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Frequently Asked Questions about Breast Surgery

Q:  How do I prepare for surgery?

A:  Prior to surgery, you will have a pre-operative appointment with the hospital or outpatient surgery center to review your history.  In most cases, you will need a chest X-ray, electrocardiogram (ECG), and basic blood tests.  If these have been done by your primary care physician recently, they may not need to be repeated.  Please let your doctor know.  Stop all aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs such as Advil, Ibuprofen, Naprosyn, Alleve, Celebrex, Vioxx, etc.) 7-10 days prior to surgery.  If you are taking any other blood thinning agents (Coumadin, Plavix, etc.), let your doctor know.  They may need to be stopped prior to surgery.  Additional pre-operative instructions will be given you to at your pre-operative appointment.

Q:  Will I need to donate blood?

A:  The blood loss that occurs during breast surgery is generally minimal and usually does not require a blood transfusion, unless breast reconstruction is planned.  Therefore, routine pre-operative blood donation is generally not necessary.  Ask your doctor if this is indicated for you.

Q:  What kind of anesthesia is used?

A:  Most breast surgery is performed under general anesthesia.  In most cases, it given through a combination of an anesthetic gas and IV medication.  This allows you to be without awareness or discomfort during the procedure.  At the completion of the operation, the surgeon will usually inject local anesthesia into the area of surgery to give you some temporary pain relief immediately following surgery. 

Q:  How long will the surgery take?

A:    This depends on the type of surgery you are having.  It is also dependent on any other medical conditions you may have.  Excisional biopsies and lumpectomies with lymph node surgery generally last 1-2 hours.  A mastectomy usually takes approximately 2 hours.  Of course, more time is needed if breast reconstruction is planned.  Ask your doctor(s) for a more specific estimate. 

Q:  Will I need medication after surgery?

A:  Following an excisional biopsy or lumpectomy, very little pain medication is necessary, and over-the-counter Tylenol or Advil is generally recommended, provided you do not have an allergy.  Otherwise, in most cases, the surgeon will prescribe a pain-relieving medication to be used during your recovery.  Antibiotics are given intravenously prior to surgery, and are usually not necessary afterwards.

Q:  Will I have to stay overnight?

A:  Following an excisional biopsy or lumpectomy (with or without axillary surgery), you are allowed to go home on the day of surgery (outpatient/same-day surgery).  A total mastectomy (with or without axillary surgery) usually requires an overnight hospital stay.  If you undergo immediate breast reconstruction, additional days may be required.

Q:  Will I have a drainage tube after surgery?

A:  You will have a drainage tube following surgery if you undergo an axillary lymph node dissection or a total mastectomy.  If you have both a mastectomy and axillary node dissection, you will have two drainage tubes.  You will not need a drainage tube if you are undergoing an excisional biopsy, lumpectomy, or sentinel node biopsy.

Q:  When can I shower after surgery?

A:  It is usually ok to take a shower on post-operative day 2.  It is also ok to take a shower with a drainage tube in place and anytime after a drainage tube is removed. 

Q: What should I look out for following surgery?

A:  Inspect your incision daily for signs of infection.  You should call your doctor if you notice any of the following:

  • Swelling – After the drainage tube has been removed, you may have swelling under your arm or at the site where the tube had been inserted.
  • Increased redness or heat
  • Increased drainage containing pus
  • A bad odor
  • Increased pain or tenderness
  • Temperature of 101° F (38.7° C) or higher – Take your temperature once each day.
  • Swelling of your hand or arm on the side of the surgery.  (Some minor swelling of the arm and hand is normally expected.)

Q:  When are the drains removed following surgery?

A:  In general, the drains remain in place for 7-10 days.  You will be asked to keep a record of the drainage output.  Initially, the drainage will be bloody.  Over time, the drainage will become lighter in color, and gradually turn pink and then clear yellow.  Once the output is less than 30 cc/day for two days in a row, the drain can be removed.  This is a relatively painless procedure done in the doctor’s office.  Drains are usually never left in place more than three weeks.  This increases the risk of infection. 

Q:  What are my limitations after surgery?

A:  You will be asked to keep the area(s) of the incision dry for 48 hours after surgery.  Beyond this, you will be able to shower, keeping the surgical tape (steri-strip) in place.  You will not have any dietary restrictions, though nausea is common after breast surgery and you are encouraged to advance your diet slowly.  If you have had axillary surgery, you will also be instructed to avoid heavy lifting (over 10 lbs) for a period of time.  Ask your doctor for details. 

Q:  Can I drink alcohol after surgery?

A:  If you are taking prescription pain medication, you should avoid alcohol.

Q:  When can I start wearing a bra after breast-conserving surgery?

A:  If you have an excisional biopsy or lumpectomy, you are encouraged to wear a supportive bra immediately after surgery.  Wires are ok.  Sports bras work well to minimize swelling and provide mechanical support.  Look for one that closes in the front which will make it easier to take on and off.  If you bring your bra on the day of surgery, we will place this on you prior to going home. 

Q:  If I have a mastectomy without reconstruction, can I still wear a bra?

A:  After a mastectomy, you are asked to avoid wearing a bra which can place pressure on the area of surgery.  Once the drainage tube is removed, your doctor will provide you with a prescription for a post-mastectomy bra and breast prosthesis.  You will be given a list of places that will help you be appropriately measured and fitted for these.

Q:  When can I drive following surgery?

A:  You should not drive if you are taking any prescription pain medication.  You arealso  asked to avoid driving while any drainage tubes are in place.  Once the drainage tubes are removed and you are not taking prescription pain medication, your return to driving will depend on how well you can move your arms.  You must have adequate range of motion to be a safe driver to yourself and others.

