The Day of Your Mastectomy Surgery
What to Expect
Before Your Mastectomy Surgery
In the hospital on the day of surgery, you’ll change into a hospital gown and wait in the preoperative holding area. You can have one or two family members or friends with you in the room.
Dr. Sandford (your breast surgeon) will come and check on you. She will often draw some markings on your breast to help with the surgery and that show where the incision will be made. Usually this is done with a felt-tip Sharpie style marker. You’ll be sitting up while this happens so that the natural crease of your breast can be marked. Sometimes, the Plastic Surgeon will also come in and do some marking.
The pre-operative nurse will see you and check on your medical history. The nurse will also start an IV and make sure all your paper work is in order. You will also be visited by the anesthesiologist who will be doing your case. They will do a brief interview and exam. They will also explain, in general terms, how they plan to manage you while you are in surgery. There will be an opportunity for you to ask any questions that you might have about your anesthesia. The anesthesiologist will have you sign a consent that is similar to the consent you signed for surgery. You will then meet the nurse who will be with you in the OR. There can be a final round of hugs and kisses then that nurse will get you prepared to be wheeled into the operating room.
You will be wheeled into the operating room on a wheeled bed. Operating rooms can feel chilly. Don’t worry, the nurse will have nice warm blankets to wrap you up in. The anesthesiologist will already be there to greet you again. The nurse will introduce you to the OR team and ask that you confirm that you are who we think you are and that we have the correct procedure planned. You will be moved over to the operating room table. The anesthesiologist will then start your anesthesia. .
During Mastectomy Surgery
The nurse will clean your skin and then the team will place several layers of sterile drapes to keep the operative field protected. After the incision is made, the breast tissue is carefully dissected from the overlying skin and from the chest wall muscle underneath. Usually, the breast is removed before any lymph nodes are sampled. After the breast has been removed, the surgeon will then either do a sentinel lymph node biopsy or axillary lymph node dissection if either procedure is indicated. The tissue that is remove, breast and lymph nodes, will be sent to the pathologist for evaluation. It can take 3 to 5 days to get the pathology report back.
After your breast surgeon has removed your breast tissue, you will be prepared to have the wound closed. If an immediate reconstruction is planned then your plastic surgeon will come in and perform the reconstruction. If you are planning on a delayed reconstruction or prefer to forego reconstruction, then Dr. Sandford will proceed to close up the wound.
As part of the closing of the wound, your surgeon will check the surgery areas for bleeding and insert surgical drains. The drains are special tubes that help remove the excess fluid that will accumulate under the breast flaps. It is our practice to review drain care before your surgery day while you are in the office. If you have questions, please feel free to ask one of the staff. Dr. Sandford commonly uses a catheter system that drips local anesthetic into the wound to help with pain. This is called an On-Q Infusion Pain Pump. This can provide targeted pain relief and help reduce a patient’s need for narcotic pain medications. After the drains are inserted, your surgeon will sew the incision closed. In almost all cases dissolvible sutures (stitches) are used that are on the inside. The surgery site will usually be covered by a special protective glue that seals the wound shut. You may have an ace wrap or similar bandage going all the way around your chest. This can be a bit snug. Let someone know if it feels too tight and is starting to hurt. Sometimes, it can be loosened.
After Mastectomy Surgery
You’ll be moved to the recovery room after mastectomy surgery, where staff will monitor your heart rate, body temperature, and blood pressure. If you are in pain or feel nauseated from the anesthesia, let the nurse know so that you can be given medication.
If we have any medical concerns, you will be admitted to the hospital. Some patients choose to go home after their mastectomy. Others prefer to spend the night in the hospital and go home in the morning. If you have a mastectomy and immediate reconstruction, you should expect to be admitted at least overnight. Some bigger reconstructions have a longer associated hospital stay.
Our office has instructions on how to care for your drain. We try to include that in your pre-operative folder. If this was overlooked or if it missing, you should be able to get another copy off this web site or from our office. If you have not had an immediate reconstruction, then range of motion exercises can be started as soon as you have gone home. If you had an immediate reconstruction, ask the Plastic Surgeon about any activity limitations and when range of motion exercises can be started. They usually like you to delay a bit.
Our practice is to make your post-operative appointment at the time of your pre-operative visit. If we overlooked this detail, or you do not recall the date and time, call the office for clarification.
Resources and Helpful Information