What to prepare before and after the breast surgery

Dr Jerry Goo
Senior Consultant, Breast Surgeon
Khoo Teck Puat Hospital

As a breast surgeon, I understand that navigating the overwhelming information and multitude of surgical options after receiving a breast cancer diagnosis can be challenging. After weighing the benefits and side effects of each type of surgery, you have decided to proceed with breast surgery. There are two primary types of breast surgery: breast-conserving surgery and mastectomy, with or without breast reconstruction.

The surgery you choose depends on the cancer characteristics and also on personal preferences of which some considerations include your lifestyle and health conditions. All these will be extensively discussed with you by your surgeon for you to make a personalized choice. Remember all ladies are different and may require a different approach to their cancer treatment.

Whether you are undergoing breast-conserving surgery or a mastectomy to treat your breast cancer, a short hospital stay (usually one day) is typically required. It is also likely that some or all of the glands (lymph nodes) from your armpit will be removed during the procedure.

This guide aims to provide you with a comprehensive idea of what to expect before and after your operation, ensuring you are well-prepared for the journey ahead. This article will guide you from the day you decide on the surgery through the first two weeks of post-recovery and getting your surgical histology report.

Preparing for Breast Surgery: What You Need to Know

A common question I get from patients before surgery is about diet. It is recommended that patients with cancer follow the same guidelines used for cancer prevention. The strongest evidence suggests that the most important things to prepare for surgery and prevent cancer from returning are maintaining a healthy weight, doing regular exercise, and eating a healthy, balanced diet. There are no special foods you should eat, diets you should follow, or specific foods you should avoid to prevent postoperative wound complications and cancer recurrence.

For Singaporean adults, a healthy diet means achieving and maintaining a healthy weight, being physically active, and choosing nutritious food and drinks to meet your energy needs. Enjoy a wide variety of nutritious foods from all food groups every day, including vegetables, fruits, protein, and grains. Limit your intake of foods containing saturated fat, added salt, added sugars, and alcohol. Avoiding smoking helps in your post operative recovery from anaesthesia and a high protein diet may help with wound healing. If you are diabetic, good sugar control is also key in wound healing.

What Happens Before the Operation?

Before your operation, you may be asked to attend a pre-admission clinic a few days beforehand to finalize paperwork and undergo any tests required by the anaesthetist.it is often during the pre-admission testing that the financial costs of surgery will be discussed and arranged. For most Singaporean MediShield life and MediSave will cover part of the costs and for others, hospitalization insurance can also be utilized.

Prior to the operation you will also be counselled about fasting instructions and about your current medications. Please adhere to these instructions to ensure a prompt and smooth surgery day.

Typically, you will be admitted to the hospital on the day of the operation, several hours before it is scheduled to start. During this time, you will be assessed by the nursing and anaesthetic team.

For patients with small tumours which cannot be easily felt, your operation may require a hookwire localization, a procedure that marks the breast cancer with a tiny wire under local anaesthetic, this will be performed in the breast imaging centre or radiology department on the day, usually 2-3 hours before surgery. Additionally, if you are having a sentinel node biopsy, the lymphatic mapping procedure will be performed during surgery with a blue dye. It is normal to observe blue discoloration of the skin of the breast and even your urine; this will wear off after a few days and is completely harmless.

Preparing for surgery can be a stressful time, but following these guidelines can help ensure you are in the best possible condition for your operation and recovery. Maintain a healthy lifestyle, attend all pre-surgery appointments, and follow the instructions of your medical team to help achieve the best possible outcome.

What to Expect After Breast Surgery? How Will I Feel After the Operation?

