Surgery

You will know at this point what type of surgery you will be having. Here are the Mayo Clinic’s general descriptions:

Operations used to treat breast cancer include:

• Removing the breast cancer (lumpectomy). During a lumpectomy, which may be referred to as breast-conserving surgery or wide local excision, the surgeon removes the tumor and a small margin of surrounding healthy tissue.  A lumpectomy may be recommended for removing smaller tumors. Some people with larger tumors may undergo chemotherapy before surgery to shrink a tumor and make it possible to remove completely with a lumpectomy procedure.
• Removing the entire breast (mastectomy). A mastectomy is an operation to remove all of your breast tissue. Most mastectomy procedures remove all of the breast tissue — the lobules, ducts, fatty tissue and some skin, including the nipple and areola (total or simple mastectomy).  Newer surgical techniques may be an option in selected cases in order to improve the appearance of the breast. Skin-sparing mastectomy and nipple-sparing mastectomy are increasingly common operations for breast cancer.

• Removing a limited number of lymph nodes (sentinel node biopsy). To determine whether cancer has spread to your lymph nodes, your surgeon will discuss with you the role of removing the lymph nodes that are the first to receive the lymph drainage from your tumor. If no cancer is found in those lymph nodes, the chance of finding cancer in any of the remaining lymph nodes is small and no other nodes need to be removed.
• Removing several lymph nodes (axillary lymph node dissection). If cancer is found in the sentinel lymph nodes, your surgeon will discuss with you the role of removing additional lymph nodes in your armpit.
• Removing both breasts. Some women with cancer in one breast may choose to have their other (healthy) breast removed (contralateral prophylactic mastectomy) if they have a very increased risk of cancer in the other breast because of a genetic predisposition or strong family history.  Most women with breast cancer in one breast will never develop cancer in the other breast. Discuss your breast cancer risk with your doctor, along with the benefits and risks of this procedure.

Complications of breast cancer surgery depend on the procedures you choose. Breast cancer surgery carries a risk of pain, bleeding, infection and arm swelling (lymphedema).

You may choose to have breast reconstruction after surgery. Discuss your options and preferences with your surgeon.

Consider a referral to a plastic surgeon before your breast cancer surgery. Your options may include reconstruction with a breast implant (silicone or water) or reconstruction using your own tissue. These operations can be performed at the time of your mastectomy or at a later date.(1)

In many cases you will go home the same day of surgery. Your surgeon will let you know if you need to check in the night before or stay overnight after surgery. It can depend on how early your surgery is, and the extent of the surgery. You will need someone to drive you home upon release and stay with you to monitor you for 24 hours.

Plan for your return beforehand. Stock up the fridge, get your laundry, bills and cleaning done. Clear your To-Do List as much as you can. It will not only give you the time to heal, but give you peace of mind, which helps in the healing process.

I was instructed to not drink any alcohol the day before, and to eat and drink normal food until midnight. I was to drink a carbohydrate drink between 4PM and 6PM the night before. They gave me a list of what was acceptable. I chose orange juice without pulp (1000 ml). It’s a lot! And the day of surgery I was instructed to not eat any food that day, and drink half the amount of carbohydrate drink 2 hours before surgery. This was new to me, but it was to help me recover from surgery faster. Follow the instructions your care team gives you.

On the day of your visit, you will most likely have Pre-op tests (like blood tests, and an ECG/EKG (electrocardiogram), blood pressure, temperature reading, and so on. Another good time to ask any questions you still have.

Before surgery, if you are having a lumpectomy, chances are you are scheduled beforehand to have wires (or pins) inserted into your breasts to show the surgeon where your tumors are located and where he needs to remove the tumors and surrounding tissue. 

Because I had two tumors, I had four wires inserted. My team used both the ultrasound and mammogram machines to locate where the wires were to be inserted, and double-checked with a “light pressure” mammogram to make sure they were in the correct positioning. Depending on where the wires are placed, you may experience discomfort. They stick out of your breast, so don’t be alarmed. Mine stuck out about 2 to 3 inches. I had to be very careful with changing gowns and moving around. This procedure was done in a separate area of the hospital where the mammograms and ultrasounds were typically done. I wore a hospital gown over the top, but left my slacks and shoes on for this. After the wires were inserted, I was moved to the pre-op area for surgery. You need to be careful not to disturb the wires while moving around. Hang in there! Surgery is just around the corner where you will be put to sleep and the wires removed.

Here is a more concise explanation from the Susan G. Komen organization:

Finding the tumor in the breast

In some cases, the surgeon uses special methods to help find the tumor in the breast.

