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What to expect before your breast cancer surgery

Food

You can eat dinner the night before surgery, but you must stop eating and drinking at midnight. You won’t eat the day of surgery, except for a clear liquid dinner of beef or chicken broth, gelatin, tea, and perhaps a popsicle. If this does not sound appetizing to you, no one will care if you return it. All that is important is that you drink clear fluids and excrete them.

If you want to bring your own broth or other clear liquid with you, that will be fine. It should be something that is stable at room temperature (such as an unopened can of broth, a bottled beverage, or a bouillon cube), since you probably will not be able to put anything in a refrigerator until many hours after admission. Alternately, you can have someone bring something in from home or a restaurant when you are ready to eat. If you’d like to bring in your own food during the rest of your hospital stay, talk to your doctor about what foods will be appropriate and any possible restrictions.

In Surgery

The standard rule for operating rooms is that you may have nothing on your body but their paper gown, paper socks, and paper hat. No jewelry, no underwear, no socks. Surgeons, nurses, and anesthesiologists need access to most of your body and it is important that they not be hampered. You will have monitors, IV, and a grounding pad for the electric cautering knife attached to your body.

If you want to bring a token, you may be able to tape a non-metal object to the bottom of your foot. You should call ahead and speak to the head nurse for the operating room to request permission in advance.

When you awaken in the recovery area, you are likely to feel cold, and perhaps nauseated. Nurses are nearby to assist you. They will be busy with several patients, so be sure to ask if there is something you need, whether it’s medication or someone to hold your hand. You may feel groggy and go back to sleep.

Inserting a Portacath

Women who are planning to have chemotherapy may wish to have a port inserted under their skin during surgery. This gives nurses easy access to a vein for blood testing and chemotherapy infusions. The port is an additional intrusion into your body, and another potential avenue for infection and complication. However, having a port protects your smaller veins from damage due to the chemotherapy itself and repeated needle insertions over the course of the chemotherapy.

Medical Appointments

The day before surgery will be busy. You will have several appointments at the hospital, including one at the business office where you will sign forms and talk about finances. You will visit with a physician’s assistant or another health professional in the pre-surgery office who will compile information about your medical history and explain what to expect during surgery. You may wish to prepare a list of medications, previous surgeries, and other pertinent information to assist your memory. Some hospitals will provide a video or DVD about the surgery or a booklet of what to expect. If you are anxious about surgery, you may ask to have this appointment earlier; it is a helpful source of answers. Additional tests, such as an ultrasound of your heart, may be scheduled if warranted.

You will have a chest X-ray to help the surgeons see how your ribs and other organs are arranged.

If you and your doctor have decided to identify and remove the sentinel lymph node during surgery, you will have a lymphoscintigraphy procedure the day before. This involves a visit to the nuclear medicine section of the radiology department, where a radiologist will inject you with two different radioactive dyes at the site of the tumor. The first injection is shallow and stings. You will immediately be positioned in front of a camera that tracks how the injected material, a radiotracer, is picked up by the lymph system. You will be able to see it move on the monitor. When the dots appear to coalesce in one spot, that indicates a lymph node. The radiologist will mark that dot on your skin and ask you not to wash it off!

The second injection pushes another radiotracer dye deep into the tumor region. Although it will not sting like the first injection, it will leave the breast tissue tender and sore until surgery. You will be asked to return in about one and a half hours for a series of scans. The purpose of this treatment is to determine if the tumor drains to any of the lymph nodes that are located toward the center of the chest, out of range of the surgery.

If you are scheduled for a lumpectomy and the lump cannot be felt by the doctors, you will have an ultrasound just before your surgical procedure. While the lump is on the screen, a doctor will inject a needle into the lump, followed by a thin flexible wire. The wire will stay in your breast, marking the lump for the surgeons.

Rituals

You are about to undergo a dramatic change in your body shape. Although many women recognize that changing or losing a breast does not change who they are or what they can do, it is still a part of the body that carries with it societal expectations and ideals. You may wish to create a ceremony or ritual to recognize your impending loss. This may take the form of a whimsical farewell party or a private journal entry. Consider going to a support group before surgery. Other survivors’ advice and stories may help you to know what to expect.

Summary

You are embarking on a significant and traumatic surgery that is necessary to cure you of cancer. Take the time to prepare yourself mentally and physically for this treatment. Even women who are well aware of the need to remove the diseased tissue become anxious and out-of-sorts as surgery draws near. Give yourself the time and space to get ready and become knowledgeable about this surgery. Ask for the support of your friends and family, and share your fears. The more people you tell, the more women you will meet who have been down this path; lumpectomies and mastectomies are a relatively common surgery. These women will most likely be happy to give you advice and share their experience. If that’s what you need, go and get it.

Time of Surgery and Hospital Stay

In some hospitals, you will be asked to call the night before surgery to find out exactly when to arrive the next day. They may not be able to tell you what time your surgery will be—only when to get there to sign in. This is because unless you are first in line, it is difficult to know which surgeries will have complications, which emergencies will arrive mid-day, and when rooms will be open. You will need to arrive at least two hours before they plan to have you in surgery.

Mastectomy patients should plan to spend one night in the hospital, even if there are no complications or extenuating circumstances. You will be tired and sleepy for much of that time, but it doesn’t hurt to bring a good book.