Breast-localisation-and-excision-PatientInformation

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MAMMOGRAPHIC LOCALISATION AND EXCISION OF BREAST LESION


MICHAEL EDWARDS


Author's note

http://www.wikisurgery.com/ This information describes what a patient may expect when having the described operation.

The information is specific to the author's practice.

Other surgeons will doubtless differ in their preferences.

The script can be down loaded and edited to suit other surgeons.

Click here for the PDF version of the leaflet

You will need Abobe Acrobat Reader which can be downloaded from http://www.adobe.com/uk/products/acrobat/readermain.html

Your Breast Operation - Some Information

These notes give a guide to your stay in hospital. They also give an idea about what it will be like afterwards. They do not cover everything. If you want to know more, please ask.

We hope you will find these notes useful and that they will help to make your stay in hospital easier.

What is the problem?

Something has shown up on your mammogram x-ray. We cannot feel it in your breast. It is not safe to leave it there.

We need to find it again on another mammogram. Then we need to pin point it with a tiny wire so that we can take that part of the breast out.

What does the x-ray and operation consist of?

You go to the x-ray department and have a mammogram again. This time we put a plastic plate with holes on it onto your breast.

We pass a tiny needle through a hole in the plate and into the problem area in your breast. We check it is in the right place and cover it up with a dressing.

Then you go to the operating theatre.

A cut is made in the skin over or near the affected part of the breast. We choose a place that will heal nicely.

We take out the suspect piece of breast. We check it is the right piece by x-raying it. Only the affected part of the breast is removed. The cut in the skin is closed up.

We can do your operation as a day case. This means that you come into hospital on the day of the operation and go home the same day.

We can do this because of new ways of doing the operation, better anaesthetics and new ways of pain relief. It will save you 2 nights or so in hospital.

The result of the test takes about one week to come through from the laboratory.

Are there any alternatives?

If you leave the breast as it is, the problem remains.

We will not be clear what is going on. You may miss out on important treatment. Needling the breast has not given the answer.

Treatment by antibiotics or hormones is not a good idea if we do not know what the cause of the problem is.

What to do before coming to hospital

Check you have a relative or friend who can come with you to hospital, take you home, and look after you for the first 3 days after the operation.

You only need normal home care, not hospital care.

Check your friend can drive or take you home in a taxi.

Check you have a telephone at home.

Have nothing to eat or drink from midnight before the operation. This means not even a sip of a drink. Your stomach needs to be empty for a safe anaesthetic. However, you can take your normal tablets and medicines.

Getting to hospital

Come with your relative or friend so that they will know the way when to coming to collect you after the operation. Also the ward staff can go over the pick-up time and any other details.

What happens before the operation?

Welcome to the ward

You will be welcomed to the ward by the nurses or the receptionist. You will have your details checked. You will be shown to your bed. You will be asked to change into your nightwear. You will have some basic tests done, such as pulse, temperature, blood pressure and urine examination.

You will be asked to hand in any medicines or drugs you may be taking, so that your drug treatment in hospital will be correct. Please tell the nurses of any allergies to drugs or dressings.

Visit by the surgical team

You will be seen first by the House Surgeon, who will interview and examine you. He, or she, will arrange some special tests such as blood samples. The operation will be explained to you. You will be asked to sign your consent for the operation. If you are not clear about any part of the operation, ask for more details from the doctors or from the nurses. They are never too busy to do this.

You will be seen by the surgeon who will be doing the operation. He will check that all the necessary preparations have been made.

Visits by the anaesthetic team

One or more anaesthetists who will be giving your anaesthetic will interview and examine you. They will be especially interested in chest troubles, dental treatment and any previous anaesthetics you have had. Plus any anaesthetic problems in the family.

Do not smoke.

Diet

You can have your usual diet until 6-12 hours before the operation. Then you will be asked to take nothing by mouth. This will let your stomach empty to prevent vomiting during your operation.

Timing of the mammogram and the operation

The timing of your operation is usually arranged the day before. The nurses will tell you when to expect to go to the operating theatre. Do not be surprised, however, if there are changes to the exact timing.

Transfer to the x-ray department.

You will be taken on a trolley to the x-ray department by a ward nurse and a porter. You will be wearing a cotton gown. Wedding rings will be fastened with tape. Removable dentures will be left on the ward.

Then we do the localisation mammogram.

After this you will go back to the ward to wait for your call to the operating Theatre.

Premedication

You may be given a sedative injection or tablets about 1 hour before the operation.

Transfer to theatre

You will be taken on a trolley to the operating suite by a ward nurse and a theatre porter. There will be several checks on your details on the way to the anaesthetic room where your anaesthetic will begin. You will go to sleep.

The operation is then performed.

What happens after the operation?

Coming round after the anaesthetic

Although you will be conscious a minute or two after the operation ends, you are unlikely to remember anything until you are back in your bed on the ward. Some patients feel a bit sick for up to 24 hours after operation, but this passes off. You will be given some treatment for sickness if necessary.

You may be given oxygen from a face mask for a few hours if you have had chest problems in the past.

You will have a dressing and a fine plastic drainage tube in the skin.

Warning after a General Anaesthetic

The drugs we give for a general anaesthetic will make you clumsy, slow and forgetful for about 24 hours. This happens even if you feel quite alright.

For 24 hours after your general anaesthetic:

Do not make any important decisions.

Do not drive.

Do not use machinery at work or at home. (e.g. do not boil a kettle).

Will it hurt?

There is some discomfort on moving rather than severe pain. You will be given injections or tablets to control this as required. Ask for more if the pain is still unpleasant.

