Surgery is usually the first line of treatment for breast cancer. At the initial surgical appointment (also called consult), your surgeon will review your medical history, recent pathology and prognostic factors (if available), complete a breast examination, and discuss the different surgical options available. At the end of the consult, the surgeon or nurse navigator will review the treatment plan and next steps. The appointment will be approximately 60-70 minutes.
A pre-op appointment will need to be set prior to surgery with each surgeon involved in the surgery (for example, if a plastic surgeon is involved for reconstruction, you will need an appointment with the breast surgeon and the plastic surgeon). At this appointment, each surgeon will review the surgery again in detail; discuss the logistics of the day such as where to go and when.
Preparing for surgery
Wear a shirt that buttons or zips in the front to wear home. Bring a small pillow or folded towel to protect the incision from the seatbelt or to go under the arm for support. We recommend a sports bra that opens in the front for post-surgery. There will be down time waiting for surgery so bring a book or other device to help.
Wire Needle Localization
For all lumpectomy patients and most mastectomy patients the night before or morning of surgery the radiologist will use ultrasound to place a small wire (size of a fishing line) into the area of the abnormality. This procedure is done to help the surgeon and pathology identify the area appropriately during surgery. The average time for the procedure is 20-40 minutes and a local anesthetic will be given to numb the area. A mammogram will be completed post-procedure to confirm the wire is in the appropriate place.
Sentinel Node Biopsy
The sentinel nodes are the first nodes that filter fluid draining away from the breast and therefore the nodes that would most likely have cancer in them if the cancer has spread. These are the lymph nodes your surgeon will remove during surgery. Prior to surgery, whether it be the afternoon before surgery or the morning of, an injection that contains a radioactive dye will be given into the nipple. The injection is very quick and lasts less than 10 seconds. This dye will then follow the drainage path and identify the sentinel nodes for the surgeon.
- Local anesthetic may last for 6 to 8 hours
- Gauze dressing must stay in place for 48 hours
- Do not remove the little white strips over incisions (if applicable), they will come off on their own after about a week.
- For lumpectomy patients, use ice pack for 20 minutes at a time
- You may take a shower 48 hours after your surgery, or as instructed by plastic surgeon
- Place occlusive dressing (air & water tight) on JP Drain exit site when showering
- If you take narcotics for post-operative pain control, please do not drive or consume alcohol
- Pathology results will be available in 72 hours. Please call for your results 303-320-7826
- You will schedule a follow up appointment for 10-14 days post-op
- If your sentinel node(s) is positive, we will have performed a full axillary dissection. A plastic tube will be placed in the operative bed leading to a bulb. You will be taught to record the output of the drain. When the output is less than 25ml per 24 hours, call your surgeon so that we can schedule your drain removal in the office.
- Do not undertake any heavy lifting or strenuous exercise for 4-6 weeks or as instructed by plastic surgeon
- For lumpectomy patients, expect firmness at surgery site to last 8-12 weeks
- You may experience sharp, shooting burning pain in post-operative period and some months thereafter once the nerves start to recover from surgery.
- Do not swim or soak for 2 weeks after drain removal or as instructed by plastic surgeon
- You may have bruising at the operative site
Call your surgeon immediately if you develop fever, chills, nausea, vomiting, redness, increased pain or swelling.