How to Prepare for Breast Surgery

How to Prepare for Breast Surgery The Cedars Breast Clinic of the MUHC Monday to Friday: 8 am to 4 pm 514 934-1934, ext. 32829 or 35166

Introduction Table of contents Dear Patients and Family Members, Having an operation is a stressful time in anyone s life. We, the staff of the Cedars Breast Clinic of the McGill University Health Centre (MUHC) have put together some information to help you and your family prepare for your operation. If have any questions, please call your doctor s office or the Cedar s Breast Clinic of the MUHC. MUHC telephone number: 514-934-1934 Breast Clinic Ext.: 32829 ou 35166 Dr. Fleiszer Ext.: 34045 Dr. Loutfi Ext.: 35611 Important general information...page 3 The day before your operation...page 4 The morning of your operation, at home...page 4 Upon your arrival in the hospital...page 5 Immediately after your operation...page 6 After your general anesthesia...page 6 Information to know when you are at home...page 7 How to take care of your wound...page 8 How to take care of your drain(s)...page 9 Exercises...Page 13 When to call for help...page 16 Questions...Page 17 Notes...Page 18 Dr. Meguerditchian Ext.: 34081 Dr. Meterissian Ext.: 36631 Dr. Milne Ext.: 35443 Dr. Tremblay Ext.: 36313 Dr. Wexler Ext.: 35178 1 2

Important general information The day before your operation You will come into the hospital the day of your operation and return home the same day. It is highly recommended that you do not stay alone the night of your operation. After your operation, hospital policy requires that you arrange to have an adult take you home by car or taxi. You will be asked the name and telephone number of this person. This person is welcome to stay in the waiting room or to leave the hospital. He/she will be given a time when to come back and pick you up from the Recovery Room. THE ROYAL VICTORIA HOSPITAL Recovery Room: Surgical Pavilion, 5th floor, Room S5.18 514-934-1934 Ext. 34702 Waiting Room: Surgical Pavilion, 6th floor, Room S6.28. Please remember that the use of cellular phones is not allowed inside the hospital. They interfere with the electronic equipment in the hospital. Please tell your friends and families. 24 HOURS BEFORE The Admitting Office or your Doctor s secretary will call you. They will tell you what time to arrive at the hospital and where you should report before your operation. This will be either the Admitting Office or the Recovery Room. You will need to take two showers or two baths. The evening before your operation, take your first bath or shower. Do not shave your underarms. Remove make-up, nail polish and jewelry, including all piercings. Do not use perfumes, hairspray or deodorant. It may be helpful to prepare some meals and freeze them so you do not need to cook right after your operation. For at least 24 hours before and for as long as possible after your operation, it is recommended that you do not smoke or drink alcohol. Smoking and drinking can slow the healing of your operation site. AFTER MIDNIGHT Do not eat or drink anything. Follow any specific instructions your doctor may have given you. The morning of your operation, at home 3 Do not eat or drink anything. Plan to wear loose (no tight sleeves) and comfortable clothes, preferably something that opens in the front, to the hospital. Remember to: 1. Bring in an updated list of your prescription medicines that you take or your actual medicines in the containers. 2. Bring in an updated list of the over-the-counter medicines that you take or your actual medicines in the containers. 3. Your hospital card and your Medicare card. 4

The morning of your operation, at home Immediately after your operation Take your second shower or bath this morning. If your doctor told you to take any medicines on the morning of your operation, you may take them with a very small amount of water. If you are unsure, do not take your medicines. Bring your medicines with you to the hospital. Do not bring any valuables, jewelry or credit cards with you to the hospital. If you are menstruating the day of your operation, do not wear tampons. Use sanitary napkins only. Do not wear contact lenses. Do not chew gum or candy. You may brush your teeth or rinse your mouth. You may wear your dentures, hearing aids or glasses. Please bring containers in which to store them. Upon your arrival in the hospital Report to the place where you were told to go. Either to the Admitting Office or the Recovery Room. Once you are with the nurse, please take the time to ask any questions you or your family may have. It is not routine to give medicine to relax you before the operation. If this is something you would like, please let the nurse know. The anesthetist will need to meet with you and decide the best choice. Before you go for your operation, the nurse will: 5 1. Check your pulse, blood pressure and temperature. 2. Ask you some questions about your health and medicines. 3. Ask you to go to the bathroom to empty your bladder. 4. Ask you to remove any dentures, contact lenses, glasses, and hearing aids. If you really need your hearing aid, you will be allowed to keep it in place. Please be aware that there is always a small chance that any item can be lost. Due to unavoidable delays and emergencies, the time of your operation may not be exact. You may go earlier or later than you may have expected. RIGHT AFTER THE OPERATION You will be taken to the Recovery Room. You will stay here for about 3-4 hours. The Recovery Room is a very large room and it can be very noisy. You may hear a lot of people talking. In the Recovery Room, the nurse will: 1. Check your pulse and blood pressure every 10 minutes. It is normal to have an oxygen mask on for a short while after anesthesia. 2. Give you medicines as needed to keep you pain free. 3. Wake you up often to check how you are feeling. AFTER HAVING GENERAL ANESTHESIA Remember that an adult must bring you home after your operation and that someone stay with you the first night. All the medicines may make you dizzy when you get up. Considering the possibility of dizziness, we suggest you do not lock your bathroom or bedroom door for 24 hours. This will allow your family and/or friends to be available to you should you need their help. During your operation, the anesthetist puts a tube down your throat. You might have a mild sore throat for a few days. Throat lozenges may help you feel more comfortable. For a few weeks after surgery, some people may feel more tired than usual. If this happens, resting or taking naps may be helpful. Do not make any important decisions or sign any important papers for 24 hours. Do not drink alcohol, or take tranquilizers, sleeping pills, or medicines that are not prescribed by the doctor, for 24 hours. Do not drive a car or operate any machinery for 24 hours. 6

