Breast Cancer Surgery It is normal to have questions about your surgery. This handout gives you information about what will happen to you before, during, and after your surgery. If you still have questions, ask your nurse or doctor for more information.
Before Your Surgery Before your surgery, a nurse practitioner or surgical resident will ask you questions about your health and your surgery. These questions may be asked during pre-admission testing, or in the Ambulatory Surgery Unit. Tests to make sure you are healthy for surgery will be done prior to surgery, such as blood tests, a chest x-ray, and/or electrocardiogram (heart tracing).
Preparing for Surgery Most patients are nervous about their upcoming surgery, especially when there is a cancer diagnosis. Getting answers to your questions may help, so please call your nurse or physician for additional information. When packing to go to the hospital, remember to bring the following: •
a roomy shirt or robe that buttons down the front
•
a soft, front-closure supportive sports bra that is one size larger than your normal size (no underwires)
•
a pillow or two to support your arm on the way home in the car
•
personal hygiene supplies More on next page Learn more about your health care.
© Copyright, (12/3/2008) James Cancer Hospital & Solove Research Institute, The Ohio State University Medical Center - Upon request all patient education handouts are available in other formats for people with special hearing, vision and language needs, call (614) 293-3191.
Page 2
Try to get a good night’s sleep before your surgery. If you are out-of-town, you may consider spending the night before surgery at one of the hotels near the hospital, which gives reduced rates for patients and families at The James. Do not drink or eat anything, smoke or chew gum after midnight. The morning of surgery, take any medications that you were instructed to with a tiny sip of water. If you have artificial nails, remove at least one nail completely, preferably the middle finger of the hand opposite your breast surgery. If you do not have artificial nails, remove all nail polish. Do not take aspirin at least 5 to 7 days prior to surgery.
Day of Your Surgery You will be instructed to report to The James front lobby desk. You will receive directions that suggest parking at the SAFEAUTO Hospitals Garage or Garage on 12th Avenue or valet parking in front of The James (10th Avenue). Generally, you are asked to report approximately two hours prior to surgery. At that time, you and one family member will be escorted to the presurgical area. Your family will be instructed where to wait for you. Your physician will come to that location after surgery to talk to your family. Note: if you are scheduled for a needle-localization procedure, report to the front lobby desk at The James, and then proceed to the Radiology Department on the second floor of Doan (the building adjacent to The James). Once escorted to the presurgical area, a nurse will talk to you. She/he will check your identification (ID) bracelet, and ask you again about allergies. Your hair will be covered with a paper hairnet, like the operating room staff wears. Your vital signs (blood pressure, temperature, pulse and breathing rate) will be taken and any additional blood tests may be done if needed. Dentures or partial plates, contact lenses, eyeglasses, hearing aids and any other prosthesis must be removed before going to surgery. Nail polish, make-up, jewelry, hair clips, wigs and head coverings will be removed. You will meet your anesthesiologist and any other personnel that will be with you in surgery. This is the time to tell the operating room staff anything special you want them to know. The nurse will put a needle into your vein (IV or intravenous) to give you fluid and medications. It will be placed in the arm opposite your breast surgery. If you are having surgery on both breasts, or if you had a prior breast can surgery and are having surgery on the other breast, your IV will be started in a vein in your neck. You will be given medication to relax you and make you drowsy.
Page 3
During Surgery All staff in the operating room wears special scrub clothes, caps, masks and shoe coverings. You will notice that the room has bright lights and is quite cool. Many pieces of special equipment and tables are set up with supplies and instruments. A scrub nurse or operating room technician gets the instruments and supplies ready for your surgery. The staff will explain what will happen to you before they are done. You will be made comfortable on the operating room table. A safety strap will be put over your knees so you stay on the table. You will be covered with an extra blanket if you are cold and your arms may be tucked in at your sides or put on an armboard. During your surgery, your vital signs will be closely checked. Three leads (held by round sticky patches) used to monitor your heart will be put on your chest. They will be connected to a monitor that counts your heart rate. As the monitor counts your heart rate it makes a beeping noise. Your heartbeat also may be seen on a screen. A small clip (pulse oximeter) is placed on your finger to measure your pulse and the amount of oxygen in your blood. The time it takes for your surgery is estimated. Your surgery may take a longer or shorter time than you and your family was told. If your surgery takes longer than you were told, it does not mean that anything is wrong. Your family will be told when your surgery starts, and how you are doing. After your surgery is over, your surgeon will call or come to the waiting area to talk with your family.
