guide to breast surgery 2 evans

8/3/2019 Guide to Breast Surgery 2 EVANS

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A GUIDE TO

BREAST SURGERY



1

Introduction

Faulkner Hospital’s Breast Centre

and Sago Imaging and Diagnostic

Centre are nationally recognized

or their eorts in the detection and

treatment o breast disease. Our

mission is to provide our patientswith the best possible care with

dignity and compassion. Toward

this end, a team o Faulkner

physicians, nurses, sta educators

and administrative sta developed

this guide on breast surgery.

This guide is designed with patients

and amily in mind and should be

used as a reerence guide beore,

during and ater breast surgery.

You may not need the inormationcontained in every section. For

easy reerence we have divided

the book into several sections.

The index will help you identiy the

pages o the sections you will need

to review as outlined in your care

plan. Please read those sections

careully and direct questions or

concerns to your doctor or nurse

practitioner.

The rst section, Faulkner HealthCare Team, identies the various

providers that will be caring or

you. The second section, Breast

Health, explains the anatomy o

the breast as well as a guide or

completing sel-breast exams. All

patients should review both these

sections.

The third section, Types o Breast

Surgery and their Risk and

Complications, explains the

various breast surgeries (in order)

rom basic to complex. In addition,

it includes a description o the

possible risks and complications

associated with each procedure.

As you review the inormation it is

important or you to ocus only

on the procedure(s) (use the index

to identiy the proper pages) which

you and your physician(s) have

agreed upon in your care plan. This

will help avoid conusion among the

dierent procedures and may also

help prevent unnecessary anxiety

over procedures or tests that you

may not require.

The ourth section, Preparing or

Surgery, outlines the necessarysteps all patients must ollow to

be prepared or surgery. The th

section, Same Day Surgery,

should be reviewed by patients

who will not stay overnight in

the hospital and the next section,

Hospital Stay, should be reviewed

by patients who are admitted to

the hospital.

The seventh section, Arm

Exercises ater Axillary Lymph

Node Dissection, Sentinel

Lymph Node Biopsy and/

or Mastectomy, provides

important arm exercise instructions

or patients who have had an

axillary node dissection and/or a

mastectomy.

The nal three sections include

inormation on requently asked

questions, a glossary o terms

and a list o local and national

resources. We hope this

inormation will be useul to you

and your amily. Please keep this

book to use as a guide during your

treatment and recovery period rom

breast surgery.

The printing o this guide was made possible through the generosity o Carol Rabinovitz.



2

Table o Contents

A. Faulkner Health Care Team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

B. Breast Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Anatomy o the Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Sel Breast Exams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

C. Types o Breast Surgery and their Risks and Complications . . . . . . . . . . . 6

Breast Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Duct excision (including surgical ductogram) . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Partial Mastectomy (lumpectomy or wide excision or re-excision) . . . . . . . . . . . . . . . . 8

Wire Localization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Sentinel Lymph Node Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Axillary Lymph Node Dissection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Total Mastectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Mastectomy with Axillary Node Dissection (or Modied Radical Mastectomy) . . . . . . . . 13

Mastectomy with Sentinel Lymph Node Biopsy . . . . . . . . . . . . . . . . . . . . . . . . 14

Breast Reconstruction (includes explanation o the various reconstruction procedures) . . . 15D. Preparing or Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Additional Support or Coping with Breast Cancer . . . . . . . . . . . . . . . . . . . . . . 17

Pre Admission Testing (PAT) clinic appointment . . . . . . . . . . . . . . . . . . . . . . . . 19

Pre-Operative (Pre-op) physical examination appointment . . . . . . . . . . . . . . . . . . 19

Two weeks prior to surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Seven (7) to ten (10) days beore surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

One week beore surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

The day beore surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

The day o surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Immediately ollowing surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

E. Day Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Recovery process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Dressing Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Signs and symptoms o inection: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Pathology Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Post-operative exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

F. Hospital Stay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Patient Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Pain Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Prevention o post-operative pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Dressing Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Drains and Drain management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Pathology Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Recovery Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Additional Post-op instructions: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

G. Arm exercises ater an Axillary Lymph Node Dissection and/or a Mastectomy 27

Beginning Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Advanced Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

H. Frequently Asked Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

I Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

J. Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35



3

•Breast Surgeon - The doctorwho perorms the surgery and

who is responsible or your

overall care. I you have breast

reconstruction your plastic

surgeon is also involved in your

care. Since some surgeons

operate at other hospitals as

well as maintain oces outside

o the Faulkner Hospital, they

may not always be available at

a given moment. However, the

surgeon always has coverage

available in his/her absence

and has reviewed your care

with the Physician Assistant

and Residents.

• Anesthesiologist - The doctor

who is responsible or your well

being during the operation.

The anesthesiologist works

with a Nurse Anesthetist who

will be present during the entire

procedure.

•Radiologist - The doctor who

reviews mammograms and

other diagnostic images. The

radiologist also perorms core

biopsies and wire-localizations.

•Pathologist - The doctor

who dissects and examines

the tissue in order to make a

diagnosis.

•Physician Assistant (PA) - Alicensed health care practitioner

who works with your surgeon

and the rest o the health care

team to ensure that your care

is the best possible we can

provide. I you are admitted to

the hospital, the PA will check

on your progress and may

perorm a physical examination.

•Resident - A licensed medical

doctor who works with yoursurgeon. Oten, the residents

have assisted in your surgery

as well. The residents are

available to address any

medical issues you may have

while in the hospital.

•Nurse - A licensed practitioner

who coordinates your care with

the members o the health care

team. The nurse acts as your

advocate to assure the plannedtreatments are progressing.

The nurse also works closely

with the nursing assistants to

provide physical care.

•Nursing Assistant - The

nursing assistant works under

the direction o the nurse in

providing physical care.

•Case Manager - A RegisteredNurse with knowledge o

health insurance, benets,

rehabilitation, skilled nursing

acilities, and certied home

care agencies. He/she will

meet with you and your amily

to discuss your discharge

plan. Your plan is based on

your treatment and health care

needs. Insurance benets and

your liestyle will determine your

individual discharge plan. With

your consent, the nurse case

manager will coordinate the

necessary arrangements.

•Clinical Social Worker - A

licensed proessional trained

to help with emotional issues

acing you and your amily.

The social worker helps you

cope during your recovery

period and assists with amily

concerns.

•Nurse Practitioner - A

licensed advance practice

nurse who works with the

surgeons in providing pre-

opertive education, post-

operative care and ollow up.

A. Faulkner Health Care Team

While a patient at Faulkner Hospital, you will have multidisciplinary team o providers monitor your care beore, during

and ater your surgery.



4

B. Breast Health

Anatomy o the Breast

Pectoral Muscle The chest

muscle extends rom yourbreastbone to your shoulder and

collarbone. It is located under your

breast and contracts and expands

to help move your arm.

Lymph Nodes Help deend your

body against inections. They are

located under your arm and lter

fuid rom your breast and arm.

Fat and Connective Tissue

Supports and encases your entire

breast. The more brous tissue, the

rmer the breast.

Fatty Tissue Located throughout

the breast. The more you have thesoter the breast.

Lobules Enlarge during pregnancy

and produce milk or nursing. The

mammary lobules are clustered

throughout your breast and empty

into the ducts.

Ducts Carry milk rom your

mammary glands to your nipples

during breasteeding. The ducts

are tube-shaped structures lined by

a single layer o cells.

Nipple Located in the center o

each breast. It is the outlet orducts carrying milk.

Areola Pigmented (or colored)

circle o skin that surrounds each

nipple.



5

How to perform a breast self-exam

1. Lie down and put a pillow under your right

shoulder. Place your right arm behind your head.

2. Use the nger pads o your three middle ngers

on your let hand to eel or lumps or thickening.

Your nger pads are the top third o each nger.

Press rmly enough to know how your breast eels.

I you’re not sure how hard to press, ask your health

care provider. Or try to copy the way your health

care provider uses the nger pads during a breast

exam. Learn what your breast eels like most o the

time. A rm ridge in the lower curve in each breast

is normal.

3. Move around the breast in a set

way. You can choose either the

circle (A), the up and down line (B), or

the wedge (C). Do it the same way

every time. It will help you to make

sure that you’ve gone over the entire

breast area, and to remember how

your breast eels.

When to perform a breast self-exam

The best time to complete a breast sel-exam is 5-10 days ater your period

starts, when your breasts are not tender or swollen. I you do not have

regular periods or sometimes skip a month, do it on the same day every

month, or instance the rst day o the month.

Sel Breast Exams

Why perform self breast exams

It is good or you to complete a monthly breast sel-exam. Sel-breast exams are easy to do and the more you do it,

the better you will get to know how your breasts normally eel. Knowing how your breasts eel normally will help younotice any changes. Changes to look or include: lump or thickening in the breast, change in size or shape, dimpling

o the skin, discharge rom the nipple, retraction o the nipple, or redness or swelling o the breast. Women nd most

breast lumps themselves, but in act, most lumps in the breast are not cancer.

“Breast exams are not a substitute or periodic examination by a qualied clinician.”



6

C. Types o Breast Surgery and their Risks and Complications

There are three basic types o breast surgeries: biopsy, partial mastectomy and mastectomy. These surgeries may

involve additional procedures such as a duct excision, wire localization, axillary lymph node dissection, sentinel

lymph node biopsy and/or breast reconstruction. In reviewing this section please note that your surgery may include

one or more o the additional procedures.

