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The type of surgery you have will depend on a number of factors. Talk to your family doctor and/or surgeon about the types of surgery that may be an option for you. Breast surgery is often done as an outpatient. This means you go into the hospital the day of your surgery and may go home after a short stay. A visiting nurse will often come to your home to help change the bandage and check to see that you are healing well.

What to expect after surgery:

• You may have numbness or tingling in your chest, shoulder or arm
• You may have pain in your chest, shoulder or arm
• You may have swelling in the chest, arm or hand. This swelling is called lymphedema. It can occur months to years after surgery and should be checked by a doctor
• The type of scar you will have will depend on the type of surgery

 For some of these procedures, breast tissue will be removed that may affect the appearance of the breast.

Ask how much tissue will be removed, from which part of the breast, if there will be a scar and the short and long term impact it will have on the appearance of the breast.

Breast-Conserving Surgery

• Example; lumpectomy/partial mastectomy
  (also called a wide excision, segmental mastectomy or quadrantectomy)
• Removes the lump and part of the surrounding tissue

Mastectomy

• Removes the entire breast and the nipple and often some axillary (underarm) lymph nodes

Axillary Node Dissection

If a breast lump has cancer cells, a few lymph nodes located in your axilla (armpit) are removed. This is done to see if the cancer has spread to the lymph nodes. The lymph node dissection (surgery) is often done at the same time as the lumpectomy or mastectomy.

Sentinel Node Biopsy

A sentinel node biopsy is a type of axillary (underarm) node dissection (surgery). The sentinel node is the lymph node most likely to have cancer cells if the cancer has spread. This surgery removes fewer lymph nodes and has less complications than an axillary node dissection.

Before surgery, a radioactive medication (Technicuim 99) is injected in the skin. It is injected next to the tumour or next to the area of the previous lumpectomy. An hour after the injection, a special picture is taken. This is called  "mapping". The mapping helps to pinpoint the lymph node(s) which have picked up the radioactive medication.

At the beginning of the surgery, a small amount of blue dye (Lymphazurin 1%)  is injected around the tumour or around the area of the previous lumpectomy. The dye enters the lymph channels. In 20 minutes the dye turns the sentinel node(s) blue. The sentinel node is also detected using a special instrument called the gamma probe. It looks for the most radioactive lymph nodes.

The sentinel node(s) are removed and sent to the lab to be examined right away. This exam is called a ‘frozen section’. If these lymph nodes do not contain cancer, it is unlikely that cancer cells will be found in the other lymph nodes of the axilla (armpit). No more lymph nodes will need to be removed. However, if the lymph node does contain cancer, the surgeon will do an axillary node dissection.

After surgery, if the final pathology exam shows cancer cells that were not seen on the frozen section, the surgeon will recommend an axillary node dissection.

A sentinel node biopsy is not recommended if:

• The tumour is very large
• Lymph nodes can be felt in the armpit (axilla)
• You had previous radiation to the breast 
• You had chemotherapy before the surgery
• There has been a lot of surgery to the breast in the past 

The Jackson Pratt Drainage Tube is a special drainage tube that has a small bulb at the end. The tube is placed under the skin during the operation. This tube drains extra fluid from the area of the surgery which helps the wound to heal.

One tube is used for a lumpectomy with an axillary node dissection. If you have a mastectomy you will have two tubes.

In hospital the nurse  will show you how to empty the drainage. At home, you will need to empty the bulb 2 – 3 times a day and write down the amounts. You will add up your total for each 24 hours. Look at the example below.

Example: Drainage Log

 
Date              Time                     Amount Drained          Daily Total
October 5        9 am                     25 cc 
                      4: 30 pm               40 cc 
                      11: pm                  35 cc                            100 cc

After surgery, the community nurse will visit you every few days. When the total amount of fluid is less than 30 cc in 24 hours (or whatever amount your surgeon decides), the nurse will remove the drain. Removing the drain may cause some discomfort.

If you have two drains, each one will be removed when needed and not always on the same day. Drains may stay in 5-10 days or sometimes a few weeks.