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.
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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.
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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
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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.
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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
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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.
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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.
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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).
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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: health-
info@osu.edu.