Most breast surgeries and recovery are uncomplicated, however occasionally complications may occur. The risks

and complications that are associated with the various breast surgery procedures ollow the description o the

procedure. Please review and do not hesitate to ask your surgeon or clarication.

Breast Biopsy

A breast biopsy is perormed to

remove an area o breast tissue

or the purpose o diagnosis. The

biopsy procedure usually takes

about 45 minutes to one hour.

Once the surgeon removes the

tissue, the surgeon sends it to the

pathology department or their

review and diagnosis.

Sometimes this procedure is

done in conjunction with a wire

localization (see page 9) to indicate

the area to be removed or with a

duct excision (see page 7).

This surgery is considered sameday surgery and there is no need

to stay overnight in the hospital.

This means that ater the surgery,

you will go to the Post Anesthesia

Care Unit (PACU) until you are

eeling well enough to go home.

NOTES:

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Please review the inormation on

“Day Surgery” on page 21.

Risks and complications include

inection, local bleeding, scarring,bruising, hematoma (blood clot in

the area o the surgery) and ailure

to remove the entire abnormal

area. There may also be a change

in the appearance o the breast.



7

Duct excision (including

surgical ductogram)

A duct excision is a type o breast

biopsy. Your surgeon will remove a

portion o the milk duct to diagnosethe cause o discharge rom the

duct onto the nipple. The radiologist

will perorm a ductogam at the

Sago Centre (4th foor in Belkin

House) beore you come to the

operating room, the day o the

surgery.

To perorm the ductogram, the

radiologist will insert a small, very

narrow cannula (tube) into the

duct (in the nipple) rom which thedischarge can be expressed. X-ray

contrast material containing blue

dye is injected through the cannula

into the milk duct. A mammogram

is then taken. The dye helps the

surgeon identiy the discharging

duct during surgery. Sago sta

will bring you to the Day Surgery

department ater the ductogram

procedure is completed.

In the operating room, the surgeon

will make a skin incision to remove

tissue. The wound is usuallyclosed with sel-absorbing sutures

(stitches). The tissue is sent to

the pathology department or

processing, review and diagnosis

by the pathologist. The duct

excision surgery usually takes I to 2

hours.

I the radiologist cannot express

discharge the day o the procedure,

that is, you have no nipple

discharge, a ductogram usuallycannot be perormed. I this

happens, the radiologist will coner

with your surgeon and with you to

discuss whether we will proeeed

with surgery; i the surgery should

be rescheduled; or i an oce

appointment should be scheduled

with the surgeon.

The surgery is considered “same

day” surgery and there is no need

to be admitted to the hospital. Thismeans that ater the surgery, you

will go to the Post Anesthesia Care

Unit (PACU) until you are eeling well

enough to go home. Please review

the section on “Day Surgery” on

page 21.

Risks and potential complications

include but are not limited to:

inability to breast eed; a change

in the appearance o the breast

and nipple; change in sensationin the nipple and/or surgical site;

insucient blood supply to the

nipple; inection; local bleeding;

scarring; bruising; hematoma (blood

clot in the area o the surgery) and

ailure to remove or completely

remove the abnormal area.

NOTES:

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8

Partial Mastectomy

(lumpectomy or wide excision

or re-excision)

A partial mastectomy is perormed

to remove the abnormal tissueor lump and a margin o normal

tissue surrounding the abnormal

area. This may be reerred to as

breast conserving surgery. Once

the surgeon removes the tissue, the

surgeon sends it to the pathology

department or their review and

diagnosis. The surgery usually

takes about one (1) to two (2) hours

and there will be a 2-3 inch scar on

your breast. The incision is closed

with sutures that disolve.

Sometimes this procedure is

perormed using a wire localization

to indicate the area to be removed.

I you are having a wire localizationplease see the explanation o the

procedure on page 9.

Sometimes this procedure also

includes perorming an axillary

lymph node dissection or sentinel

lymph node biopsy to remove

lymph nodes rom under the arm.

Please see the explanation or these

procedures on pages 9 or 11.

This surgery is considered sameday surgery and there is no need

to be admitted to the hospital. This

means that ater the surgery, you

will go to the Post Anesthesia Care

Unit (PACU) until you are eeling wellenough to go home. Please review

the section on “Day Surgery” on

page 21.


inection, local bleeding, scarring,

bruising, hematoma (a collection o

blood in the area o the surgery),

seroma (fuid collection in the

area o the surgery) and ailure to

remove the entire abnormal area.

There may also be a change inthe appearance o the breast as a

result o the procedure.

NOTES:

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9

Wire Localization

This procedure is perormed

immediately prior to a biopsy (page

9) or partial mastectomy (page 8)

in help guide the surgeon to themammographic abnormality that

he/she cannot eel.

Wire localization is a technique

used to locate an abnormal area in

the breast when the area cannot be

palpated and/or when calcications

are seen on mammogram. The

wire localization procedure makes

it more likely that the area seen on

the mammogram and the tissue

removed in surgery correspond.In addition, this relatively painless

procedure makes it possible or

the surgeon to remove less breast

tissue during surgery without

increasing the risk o missing the

mammographic abnormality.

The wire localization is perormed

by a radiologist at the Sago

Centre in the Belkin House on

the ourth (4th ) foor. To localize a

mammographic abnormal area, theradiologist will position your breast

in the mammography machine.

The compression plate or this

procedure is a special plate with

an opening and a grid to mark your

mammogram. The radiologist uses

the grid markings to determine

exactly where the area (tissue) to be

removed is located.

Sometimes the wire localization

can be perormed using ultrasoundinstead o mammography. For this,

you will lie down on the ultrasound

table and the radiologist will use

the ultrasound sensor to nd the

area where the wire needs to be

inserted.

Beore starting the localization

procedure the radiologist numbs

your breast with a local anesthetic.

Then he or she will insert a

needle into the area where the

abnormality is located. A ew more

mammographic pictures may be

taken beore a thin, fexible wire

is passed through the needle

and than the needle is removed.

The nal X-rays are taken to

demonstrate that the wire is located

in the correct area and to act as a

guide or the surgeon.

A bandage is taped over the sot

wire and you can get dressed

leaving your bra o. Once you are

dressed you are accompanied back

to the surgical area in the hospital

or the surgery.

Sentinel Lymph Node Biopsy

This procedure is oten perormed

in conjunction with a partial

mastectomy or mastectomy. It may

also be perormed in conjunction

with an axillary node dissection.

The procedure identies andremoves sentinel lymph node(s)

rom under the arm. These are

the rst lymph nodes to receive

drainage rom the area o the tumor.

There is oten more than one

sentinel lymph node.

Your surgeon will use a blue dye, a

radionuclide dye, or a combination

o both to identiy the sentinel

lymph node. Once the surgeon has

identied and removed the sentinellymph node(s), he/she sends it to

the pathologist or their review and

diagnosis. The results will be given

to you when you awaken

This procedure does require

that you perorm post-operative

exercises, please see “ Arm

Exercises” on page 27.

I a radionuclide dye is used, it will

be injected into the breast in the

area where the tumor is located ornear the areola. This injection is

done by a radiologist at the Sago

Centre in Belkin House on the

ourth (4th) foor. The radiologist

uses either mammography or

ultrasound to guide the injection,

with a technique that is very

similar to the technique described

or “wire localization”. The

injection o radionuclide is usually

done at least 2 hours prior to your

scheduled surgery. The amount

o radiation exposure is less than a

routine chest x-ray. Ater injection,

you can get dressed leaving your

bra o. Once you are dressed

you will either be accompanied to

the surgical area or your surgery

or to Nuclear Medicine, where a

scan is done to check the location

o the sentinel lymph node. Once

your scan is completed, you are

escorted back to the surgical areaor the surgery.

I blue dye is used, it will be injected

into your breast by your surgeon in

the operating room. This is done

immediately prior to the surgery.

Risks and complications o sentinel

lymph node biopsy include all the

risks described or Axillary Node

Dissection on page 11 and the

instructions on page 27. In addition,

i blue dye is used, you may notice

a blue discoloration o your breast

ater surgery. This will ade in time.

You may also notice a blue-green

discoloration or your urine or other

bodily fuids immediately ater

surgery.

An axillary node dissection may be



10

required at the time o surgery or at

a later date. At the time o surgery,

an axillary node dissection would

be perormed i the sentinel node(s)

could not be identied or i the

surgeon nds cancer in the axilla.

It might also be required once the

nal pathology results are known i

those results are positive or cancer

in the sentinel node(s).

Care o your arm

It is important to always watch out or and prevent inections on the aected

arm. Avoid cuts, scratches, irritations and burns as much as possible by

doing the ollowing:

· use insect repellent and protective sunscreen

· wear gloves or washing dishes and using cleaners· wear gloves or gardening

· wear padded gloves or reaching into a hot oven

· use an electric razor or underarm shaving

· and do not cut your cuticles

In addition, avoid tight jewelry or clothing on the aected arm, carry your

purse on the opposite shoulder, avoid blood draws, injections, IV’s and

blood pressures on the aected side.

NOTES:

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11

Axillary Lymph Node Dissection

This procedure is oten perormed in conjunction with a partial mastectomy (page 8) or total mastectomy (page 12)

in order to remove some o the lymph nodes rom under the arm. The atty tissue that is removed usually contains

about six to twenty lymph nodes.

