the shadow of cancerous cells across the breast.

Despite feeling devastated, the Duchess of York told friends that she had "no choice" but to go through with the surgery. She echoed the same sentiment during her "Tea Talks" podcast episode. She told listeners, "Now is my chance, and this extraordinary position I'm in right now, it means there's no choice. I can't make another excuse. I have to go through this operation and I have to be well and strong. And therefore no choice is the best choice."

Ferguson reportedly also told friends last week that she has a "long road" to recovery but is determined to "beat it." She is now convalescing at Royal Lodge where Princess Eugenie has "all but moved in" to help look after her. Meanwhile, Princess Beatrice is said to be a frequent visitor and "constantly on the phone" with their mother. Prince Andrew has also been on hand to help and a Buckingham Palace source shared that King Charles III wrote the duchess a letter expressing his sincere wishes for her speedy recovery.