What to Expect

Primary patient's role:

  1. Dig up the coping methods you have used in the past during difficult situations.
  2. Learn the facts about your breast cancer.
  3. Keep a list of ongoing questions in your notebook with answers as you go throught your treatment.
  4. Put YOUR needs first, take time for yourself.
  5. Talk with your family and friends, pastor, Nurse Navigator for support.
  6. Join a support group for cancer, (visit at least 1 time)
  7. Discuss your treatment options and know what you feel is right for you.

Family and Friend's role:

  1.  Listen to your breast cancer family member, allowing them to ventilate, ask questions and openly communicate.
  2.  Express your caring for your loved one, letting them know their body does not define who they are to you and your family.
  3.  No matter the decisions during treatment reassure them that you will stand by their side.
  4. Encourage support group attendance, go with them. Learn from others and enjoy the support of others who have shared the same diagnosis.

Nurse Navigator's role:

  1. Scheduling of appointments for you to see the surgeon, medical oncologist and radiation oncologist.
  2. Guidance through the process and reiteration of important information, answering questions and assisting with planning.
  3. Help you understand your type of cancer and what that means to you.
  4. Assistance learning and practicing survival skills you will need to get throught the disease, before, during and after treatment.
  5. Encourage your family and friend supportive care and guidance.
  6. Help to locate resources needed for treatment and for successful recovery.
 

Biopsy

A breast biopsy is performed to remove some cells or tissue from a suspicious area in the breast and examine them under a microscope to determine a diagnosis. For all biopsy procedures, if the samples show cancer, more tests are done to help provide the best plan of treatment for you.​

Ultrasound Biopsy

An ultrasound biopsy is a needle biopsy utilizing ultrasound equipment to locate a lump or abnormality. A small amount of tissue is removed by a radiologist and will be studied in the lab under a microscope to determine if the cells or tissue contain cancer. The ultrasound biopsy is the least invasive of all methods for gathering samples of breast tissue.

Stereotactic Biopsy

This type of biopsy uses mammography to guide the needle to the affected area with local anesthesia. This procedure requires you to lay on your stomach while a cluster of microcalcification and breast tissue are removed via vacuum assist.The samples are then studied by a pathologist under a microscope to see if they contain cancer.

Surgical Biopsy 

A surgical biopsy is performed in an operating room by a surgeon using a general anesthetic and IV. An ultrasound image helps to guide a small thin wire into the area that needs to be biopsied to collect a sample of cells or tissue.


Lumpectomy

Lumpectomy is surgery to remove cancer. It is a breast conserving surgery, which means your breast will stay intact. If you are having a lumpectomy, you will likely have radiation therapy as well.

Risks & Complications

Lumpectomy and lymph node surgery involve certain risks. These include:

  • Infection
  • Bleeding
  • Fluid collection (seroma)
  • Pain or numbness
  • Long-term swelling of the arm (lymphadema)

Before Surgery

A week or more before the procedure, you will have an exam and routine tests. Remember to:

  • Sign any consent forms
  • Tell your healthcare provider about any medications, herbs, or supplements that you are taking.
  • Avoid eating or drinking for 8-12 hours before surgery, or as directed.
  • Arrange for a trusted adult to drive you home after surgery.
  • Bring a soft shirt that buttons in the front to wear on the way home.
  • Talk to the anesthesia care provider, they will explain how you will be kept free of pain during surgery.

During Surgery

Your surgeon will make an incision to remove the tumor. A surrounding margin of normal tissue will also be taken. You may have two incisions, one will be near the tumor site and the other may be under the arm, near the lymph nodes.

Sentinel Node Biopsy

Cancer cells can travel beyond the breast to the lymph nodes. During surgery, the first lymph node or nodes that cancer cells could reach may be removed and screened (sentinel node biopsy). If appropriate, more of the nodes are removed. If any nodes contain cancer, adjuvant therapy is often needed.

Right After Surgery

You will wake up in the recovery room. You may have an IV (intravenous) line for fluids and medications. Pain medications will be given to you as needed. A nurse will check your temperature, pulse, and blood poressire. You should be up and walking soon after surgery. You'll likely go home the same day.

At Home

Before leaving the hospital, you will receive instructions on home care. You may have:

  • A dressing over your incision. You may be told to change the dressing in a day or two. Be sure to ask about bathing.
  • Stiches at the incision site. They may dissolve on their own. Or they may be removed at your follow-up visit.
  • Pain medications to help relieve discomfort. They should be taken as directed.

When to call your doctor

Call your doctor right away if you have any of the following:

  • Fever of 101 degrees F (38.3 degrees C) or higher
  • Increased pain, warmth, drainage, swelling, or redness at the incision or drain site.
  • Cough or shortness of breath
  • Pain in the chest or calf
  • Bleeding that soaks through the dressing.

If you have a drain:

If axillary lymph nodes were removed during surgery, you may have a soft plastic drain. This draws off fluid from around the incision. Be sure to empty the drain at least every 8 hours, or as directed. The drain will be removed in your doctor's office.

 

Mastectomy

Mastectomy is surgery to remove the breast. You may have a simple mastectomy or a modified radical mastectomy. The type of surgery you have depends on the size of your tumor and how far it has spread. If you are nervous about surgery, ask someone you trust to go with you. The hospital staff is also there to help keep you comfortable.