This procedure usually takes an additional hour. Once the surgeon has removed the breast tissue and lymph nodes,

he/she sends it to the pathologist or their review and diagnosis. I the axillary node dissection is perormed in

conjunction with a mastectomy you will be admitted to the Hospital, see page 23, otherwise you will go home the

same day, see page 21.

This procedure does require that you perorm post-operative exercises, please see “Arm Exercises” on page 27.

Risks and complications include:

• Injury to the intercostal

brachial nerves: These

nerves run through the middle

o the lymph nodes and give

sensation to a small area in the

back o the armpit. Every eort

is made to save these nerves.

However, should they be cut or

stretched during the procedure,

the result would be an area o

numbness along the armpit and

the back portion o the upper

arm. This may be temporary or

permanent and will in no way

aect unction or use o thearm or hand. Please be careul

when shaving your armpit.

• Collection o lymph fuid

(Seroma): The fuid that

traveled through the lymph

nodes may accumulate in the

space where the lymph nodes

were removed until your body

absorbs it. This is usually not

signicant and results in a small

amount o swelling. I there

is a larger amount o swelling

and it is painul, aspiration o

the fuid may make you more

comortable. Please contact

your doctor’s oce to make

arrangements or you to havethe fuid aspirated.

•Swollen arm (Lymphedema):

This may occur because the

lymph fuids rom the arm must

reroute and lter through the

remaining axillary lymph nodes.

Because only the lower lymph

nodes are removed with this

procedure, this complication

happens much less oten

than it did with more radical

types o surgery done in the

past. Lymphedema occurs

in a small number o patients,

and symptoms can range rom

hand swelling alone to total armswelling. Should you note any

swelling o your hand or arm,

please contact your surgeon’s

oce who will instruct you in

the appropriate exercises and

ollow-up care. Intervention

includes physical therpy,

manual lymph drainage and

garments. Early intervention is

important, please review “care

o your arm” page 10.



12

Total Mastectomy

A total mastectomy is the removal

o the entire breast. The surgery

usually takes 1-1/2 to three hours

and there will be a 4-8 inch scar.Once the surgeon removes the

tissue, he or she sends it to the

pathology department or their

review and diagnosis. Drains will be

placed under the skin at the bottom

o the incision to collect fuid during

the rst ew post-operative days.

See drain inormation page 25.

Ater the procedure, you will go the

Post Anesthesia Care Units (PACU)

or observation until you eel well

enough to be transported to your

room. Patients are admitted to the

hospital overnight. Please see page

23 or inormation on “Hospital

Stay”



bruising, hematoma (a blood clot

in the area o the surgery), seroma

(fuid collection in the area o the

surgery). Delayed healing o the

scar may occasionally occur due

to decreased blood supply. This

is more common in women who

smoke or who have diabetes. I this

happens a large “scab” will orm

and will gradually all o as healing

occurs. The incision will still heal

normally.

The mastectomy procedure does

require that you perorm post-

operative exercises. Please see

“Arm Exercises” on page 27.

NOTES:

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_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________



13

NOTES:

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

Mastectomy with Axillary

Lymph Node Dissection (or

Modied Radical Mastectomy)

The surgery will take 2 to 4 hours

including removing both the breasttissue and axillary lymph nodes.

There will be a 4-8 inch scar. Once

the surgeon removes the tissue, the



diagnosis. Drains will be placed

under the skin at the bottom o the

incision to collect fuid during the

rst ew post-operative days.

Ater the procedure, you will go the

Post Anesthesia Care Units (PACU)or observation until you eel well

enough to be transported to your

room. Patients are admitted to thehospital overnight. Please see the

inormation on “Hospital Stay” on

page 23.








to decreased blood supply. Thisis more common in women who

smoke or are diabetic. I this

happens a large “scab” will ormand will gradually all o as healing


normally.

To understand the risks and

complications o an axillary lymph

node dissection, please review the

description on page 11.

This procedure does require

that you perorm post-operative

exercises. Please see “ArmExercises” on page 27.



14

NOTES:

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

Mastectomy with Sentinel

Lymph Node Biopsy

This procedure removes the

entire breast and the sentinel

lymph node(s). The surgery willtake two to our hours and there

will be a 4-8 inch scar. Once the

surgeon removes the tissue, the



diagnosis. Drains will be placed

under the skin at the bottom o the

incision to collect fuid during the

rst ew post-operative days.

Ater the procedure, you will go

to the Post Anesthesia Care Units(PACU) or observation until you eel

well enough to be transported to

your room. Patients admitted to the

hospital overnight. Please see page

23 or inormation on “HospitalStay.”








to decreased blood supply. This

is more common in women who

smoke or who have diabetes. I thishappens a large “scab” will orm

and will gradually all o as healing


normally.

To understand the risks and

complications o the Sentinel

Lymph Node Biopsy, please review

the inormation on page 9.

The mastectomy procedure

does require that you perorm

post-operative exercises.

Please see “Arm Exercises” on

page 27.



15

Breast Reconstruction

(includes explanation o

the various reconstruction

procedures)

Breast reconstruction is intendedto restore your breast shape.

Reconstruction can be done at

the same time as a mastectomy

(immediate reconstruction) or

months or years later (delayed

reconstruction). There are several

techniques a plastic surgeon can

use or breast reconstruction.

One is using articial materials

(expanders and implants), the

second uses your own tissue, and

the third uses a combination o

both. Patients who have breast

reconstruction are admitted to

the hospital or approximately 3-5

days. Please see the section on

“Hospital Stay” on page 23.

Each type o reconstruction

technique has risks and

complications that are unique to

that procedure. However, as or

all surgeries the usual risks and

complication include inection,

local bleeding, scarring, bruising,

hematoma (a blood clot in the

area o the surgery) and seroma


surgery).

Risks o smoking: Smoking

causes the blood vessels to

narrow. This lowers the supply o

nutriebts and oxygen to the body.

Smoking can slow down healing

ater surgery, making recovery time

longer.

A. Using articial materials

1. Implant - Synthetic implants

are tear drop shaped pouches that

are inserted under the pectoralis

muscle or skin at the time o the

mastectomy to create the orm o

the breast. Most commonly these

are silicone lled. Implants are oten

used in conjuction with another

synthetic material called alloderm

that can sometimes allow plastic

surgeon to place your nal implant

at the time o your mastectomy.

Silicone implants can also be used

in conjunction with expanders in a

two-step procedure as describedbelow. Your plastic surgeon will

discuss the best approach with

you.

The nipple will be reconstructed

3 months ollowing the complete

reconstruction on an outpatient

basis. The nipple will have no

sensation.

2. Expander - Ar ticial materials

include the use o tissue expandersand saline implants. When

reconstruction is done using a

tissue expander, an empty plastic

sac or tissue expander is placed

under the muscle layer. The tissue

expander is like a balloon and is

gradually lled up or expanded

by injecting a salt-water solution

through the skin into a port leadingto the expander. This is usually

done on a weekly basis. Ater a

saline injection, you may eel some

discomort or approximately 24

hours, that usually is relieved with

Tylenol. As it is lled, it stretches

the tissue overlying it just like your

abdominal muscles and skin is

stretched with pregnancy.

The process o expansion takes

4-6 months. I you receivedchemotherapy, it may take 8-12

months. The tissue expander

is placed at the time o the

mastectomy. Once the expansion

is complete, the expander is

replaced by a permanent silicone

lled implant. Nipple reconstruction

is perormed on an outpatient basis

3 months ater the permanent

implant surgery. The nipple will

have no sensation.

I you have an implant, you will need

to take antibiotics beore dental

work and some gynecological

procedures or the rest o your lie.

B. Using one’s own tissue

Using your own tissue involves

transplanting one’s own skin, at

and muscle taken rom another part

o the body to recreate the breast.

The transplanted tissue is reerredto as the fap. Once successully

transplanted, the living tissue may

be sculptured to achieve the most

appealing shape, size and contour

while accurately restoring balance

with the other breast and oten with

return o some sensation. There are

dierent methods o transplanting



16

your own tissue and your body’s size

and medical history help determine

which method is best or you.

1. TRAM Flap -

The TRAM fap tissue is harvested

rom the abdomen using a similar

incision to that used or a “tummy

tuck” procedure. The muscle

can be detached rom its normal

position and brought up to the

chest area to reconstruct a new

breast. There will be a straight-

line incision across your lower

abdomen. The chest will have an

oval shaped incision where the skin

and muscle rom the abdomen are

attached to the skin o the chest.

The TRAM fap is not suitable or

patients who have too much or too

little abdominal at.

Your plastc surgen will urther

explain this procedure to you aswell as determine whether you are

an appropriate candidate.

Please see page 23 or discussion

on pain control and patient

controlled analgesia.


on pain control o constipation.

This surgery can take an additional

3-4 hours ater the mastectomy.

Drains are placed to collect

fuid post-operatively. Nipplereconstruction is perormed on an

outpatient basis 3 months ater the

surgery. The nipple will have no

sensation.


poor blood fow to the TRAM

fap and thereore tissue may

partially or entirely die. Patients

who are smokers, have diabetes,

prior abdominal surgery or are

obese may be at a higher risk orcomplications.I this happens,

the dead tissue may need to be

removed surgically. The incision will

still heal normally. This technique

may also cause abdominal wall

weakness that can lead to an

abdominal bulge or hernia. You

may experience unusual sensations

in the abdomen or breast areas,

including numbness. This may

last rom several weeks to several

months or may be permanent.

