Mastectomy-PatientInformation

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MASTECTOMY

MICHAEL EDWARDS


Author's note

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 Mastectomy 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 a Mastectomy?

Mastectomy means removal of a breast. The end result is smooth skin across half the chest with a barely visible scar across it.


Are there any alternatives?

Together we have decided against simply taking out the diseased part and using x-ray treatment for the rest of the breast. This is because we cannot get a safe margin or the background tissue is not stable, or you are not happy with the idea. X-ray treatment on its own would not be as good in your case. Neither would drug treatment on its own. Coring out the breast tissue would not give a safe margin.

Re-building the breast with an implant at the time of mastectomy is risky from the point of view of healing.

If you do nothing, the problem in the breast will get steadily worse.


What happens before the operation?

You will already have met Sister Judith Curtis or Sister Jean Walker. They will continue to help you during and after your hospital stay.


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 and 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.


Visits 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 x-rays and 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.


Visit by the physiotherapist

The physiotherapist will show you how to keep your chest clear after the operation and how to keep moving about. You should not smoke. The physiotherapist will show you arm exercises for after the operation.


Diet

You will 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 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.


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. You will be wearing a cotton gown. Wedding rings will be fastened with tape. Removable dentures will be left on the ward. There will be several checks on your details on the way to the anaesthetic room where your anaesthetic will begin.


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 drip tube in an arm vein and also two fine plastic drainage tubes in the skin near the wound. These last tubes are each connected to a plastic vacuum container. You will find these vacuum containers lying near you under the sheets.


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.


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.

You will be expected to get out of bed the day after operation, despite the discomfort. You will not do the wound any harm, and the exercise is very helpful for you.

The second day after operation you should be able to spend most of your time out of bed and in reasonable comfort. You should be able to walk slowly along the corridor. 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

It is quite normal for the bowels not to open for a day or so after operation. If you have not opened your bowels after two days and you feel uncomfortable, ask the nurses for a laxative.


Passing urine

It is important that you pass urine and empty your bladder within 6-12 hours of the operation. If you find using a bed pan or a bottle difficult, the nurses will assist you to a commode or the toilet.

If you still cannot pass urine let the nurses know and steps will be taken to correct the problem.


Sleeping

You will be offered painkillers rather than sleeping pills to help you to sleep. If you cannot sleep despite the painkillers please let the nurses know.


Physiotherapy

The physiotherapist will check that you are clearing your lungs of phlegm by coughing. You can help your circulation by continuous movement of body and limbs.

The physiotherapist will also encourage you to move and exercise your arm and shoulder.


The wound and stitches

The wound has a dressing which may show some staining with old blood in the first 24 hours. The dressing will be exchanged for a clean one which stays until the drain tubes are removed after 4 to 5 days.

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 to 3 days. It is not important. There may be some swelling of the surrounding skin which also improves in 2 to 3 days.

The drain tubes are removed in 4 to 5 days depending on the amount of drainage. Do not be disappointed if the drainage actually increases after 3 days or so. The wound gradually improves for one to two months after the operation.

You will be fitted with a soft sponge filling for your bra to give you some shape until a more permanent filling can be fitted when the wound has settled down. There may be some tablet or injection treatment while you are in hospital. The House Surgeon will explain this to you.


Injections

You will have tiny injections in the skin of the tummy twice a day to keep the circulation going.


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.


How long in hospital?

Usually you will be able to go home within a week of the operation. The nurses will talk to you about your home arrangements so that a proper time for you to leave hospital can be arranged.

You will be given an appointment to visit the Out Patient Department for a check up about two weeks after you leave hospital.


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 to 3 times a day for a week or more. You will gradually improve so that by the time a month has passed you will be able to return completely to your usual level of activity.


Lifting

At first discomfort in the wound will prevent you from harming yourself by too heavy lifting. After one month you can lift whatever you like. There is no value in attempting to speed the recovery of the wound by special exercises before the month is out.


Driving

You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about 10 days. You can safely wear a seat belt.


What about sex?

You can restart sexual relations within a month or so, when the wound is comfortable.


Work

You should be able to return to a light job after about 4 weeks and any heavy job within 8 weeks.


Complications

Complications are minimal and seldom serious.

If you think that all is not well, please ask the nurses or doctors. Bruising may be troublesome. Occasionally some old blood collects under the wound, but this can easily be removed.

Occasionally the wound edge does not heal well in places. This always settles down but may take 2 or 3 weeks to do so.

Infection is a rare problem and settles down with antibiotics in a week or two. Aches and twinges may be felt in the wound, shoulder and arm for up to 6 months. Occasionally there is a numb patch in the skin of the armpit and down the inside of the upper arm. This patch slowly lessens in size but may always be present.

General advice

The mastectomy operation is much less of an undertaking than was the rule 10 or more years ago. Patients are usually surprised how little upset they feel. Details of further treatment, if any, will be discussed with you by the surgeon before you leave hospital.


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.