Risks & Complications

Mastectomy and lymph node surgery involve certain risks. These include:

  • Infection
  • Bleeding
  • Fluid collection (seroma)
  • Pain or numbness
  • Stiffnedd of the soulder
  • Long-term swelling of the arm (lymphadema)

Before Surgery

A week or more before the procedure, you will have a routine exam. You may also have tests such as a blood test and chest x-ray. Remember to:

  • Sign any consent forms
  • Tell your healthcare provider about any medications, herbs, or supplements that you are taking.
  • Avoid eating or drinking for 8-12 hours before surgery, or as directed.
  • Bring a loose blouse that buttons in the front to wear on the way home.
  • Arrange for a trusted adult to drive you home after surgery.

Arriving for Surgery

You may feel nervous on the day of surgery. Knowing what to expect may help you feel more at ease. On hte day of surgery:

  • An IV will be started to provide you with medications and fluids.
  • The anesthesia care provider will talk with you about how you will be kept free of pain during surgery. You will likely have gerneral anesthesia that will let you sleep during the surgery.

Two Types of Mastectomy

The most commonly done mastectomies are called simple and modified radical. During these procedures, the chest muscle is not removed. As a result, arm strength remains. Keeping the chest muscle also makes reconstruction easier.

Simple Mastectomy

During a simple mastectomy, the breast tissue (lobiles, ducts, and fatty tissue) and a strip of skin with the nipple are removed. This surgery often requires a hospital stay. Based on the results of the surgery and any follow-up tests, frther treatment may be needed.

Modified Radical Mastectomy

This type is usually done to treat invasive cancer. With a modified radical mastectomy, the breast tissue, a strip of skin with the nipple, and some of the axillary lymph nodes are removed. Modified radical mastectomy almost always requires a hospital stay. Based on the results of surgery and follow-up tests, further treatment may be needed.

Checking Lymph Nodes

Cancer cells can travel in the lymph fluid. During surgery, the first lymph node or nodes that cancer cells could reach may be removed and screened (sentinel node biopsy). Sometimes all of the nodes are removed. If the nodes contain cancer, adjuvant theraphy is often needed.


Jackson Pratt Drain Care

The purpose of your wound drain(s) is to help healing by draining fluid from the surgical site. This is very important after this delicate surgery. These drains are often called “JP” drains – common brand names are Jackson Pratt® and Blake® drains. These devices help prevent swelling and pooling of blood and fluid. The drainage tube is placed into the area near the surgical incision and is held in place by stitches.

Taking Care of Your Drain(s)

You will need to clean the area of your skin around the tubing according to your doctor’s directions on your discharge instruction sheet. You do not need to use a dressing over the drain site. If you prefer to have the site covered, you may use a split gauze dressing. Put it around the drainage tube where it enters the skin then tape it around the edges.

Emptying your drain(s):

Empty the fluid collected in the drain bulb in the morning and again in the evening. If the bulb is heavy with a lot of fluid, you may empty it as needed.

Your drain(s) will be labeled according to the location on your body (for example, LB = left breast, SP = supra-pubic) and numbered if more than one drain is in one area. Empty the bulbs one at a time and record the amount of fluid on the Wound Drainage Record Sheet. It is important to keep track of which bulb the drainage came from. Each of your drains will be taken out based on the decreasing amount of fluid output.

Supplies needed:

  • Measuring cup,
  • 4" x 4" gauze & tape 
  • elastic band
  • safety pin
  • Wound Drainage Record Sheet, pen/pencil

Steps to empty drains:          

  • Wash your hands well with warm water and soap.
  • Look for any redness, unusual or foul smelling drainage where the tube leaves your body. Call your doctor or nurse if you have redness or drainage at the insertion site.
  • Loosen the safety pin or clip that holds the bulb to your clothing.
  • Open the plug on the bulb.
  • Turn the bulb upside down over the measuring cup to empty. You may need to squeeze the bulb to empty it.
  • Squeeze the bulb until it is fl at. Without letting go, replace the plug.
  • Reattach the bulb to your clothing.  Attach it lower than the place where the tube comes out of your body. Make sure the tube lies fl at underneath clothing without kinks.
  • Use the markings on the side of the cup to measure the amount of drainage in milliliters (ml). Check the drainage for color and smell. If you notice a bad smell (like rotten eggs), call your doctor or nurse right away during office hours. Empty the drainage in the toilet.
  • Record the date, time, amount and color of drainage on the Wound Drainage Record Sheet.
  • Wash your hands with soap and water.

How often do I need to empty my drain?

Usually you empty the drain when it is half full. Most find they need to empty the drain 3 to 5 times a day or when the bulb fills up more than halfway.

How much drainage should there be?

The amount of drainage may vary from day to day. It should be less each day. If you increase your activity, it may increase the amount of drainage.

What color should the drainage be?

The color will vary. It may go from bright red to pink, then yellow.

What do I do with my drainage record? 

Bring it to your follow-up visit.

When should I call the doctor?

  • Elevated temperature (fever above 100.5 degrees F)
  • A sudden increase in the amount of drainage (greater than 40 ml’s)
  • There is little or no drainage in the bulb and fluid is leaking where the tube exits the skin.
  • Drain stitches come loose or break.
  • The drain tube pulls out of your skin
  • Redness, swelling, or unusual drainage where the tube exits the skin
  • Foul smelling drainage (such as that of rotten eggs)
  • New or increased pain