2. Latissimus Flap

This procedure involves the transer

o one o the large muscles o the

back (the latissimus dorsi) to restore

skin and the volume to the breast.

The muscle is detached rom its

normal position and brought around

to the ront. Despite the transer o

this muscle, shoulder unction is not

aected. This technique is good

to reconstruct a small breast, but

oten more tissue is needed and a

saline implant is inserted under the

fap as well to add volume. There

will be a straight scar on the back.

The ront will have an oval shaped

incision where the skin and muscle

rom the back are attached to the

skin o the chest.

This procedure can take an

additional 3-4 hours ater the

mastectomy. Drains are placed to

collect fuid post-operatively. Nipple

reconstruction is perormed on an

outpatient basis 3 months ater the

surgery. The nipple will have no

sensation.


on pain control and patient

controlled analgesis.

Please see page 21 or discussionon pain control o constipation.


poor blood fow to the fap and

thereore tissue may partially or

entirely die. I this happens, the

dead tissue may need to

be removed surgically.

Seromas (fuid collections)

in the back wound are

quite common. These

occasionally require drainagein the oce.

You may experience unusual

sensations in the back

or breast areas including

numbness. This may last

or several weeks or months

or even permanently.



17

D. Preparing or Surgery

It is important to have all your

questions answered beore surgery

in order to eel condent about

the choices and plan you have

made with your surgeon. Women

are anxious prior to surgery. In

the days beore the surgery, be

sure to do some nice things or

yoursel, eat well, and do whatever

you can to eel as relaxed as

possible. Make sure your work

responsibilities are covered in your

absence, so you can concentrate

ully on your recovery. Women living

alone nd it helpul to have some

meals prepared ahead o time at

home and groceries bought, so that

they won’t have to prepare much

when they get home. I riends

ask how they can be helpul, have

someone suggest to them that they

send over some prepared meals.

Additional Support or Coping

with Breast Cancer

The ollowing will explain the steps

you may need to take in order toprepare or surgery.

Social Work Services

One o the most stressul times in

the breast cancer experience is at

the point o diagnosis. For most

women the diagnosis o breast

cancer comes as a surprise without

advance notice or warning. Most

women do not have a amily history

o breast cancer and do not havea ready-made team o clinicians to

treat their breast cancer. Women

typically eel physically well, which

makes it hard to believe that

anything is actually wrong. In the

absence o complete medical

inormation it’s common to have

one’s mind wander toward worst

case scenarios. During this time o

enormous anxiety, women need

to integrate inormation about a

complicated disease, and make

complex decisions about their own

care. Family and riends mean well,

but are oten themselves distraught

by news o the diagnosis and don’t

always know the right thing to say.

Breast cancer causes distress in

many areas o one’s lie. Women

worry about how they will be able

to continue working, or caring or

their children. Women worry about

side eects rom breast cancer

treatment. Women worry about

their mortality. At the Faulkner

Breast Centre, we are concerned

not only with your physical recovery

rom breast cancer, but also with

your emotional health during breast

cancer treatment. We have, as

part o our proessional team, a

clinical social worker specializing

in counseling women with breast

cancer. The counseling is designed

to provide you with additional

support or coping with the myriad

o stresses caused by the diagnosis

as well as reduce your risk or

anxiety or depression. Some o the

topics covered in counseling can

include:

•decidingbetweentreatment

options

•helpingone’schildrencope

with the diagnosis and

treatment

•managingworkresponsibilities

during breast cancer treatment

•maximizingone’ssupport

system

•interactionofbreastcancer

treatment with other personal

or amily stressors

•psychologicalimpactof

stopping hormone replacement

therapy

• referralstocommunity

resources and supports

•makingconnectionstoother

women who have completed

breast cancer treatment

•howbreastcancertreatment

will interact with a history o

depression or anxiety

• “whydidthishappentome;

what does this diagnosis mean

in my lie?”

Most women begin to eel less

anxiety once some o their

particular issues o concern have

been addressed, and once the ull

details o their diagnosis are known

and a treatment plan is underway.

For more inormation, or to

schedule an individual or amily

appointment please call Janet

Rustow, LICSW at (617)983-7967.

Helping Your Children Cope

with Your Breast Cancer

Diagnosis and Treatment

When diagnosed with breast

cancer, a mother’s most immediate

concern is oten how to help her

children cope with the experience.

While parents generally want

to protect their children rom

dicult and painul situations, theirchildren may actually be imagining

something ar worse than the reality

o the breast cancer diagnosis.

Children rely on their parents

or inormation and or ways o

coping with dicult situations. The

ollowing suggestions are designed



18

to give parents a basic guideline to

begin thinking about how best to

help their children.

Tell Your Children Early on

About Your Breast Cancer

Many children have already picked

up that something is wrong by the

increase o telephone calls and the

anxiety that is present in the home.

Children’s antasies are oten worse

than the reality. Set the example

with them, early on, that you will

give them honest inormation,

answer their questions, and listen to

their concerns. We recommend that

children hear the inormation romtheir parents and that you use the

word cancer. Wait until a time when

you are able to ocus on your child’s

needs. It is ne to take a ew days

to allow yoursel to begin to digest

the news, beore you share it with

your children.

Assure Your Child That You are

Taking Active Steps to Treat

Your Breast Cancer

Children oten eel helpless in their

ability to help in a time o crisis and

need reassurance that you are

working with doctors who have

helpul treatments or your breast

cancer. Let them know what needs

to happen. Children should be told

about the treatments you will be

having, how it will impact the amily

routine, and who will be available to

them when you are busy with your

treatments. Encourage them to askquestions. Answer them truthully. I

you don’t know the answer, assure

them you will nd out and get back

to them. All mothers ear their child

asking whether they are going to

die rom the cancer. Assure them

that the doctors are hopeul about

the treatments they are oering.

The doctors will let you know i

the treatments are not working, in

which case, you will let your childknow.

How Children React

Children will typically react to their

mothers’ breast cancer with ear,

curiosity, sadness and anger. Young

children will be most concerned

with how the illness will eect them.

Even though they cannot ully

comprehend the meaning o the

illness, they should be told aboutit, with age-appropriate language.

Young children are very dependent

upon their parents or their

emotional wellbeing. Try to arrange

or their dad, or avorite baby

sitter inormation or grandparent

to spend extra time with them.

Try to keep routines as normal as

possible. Since children o this

age engage in magical thinking, it

is important to assure them that

they did not cause your cancer,and that cancer is not contagious.

I your child wants to help you, let

them, in age-appropriate ways.

Drawing pictures or you is a great

way or young children to express

emotions.

Older children are typically

concerned about themselves and

their own world. Discuss with them

in more detail how your illness and

treatments will impact their lie. Arrange or avorite other people

to accompany them to activities

in your absence. Adolescents

are keenly worried about body

image and may be embarrassed

or worried about various side

eects o your treatment. Seek

out their specic concerns and

address them. For example, you

may need to assure them that you

won’t arrive at their school without

a wig or scar in place while on

chemotherapy

Notiy Key People in Your

Child’s Lie About Your Breast

Cancer

It is wise to let your child’s

babysitter, teacher or guidance

counselor know about your illness.

They can watch or signs o anxiety

or depression in your child. Let your

child know that you have discussed

your illness with the babysitter,

teacher or counselor. This willprovide your child with someone

during the day that they can talk

to about what is happening in the

amily.

Most children who were coping

well beore their mother was

diagnosed with breast cancer do

not require proessional help to

cope with their mother’s illness.

Do watch or the ollowing signs

and seek proessional help i younotice any o them lasting or more

than a couple o weeks: sleep

or eating disturbance, inability to

concentrate, sudden changes in

school perormance or attendance.

We hope these guidelines are

helpul. They are meant only as

general suggestions. You know

your child best, and are in the best

position to convey the inormation in

a way most helpul to your child.

For more specic inormation, or to

discuss your particular concerns,

please call our clinical social worker,

Janet Rustow, LICSW at (617)

983-7967.

Pre Admission Testing (PAT)



19

clinic appointment /

At the same time your surgeon’s

oce sta schedules the surgery,

a vist to PAT (Pre Admission

Testing) will be scheduled. Thisis a separate appointment rom

your pre operative physical by your

primary care physican. During this

time, you will meet with a member

o the anesthesiology sta who

will evaluate you and answer any

questions you have concerning

anesthesia. You will also meet

with a day surgery registered nurse

who will explain specically what to

expect during your hospital stay.

Pre-Operative (Pre-op) physical

examination appointment

A pre-op physical exam must be

completed beore surgery to ensure

that you have no health --problems

that may put you at risk or surgery

and anesthesia. Should you have

health problems, both your Primary

Care Physician (PCP) and surgeon

will coordinate a treatment plan

to minimize your surgical risk.

The pre-op physical exam can be

completed by your PCP or at the

Faulkner Hospital. The oce sta

at your surgeon’s oce who books

the surgery will help you plan or the

pre-op.

Two weeks prior to surgery

Be sure to inorm the anesthesiology sta o any medication you are taking and whether you

smoke and your previous anesthesia experience.

I you have any questions about your medications and surgery, you may call anesthesia

at Faulkner Hospital at 617-983-7179.

•PleasediscontinueVitaminE

and any herbal supplements.