Wire-localization or radio-seed localization at the time of surgery

Sometimes breast cancers found by mammography (or other imaging) are nonpalpable (cannot be felt).

If the tumor is nonpalpable, a procedure called wire-localization or radioactive seed localization will be done just before surgery.

Local anesthesia is used with this procedure.

A radiologist will use a mammogram, breast ultrasound or breast MRI as a guide and insert a very thin wire or radioactive seed into the breast in the area of the cancer. The surgeon then uses this wire or seed as a guide to find and remove the tumor during surgery. The wire or seed will be removed during surgery.(2)

And, here is what the needle generally looks like. (select)

This is similar to what mine looked like. Mine were different colors, and the colored plastic tops drooped a bit due to the weight, so you had to be very careful. They were located under your hospital gown.

 Pre-surgery, you’ll remove all of your clothing, shoes and socks and put into clean hospital gowns. I was always given two gowns. One to cover the back, then one to cover the front to keep warm. They reversed the way I was to wear them for the surgery. You will meet with more of your care team before going into surgery.  Someone will be assigned to put you onto a hospital bed and be taken to the operating room (he/she will most likely give you the last opportunity to use the restroom, but if not, and you have to go, say so!) Your anesthetist will meet with you in the operating room, explain things further, then put your to sleep. 

During the surgery, to check for the spreading of cancer cells, they inject radioisotopes and blue die (in my case) to check for the leakage of cancer past the tumor and into the surrounding lymph nodes. In my case, they removed only one (sentinel) node for further testing, because they did not see any leakage further than the tumors.

You’ll wake up in recovery where you will be monitored until you are ready to be released. During that time, you may have been given exercises that you needed to remember to do with your legs to help with circulation and stave off blood clots post-surgery. If you have pain, let them know.

When you get home you’ll need to monitor your incisions, your temperature for fever, as well as nausea and pain. Call the numbers the hospital gives you in case of an emergency. Have it on hand.

Follow all instructions for when you are able to shower and maintain the incision area. I had two layers of bandaging. One that came off after a period of days, and another that would gradually come off on its own later on.

In more extensive surgeries, you may also have a drain installed (lymph nodes removed from the underarm area, for axillary node dissection procedures). Follow your doctor’s and hospital instructions for the cleaning and management of the drain.

I had a partial lumpectomy, where they removed only the two tumors, not the entire breast. I took prescription pain killers for only one day. Thereafter I took Tylenol for about a week to manage the pain for me. I also have a hard time with anesthesia, generally, a history of motion sickness and migraines and vertigo, so I also needed to take some anti-nausea, over-the-counter drugs. I also was in recovery longer than normal (normal being 3-4 hours) because I have a tough time waking up from anesthesia. I had warned the anesthetist about this beforehand, so he was aware. Tell your team as much about your personal history as you can remember. It is important to get the right care for you personally. 

I was instructed to wait 3 days to shower after surgery, and that is when I was able to remove the first layer of bandages. The second layer of “steri-strips” were to be removed by the second week if they had not fallen off in the shower yet. Again, follow YOUR doctor and hospital’s instructions. This is all just to give you a general idea of the procedures involved. Different hospitals will have different protocols.

I was instructed to buy a wireless (no underwire) bra that I had to wear 24/7 after surgery, starting in the recovery room at the hospital and even to bed at night. This is to keep the breast in place while it heals. I was told specifically not to use a sports bra. There is not enough support during the healing process. I purchased a couple of larger sized wireless bras for this. You will have some swelling at first. It was more comfortable for me. And I wanted a clean one to change into.

It is normal to have bruising and swelling for up to 6 weeks. Don’t panic. The hospital will instruct you on what to look for outside the norm of healing from surgery.

I was given a list of exercises to do starting the very next day to help me regain the proper movement of my arm on the side of surgery. I had to do them 3-4 times a day, with 10 repetitions per exercise. I did them diligently. Follow your instructions post-surgery. I was also instructed to not lift anything from 8-9+ pounds in weight. Do not take a chance in doing damage to the surgical area. 

You will probably experience some numbness at the location of your surgery and around that breast. Especially if you have one or more lymph nodes removed. This can last months or it can be permanent. Consult your surgeon and follow-up team.

I, personally, still have breast numbness and numbness in my upper left arm from the port-a-cath surgery (nerves were severed that have not regrown yet). I had some complications where the surgeon could not find a large enough vein for the port (towards my arm), therefore he had to insert the tube into a vein in my neck instead. The nerves he severed towards the arm have not come back to life yet. I am continuing to exercise and train that arm in hopes of a full recovery.