Lumpectomy/ Partial Mastectomy with Axillary Lymph Node Dissection
(Removal of Lymph Nodes)
Instructions Before Surgery

The following information will help you to prepare for your upcoming surgery. We hope this information may help to make this experience more comfortable for you. If you have any questions regarding the instructions, please contact the Breast Care Center staff.

• You may be able to go home the same day, but generally will stay overnight in the hospital after your lumpectomy/ partial mastectomy. You may stay longer if it is medically necessary. You will need to have a responsible adult with you to drive you home. It is unsafe and against hospital policy to permit you to drive home after surgery when you have received any medication that might slow your responses (anesthesia, pain medication, or any medication to relieve anxiety).
  
  
• NOTHING TO EAT OR DRINK AFTER MIDNIGHT on the night before your surgery. Any medications that you take routinely should be taken at the usual time with a sip or two of water. People with diabetes, heart disease, and other illnesses should contact their primary care physicians for directions. Inform your physician if you are taking Coumadin® or other blood thinning medication.
  
  
• DO NOT TAKE ASPIRIN or aspirin containing products for 10 days before your surgery. Tylenol® is okay. STOP vitamin E supplement 2 weeks before or as soon as possible. Vitamin E in a multivitamin is okay.
  
  
• Wear comfortable clothing: a two-piece, loose outfit with a zipper or buttons in front is the easiest to put on. Please bring it with you.
  
  
• Recommended items to bring with you if you stay overnight in the hospital:
  - DO NOT BRING VALUABLES, or give them to family/friends
  - Personal items (toothbrush, toiletries, pillow, earplugs)
  - Slippers, extra socks
  - Tape player and headphones, favorite music, books on tape
  - Bathrobe open in front, button or zipper sweater or bed jacket
  - Light reading
  - Important telephone numbers
  - A supportive bra NO UNDERWIRE, (sports bra or bra that hooks in front) PLEASE WEAR A BRA FOR 3-4 DAYS FOLLOWING SURGERY, EVEN WHILE YOU SLEEP. This minimizes post-operative bleeding and will make you more comfortable.

Lumpectomy/ Partial Mastectomy with Axillary Lymph Node Dissection
Instructions After Surgery

Pain Management

• People experience different types and amount of pain or discomfort after surgery. The goal of pain management is to assess your own level of discomfort and to take medication as it is needed. You will have better results controlling your pain if you take pain medication before your pain is severe.
  
  
• You will be given a prescription for Vicodin® for the management of moderate pain. It is recommended to take medication for pain when pain is experienced on a regular schedule. Ibuprofen (Advil® or Motrin®) or Tylenol® can be added to or replace Vicodin®. Everyone is different and if one plan to decrease your pain is not working, it will be changed. HEALING AND RECOVERY ARE IMPROVED WITH GOOD PAIN CONTROL.
  
  
• An ice pack may be helpful to decrease discomfort and swelling, particularly to the armpit after a lymph node dissection. A small pillow positioned in the armpit may also decrease discomfort.
  
  
• Please notify us of any drug allergies, reactions or medical problems that would prevent you from taking these drugs. Vicodin® is a narcotic and should not be taken with alcoholic drinks. Do not use narcotics while driving.
  
  
• Narcotics can also cause or worsen constipation, so increase fluids, eat high fiber foods (like prunes and bran), and make sure you are up, out of bed, taking small walks.
  
  
• Although you will not have felt it at the time, nor remember it afterwards, you will have had a tube down your throat during the surgery. This can often cause a sore throat for a few days following your surgery.

Incision (Scar) and Dressing Care

• Your incision (scar) has both stitches and steri-strips (small white strips of tape) and is covered by a gauze dressing and tape or a plastic dressing.
  
  
• DO NOT REMOVE THE DRESSING, STERI-STRIPS OR STITCHES. We will remove the dressing in 7-10 days. We will also remove the sutures (unless they absorb on their own) in ten days to two weeks. If the dressing or steri-strips fall off, do not attempt to replace them.
  
  
• You may shower 2 days after the surgery if you do not have a drain and if you have a plastic dressing; if you have a drain, shower 24 hours after the drain is out.
  
  
• If you have gauze and paper tape, you may remove it 2 days after surgery and shower after that. Towel dry your incision thoroughly after showering. BE CAREFUL NOT TO TOUCH OR REMOVE THE STERI-STRIPS OR SUTURES.
  
  
• Bruising and some swelling are common in women after surgery.
  
  
• A low-grade fever (under 100ƒF) is normal the day after surgery.
  
  
• You may have a Jackson-Pratt (JP) drain after your surgery. This drain is a plastic tube from under the skin to outside your body with a bulb attached to it. A nurse will teach you how to empty your drain prior to going home from the hospital. Empty the drain 2-3 times per day or when the bulb is full. Write down the amount drained on a sheet of paper. An information sheet on the JP drain is included in your binder.

Activity

• Avoid strenuous activity, heavy lifting, and vigorous exercise until the stitches are removed. Tell us what you do and they will help you make a personal plan for "what you can do when" after surgery.
  
  
• Walking is a normal activity that can be restarted right away.
  
  
• No housework, no driving until the drain is out. You may restart driving when you are no longer on narcotics and you feel safe turning the wheel and stopping quickly.
  
  
• Following a lymph node dissection, don't avoid using your arm, but don't exercise it until your first post-operative visit. Please review "Protecting Your Arm" on page 15 of the California State Guide "A Woman's Guide to Breast Cancer Diagnosis and Treatment" for prevention of infection and lymphedema (swelling of the arm).
  
  
• You will be given exercises to regain movement and flexibility (on the surgical side). You may be referred to Physical Therapy for additional rehabilitation if it is needed.
  
  
• Most people return to work within 3 to 6 weeks. Return to work varies with your type of work, your overall health and personal preferences. Discuss returning to work with your physician or nurse.

Diet

• You may resume your regular diet as soon as you can take fluids after recovering from anesthesia.
  
  
• We encourage 8-10 glasses of water and non-caffeinated beverages per day, plenty of fruits and vegetables, and lower fat foods. Talk with us about recommendations for healthy eating.
  
  
• A nutritionist is available for consultation in the Breast Care Center. Call the front desk to schedule an appointment.

Follow-Up Care

• The pathology results from your surgery should be available within one week after your surgery.
  
  
• We will contact you by telephone with the results or will inform you at your post-operative visit. Please let us know the telephone number where you may be reached with the results.
  
  
• Follow-up appointments are generally made before surgery with your physician and a nurse. Your sutures will be removed in approximately 10-14 days. Call the Breast Care Center if you do not have or remember an appointment.
  
  
• Your dressing will be changed or removed at your post-operative visit.