•Pleasediscontinueanydiet

drugs (notiy your physician)

•Pleasedonottakeaspirinfor

10 to 14 days prior to your

scheduled surgery. I you take

aspirin daily, please notiy us

and check with your doctor

beore stopping.

Seven (7) to ten (10) days beore

surgery

Do not take any non-steroidal

anti-infammatory drugs such as

ibuproen (Motrin, Advil, Aleve,

Naprosyn, Relaen, etc) or 7 to10 days prior to surgery. Tylenol is

okay to take.

One week beore surgery

•PleasediscontinuePlavixafter

checking with your physician.

The day beore surgery

On the last business day beore

your surgery you must contact the

Day Surgery Unit at (617) 983-7179

between 9 a.m. - 3 p.m. to conrm

your time o arrival.

•Do not eat or drink

(including water, ice,

vitamins, hard candy, gum,

etc.) ater midnight on the

night beore your operation.

•Removenailpolish

•Removeall jewelry including

rings

•Removecontactlenses

•Leavevaluables(checkbook,

credit cards, etc.) at home

•Arrangetohavesomeonedrive

you home once your are ready

to be discharged.

•Arrangeforsomeonetobeat

home with you during the rst

24 hours ater surgery

•Youmaybrushyourteeththe

morning o surgery

• Ifyouareinstructedtotakesome o your medication on the

morning o your surgery, pleasetake with just a sip o water

•Bringyourasthmainhalerswith

you

• Ifyouhavediabetes,donot

take insulin or diabetic pills

The hospital sta will make

every eort to saeguard your

possessions while you are a patient.

Our ocus is on the important

essentials or daily living such as

eyeglasses, dentures, and hearingaids.

Please consult with your doctor to determine the best plan or you.



20

The day o surgery

On the day o surgery, go directly

to the Day Surgery PreOp unit on

the rst foor. Plan to arrive at the

designated time.

Ater checking in at Day Surgery,

you will remain in the waiting room

where your amily and riends can

join you. I you are scheduled or a

wire-localization or sentinel lymph

node biopsy, the nurse will direct

you to the Sago Centre in the

Belkin House on the ourth (4th)

foor. Once the radiologist has

placed the wire, you will return to

the day surgery unit.

The nurse will ask you to change

your clothes and she/he will meet

with you to prepare you or surgery.

At this time, the nurse will answer

any questions or address any

concerns you may have.

Next, the nurse will escort you to

the anesthesia holding area where

a member o the anesthesia team

will place an intravenous (I.V.) linein your arm. Your surgeon will also

visit you briefy. You may bring

along a book or portable cassette/

cd player with headphones to help

pass the time.

A nurse anesthetist will then take

you by stretcher to the Operating

Room. During your operation, anurse anesthetist continuously

monitors your heart rhythm, blood

pressure, breathing and oxygen

saturation (eectiveness o oxygen

delivery to the tissues o the body).

Immediately ollowing surgery

Ater surgery, the sta will transport

you to the Post Anesthesia Care

Unit (PACU or Recovery Room),

where you will remain until youare ully awake. Your vital signs

(blood pressure and heart rate) will

be monitored and the ollowing

medical devices may be used:

• Oxygen mask

• Heart Monitor

• Automatic blood pressure

cu

• Small device on your nger

to monitor blood oxygen

levels

Recovery time varies by individual,

but the average stay in the PACU is

typically between 1 and 2 hours.

With a breast biopsy or partial

mastectomy, you may have a

bandage on your chest, which you

can remove 24 hours ater surgery,

or you may have a clear dressing

which will wear o in a couple

weeks. Do not try to remove

it. Under the bandage there are

multiple steri-strips (narrow, one

inch long adhesive strips) across

the incision. These strips will all o

on their own about 7-10 days ater

surgery. The nursing sta will give

you instructions on how to care or

the incision at home. It may help to

place a pillow under seat belt or

the ride home.

Only patients who had a

mastectomy, with or without breast

reconstruction, will be admitted

to the hospital. Please see the

inormation on “Hospital Stay”,

on page 23. All other patients go

home as soon as they eel ready

to go. Please see “Day Surgery”

section on page 21.

This section will explain what you

can expect once you are home.



21

E. Day Surgery

This section will explain what you

can expect once you are home.

Recovery process

You will receive pain medication

in the PACU. Your surgeon will

give you a prescription or pain

medication or at home, especially

the rst night. You may experience

pain or discomort in the area o

the incision as well as tiredness

rom the general anesthesia. The

tiredness may last a ew days.

Constipation can occur rom

anesthesea or pain medicinecontaining a narcotic. Do not avoid

pain medication because o risk o

constipation. Constipation can be

prevented / minimized by:

•adequateuidintake

•earlyambulationastolerated

•useofstoolsoftnerorlaxative

while taking pain medication

containing narcotics.

Recovering rom surgery is an

emotional process as well as a

physical one. Not only will you be

tired rom the anesthesia, you will

need time to catch up emotionally

with all that has happened

physically. Don’t rush yoursel.

You may wish to begin preparing

yoursel or the next phase o

treatment by reading or by talking

to other women who have been

through the experience.

Dressing Care

The surgeon will cover your incision

with a dressing, or a clear liquidbandaid sometimes with an elastic

(ace) bandage wrapped around

it. You will be discharged with the

dressing in place, please note the

ollowing (the nurse will review all o

this with you beore you go home):

•Removethedressing24hours

ater surgery, you may then

shower

•Gentlywashtheincisionarea

and pat dry•Iftheincisioniscoveredwith

strips o tape (steri strips) they

should remain in place until

they loosen on their own (may

take as long as 7 to 10 days.) or

are removed by your surgeon

Signs and symptoms o

inection:

Please contact your doctor’s oce

i you note the ollowing:

•Elevatedtemperature

•Increasedrednessaroundthe

incision

•Foulsmellingdrainagefrom

incision

For patients who also had an

axillary node dissection or sentinel

lymph node biopsy, have a

simliar bandage as your breast

incision. Please ollow the same

guidelines or incision care and

inection monitoring as or the

breast incision. It is not unusual

to have decreased sensation or

numbness in the armpit and along

the back portion o your upper

arm. This may last or weeks or

months and in some instances

may be permanent. You may also

experience a eeling o “pulling”

under your arm and have some

restriction in the use o your arm

initially ater surgery.

Pathology Results

The pathology report outlines the

results o the examination o the

breast tissue and/or lymph nodes.

Your surgeon will ollow up with

you by phone to inorm you o

the pathology results as soon as

they are available. At that time the

surgeon will review the results with

you as well as discuss any urther

consults you may need.

Important components o the

pathology report include:

•whetherthemarginsoredges

o the tissue are “clean” (ree

o cancer cells) or “dirty” (have

cancer cells present) - dirty

margins usually indicate the

need or a re-excision to

remove the remaining cancer

cells

•whetherestrogen-receptors

DO wear a bra at all times or support ater a partial mastectomy (or re-excision) or 48 hours

or more and then while you are awake or at least three weeks

You may use an ice pack or relie o moderate pain or swelling. Apply to incision intermittently

(Twenty minutes on / twenty minutes o.)



22

are present - i estrogen

receptors are present itindicates that the breast cancer

is sensitive to hormones and

may respond to hormonal

treatment.

•ifyouhadanaxillarynode

dissection, whether there

are any breast cancer cells

in the lymph nodes - i the

lymph nodes contain tumor

cells urther treatment

may be indicated, such as

chemotherapy or hormonetherapy

Post-operative exam

You will need to make a post-

operative appointment with your

surgeon or a post-operative check.

Your surgeon will inorm you about

scheduling this appointment.

Please review the inormation on “ Arm Exercises” on page 27.



23

F. Hospital Stay

This section is or patients who

are admitted to the hospital and

explains the services and care

patients receive while in the

hospital. The rooms are located

on the 7th foor and all are private.

Visiting hours are rom 12 pm to 8

pm daily. Family may visit but rest

is important and it is wise not to

overexert onesel.

Patients who had a mastectomy

stay overnight in the hospital.

Patients who also had breast

reconstruction will stay in the

hospital or 3-5 days.

I you had a TRAM Flap

reconstruction you will have an

abdominal incision as well as the

breast incision. With a Latissimus

Flap reconstruction you will have an

incision on your back to the side o

the scapula as well as the breast

incision.

Patient Care

Your surgeon will stop by and

check on you daily. I you had

breast reconstruction your plastic

surgeon will also come in to check

on you. In addition to the surgeon

monitoring your care, a team o

residents, physician assistants and

foor nurses will do the same. We

encourage you to ask questions

you may have or the health care

team.

You will eel drowsy or a ew hours

ater arriving in your room. Your

incision will be bandaged and

you will have one or more drains

in place as well as oxygen and

Venodyne Boots. Venodyne Boots

are special compression wraps

which are applied to your legs to

help maintain good circulation to

avoid blood clots rom orming in

your legs. These gently squeeze

and release your legs in the cal,

knee and thigh areas. They will be

removed once you are out o bed

and walking. You may also have a

Foley catheter in place and an IV or

fuids.

A nurse or nursing assistant will

help you get out o bed or the

rst time and activity is increased

gradually. Once the Foley catheter

is removed, a nurse or assistant

will help you go to the bathroom.Moving helps to increase your

strength and is good or your

circulation.

Once your bowel unctions have

returned you are ready to eat.

You will start with clear liquids

and advance to regular ood, as

you are able to tolerate this. This

usually occurs over one to two days

ollowing surgery. For patients who

had TRAM Flap reconstruction, bowel unction takes longer to

return.