After Surgery After your surgery, you will be moved on a cart and taken to the Post Anesthesia Care Unit (PACU). As you come out of anesthesia, a PACU nurse will watch you closely and will take your vital signs frequently. Your pulse and the amount of oxygen in your blood will be checked. If you need oxygen after your anesthesia, you will feel a tube on your face, with little prongs in your nose. When you first wake up, you may feel cold and you may shiver. This is normal if you have had general anesthesia. Warm blankets are available. There will be other patients and a lot of activity and noise in the PACU. The nurse will try to wake you up during your time in PACU, but you may keep falling back asleep. If you have pain or nausea, ask your nurse to give
Page 4
you medication. It will be given through your IV. When you are awake and your vital signs are normal, you will be taken to the checkout area or to your hospital room. Your vital signs, IV fluids and any drainage tubes and dressings will be checked. At this time, your family will be allowed to visit.
Recovering from Surgery You may be released to home after surgery, especially if you had a lumpectomy only. If you had a lumpectomy and your lymph nodes removed, or a mastectomy, you will be spending one night in the hospital. If you had a mastectomy with reconstruction, you may spend one to four nights in the hospital, depending on the type of surgery. During your stay, your nurse(s) will monitor your vital signs, your liquid and solid food intake, your output (urination and bowel movements), and your level of activity. Your dressings will be checked frequently for any signs of bleeding or swelling. Your nurse will ask about any nausea or discomfort / pain you are having, and give you medications to help. Once you are drinking and eating, your IV will be removed and all medications will be given by mouth. Be sure to tell your nurse or physician about any problems. •
Activity It is important for you to be active after your surgery to prevent complications. As soon as you return to your room, you may turn to a comfortable position, remembering to avoid lying on the arm and side of your surgery. Your arm may be elevated on one or two pillows to aid in comfort and circulation. Use your arm as able, but limit raising your arm to 90 degrees. You may have compression garments on your lower legs. These are used to prevent blood clots, and should be kept on when you are in bed. You will get up the night of your surgery and possibly walk in the room and hall. You will need to cough and deep breathe 5 to 6 times every 1 to 2 hours while you are awake. This will reduce your risk of lung problems after anesthesia. A breathing exerciser device may be given to help you take deep breaths.
•
Pain Control It is normal to have some pain around the area of surgery. It is important to be comfortable enough to move, cough, deep breathe, eat and walk. Your pain medication will be given in small doses through your IV.
Page 5
Work with your nurse to get the level of comfort that allows you to rest as well as move around. The IV medications usually work within 5 to 10 minutes. Once you are able to keep fluids down, you will be given pain pills by mouth, which often work better than the IV medications. Try to eat a little food each time you take your pills. Pain pills usually take 30 to 45 minutes to work, so it is best to take in time to stay ahead of severe pain, and to prepare for activity, such as bathing or walking in the hall. Pain pills can be given every 3 to 4 hours. •
Food / Drink When you return to your room, you may have ice chips, water or 7-Up if you are thirsty. Once you are fully awake, you may have liquid and progress to regular food. If you feel nauseated, continue with liquids, crackers and toast. It is important to eat whenever you take pain pills or antibiotics to avoid nausea.
•
Incision Care You will have one or two incisions, depending on the type of your surgery. If you had a lumpectomy only, you will have a 2 to 3 inch curved incision on your breast. If you also had your lymph nodes removed with your lumpectomy, you will have a second incision below your armpit that is about 4 inches long. If you had a mastectomy (with or without lymph node removal) you will have an incision that starts near your breastbone and continues across your chest into your armpit. Your stitches will all be on the inside, except for the stitch that holds your drainage tube in place. Your incision edges will be secured with paper stitches called steristrips. A dressing will cover the whole area.
•
Drainage Tubes You will wake up with one or two wound drains if you had a mastectomy, or if you had lymph nodes removed along with a lumpectomy. The tubes exit on your surgery side below your armpit. The drains help remove fluid and blood to speed healing. A small collecting device at end of each tube gently suctions and collects the fluid. These will be emptied and the fluid measured every eight hours while you are in the hospital. The usual drainage can range from a few teaspoons (15 to 20 ml) up to several ounces (150 ml). You and your caregiver will be taught how to care for your drainage tube(s) before you leave the hospital. You will empty the fluid and record the amount of drainage for each drain. You will have these drains as long as needed – usually for 7 to 14 days, depending on the amount
Page 6
of fluid drained. A home care nurse can be arranged if desired. This nurse will visit you in your home every few days. What home care nursing you have may depend on your insurance coverage. You will have dressing supplies sent home with you to last several days.
About Feelings This can be a very emotional time for you and your family. You may have many feelings after surgery, including anger, fear, nervousness, frustration, relief, or depression. These feelings are all normal. Share these with your loved ones, friends, or health care team to help you cope as you recover. All of our nurses are trained to help you through this time, and additional specialists are available if needed. Several support groups for breast cancer patients are available to you. Some common concerns patients have after breast cancer surgery are about changes in their physical appearance. You will wake up after surgery with a bulky dressing over the incisions. These will be removed the next morning, which is often a difficult time, especially after a mastectomy. How the incisions look the day after surgery is not how they will look after you heal. Often it takes several months for the skin and tissues to relax and soften. Your nurse will explain expected changes and try to make this time easier for you. Your nurse will contact the American Cancer Society volunteer program called Reach to Recovery. This is a program provided free of charge to breast cancer patients. A trained volunteer who has recovered from breast cancer and is leading an active life will call on you either in the hospital or at home. This volunteer will bring you information about arm exercises and a temporary prosthesis which can be worn immediately after a mastectomy. For women, special bras are available that can be worn immediately after surgery, or you can wear a soft sports-type bra. A permanent prosthesis can be fitted about three months after surgery.
Discharge Instructions / Home Care Your nurse will review discharge instructions with you and your family before discharge. Things to remember: •
Activity
Limit raising surgical arm to 90 degrees; use arm to eat, comb hair and do light activities.
Page 7
•
Avoid lifting over two pounds with surgical arm until drain(s) removed. (A gallon of milk weighs 8.6 pounds.)
No driving until drain(s) removed.
Elevate surgical arm when sitting, or at night, for at least one week after surgery.
You may resume sexual activity when comfortable, avoiding pressure on incision(s) and breast.
You may wear a bra, whenever comfortable, especially if you had a lumpectomy, as it will give you added support. Use a soft, loose bra, or try a sports bra with a front closure. If you had a mastectomy, you may use the temporary prosthesis from Reach to Recovery, or shoulder pads, in your bra. You will be given a prescription for a permanent prosthesis about 12 weeks after surgery, once you are completely healed.
Incision Care
Leave incision(s) open to air; keep clean and dry.
Observe incision(s) daily and call if evidence of infection, redness, excessive or foul-smelling drainage.
Call if oral temperature is greater than 101 degrees.
Leave steristrips on until they fall off by themselves, or until 10 to 14 days after surgery.
You may sponge bathe while drain(s) are in place; if desired, you may take a tub bath if water level is kept below level of drainage tube exit site.
You may shower three days after surgery - have help nearby, and avoid direct water contact on incisions and drainage tubes. After showering, change dressings on drainage tube exit site. You may cover the incision(s) with plastic wrap while bathing, if desired, although it is not necessary. Hint: wear an old belt in the shower and pin your drainage tube receptacle to it.
Avoid scrubbing over the incision. Three days after surgery, you may gently wash the armpit area with a clean washcloth and antibacterial soap.
Page 8
•
Avoid using deodorants or powders until your incisions completely healed. If a product caused a rash or irritation in the past, do not use it again.
Avoid shaving your underarm, until completely healed. If lymph nodes were removed, shave with an electric razor to avoid nicking your skin. For the future, using an electric razor may help protect against infection or lymphedema.
Drain Care
Empty, measure, and record drainage from receptacle(s) twice daily, or more often if necessary. Call if drainage becomes foul-smelling.
If you have more then one drain be sure to label each one and record the drainage amounts according to which drain it came from: example, drain A or drain B.
Change drainage tube exit dressing daily (and as needed, if wet); clean around the tube exit site(s) with medicated swab (Betadine and/or alcohol), and apply clean dressing.
Gently strip tubing(s) twice daily to keep clots loosened.
Call if leakage of fluid persists from drainage tube exit site(s), and if unable to identify area of clog or unable to move clot(s) down tube.
Call if drainage receptacle fails to maintain suction.
If wearing a bra, make sure drainage tubes lie flat underneath, and are not kinked.
See your Patient Education handout “Home Care for your Wound Drain.”
Medications A prescription for pain medication will be sent home with you. If this medication is too strong, or no longer necessary, you may take: •
Advil / Ibuprofen / Motrin 200 mg. 2 tablets every 4 to 6 hours as needed for pain (avoid if you have stomach problems, a history of ulcers, or are on blood thinners, ex. Coumadin).
•
Tylenol Extra Strength / Acetaminophen 325 or 500 mg. 2 tablets every 4 to 6 hours as needed for mild pain (avoid if liver disease).
Page 9
Note: Remember to eat when taking pain medications in order to avoid nausea. To help with possible constipation, eat plenty of fruits, vegetables, juices, and water. An antibiotic prescription may also be sent home with you. Take this antibiotic until your drain(s) are removed.
Follow up Appointment / Questions •
Call your physician's office today, or within two days, to arrange an appointment for approximately one week after surgery.
•
Call if you have any signs of infection or bleeding, such as:
increased swelling
drainage from incision
increased pain, not relieved by medication
redness around incision
Call your physician or nurse practitioner for any problems or questions.
Other helpful phone numbers: •
OSU Medical Center Emergency Department - (614) 293-8333
•
OSU Medical Center Operator - (614) 293-8000 ask for surgical oncology resident on call
•
James Care at University Hospital East - to contact the doctors after hours call the office number (614) 257-2084
Talk to your doctor or health care team if you have any questions. You may request more written information from the Library for Health Information at (614) 293-3703 or email:
[email protected].