Q:  When can I start exercising after surgery?

A:  You can resume walking immediately.  However, you will be asked to avoid vigorous aerobic exercise (including jogging or running) the first week after surgery.  After that, be sure to wear a supportive sports bra.  If you have axillary node surgery (sentinel node or axillary dissection), you should avoid heavy lifting (greater than 10 lbs) in the first 4-6 weeks.  Once the wound is healed, you can gradually increase the weight you lift.  However, avoid repetitive lifting or arm exercises.  Ask your surgeon when you can advance your activities.  After axillary surgery, your range of motion might be limited (limited ability to move your arm in all directions), and you will be given simple range of motion exercises.  If this persists beyond 4 weeks, you will be referred for physical therapy.

Q:  How can I avoid lymphedema?

A:  Lymphedema occurs in 10-40% of patients who have undergone an axillary lymph node dissection.  Following surgery, you will be given lymphedema precautions by a licensed therapist (also available in your Breast Center Workbook).   Lymphedema occurs much less frequently following sentinel node biopsy, but the same precautions apply.  Unfortunately, there have been very few studies examining the factors which exacerbate and prevent lymphedema.  Keep in mind these are general guidelines developed over a century ago and are not guaranteed to prevent lymphedema.  Ask your surgeon if you are concerned about a specific activity or precaution. 

Q:  When can I resume sexual activity following surgery?

A:  There are no specific guidelines.  You may resume sexual activity as soon as you feel psychologically and physically able.  Be careful in the first 1-2 weeks to avoid heavy pressure on the surgical area.  If a drain is in place, be careful not to dislodge it.  Sexual activity is natural and healthy, and can help maintain the bond between a patient and her significant other.  

Q:  How long will my recovery be?

A:  The duration of your recovery depends on the type of surgery.  Recovery after an excisional biopsy is relatively quick, and most patients are able to resume work within 1-2 weeks.  This is similar to the recovery following a lumpectomy with or without a sentinel node biopsy.  Recovery after axillary node dissection is longer (2-4 weeks) due to the more extensive lymph node surgery which can result in prolonged discomfort and limited range of motion.  Following a mastectomy, most patients can expect a 2-4 week recovery.  Physical therapy is often necessary after axillary node dissection or mastectomy to help regain full range of motion.  Immediate breast reconstruction will length your recovery period.  Keep in mind these are just rough estimates, and every patient recovers at a different rate. 

Q:  When will I see the surgeon after surgery?

A:  You will be scheduled for a post-operative appointment with your surgeon the week following surgery (5-10 days).  Call the next business day after surgery to schedule your follow-up appointment. 

Q:  When will I receive my pathology results?

A:  Your surgeon will go over the results of your surgery at your first post-operative visit.  In general, it takes 3-5 full working days.  Additional molecular tests such as estrogen receptor (ER), progesterone receptor (PR), and HER2/neu are usually available 7-10 days after surgery. 

Q:  Will I get a copy of my pathology report?

A:  Yes.  These are a part of your medical records.  We encourage all patients to keep a copy of their pathology report.  A copy will also be faxed and mailed to your primary care physician’s office for their records.

Q:  Who determines what additional treatment I will need?

A:  If you undergo a lumpectomy, radiation therapy is required in most cases.  Your surgeon will discuss this with you and refer you to a radiation oncologist if it is indicated.  Additional treatments such as chemotherapy and anti-hormonal therapy may also be needed.  If so, the surgeon will refer you to a medical oncologist to help you make these decisions. 

Q:  If I need chemotherapy, when will this start?

A:  Following surgery, chemotherapy generally starts approximately 4 weeks afterwards, provided you have adequately healed.  In some cases, chemotherapy is given prior to surgery (pre-operative chemotherapy or neoadjuvant chemotherapy). 

Q:  Is chemotherapy ever given before surgery?

A:  Yes.  In some cases, if it is clear that you will be needing chemotherapy (based on the tumor size, the presence of lymph node involvement, and other factors), the surgeon may recommend chemotherapy before surgery.  This has the advantage of downsizing (shrinking) the tumor to help facilitate surgery.  This also has the theoretical advantage of giving the oncologist the opportunity to watch your tumor’s response to chemotherapy.  Ask your surgeon if you are a candidate for pre-operative (or neoadjuvant) chemotherapy. 

Q:  Will I lose my hair during treatment?

A:  Hair loss occurs with most of the standard chemotherapy regimens.  It may also occur to a lesser extent with anti-hormonal therapy.  It does not occur with radiation therapy.

Q:  If I need radiation, when will this start after surgery?

A:  If you need chemotherapy, radiation will start approximately 4 weeks after chemotherapy is completed (unless you are receiving partial breast irradiation).  If you do not need chemotherapy, radiation will start approximately 4 weeks after surgery.

Q:  Can I get a second opinion?

A:  Yes.  Second opinions are generally a good idea.  They help you gather additional information so that you can make an informed decision about your treatment. 

Q:  Who can I talk to if I’m feeling sad or anxious?

A:  Anxiety and depression are natural feelings following the diagnosis of breast cancer.  Learning more about your options can help alleviate the fear of the unknown.  It may also help to talk to others who have been through treatment.  Wellness resources are available, in the form of community and hospital-based support groups.  A list of these resources is available to you in the last section of the Breast Center Workbook.  In addition, some patients may benefit from psychotherapy or anti-depressant medication.  Talk to your breast surgeon if you would like more information.

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