For patients who had breast

reconstruction the nurse will visit

requently to check the skin fap or

adequate blood fow by checking

the skin’s color and temperature.

Your room temperature will be kept

warm to acilitate optimal blood

fow.

For patients who did not have

breast reconstruction, your doctor

will order a consult or you to be

tted or a prosthesis and special

bra. In the initial post-op period,

you will receive a temporary orm.

When your incision has healed,

you can then be tted with the

permanent prosthesis and surgical

bras.

Pain Control

When you rst awaken, you may

have some discomort over your

chest and under your arm i you

also had lymph node surgery.

Many women describe the pain

as moderate although you may

eel more or less discomort

depending on your procedure and

your individual sensitivity to pain

(everyone is dierent.)

Various methods o pain control

are available. You may receive

injections o pain medicine or a

Patient Controlled Analgesia

(PCA) pump. The pump

administers intravenous medication

that you control. The nurse will

instruct you on how to use the

pump to administer a dose by

pushing a button. Use o this

device allows a steady level o

pain medication to remain in thebloodstream.

• You cannot overdose! The

pump has been preset to

deliver only certain amounts o

medication; you cannot receive

more than is programmed.

• Do not feel the need to

tolerate pain! You must

have adequate pain control,

particularly early in the post-

operative period, in order

to actively participate in the

recuperative process.

See constipation inormation page

21.

Eventually, your pain medication will

be changed to the oral orm (pills) in



24

anticipation o your discharge rom

the hospital.

Prevention o post-operative

pneumonia

Pain control ater surgery is

important not only or your comort

but also to ensure you maintain

adequate breathing and to allow

you to actively participate in your

physical therapy. As is the case

ater any type o surgery, deep

breathing, coughing and using an

incentive spirometer are important

or preventing post-operative

pneumonia. Being out o bed

and walking, as you are able,are also preventive measures or

pneumonia.

The nurse will show you how to

use an incentive spirometer and

help you practice the breathing

exercises. The spirometer is a

clear plastic tube with a ball inside

and the tube is attached to a

mouthpiece. As you take a deep

breath IN, the plastic ball should

rise to the top. This ensures youare taking deep breaths to prevent

respiratory congestion and ever.

Dressing Care

The surgeon will cover your incision

with a dressing, or liquid bandaid,

or with an elastic (ace) bandage

wrapped around it. The surgeon or

physician assistant will remove the

dressing on the rst or second day

ater surgery. Your incision may be

covered with strips o tape (steri-

strips) or xeroorm gauze. The steri

strips should remain in place until

they are removed by your surgeon

or until they loosen on their own.

(May take as long as 7 to 10 days.)

Drains and Drain management

You will have one or more drains

(also called Jackson-Pratt or

JP drain ) placed during surgery

to help drain fuid and blood rom

around the surgical site. Drainage

and/or bleeding into the drain is

normal and expected or the rstseveral days ater surgery. The

nurses will check your drains and

empty them. Each shit the nurse

will document the amount o fuid

in the drain(s). I the drain(s) is/are

ready to come out beore you are

discharged rom the hospital, the

surgeon or physician assistant will

remove them.

Should you go home with drains

in place please ollow theseinstructions (the nurse will review

them with you beore you leave the

hospital):

•Keeptheincisiondryuntilyour

drain is removed.

•Pinthetabonthebulbtoyour

clothing to prevent pulling or

put drain bulb in camisole

pocket.

•“Strip”or“milk”theJ.P.tube

to release any clotty threads

that may accumulate along theinside o the JP drains. This

will help keep the tube rom

clogging.

•Keeptrackoftheamountof

fuid in the drain. Once the

fuid is less than 30 cc’s over

24 hrs per drain, call your

surgeon’s oce to schedule an

appointment to have the drain

removed. It is advisable to take

a pain pill one hour beore thedrain is removed.

•Toemptythedrain:

- wash your hands, wear

gloves

- open the top o the bulb and

empty contents into reuse

container

- compress sides o bulb and

close top

- measure fuid and record

under appropriate drainnumber

•Donotputanythingintodrain

bulb - only empty it. Empty

twice daily.

In order to make the monitoring

process easier; the nurse will give

you a orm to take home, so you

can write down the fuid measures.

See example.



25

I your drain loses suction open the top, compress the sides o the bulb and replace the top.

Call your doctors oce to schedule appointment or drain removal when amount is less

than 3Occ or ml’s in 24 hours per drain. You need to empty your drains twice a day.

How to record your output:

– EXAMPLE –

Date Time Drain #1 Drain #2 Drain #3

Drain #4

1/1 8 AM 10 15 20 30

1/1 2 PM 15 8 16 7

1/1 10 PM 8 5 6 10

1/1 24 HR TOTAL____________________________________________________________

33 28 42 47

DATE TIME DRAIN #1 DRAIN #2 DRAIN #3 DRAIN #4

•Forpatientswhohadbreast

reconstruction, please call your

plastic surgeon to have the

drain removed.

•Ifyouhaveadressingover

the drain site, it will need to

be changed daily. Wash your

hands ater careully removing

the existing dressing. Place

the new dressing over the drain

site. I you have someone to

help you, have him or her apply

the tape while you hold the

dressing in place. Use only a

small strip o paper tape. Avoid

placing the tape on the incision.I you are doing this alone, tear

the piece o tape rst, then hold

the dressing with one hand

over your drain site and apply

the tape with your other hand.

•Onceyourdrainhasbeen

removed you will only need a

dressing over the site or one

day in case o any drainage

rom the drain site. Shower

24 hours ater last drain is

removed.

Signs and symptoms o

inection:

Please contact your doctor’s oce

i you note the ollowing:

•Elevatedtemperature

•Increasedrednessaroundthe

incision or drain site

•Foulsmellingdrainagefrom

incision or drain site

Pathology Results

A pathology report is a report on

the examination o the breast tissue

and/or lymph nodes. The surgeon

will ollow up with you to inorm you

o the pathology results as soon

as they are available. This may be

while you are still in the hospital

or by telephone. At that time the

surgeon will review the results with

DO NOT shower, shave underarms, use deodorant, or powder on this area until the drain is removed,

unless otherwise instructed by your surgeon.

DO resume the above activities ater the drain is removed as instructed by your surgeon.



26

you as well as discuss any urther

consults you may need. You will

then schedule a ollow up vist with

the breast surgeon.

Important components o thepathology report include:

•whetherthemarginsoredges

o the tissue removed are ree

o cancer cells or have cancer

cells present.

•whetherestrogen-receptorsare

present - i estrogen receptors

are present it indicates that the

breast cancer is sensitive to

hormones and may respond to

hormonal treatment•ifyoualsohadanaxillarylymph

node dissection or sentinel

lymph node biopsy, whether

there are any breast cancer

cells in the lymph nodes

Recovery Process

It is important to take requent rests

during the day and not to “overdo”

it. It can take several weeks to

get back to your previous level o activity. Recovering rom surgery is

an emotional process as well as a

physical one. Not only will you be

tired rom the anesthesia, you will

need time to catch up emotionally

with all that has happened

physically. Don’t rush yoursel.

You might wish to begin preparing

yoursel or the next phase o

treatment by reading or talking

to other women who have been

through the experience.

For lumpectomies or lymph node

surgery, there is a chance o blood

or fuid collecting under the skin

(seroma) that can cause swelling

and discomort. To ease the

discomort, apply ice to the area.

Call the surgeon’s oce i the area

continues to swell and cause pain.

It may need to be aspirated (remove

fuid with a needle and syringe)

at the doctor’s oce. This is not

painul since the area is usually still

numb. I the fuid re-accumulates,

the aspiration may be repeated.

Vigorous movement or activity o

the aected arm may increase the

chance o developing a seroma or

worsen an existing one.

Additional Post Operative

Instructions:

Mastectomy withreconstruction:

•Youwillneedapostoperative

appointment with your plastic

surgeon and your breast

surgeon.

•Donotsleeponyourstomach

or on the operative side.

•Yourplasticsurgeonwillinstruct

you about wearing a bra.

•DoNotliftanythingheavier

than 5-10 lbs or 6-8 weeks.

Mastectomy without

reconstruction:

•Youwillneedapostoperative

appointment with your surgeon.

•Prosthesis-youmayweara

camisole with insert ollowing

your surgery. Ater your drains

are removed you may wear

a sot bra with insert. In one

month you may be tted ora permanent prosthesis. A

representative rom a supply

company may visit you in the

hospital and provide you with

a camisole. A list o prosthesis

providers is also on page 43,

these products are covered by

your insurance.

•Yoursticheswilldissolve.

•DoNotliftanythingheavier

than 5-10 lbs or 4 weeks.



27

G. Arm exercises ater an Axillary Lymph Node Dissection and/or a Mastectomy

The ollowing are general Range o Motion exercises to help you increase your arm motion. Please check with

your doctor beore attempting. Do the exercises slowly. Aim or gentle stretching. Remember not to hold your

breath while exercising. You might want to exercise ater your muscles are relaxed rom a warm shower, or 45

minutes ater pain medication. Try to do each exercise 5-10 times, 2-3 times per day

Beginning Exercises

A series - WEEK 1

I you had an axillary node dissection, start 2 days ater surgery. I you had a mastectomy , start 1 day ater the

drains are removed. I you had breast reconstruction, check with the plastic surgeon.

