Procedures

Breast Cancer Procedures

• Description
• Risks
• Pre operative information
• Information about the day of surgery

• Length of recovery
• Post operative information

Description:

The procedure that you have will depend on how far your cancer has spread and the stage of the cancer.

Lumpectomy

If your cancer is caught in stage I or II, meaning that it's less than 5 centimeters in diameter and hasn't spread beyond the lymph nodes into the rest of the body, you may be able to have a lumpectomy or a partial mastectomy. In this surgery, usually an outpatient procedure, the cancerous area is removed, along with some surrounding tissue and possibly some lymph nodes. Most patients need six to seven weeks of radiation therapy afterward. Many studies have found that for women whose tumors are 5 cm. or less, a lumpectomy followed by radiation can be as successful in preventing the recurrence of cancer as a mastectomy without radiation.

Mastectomy

If your tumor is large or aggressive, you may need a mastectomy, in which your whole breast is removed. This might also be a good choice for you if you're looking to avoid radiation treatment, want to minimize the chance that cancer will recur, or plan to have your breast reconstructed. A simple mastectomy removes only the breast tissue, but most women end up having some lymph nodes removed from the axilla as well. An overnight stay in the hospital can usually be avoided.

Breast reconstruction is performed by a plastic surgeon working closely with your breast surgeon. This can be done in an immediate or delayed fashion dictated by the clinical stage and the need for additional therapy. Both your plastic surgeon and your breast surgeon will help you decide which is right for you.

Lymph node sampling

Many women who undergo surgery for breast cancer need to have some or all of their axillary (underarm) lymph nodes removed to determine how far their cancer has spread and what other therapies may be necessary. Lymph nodes are small, bean-shaped glands that cluster inside your armpits. They contain lymph, a colorless fluid that circulates throughout your body like blood, carrying toxins away from your tissues. If cancer gets into the lymph nodes, it can spread more easily throughout the body. Typically, several nodes are removed for examination during a biopsy. If cancer is found in one, the surrounding nodes may need to be removed as a precautionary measure.
An increasingly popular way to spare a woman removal of uninvolved lymph nodes is called sentinel lymph node mapping. The doctor injects a radioactive dye into your breast, which takes the same path to the lymph nodes that cancer cells would take. The surgeon can then tell which node is the sentinel node and remove it for testing. If it's cancer-free, chances are good that you won't need to have other lymph nodes removed.

Risks:

The significant risks of the partial mastectomy with axillary dissection procedure are recurrence of cancer, numbness of chest wall or axilla, range of motion limitations, breast pain, lymphedema, and the need for more surgery because of positive margins. The significant risks of the mastectomy procedure are recurrence of cancer, numbness of chest wall or axilla, range of motion limitations, breast pain, and lymphedema.

Pre operative information:

Before your surgery, you will be required to have a pre admission testing appointment. At this appointment, you will be registered at the hospital; you will have lab work done and possibly a x-ray. You will also meet with an anestheologist.

Information about the day of surgery:

No food starting midnight the night before surgery. Solid food must be avoided the day of surgery-regardless of the surgery time. Clear liquids must be stopped four (4) hours before your surgery.

Clear liquids are considered: water, apple juice, cranberry juice, black coffee (no cream), tea, and soda (7-UP, pepsi, ect).

Length of recovery:

With both lumpectomies and mastectomies, most women are able to go home the same day as the surgery. However, your surgeon may recommend additional treatment after your surgery.
Your treatment after surgery depends on the specifics of the cancer you have. Lumpectomy patients usually receive six to seven weeks of radiation therapy. Women who've had mastectomies usually don't need radiation unless the tumor was larger than five centimeters, there were multiple lymph nodes involved or the cancer metastasized to other parts of the body.
The decision about whether you'll need chemotherapy or any other kind of drug therapy will depend on factors such as the type and grade of the tumor, lymph node involvement, the size of the tumor, and your age and overall health.

Post operative information:

The following information is intended to guide you through your post-op recovery:

Diet:

For the first few days after your return home you should eat foods that you easily tolerate normally.