After your operation, you will wake up in the recovery room, possibly with an oxygen mask to help you breathe. You might feel sleepy and notice a small, plastic tube in one of the veins in your arm attached to a drip, which will provide you with fluids until you can eat and drink on your own. A nurse will regularly check your pulse and blood pressure. Once you are well enough, you will be moved to a ward. It is common to feel sick after a breast operation. If you do, inform a nurse, and you will be given medicine to prevent vomiting. Pain is also normal after surgery, and your surgeon or anaesthetist would have discussed different types of pain control with you before the operation. Make sure to ask for pain medication if you feel discomfort to make your hospital stay as comfortable as possible. Generally, you should be able to move around the next day.

Caring for Your Wound

After surgery, your wounds will be covered by a waterproof dressing on top of steristrips (paper tapes). Most surgeons use dissolving stitches that do not need to be removed. These dressings should remain in place until your postoperative appointment 5 to 7 days after surgery. You can shower with the waterproof dressing in place but avoid soaking the wound in a bath. Swimming should be avoided until the wound has healed.

Caring for your Drains

You may wake up with tubes (drains) coming from your wound to remove fluid and blood from the space under the wound, helping to prevent healing problems. If a drainage tube (drain) is placed in the breast wound, it may stay in for a week or more, and you willgo home with it. You will be shown how to care for the drain and keep a record of the fluid volume. The drain will be removed by your breast care nurse or surgeon.

Looking After Your Arm

Start by gently moving the arm on the side of your surgery. Use your other arm for blood pressure measurements or injections. Follow the arm exercises prescribed by your doctor or physiotherapist to prevent stiffness. Perform the arm and shoulder exercises recommended by your doctor and physiotherapist to prevent stiffness. Using your arm for daily activities within the limits of pain does not delay wound healing.

Eating and Moving After the Operation

You can start eating as soon as you are wide awake, usually within 2-4 hours after the operation. How quickly you return to a normal diet depends on how you feel, but most patients recover quickly. It is best to get out of bed as soon as you can to help prevent blood clots. If you cannot get out of bed on the first day, move your legs while lying down.

When Can You Leave the Hospital?

You may be able to go home as early as on the day itself or the next day, depending on how quickly you recover, the type of operation, and your doctor's advice.

Returning to Normal Activities

The timeline for resuming day-to-day activities varies depending on the type of surgery. After a breast biopsy, you can usually return to normal activities within a few days. For more extensive operations, like a mastectomy or a breast cancer operation with axillary dissection, recovery may take longer. You can generally start gentle activities within a week and return to vigorous activities or driving within 2-4 weeks.

Common Problems After Surgery

Pain: Normal after surgery; pain tablets can help manage it.

Bruising: Common around the wound; usually not a problem and resolves in 2-3 weeks.

Wound Swelling: Common along the wound edges; resolves as scar tissue forms.

Drain Issues: Clean around a leaking drain and apply a clean pad; contact your nurse if the issue persists.

Seroma: Fluid buildup in the armpit causing discomfort; may need to be drained by a doctor or nurse.

Numbness: Normal under the arm and along the chest after armpit surgery.

What to Expect When You See the Surgeon for Follow-Up

When you are discharged from the hospital, a follow-up appointment will be scheduled for you. About two weeks after the surgery, you will return to see your surgeon. During this appointment, you will have the opportunity to discuss any problems, ask questions, and have your wound checked.

One of the key aspects of this visit is the discussion of your pathology results. The tissue removed during the operation would have been thoroughly examined by a pathologist. Your surgeon will go over these results with you in detail. With the information from the pathology report, you and your doctor can discuss whether additional treatments such as radiotherapy, chemotherapy, or hormone therapy are needed. Recommendations for further treatment are often made based on tumour board discussions, which involve a team of specialists who review your case to provide comprehensive treatment advice.

Conclusion

Treatment for breast cancer and breast surgery can be a very unsettling experience. However, please remember that you are not alone on this journey. Your surgeon, breast care nurse, and other health practitioners are available to help you every step of the way.

By staying informed, attending follow-up appointments, and reaching out to your healthcare team with any concerns, you can navigate this challenging time with confidence and support. Your path to recovery is shared by many who are committed to your well-being and success.

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