B Series - Week 2

Advanced Exercises

Add these exercises as follows:

For axillary node dissection,

1 week ater surgery. For

mastectomy 1 week ater

drains are removed.

Standing rmly

with eet slightly

apart, rotate trunk

while swinging arm

behind.

Elbow bent at right

angle and held

against trunk, slide

arm on table surace

in an inward arc.

Seated with elbow

bent and held against

side, slide arm in an

arc, outward with table

surace or support.

Holding arms with

hands under elbows,

move side to side as

i rocking a baby.

Lit arm out to side, elbow

straight, palm downward.

Do not shrug shoulders or

hit trunk.

With elbow straight use

ngers to “crawl” up a

wall or door rame as

ar as possible

Graphics source: Visual Health

Inormation



28

Advanced Exercises

Do the exerises slowly. Aim or gentle stretching. Remember not to hold your breathe while exercising. Try to do

each exercise 5-10 times, 2-3 times a day. Call your surgeon’s oce i you have any questions or concerns about

the exercises, or your progress.

For axillary node dissection, start 2 days ater surgery and you have mastered the beginning exercises. For

mastectomy , start 2 weeks ater the drains are removed and you mastered the beginning exercises.

WEEK 3

Bring arm across

ront to opposite

side.

Gently pull on elbow

with opposite hand

until a stretch is elt in

the shoulder.

Maintaining erect

posture, draw

shoulders back while

bringing elbows back

and inward. Return to

starting position.

Raise arm to point

to ceiling, keeping

elbows straight

With ngers clasped

relaxed at sides. Roll

shoulders continuously in

backward direction. This

exercise can also be done

one shoulder at a time.

With elbow straight use

behind head, pull elbows

back while pinching

shoulder blades together.

Stand straight with arms

ngers to “crawl” up a

wall or door rame as

ar as possible



29

Important Do’s and Don’ts

or patients who had an

axillary lymph node surgery.

Inormation ollowing axillary lymph

node surgery:

1. Start exercises as instructed;

do not exceed exercise times

and amounts. Your surgeon

will instruct you on weight

limitations.

2. You may use an electric razor

on the aected side one week

ater surgery.

3. Do not use powder or

deodorant or one week

ollowing surgery. When

showering, use soap and water.

Dry gently.

4. Maintain arm precaution (see

page 10) indenitely.

5. Use moisturizer on hands.

6. Call your surgeon/NP with any

questions or concerns you mayhave.

7. Call immediately i you notice

swelling or redness on the

aected arm.

Note that you may experience

swelling o the hand or arm (please

see risk and complications or

“axillary lymph node dissection”

on page 11). This may occur

immediately ater surgery, or yearslater. I you note any swelling o your

hand or arm, contact your surgeon

and you will receive appropriate

instructions.

It is important to watch out or and

prevent inections on the aected

arm. You should avoid cuts,

scratches, irritations and burns

as much as possible by doingthe ollowing; use insect repellent

and protective sunscreen, wear

gloves or washing dishes and

using cleaners, wear gloves or

gardening, wear padded gloves or

reaching into a hot oven, use an

electric razor or underarm shaving,

and do not cut your cuticles. Keep

your skin sot and ree o cracks

with a moisturizing lotion.

In addition, avoid tight jewelryor clothing on the aected arm,

carry your purse on the opposite

shoulder, avoid blood draws,

injections, IV’s and blood pressures

on the aected side.



30

F. Frequently Asked

Questions

1. How long is the recovery

period ater surgery?

Approximately 2 days or a

biopsy or duct excision, 2

weeks or partial mastectomy

and sentinel lymph node

biopsy, 2-3 weeks or partial

mastectomy and axillary node

dissection and 3-4 weeks or

mastectomy. Mastectomy with

breast reconstruction can have

a 4-6 week recovery period. I

complications occur, recovery

may be longer.

2. Do you have a drain in ater

a partial mastectomy? I

you have a drain, how long

does it stay in?

Usually a drain is not placed

or a partial mastectomy .

Some surgeons place drains

ater axillary dissections.

Mastectomy with or without

breast reconstruction will

always have drains. Over the

course o several postoperative

days, the amount o drainage

will decrease and the drains

can be removed. I the drain is

not ready to be removed, you

will go home with the drain.

You will be taught how to take

care o the drain and measure

the drainage. A visiting nurse

will visit you daily to check on

you. The drain will be removed

at the surgeon’s oce.

3. Are there stitches to be

removed?

Most surgeons use absorbable

stitches on the inside and these

do not need to be removed.

On the outside you will see

liquid bandaid or steri-strips

across the incision. Steri-

strips are small pieces o white

adhesive tape which stay in

place or 7-10 days, when they

usually all o. Your surgeon

may remove them at your post-

op visit.

4. Will I experience pain ater

the surgery?

You may experience

postoperative pain at the

incision area (breast, chest,

abdomen or back) and/or

your upper arm or under the

arm. I you are in the hospital,

you will receive pain medicine

intravenously or by injection

initially, and then orally with

pain pills, once you are able to

tolerate a diet. I you have day

surgery, your surgeon will give

you a prescription or a pain pill.

5. Is the surgery “ day

surgery” or do I stay in

the hospital? I I stay in

the hospital, how long do I

stay?

Biopsy, duct excision, partial

mastectomy and axillary

lymph node dissections or

sentinel lymph node biopsy are

day surgery and you will be

discharged rom the recovery

room once you are ully awake

and recovered rom the eects

o anesthesia. I you have a

mastectomy , you will be in

the hospital approximately 1

day. I you also have breast

reconstruction, you will be in

the hospital or 3-5 days.

6. Where will the incision(s)

be?

Incisions will be made on your

breast or a partial mastectomy,

under your arm or an axillary

lymph node dissection, on

your chest or mastectomy and

additional incisions on your

abdomen or back or breast

reconstruction.

7. When can I take a shower?

Following a partial mastectomy

and/or axillary lymph node

dissection or sentinel lymph

node biopsy , you can shower

approximately 24 hours ater

the surgery when the bandage

is removed. I you have had

a mastectomy with or without

breast reconstruction, you

cannot shower until ater

the last J.P. drain has been

removed.

8. Can you travel by plane i

you have an implant?

Yes, it is sae to fy with an

implant.

9. When can I resume sexual

activity?

The general rule is that you may

resume sex when you eel able

and your wound has healed. I you have had reconstruction,

avoid activities that will make

you sweaty, red in the ace

or out o breath or the rst

ew weeks ater surgery. It is



31

important or you to remember

that your sensation in the

reconstructed breast will be

decreased or absent. Check

with your individual surgeon or

urther inormation.

10. How soon can I start

driving again?

For same day surgery patients

you can drive again 24 hours

ater the procedure i you are

not taking prescription pain

medication and are able to

move your arm easily.

For mastectomy patients youcan drive again 24 hours ater

discharge rom the hospital i

you are not taking prescription pain

medication and are able to move

your arm easily.

It is best to drive only short distances

at rst and gradually increase your

driving time over a ew days.

I you had breast reconstruction,

please check with the plasticsurgeon beore driving.



32

I. Glossary

Adjuvant therapy (AD-ju-vant):

Treatment given in addition to

the primary treatment.

Areola (a-REE-oe-la)): The

area o dark-colored skin that

surrounds the nipple.

Aspiration (asp-er-AY-shun):

Removal o fuid rom a lump,

oten a cyst or post operative

fuid (a seroma), with a needle.

Atypical hyperplasia (hy-

per-PLAY-zha): A benign

(non-cancerous) condition

in which breast tissue has

certain abnormal eatures. This

condition increases the risk o

breast cancer.

Axilla (ak-SIL-a): The underarm

(armpit).

Benign (bee-NINE): Not

cancerous; does not invade

nearby tissue or spread to other

parts o the body.

Biopsy (BY-op-see): The removal

o a sample o tissue, which

is then examined under a

microscope to check or cancer

cells. Excisional biopsy is

surgery to remove an entire

lump. Incisional biopsy, is

when the surgeon removes part

o the tumor. Removal o tissue

with a needle is called a needle

biopsy.

Bone Scan: A nuclear medicine

scan to assess whether the

breast cancer has spread

(metastasized) to the bones

Cancer: A term or more

than 100 diseases in which

abnormal cells divide without

control.

Carcinoma (kar-sin-OE-ma):

Cancer that begins in the lining

or covering o an organ.

Carcinoma in situ (kar-sin-

OE-ma in SY-too): Cancer that

involves only the tissue in which

it began; it has not invaded

other tissues.

Chemotherapy (kee-moe-

THER-a-pee): Sometimes

chemotherapy is used in

addition to surgery and

radiation therapy. Chemo

therapy involves using drugs

to destroy cancer cells by

stopping them rom growing

or multiplying at one or more

points in the cell’s lie cycle.

Chemotherapy may oten

consist o more than one drug.

How oten and or how long

you will get chemotherapy

depends on the kind o cancer

you have. Depending on

the type o cancer you have

the chemotherapy may be

administered intravenously,

by mouth or into the muscle.

I you are a candidate or

chemotherapy, your surgeon

will reer you to a medical

oncologist or a discussion

o the dierent types o chemotherapy.

Clinical trials: Research studies

that involve patients. Each

study is designed to answer

scientic questions and to nd

better ways to prevent or treat

cancer. Your decision about

participating in a clinical trialdoes not aect your care.