The day after the operation the wound may feel a little stiff and sore but this passes off after a day or two.

By the end of one week the wound should be virtually pain-free.

Drinking and eating

You will be able to drink within an hour or two of the operation provided you are not feeling sick.

The next day you should be able to manage small helpings of normal food.

Opening bowels

This should not be affected by the operation.

Passing urine

This should not be affected.

Sleeping

Take painkillers rather than sleeping pills to help you to sleep. If you cannot sleep despite the painkillers, phone the ward.

The wound, drainage tube and stitches

The wound has a dressing that will be exchanged on the day of the operation. This dressing is best kept on for one week.

There is a fine plastic drainage tube in the skin. This is joined to a plastic container which drains excess blood from the wound.

The drainage tube is removed when the wound is redressed, before you go home. There are no stitches in the skin. The wound is held together underneath the skin and does not need further attention.

There may be some purple bruising around the wound which spreads downwards by gravity and fades to a yellow colour after 2 or 3 days. It is not important. There may be some swelling of the surrounding skin which also improves in 2 to 3 days.

After 7 to 10 days, slight crusts on the wound will fall off.

Occasionally minor matchhead sized blebs form on the wound line. These settle down after discharging a blob of yellow fluid for a day or so.

Washing

You can wash the wound area as soon as the dressing has been removed. Soap and tap water are entirely adequate. Salted water is not necessary.

What about informing my relatives and contacts?

With your permission, the nurses and doctors will keep your relatives and contacts up to date with your progress.

Leaving the ward

After an hour or two on the ward, you should feel fit enough to go home.

Before you go, we do the following:

Check the wound is comfortable

Check the wound is not bleeding

Check there is no swelling

Take out the drain

Change the dressing

Give you 2 spare dressings

Give you 20 CoCodamol tablets to take home. You can take 2 at a time every 6 hours as needed

Give you a Follow Up Appointment for 1 week. (The result on the examination of the breast will be ready then).

Give you a note to be given to your General Practitioner

Give you a work certificate, sick note, etc.

Check you have the ward telephone number

NB. If you do not feel like going home, we can easily arrange for you to stay in hospital.

Getting home

Make sure you are going home by car with your relative or friend.

At home

Go to bed

Take 2 CoCodamol tablets every 6 hours to control any pain.

Next morning

You should be able to get out of bed quite easily despite some discomfort. You will not do the wound any harm. The exercise is good for you.

Phone us up in the Day Ward during the morning to let us know how you are getting on. The second day after the operation, you should be able to spend most of your time out of bed in reasonable comfort. You should be able to walk 50 yards slowly.

By the end of a week the wound should be nearly pain-free.

Sick notes

Please ask the nurses for sick notes, certificates etc.

After you leave hospital

You are likely to feel very tired and need rests 2 or 3 times a day for a day or two or more. You will gradually improve so that by the time a week has passed you will be able to return completely to your usual level of activity.

You can drive within 24 hours of the operation. You will be able to wear a seatbelt.

Work

You should be able to return to work in a day or so.

What if anything goes wrong?

Complications are rare and seldom serious.

If you think that all is not well, please phone the ward. We can advise and help 24 hours a day.

Bruising and swelling may be troublesome, particularly if the swelling was large. The swelling may take 4 to 6 weeks to settle down.

Infection is a rare problem and settles down with antibiotics in a week or two. Aches and twinges may be felt in the wound for up to 6 months.

Occasionally there are numb patches in the skin around the wound which get better after 2 to 3 months.

Things to look out for in the first 24 hours

Bleeding from the wound is the most important thing to look out for.

A little blood staining of the dressing is normal.

If bleeding continues after changing the dressing twice, phone the ward.

If you cannot get through to the ward, come straight away to the Casualty Department of the hospital.

The bleeding is not life-threatening, but is a nuisance if allowed to continue.

Bleeding can also show up as a painful swelling under the skin. Phone us up about this.

Things to look out for in the first week

If the wound gets painful, reddened, and swollen, there may be some infection. Phone the ward.

If you are not happy about your progress, phone the ward.

General advice

The operation is usually easily tolerated.

If you have any problems or queries, please ask the nurses or doctors.

Any Questions?

If you have any questions, jot them down here and ask the doctors or nurses for answers.

Any complaints?

If you have any complaints, please contact the doctors or nurses straight away. If this does not solve the problem, please write to your surgeon

Have you any comments?

We welcome your comments and suggestions covering your illness, your treatment in hospital, and your recovery. Please write below any points you would like to make. If you prefer, you need not give your name.

Full name:

Hospital:

Ward:

Date of stay in hospital:

Operation:

Out patients department:

Your admission arrangements: Your welcome on the ward:

Nursing staff: General ward atmosphere:

Medical staff: Ward orderlies:

Portering staff: X-ray staff:

ECG staff: Did you know who was who?:

Bedding: Food and drink:

Privacy: Locker space:

Toilets: Bathrooms:

Other patients: Noise:

Information: Telephone/TV/radio/newspapers:

Timing of operation: Preparations for your operation:

Going into the theatre: In the operating theatre:

In the recovery room: Coming back from theatre:

Intensive Care ward: Recovery on the ward:

Pain control: Sleeping:

Wound dressings: Stitches, clips:

Progress reports: Visiting hours:

Rest room: Tablets, medicines, injections:

Going-home arrangements: Out-patient follow up:

Anything else?

Continue comments overleaf if you wish.

Please send this questionnaire to your surgeon.