What to expect with surgery

What to expect with surgery

For many, the thought of surgery is frightening. But with a better understanding of what
to expect before, during, and after the operation, many fears can be relieved.
Before surgery: You will find out if you have breast cancer within a few days of your
biopsy, but the extent of the breast cancer will not be known until after imaging tests and
the surgery for local treatment are done.
Usually, you meet with your surgeon a few days before the operation to discuss the
procedure. This is a good time to ask specific questions about the surgery and go over
potential risks. Be sure you understand what the extent of the surgery is likely to be and
what you should expect afterward. If you are thinking about breast reconstruction, ask
about this as well.
You will be asked to sign a consent form, giving the doctor permission to perform the
surgery. Take your time and read the form carefully to be certain that you understand
what you are signing. Sometimes, doctors send you material to review before your
appointment, so you will have plenty of time to read it and won't feel rushed. You might
also be asked to give consent for researchers to use any tissue or blood that is not needed
for diagnostic purposes. This may not be of direct use to you, but it may be very helpful
to women in the future.
You might be asked to donate blood before some operations, such as a mastectomy
combined with natural tissue reconstruction, if the doctors think a transfusion might be
needed. You might feel more secure knowing that if a transfusion is needed, you will
receive your own blood. If you do not receive your own blood, it is important to know
that in the United States, blood transfusion from another person is nearly as safe as
receiving your own blood. Ask your doctor if you will possibly need a blood transfusion.
Your doctor will review your medical records and ask you about any medicines you are
taking. This is to be sure that you are not taking anything that might interfere with the
surgery. For example, if you are taking aspirin, arthritis medicine, or a blood-thinning
drug (like coumadin), you may be asked to stop taking the drug about a week or 2 before
surgery. Be sure you tell your doctor about everything you take, including vitamins and
herbal supplements. Usually, you will be told not to eat or drink anything for 8 to 12
hours before the surgery, especially if you are going to have general anesthesia (will be
asleep during surgery).
You will also meet with the anesthesiologist or nurse anesthetist, the health professional
who will be giving you the anesthesia during your surgery. The type of anesthesia used
depends largely on the kind of surgery being done and your medical history.
During surgery: Depending on the likely extent of your surgery, you may be offered the
choice of an outpatient procedure (where you go home the same day) or you may be
admitted to the hospital.

General anesthesia is used for most breast surgery. You will have an IV (intravenous)
line put in (usually in a vein in your arm), which the medical team will use to give
medicines that may be needed during the surgery. Usually you will be hooked up to an
electrocardiogram (EKG) machine and have a blood pressure cuff on your arm, so your
heart rhythm and blood pressure can be checked during the surgery.
The length of the operation depends on the type of surgery being done. For example, a
mastectomy with axillary lymph node dissection will usually take from 2 to 3 hours.
After surgery: After your surgery, you will be taken to the recovery room, where you
will stay until you are awake and your condition and vital signs (blood pressure, pulse,
and breathing) are stable. How long you stay in the hospital depends on the type of
surgery being done, your overall state of health and whether you have any other medical
problems, how well you do during the surgery, and how you feel after the surgery.
Decisions about the length of your stay should be made by you and your doctor and not
dictated by what your insurance will pay, but it is important to check your insurance
coverage before surgery.
In general, women having a mastectomy and/or axillary lymph node dissection stay in the
hospital for 1 or 2 nights and then go home. However, some women may be placed in a
23-hour, short-stay observation unit before going home.
Less involved operations such as breast-conserving surgery and sentinel lymph node
biopsy are usually done in an outpatient surgery center, and an overnight stay in the
hospital is usually not needed.
You may have a dressing (bandage) over the surgery site that may wrap snugly around
your chest. You may have one or more drains (plastic or rubber tubes) coming out from
the breast or underarm area to remove blood and lymph fluid that collects during the
healing process. You will be taught how to care for the drains, which may include
emptying and measuring the fluid and identifying problems the doctor or nurse needs to
know about. Most drains stay in place for 1 or 2 weeks. When drainage has decreased to
about 30 cc (1 fluid ounce) each day, the drain will usually be removed.
Most doctors will want you to start moving your arm soon after surgery so that it won't
get stiff.
How long it takes to recover from breast cancer surgery depends on what procedures
were done. Most women can return to their regular activities within 2 weeks after a BCS
with ALND, while recovery time is often shorter for BCS plus a SLNB. It can take up to
4 weeks after a mastectomy. Recovery time is longer if reconstruction was done as well,
and it can take months to return to full activity after some procedures. Still, these times
can vary from person to person, so you should talk to your doctor about what you can
expect.
Even after the doctor clears you to return to your regular level of activity, though, you
could still feel some effects of surgery. You might feel stiff or sore for some time. The

skin of your chest or underarm area may feel tight. These feelings tend to improve over
time. Some women have problems with pain, numbness, or tingling in the chest and arm
that continues for a long time after surgery. This, sometimes called post-mastectomy pain
syndrome, is discussed in more detail later.
Many women who have breast-conserving surgery or mastectomy are often surprised by
how little pain they have in the breast area. But they are less happy with the strange
sensations (numbness, pinching/pulling feeling) they may feel in the underarm area.
Ask a member of your health care team how to care for your surgery site and arm.
Usually, you and your caregivers will get written instructions about care after surgery.
These instructions should include:
· The care of the surgical wound and dressing
· How to monitor drainage and take care of the drains
· How to recognize signs of infection
· Bathing and showering after surgery
· When to call the doctor or nurse
· When to begin using the arm and how to do arm exercises to prevent stiffness
· When to resume wearing a bra
· When to begin using a prosthesis and what type to use (after mastectomy)
· What to eat and not to eat
· Use of medicines, including pain medicines and possibly antibiotics
· Any restrictions of activity
· What to expect regarding sensations or numbness in the breast and arm
· What to expect regarding feelings about body image
· When to see your doctor for a follow-up appointment
· Referral to a Reach To Recovery volunteer. Through our Reach To Recovery
program, a specially trained volunteer who has had breast cancer can provide
information, comfort, and support (see our document, Reach To Recovery for more
information).
Most patients see their surgeon about 7 to 14 days after the surgery. Your doctor should
explain the results of your pathology report and talk to you about the need for further
treatment. If you will need more treatment, you will be referred to a radiation oncologist

and/or a medical oncologist. If you are thinking about breast reconstruction, you may be
referred to a plastic surgeon as well.