Core Biopsy: Removal o a

portion o the breast lump

or abnormality seen on

mammogram or ultrasound

using local anesthesia and a

special core biopsy instrument

Cyst (sist): A closed sac or

capsule lled with fuid.

Duct: A tube in the breast

through which milk passes

rom the lobules to the nipple.

Cancer that begins in a duct is

called ductal carcinoma.

Ductal carcinoma in situ:

involves only the ducts and has

not spread to other tissue.

Estrogen (ES-troe-jin): A emale

hormone.

Estrogen Receptor: A binding

site on tumor cells or estrogen.

This can be measured in breast

cancer cells

Estrogen receptor test: A

test to measure the amount

o certain proteins, called

hormone receptors, in breast

cancer tissue. Hormones can

attach to these proteins.

Hematoma (hem-a-to-ma):

collection o bloody fuid which

may accumulate in areas where

tissue was removed.



33

Her-2: A tumor marker that can

be measured in breast cancer

cells.

Hormones: Chemicals produced

by glands in the body.Hormones control the actions

o certain cells or organs.

Hormone therapy: Treatment o

cancer by removing, blocking,

or adding hormones.

Jackson-Pratt (J.P.) Drain :

A device which drains and

collects fuid rom the incisional

area.

Lobe: A part o the breast; each

breast contains 15-20 lobes.

Lobular carcinoma in situ:

involves only the lobules o the

breast and has not spread to

other tissues.

Lobule (LOB-yool): A subdivision

o the lobes o the breast.

Cancer that begins in a lobule

is called lobular carcinoma.

Local therapy: Treatment that

aects cells in the tumor and

the area close to it. (i.e. the

breast and adjoining lymph

nodes)

Lumpectomy (lump-EK-toe-

mee): Surgery to remove only

the cancerous breast lump;

and margin o normal tissue ,

usually ollowed by radiation

therapy. Also reerred to aspartial mastectomy.

Lymph (lim): The almost

colorless fuid that travels

through the lymphatic system

and carries cells that help ght

inection and disease.

Lymph nodes: Small, bean-

shaped organs located along

the channels o the lymphatic

system. Bacteria pr cancer cells

that enter the lymphatic system

may be ound in the nodes.

Also called lymph glands.

Lymphatic system (lim-FAT-

ik): The tissue and organs

(including the bone marrow,

spleen, thymus, and lymph

nodes) that produce and store

cells that ght inection and

disease. The channels that

carry lymph also are part o this

system.

Lymphedema (lim-a-DEE-ma):

Swelling o the hand and arm

caused by extra fuid that may

collect in tissue when underarm

lymph nodes are removed or

blocked.

Malignant (ma-LIG-nant):

Cancerous; can spread to other

parts o the body.

Mammogram (MAM-o-gram): An x-ray o the breast.

Mammography (mam-OG-ra-

ee): The use o x-rays to create

a picture o the breast.

Mastectomy (mas-TEK-to-

mee): Surgery to remove the

breast. Modied Radical

(MRM) Mastectomy includes

removal o lymph nodes. Total

Mastectomy does not include

removal o lymph nodes.

Menopause: The time o a

woman's lie when menstrual

periods stop; also called

"changing o lie."

Metastasis (meh-TAS-ta-

sis): The spread o cancer

rom one part o the body to

another. Cells in the metastatic

(secondary) tumor are like

those in the original (primary)

tumor.

Microcalcications (MY-

krow-kal-si--KA-shunz):

Tiny deposits o calcium in

the breast that cannot be

elt but can be detected on

a mammogram. A cluster o

these very small slecks o

calcium may indicate that

cancer is present.

Milking & Stripping: technique

or releasing clotty threadsthat may accumulate along the

inside o the J.P. Drain.

MRI: A type o breast imaging

that is done with the use o a

large magnet. No radiation is

used.

PACU: Past Anesthesia

Care Unit, the unit you are

transported to right ater your

surgery.

Palpation (pal-PAY-shun): A

simple technique in which a

doctor presses on the surace

o the body to eel the organs

or tissues underneath.

Partial Mastectomy: Partial

mastectomy is surgery to

remove the abnormal tissue

or lump and a margin o

normal tissue surrounding the

abnormal area; is also reerred

to as lumpectomy.

Pathologist (path-OL-o-jist): A

doctor who identies disease

by studying cells and tissues

under a microscope.



34

Progesterone (proe-JES-ter-

own): A emale hormone.

Prognosis (prog-NOE-sis): The

probable outcome or course

o a disease; the chance o recovery.

Prosthesis (pros-THEE-sis):

An articial replacement o

a part o the body. A breast

prosthesis is a breast orm

worn under clothing.

Radiation therapy (ray-dee-

AY-shun): Sometimes radiation

therapy is used in addition to

surgery. Radiation therapyconsists o X-ray treatments to

the tumor containing area in

the breast. The X-rays can kill

the tumor cells or keep them

rom growing and dividing.

The treatments involve

positioning you in a radiation

therapy machine to receive the

treatments. Small tattoos are

placed on your skin to allow

exact positioning o the X-rays.

The treatments are given on anoutpatient basis 5 times a week

or 6.5 weeks, 5 weeks are or

total breast irradiation and 1.5

weeks o a boost (extra dose)

to the tumor area.

Remission: Disappearance o

the signs and symptoms o

cancer. When this happens,

the disease is said to be “in

remission.” A remission can be

temporary or permanent.

Risk actor: Something that

increases a person’s chance o

developing a disease.

Sentinel Lymph Node: First

lymph node or nodes to receive

drainage rom the area o the

tumor

Seroma: collection o bodily

fuid which may accumulate

postoperatively in area where

tissue was removed.

Stage: The extent o the cancer.

The stage o breast cancer

depends on the size o the

cancer and whether it has

spread rom its original site to

lymph nodes and/or distant

sites.

Staging: Staging is a term

used to describe those tests

we do on all patients with

a new diagnosis o breast

cancer to determine i there

are any obvious signs o

spread (metastasis). The tests

commonly used include a chest

x-ray, liver unction tests and

tumor makers (a blood test),

and a bone scan. (You may

eat and drink as you usually

do beore and ater these

tests.)

Systemic therapy (sis-TEM-ik):

Treatment that reaches and

aects cells all over the body.

Tissue (TISH-oo): A group or

layer o cells that perorms aspecic unction.

Tumor: An abnormal mass o

tissue.

Ultrasonography (ul-tra-son-

OG-ra-ee): A test in which

sound waves are bounced

o tissues and the echoes

are converted into a picture

(sonogram). These pictures

are shown on a monitor like a TV screen. Tissues o dierent

densities look dierent in the

picture because they refect

sound waves dierently. A

sonogram can show whether a

breast lump is a fuid-lled cyst

or a solid mass.

Wire-Localization: A technique

to localize a breast abnormality

that cannot be elt. The

procedure involves placing awire into the breast under local

anesthesia beore the surgical

procedure. The localization

can be done under guidance

o either mammography or

ultrasound.

X-ray: Radiation is used in low

doses to diagnose diseases

and in high doses to treat

cancer.



35

J. Resources

Service Category Local Resources National Resources

Counselling Faulkner Breast Centre Cancer Care Inc. 1-800-813-Hope

social worker Janet Rustow, LICSW www.youngsurviva l.org www.cancercare.org1153 Centre Street, Boston, MA 02130 www.lotsahelpinghands.com617-983-7967

Look Good, Feel Better Peer support Zakim Center for Integrative Therapies 1-800-395-LOOK

617-632-3322 National Coalition for Cancer Survivors

1-877-NCLS-YWSwww.cansearch.org

Genetic Counseling Dana Farber Cancer Institute

High Risk Clinic617-632-2170

New England Medical CenterDivision of Genetics617-636-5461

Lymphedema Support Greater Boston Lymphedema Network National Lymphedema Network

Meetings on 3rd Wednesday of the month 1-800-541-3259781-894-2309 www.lymphnet.org

Breast Prosthesis New England Medical Fitting988 Middle StreetWeymouth, MA 021881-800-341-1512

Friends Boutique - DFCI44 Binney StreetBoston, MA 02115617-632-6178

Internet Sources

Internet Massachusetts Breast Cancer Coalition www.breastcancer.org1-800-649-MBCC

American Cancer Society – MA American Cancer Society (ACS)www.ma.cancer.org 1-800-227-2345 www.cancer.org

Breast Cancer Network of Strength National Alliance of Breast Cancer 312-986-8338 www.networkofstrength.org Organizations (NABCO)

1-888-806-2266 www.nabco.org Young Survival Coalition 646-257-3000 www.youngsurvival.org National Breast Cancer Coalition

1-202-296-7477 www.natlbcc.org

National Cancer Institute1-800-4-CANCERwww.cancernet.nci.nih.govwww.nci.nih.gov

Center for Cancer Suppport and Education

781-648-0312 www.centerforcancer.org

Susan G Komen Breast Cancer Foundation1-800-462-9273 www.komen.org

Oncology Nursing Societywww.ons.org

Onco.Linkwww.onco.link.upenn.edu

Lance Armstrong Foundationwww.livestrong.com

Lotsa Helping Handswww.lotsahelpinghands.com

CaringBridge651-452-7940 www.caringbridge.org



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www.FaulknerHospital.org

Faulkner Hospital

1153 Centre Street

Boston, MA 02130

guide to breast surgery 2 evans

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