Considering a Mastectomy: Here is What to Expect

To help you make a decision on the type of surgery you will have, you and your surgeon will discus your options and the specifics of your breast cancer and any medical issues that need to be taken into consideration in the decision. Reconstructive surgery can be done at the same time as your primary surgery. If you wish to explore this option ask for a referral to a plastic surgeon.

Aftr you have made the decision to have a mastectomy the surgery will be scheduled. You will be asked to stop taking medications such as aspirin and drugs used to decrease blood clotting that might increase your surgical risk about 1 to 2 weeks before surgery.

You will have a general physical to determine any health problems that might affect your surgery and recovery. You may have a pre-admission interview with hospital staff, and blood may be drawn, or this may be done when you arrive for surgery. You also may meet with the anesthesiologist prior to admission. If you do not, then you will meet him or her the day of surgery.

You will be asked to sign a legal document called a consent. This document certifies that you understand and accept the risks normally associated with your surgery. Signing the consent does not mean that you have signed away your legal rights, nor given your health care providers permission to make medical mistakes. However, as with any legal agreement, you should read and understand the consent before signing it.

You will be instructed to take no food or fluids after midnight or for 8 hours before your surgery. If you are on special medications, ask your doctor if you should take them the day of surgery.

Usually you arrive at the hospital 2 to 3 hours before surgery is scheduled. You will be admitted to the pre-operative area. Your blood pressure and other vital signs will be taken and lab tests may be performed. You will change to a hospital gown and move to a gurney, or wheeled bed.

The day of the surgery

If you are having a sentinel node biopsy, you will be transported to nuclear medicine for an injection of the radioactive tracer. After this injection, you will return to the pre-operative area for your pre-operative workup.

Your anesthesiologist will take your health history, if you haven't previously given it, and will start your IV, giving you medications to relax you and make you sleepy.

Your wait in the pre-operative area will depend on the operating room schedule. When ready, you will be wheeled to the operating room and you will be awake until you get there. When you arrive, a team of people will be preparing for your surgery and you will be moved to the operating table.

Your anesthesiologist will add drugs to the IV that put you to sleep, then will pass a tube through your mouth and throat into your windpipe. This tube will keep your airway open during surgery to give you oxygen and provide further anesthesia.

The skin in the area of the surgical site is scrubbed with anti-bacterial soap and covered with sterile cloth, except for the surgical site. A protective stocking may be placed over the surgery-side hand and arm. The incision for a total mastectomy will surround the nipple, areola and, if possible, any existing scars.

If a sentinel node biopsy is planned, it will be completed prior to any other procedure you will have.

As the tissue is excised, a tool called an electrocautery will be used to seal small blood vessels that would otherwise bleed. This reduces scarring and the chance of post-operative hematoma. The surgeon will separate the breast and the muscle lining or fascia to which it is attached from the muscles beneath. The blood vessels are larger in this area and are closed with clips to prevent bleeding.

When the breast is fully separated from the muscles beneath it, it is marked with ink or sutures so that its original placement, called orientation, will remain clear. The breast is then removed. It will be sent to a pathologist for microscopic examination. If breast reconstruction is planned, less skin is removed. Otherwise, enough is removed so that the remaining skin will not be loose.

If axillary node dissection is to be performed, it is done next, usually using the same incision. The dissection often involves a partial axillary node dissection, where some, but not all, of the lymph nodes in the armpit are removed.

This type of surgery results in some blood and fluid draining. The surgeon will place one or two drains under the skin. A drain is a flexible tube similar to the rubber tube used around your arm when blood is drawn. One drain is for the area where the breast was. If axillary node dissection is performed, another drain will be used for the armpit. The drains exit your side through small incisions in the skin and empty into reservoirs. Some surgeons use drains routinely, while others use them based on the appearance of the surgical area.

If you are having immediate reconstruction, the plastic surgeon will take over in the operating room and perform the reconstruction surgery. If not, the incision is closed with sutures and tape to hold the incision edges together, and a soft, bulky pad is taped over the incision. A bandage is wrapped around the chest to hold the pad in place, or a special surgical bra will be used to hold the dressings in place.

When your surgery is completed, the anesthesiologist stops the anesthesia, makes sure that you are breathing well and removes the breathing tube. You are then transferred to the recovery room where you will be monitored until you are awake, medically stable and ready to be moved to a room.