Breast Cancer Surgery Overview

Pre-Operation Visits

• The breast care coordinator is available to every person with breast cancer. She will advise you of educational and support resources available to you, and help you sort out what will be helpful to you. With your surgeon, she will answer questions about your pre and post operative care.
• Your surgeon will meet with you to discuss your surgical options and his/her recommendations, order any lab tests necessary, perform a history and physical exam preoperatively, and answer any questions you may have.
• The preop nurse will provide specialized teaching for your surgery.
• If necessary, a consultation with an anesthesiologist is made to evaluate special needs.

Preparing for Surgery

• You may want to read through Preparing For Successful Surgery from the Anesthesiology department.
• Expect to be off work about 7 days depending on your type of surgery, occupation and recovery.
• You will be tender and sore for the first 2-3 days, and then you should improve day by day. Most people have returned to limited household activity after one week.
• You should not drive while taking pain medications or while you have a drain.
• You will get a work release form at your post-op visit with the surgeon. If disability forms are needed, submit a copy of the work release to the Business Office [Map] and complete your portion of the state form they will give you.
• Make arrangements for childcare, grocery shopping, transportation and general support for 3-4 days. Put some meals in the freezer for the immediate post-operative period. If you live alone, arrange for someone to either stay with you the first night and/or to check on you by phone. You will need someone to drive you to and from your surgery and possibly to your first post-op appointment.
• Do take a daily multivitamin. Do not take ibuprofen, naprosyn or aspirin for a week before and after surgery Do not take any additional Vitamin E supplements 3 weeks before or after surgery.
• You may not eat or drink anything after midnight the night before surgery. You will be advised if you should take any regular prescription medications with just a sip of water.
• Arrange to arrive a few minutes early at the Admitting Office [Map]
• Bring your Kaiser card, an ID, and a means to pay for your hospital co-payment (cash, check or credit card)
• Wear comfortable clothes with an open-front shirt. You will change into a hospital gown and leave your things in a small locker during surgery.
• Your family or friends can wait for you during the surgery or, if you prefer, they can be called when you get to the recovery room. You will be in the Ambulatory Surgery department about 2-8 hours depending on your recovery from anesthesia.
• Pick-up: When you are ready for discharge, your driver can pick you up from the front entrance of the hospital.

Post Operative Care

• It is important for you to get up and move around the house and take some deep breaths 4-6 times a day.
• Plan to sleep on your back with your head elevated, if possible. A recliner chair is one solution.
• Use pillows to maintain a comfortable position. Often a very small pillow between the armpit and chest is helpful.
• Some people experience a slight sore throat or mild cough for 2-3 days after surgery. This is a side effect of anesthesia and should resolve in 48-72 hours.
• The first night after surgery is your most uncomfortable time. Your pain will then decrease day by day. Most people will not need prescription pain relievers after the first few days, many people only take a couple of doses and then use Tylenol. The pain medicine is usually a combination of acetaminophen (Tylenol) and a narcotic, so don`t combine medicine for pain.
• To avoid nausea, always take the pain reliever pills with food in your stomach. Constipation can be a side effect, so double your fiber and fluid intake while taking these pills. A stool softener like Colace may also be helpful.
• You may take non-steroidal pain relievers like ibuprofen 5-7 days after surgery.
• It is common to have areas of numbness in your breast or arm. This may be permanent but most patients experience improvement over time. Expect soreness, tingling, pins and needles or other signs that feeling is returning.

Wound Care

• If you don't have drains, you may ask the doctor if you can remove the dressings at home 1-3 days after surgery. Remove the outside adhesive gauze and gauze padding. It is normal to have some dark brown old drainage on the gauze and a scab along the incision. You may have some bruising as well. Do not remove the Steristrips.
• You may shower after the original dressings and drains are removed. Lather up with your normal soap on your chest above the incisions and Steristrips. Let suds wash over breast, rinse and pat dry.

Limitations on Activity After Surgery

• Restrict your arm movements for the 3-4 or while the drain is in place: no reaching above your shoulders, twisting or lifting more than 5 pounds.
• No heavy activity or lifting or aerobic exercise for 1-2 weeks. Any activity that makes your face flush or makes you sweat can make you swell.
• No soaking your incisions (bath tub, hot tubs) until your steristrips have fallen off, your sutures have been trimmed, and all scabs have healed.
• You may go back to most jobs after 7 – 14 days.
• After two weeks, ask your doctor if you may resume all normal activities, including gradually increasing weight training and aerobic fitness training.

Scar Care

• Scar development is a process that lasts up to a year and a half after your surgery. Scarring can be significant but a little care will improve your scar's appearance. For the first year, avoid sunlight on your scar to keep it from pigmenting darker than your surrounding skin. Use clothing and sunscreen to protect it.
• Scar tissue does not have the same lubrication glands as regular skin. After 3 weeks, you can help your scar by keeping it moistened with lotion or ointment. Massage the length of the scar with firm circular motions four times a day. This will help organize the scar tissue and make it more mobile and soft.
• You may notice a normal increase in redness in your scars between 3-6 months after surgery.
• If your scars are growing thick, rope-like, outside their original boundaries, or are itchy, burning and painful, please contact the clinic.
• If you have a history of keloids or hypertropic scars, please discuss this with your surgeon or nurse.

Body Image

It may take a few months to get comfortable with the surgical changes of your body. It is helpful to talk with other women who have coped with a similar diagnosis and treatment. The breast care coordinator can refer you to support groups or give you a referral to an individual counselor. She can also order a camisole-like garment to wear after a mastectomy and a permanent breast form and 3 bras when you are healed from surgery (about 6 weeks).

Follow-up Visits

You will be asked to come in for regular checkups until the surgical recovery is complete. You will be referred to the oncology clinic approximately 2-3 weeks after surgery. Your oncologist will discuss the need for further treatment including radiation therapy to complete local treatment after a lumpectomy. You will be followed in the oncology clinic for the next 3-5 years.

Remember to do your monthly breast self-exams and have routine clinical exams with your regular primary care provider. The breast care coordinator can teach you breast self examination after treatment is complete if you wish.