Surgery Information

Breast Care

Many women have breast care issues. Some of these are benign (non-cancer) and some are malignant (cancer). The breast is primarily for lactation (milk production). It is made up of glandular tissue and fatty tissue. As a woman ages, the breast becomes primarily fatty. The breast is affected by a number of hormones in both cancers and non-cancers.

Breast Pain

Breast pain is a common problem for a number of women. Full evaluation should be performed including a breast exam. Radiological studies such as a mammogram and an ultrasound may be helpful in detecting cysts or other causes of breast pain. Most cases of breast pain can be managed symptomatically and are more common in young women and perimenopausal women. Caffeine can be a contributor to this problem and should be avoided.

Breast Abscess

Breast abscesses are collections of pus found in the breast. They are common in women who are breast-feeding. They can occur in other women as well. Older women may need a biopsy or a mammogram to look for a possible cancer. They abscesses are often drained in the operating room and then left open for healing. Antibiotics are given and wound care is often arranged.

Breast Lump

Many women see a surgeon when they have a breast lump. There are multiple kinds of lumps and many are seen with the help of a mammogram or ultrasound. In young women, breast cysts are very common. Cysts of small size can be followed by ultrasound. Larger cysts may require drainage as some mask cancers. Most cysts, however, are benign and be followed by ultrasound after drainage. Also common in young women are fibroadenomas. These have a characteristic appearance on ultrasound and mammogram. Biopsy or removal is often recommended so that multiple studies are not needed. In most women that have a solid mass, a breast biopsy is recommended.

Breast Biopsy

Most breast biopsies used to require a trip to the operating room. Now, however, we have less invasive options for diagnosis and sometimes removal of a breast mass. Stereotactic biopsy is a breast biopsy performed with the assistance of mammogram-like pictures. The mass is located using fluoroscopy (x-rays) and then magnified. When the specific lesion is located, local anesthetic is used to deaden the skin and tissue surrounding the mass. The use of a suction-assisted biopsy device is then used to obtain the biopsy. If the abnormality on your mammogram has been described as calcifications, the x-rays are used to confirm the presence of these in the specimen. A clip is then left in place and is visible on future mammograms. This clip provides follow-up for the surgeon and radiologist. Another minimally invasive approach uses ultrasound guidance. This biopsy is performed in the office with an ultrasound machine and local anesthetic. A mammotome machine (suction-assist) device is then used for the biopsy. Some benign masses can be removed in the office using this technique as well. A clip is then left in place and is visible on future mammograms. Advantages of these less invasive techniques include smaller incisions with smaller scars without a lot of time commitment. Additional advantages of the ultrasound technique include being able to lie comfortably on your back in most cases. Some women still require open biopsies if their masses cannot be localized easily using x-ray or ultrasound. Results of a biopsy are usually available in about a week with special tests taking additional time.

Breast Cancer Surgery

The diagnosis of breast cancer can be frightening but our goal is to provide the best surgery to help achieve a cure. Minimally invasive breast cancer surgeries can often be performed instead of mastectomy (breast removal). These surgeries are often called lumpectomies. They can be performed an outpatient setting where the patient returns home the same day of surgery. Sometimes, the breast cancer may require placement of a marker by the radiologist the day of surgery called a needle localization. Needle localizations are often performed for open breast biopsies for benign disease as well. In breast cancer, it is important to determine if there is cancer in the lymph nodes. A minimally invasive technique called sentinel node biopsy can often be performed. This technique requires the injection of a dye by the radiologist into the breast. Pictures are then taken to determine the location of the lymph node(s) where the dye goes first. These are called sentinel nodes. They do not necessarily have cancer in them but they are the most likely nodes to have cancer if the cancer has spread. These sentinel nodes are then located in the operating room with the assistance of a special probe as well as blue dye. Nodes are then sent to pathology to determine if the cancer is in the nodes. Cancer found in the nodes may require lymph node dissection. Lymph node dissection is the removal of all of the nodes from the axilla (under the arm). Sentinel nodes that are negative eliminate the need for lymph node dissection. Should lymph node dissection be needed, a drain will be placed in the axilla and special exercises will be recommended to maintain optimal mobility of the arm.
Some women may still require a mastectomy (removal of the breast) with or without lymph node dissection. A drain will be placed and at least an overnight stay in the hospital is recommended. All women will be offered the opportunity for breast reconstruction. A consultation with a plastic surgeon may be desired prior to a mastectomy so that reconstruction can be optimally planned.

Lumpectomies will require radiation after surgery. Radiation is done by a radiation oncologist. It is often done daily for 6 weeks. A newer option, called a mammosite catheter, can be placed near the time of surgery and can shorten radiation to one week. Please ask if this is an option for you.

Breast care is very important to our practice and is constantly changing. We hope we can be of service to you should the need arise.

Pre-Operative Instructions:

1. No food or drink after midnight the night before surgery.
2. Please stop taking aspirin and any other blood thinners at least 5 days prior to your surgery day.
3. Clearance from your primary doctor or a cardiologist may be required prior to your surgery especially if you have pre-existing medical problems.
4. Labwork may be required prior to any scheduled procedure. This will be scheduled for you.
5. The surgery day may be a long one especially if you need a needle localization or an injection for a sentinel node biopsy. These procedures will be scheduled for you.
6. If a mastectomy is part of your treatment plan, a consultation with a plastic surgeon may be requested prior to your surgery.
7. Please check with anesthesiology or your primary care doctor as to which prescription medicines to take the day of surgery.

Post-Operative Instructions:

1. You may resume a regular diet as tolerated.
2. No heavy lifting for 2 weeks.
3. Incisions will have 2 dressings, and outer dressing and an inner dressing. The outer dressing may be removed the day after surgery. The inner dressings may resemble band-aids and are called steri-strips. You may shower once the outer dressing has been removed. Leave the steri-strips in place. They will fall off on their own.
4. Please call the office if you have redness or swelling around your incision or fevers. These symptoms may represent an infection.
5. Expect some bruising on your breast. This will resolve over approximately 2 weeks.
6. Persons who had a sentinel node biopsy with a blue dye injection will have some blueness of the skin. This will fade over time. Also expect some green urine.
7. Patients who have a drain should measure how much it puts out over a 24-hour period and record this number daily until their follow-up appointment. Should the drainage suddenly stop, please call the office. If the drain falls out, please call the office. Keep the drain site covered with gauze or a bandaid. Bathing with the drain in place is permitted.
8. Driving is not permitted while on narcotic pain medicine (Vicodin) or while pain is severe. Driving is not recommended for several days after surgery.
9. Patients who have had a lymph node dissection should try to increase the mobility of that arm on a daily basis starting a couple of days after surgery for optimal healing.
10. Pathology results are available approximately one week after surgery. Please call us if we have not called you.