Medications:

Follow the directions on any new prescriptions that your doctor has given you. You will be instructed prior to your discharge about what daily medications you will need to take when you return home.
Pain management is an important part of your post-surgery care. You should expect some discomfort after your surgery. You may be sent home with a prescription for pain medication. It is important to take your pain medicine prior to your pain becoming intense in severity.

PLEASE NOTE:

No pain medication refills will be authorized on the weekends. If a refill is needed, the request must be made before 12:00 on Friday.
Some side effects from the pain medications include nausea and constipation. If you experience nausea or vomiting related to your pain medications, you should stop the medication and take ibuprofen or acetaminophen for pain management.

Bowel Care:

To prevent constipation you should drink plenty of fluids and take a stool softener daily.
If you have not had a bowel movement within 48 hours after your return home, you should increase your fluid intake. You may take one single dose of Milk of Magnesia, as long as you have no abdominal distention.

Incision Care / Drain Care:

Please leave your dressings in place until your first office visit. You may retape any part of the dressing that loosens and is about to fall off.
You may have one or two drainage tubes in place after your surgery. You will need to empty those tubes twice a day and keep a record of those volumes. The hospital staff will give you instructions on the care of those tubes. You may not shower while the tubes are in place. The tubes are likely to be removed once you are draining less than 30cc in a 24 hour period.

If your dressing becomes extremely soiled, or loosens and comes off prior to your first office visit, you may replace it with a dry sterile dressing and tape, and hen call the office to arrange a nurse visit for a dressing change.
If your clothes irritate the incision or if you have some drainage you may leave a dry gauze dressing over your incision.
Once the dressing is removed you must observe your incision daily for signs or symptoms of infection. These signs would include: increased swelling, redness or smelly wound drainage. It is normal to have some swelling and bruising around your incision.
Once your dressing is removed you will notice that you have steri-strips/tapes across your incision. Those strips should remain in place for 5-14 days. The strips will gradually loosen and come off. If they do not come off within two weeks you may remove them yourself.

Physical Activity:

Minimize your activity level for the first few days at home. You may return to exercising when your physician states it is OK
Please bring a “support” type bra or your breast binder with you to your follow-up appt. You will need to wear a bra with firm support or a breast binder for about one week after your appt.

Bathing and Showering:

You may start showering 48 hours after your dressing and drain have been removed. You may shower with your steri-strips and staples or stitches in place. Do not scrub across your steri-strips or staples. Do not bathe in a tub for 10-14 days after your surgery. This includes a “hot tub”.

Driving:

You may drive when you no longer are taking narcotic pain medications and you feel you can quickly respond to situations that will not place others in jeopardy.

Return to Work:

As a general guideline the following will give you a guide for when to return to work:
Light lifting or no lifting type jobs: You may return to work the within three to seven days of surgery.
Heavy lifting or physical type jobs: You may return to work within one to two weeks after surgery.
Please notify our office if you need a return to work letter to your employer. It may take up to 48 hours for the letter to be completed. Please leave a fax number for your employer so we can fax your release

Pathology Results:

The pathology results will usually be available two-three “working” days after your surgery. You should call the office in the afternoon, on your third post-op day, if you have not heard from our office.

NOTE:

You should receive written information about “arm exercises” and “prevention of lymphedema” and “breast prosthesis prescriptions” within two weeks of your surgery. Please inquire about this if you have not received this information.

Do not allow any blood pressures or lab / IV punctures on the arm of the affected side (surgery side).

Follow-up Appointments:

You will need to return to the office for a follow-up visit usually within 7-10 days after your surgery. Please make sure you have your appointment scheduled.

Problems to Observe For:

Call the office for the following:
1. Fever >101.0
2. Uncontrolled pain. That is on a scale of 1-10 (10 being the worst pain imaginable) your pain is a level 7 or above.
3. Nausea and / or vomiting that continue for 12-24 hours.
4. Diarrhea that continues for 12-24 hours.
5. Signs of a wound infection.
6. Chest pain or difficulty breathing
7. Your incision separates or opens up.

If you have further questions after reading this handout, the office is open from 9:00AM to 5:00PM Monday through Friday. For emergencies after office hours, the answering service will be available when you call the office number.

References: