Breast Surgery for Cancer

Mastectomy

• Removal of your entire breast
• You can choose to not undergo reconstruction, and will have a flat scar
• You may choose to have reconstruction
  • You will be recommended to meet with a plastic surgeon (often preoperatively) to discuss plans for reconstruction, which can affect your type of mastectomy
    • If planning reconstruction, a skin-sparing, or nipple-sparing surgery may be offered, which can improve cosmetics
• One larger incision o Entire breast is removed off the underlying muscle.
• A drain is left in this space to collect the fluid that will accumulate until this scars down
• The skin is closed
• Overnight stay
• You will go home the following day with drain in place for a couple weeks
• You will be taught how to care for the drains, empty and record outputs (see below)

Axilla

Sentinel Node Biopsy

• This is done for “staging” for invasive cancer
• A few lymph nodes are removed, so the pathologist can look at the under the microscope to determine if the cancer has spread here
• This surgery was developed to prevent the unnecessary removal of large numbers of lymph nodes that aren’t involved by the cancer.
• To identify the sentinel lymph node, doctors inject a tracer that accumulates in the first lymph node(s) that cancer would spread to.
  • Magtrace – magnetic, injected 1-3 weeks before surgery by a radiologist
  • Radioactive tracer and blue dye – injected the morning of surgery, and during your surgery while you are asleep
  • Small incision in the axilla (armpit), or done through a standard mastectomy incision
• A probe is used to identify the sentinel lymph nodes by locating the tracer that has accumulated in these nodes
• Everyone is different, but most people have 1-4 sentinel lymph nodes
• These are completely removed to send to pathology
• A sentinel lymph node biopsy can be done with either a lumpectomy or a mastectomy and is often performed at the same time as your breast surgery
• Pathology results will take 2-4 days to result

• Risks
  • Bleeding, infection, Injury to surrounding structures
  • Fluid collection (seroma, hematoma)
  • Need for further surgery or treatments if there is cancer present in the lymph nodes
  • Minimal risk of lymphedema (arm swelling)
  • Anesthesia-related risks (heart, lung complications and blood clots)

What to expect

Day of Surgery

• You may receive general anesthesia and have a breathing tube (endotracheal tube) put down during surgery. You will be completely asleep and the tube is removed before you wake up.
• You may have a lighter anesthetic if your cancer is small and your anesthesia provider feels this is safe. The anesthesia provider will meet with you the morning of surgery
• Most people go home within a few hours after surgery, unless you are having a mastectomy
• You will need someone to drive you home and be close for the first night following your surgery
• Surgery Locations
  • Brightside Surgical
    • 401 N. 9th Street Bismarck, ND 58501
      North side of the Essentia/MDC main building
      Enter through door #7
  • CHI St. Alexius
    • 900 East Broadway Bismarck, ND 58501
      Enter through the East Patient Entrance (Door #17)

Postoperatively

• Eat normal diet, start with bland foods. Ensure you are drinking 8-10 glasses of water a day after surgery. Eat high-fiber foods or take fiber supplement (ex. Metamucil) to help with your bowel movements after surgery.
• If you had a lumpectomy, you will not need narcotics. You may take Tylenol or ibuprofen as needed
• If you had a mastectomy, you will stay overnight. You will be sent home with pain medications which most people will take for a few days after surgery then are able to wean to non-narcotic mediations
  • Take ibuprofen (unless you have a medical reason not to) in addition to help decrease the amount of narcotic you are taking.
  • Norco (the narcotic most commonly prescribed) has Tylenol in it. Either take norco OR Tylenol in addition to the ibuprofen.
• Take stool softeners and/or laxatives as needed (docusate, miralax) to help your bowels stay regular following surgery. Anesthesia and pain medications can contribute to constipation postoperatively.
• Walk around as able. Take deep breaths to fully expand your lungs. This can help prevent pneumonia and blood clots
• Slowly increase your activity. Your surgeon will let you know if you have any restrictions after your surgery.
• Most people will be able to return to work or school a few days to a week after a lumpectomy, and 2-4 weeks after a mastectomy
• Wound care
  • It is expected you will have a fluid collection at the site of your lumpectomy and/or axilla surgery. This will feel hard and round. Your body will slowly absorb this over time, but this takes weeks to months. If you develop sign of infection (fevers, drainage, significant redness please call the office)
  • All sutures used will be buried under the skin and absorbable. o If you have steri strips over your incisions. Remove dressings in 24-48hrs after surgery. Leave white strips (steri strips) in place and shower. Let soapy water run over these and pat dry. They will begin to peel off in about 7-10 days then you may remove.
  • If you have skin glue (dermabond) over the incisions you may shower immediately. When this begins to flake off you may peel off, typically in a week. o Do not bathe, soak incisions, go in hot tube, pool or lake/ocean for 2 weeks.
  • Your scar with heal over the next 4-6 weeks and continue to fade and soften over the next year. Use sunscreen over incisions if exposed to sun for the next year.
• Drain care
  • If you have a drain in place, you will be taught how to empty and record the outputs.
  • This will first appear bloody, then turn light red and eventually yellow.
  • You should strip your drains to ensure these stay clear and functioning o When the output is <30mL/day for 3 days in a row please call the office to have this removed.
  • Please visit this link for instructions regarding drain care
    • https://www.facs.org/for-patients/home-skills-for-patients/breast-cancer-surgery/after-your-operation/surgical-drain-care/
• Exercise
  • Doing arm and shoulder exercises will help you get back your full range of motion on the affected side
  • These exercises can help keep scar tissue from forming in your armpit and shoulder. Scar tissue can limit your arm movements later.
  • Do these exercises 3 times a day until you can move your affected arm the way you did before surgery. After that, keep doing them once a day. o Start slow and slow increase as you are able.
  • If you still have trouble moving your shoulder 4 weeks after your surgery, tell your surgeon.
  • https://www.facs.org/media/k3on0wvl/common_exercises.pdf
• Massage
  • You may massage your incision with clean hands after 2 weeks. This may help the way it scars.

Patient Information & Documents