Information to know when you are at home How to take care of your wound WHAT CAN I DO WHEN I GET HOME? DRIVING You should not be driving if you are taking painkillers with codeine or morphine, i.e. narcotic mediction. WORKING Unless your doctor has told you otherwise, you may return to work as soon as you feel up to it. ACTIVITY Begin doing all normal activities at a rate where you are comfortable. WHAT CAN I EAT AND DRINK WHEN I GET HOME? You may eat a regular diet after your operation. You may find it easier if you start with clear liquids and light food. For example: light soup, broth, juice, toast, and crackers. Progress every day until you are back to your normal diet. This may take about 24 hours after your operation. For a very short time after your operation, you may become constipated. This may be due to changes in your usual level of activity and the addition of some pain medicines (ex. Empracet). To help prevent constipation: 7 1. Drink more water 2. Eat more fruits, vegetables and whole grains 3. Take walks 4. Take a laxative or stool softener as prescribed WHAT MEDICINES CAN I TAKE WHEN I GET HOME? On your way home from the hospital, fill out any prescriptions that have been ordered by your doctor,. Take Acetaminophen (Tylenol) for mild to medium pain. If this is not enough for your pain, take the medicines that your doctor has ordered for you. Do not take aspirin or any medicine that contains aspirin. You can start taking all your pills and medicines 24 hours after surgery, unless your doctor has told you something different. If you are taking Coumadin, Plavix or any other blood thinners, speak with your doctor about when you can re-start them again. At your first visit after your operation, please tell your doctor about any medicines, vitamins or health food supplements you take. Bring a list of all these medicines, or the medicines in their container with you to your appointment. TAKING CARE OF YOUR WOUND You may just have a bandage or you may have a bandage and a drain. Do not get these areas wet. Some bruising and swelling is normal. It may last up to 4-6 weeks. The skin on your chest and around the area may be a pink color. This is from a cleanser that is used during the operation. Once you are allowed to wash these areas, regular use of soap and water will slowly remove it. Gently wash your operation site with soap and water, rinse well and pat dry with a clean towel. Do not put direct water pressure on the incision. You may be more comfortable to wear cotton t-shirts and nightgowns. They feel softer next to the skin. Please follow the instructions on the following pages on how to take care of your drain. Please follow your individual doctor s directions. 8

How to take care of your drain(s) How to take care of your drain(s) GENERAL INFORMATION When you have breast surgery with lymph nodes removed from the underarm area (axillary node dissection), a drain is left in place. The drain will be left in place for about one week. The fluid that collects in the drain is a mixture of blood and lymph fluid. At first, there might be a lot of drainage, often blood-tinged. The amount will slowly decrease over the coming days and become clear yellow. The drain is usually removed about one week after surgery. Your doctor will remove the drain. The drain bulb should always be collapsed. If the bulb becomes completely round, there is no suction and the drain will not work properly. Check the drain regularly and make sure the bulb is not completely round. Once the bulb starts to fill up with fluid, it may not be collapsed. This is normal. IF THE DRAIN IS BLOCKED: 1. Gently squeeze and pull down on the tubing (milking the tubing) of the drain. Often, this will dislodge the clot and solve the leakage problem. 2. While milking the tubing, hold the tubing of the drain closest to your chest with one hand, while milking the tubing downwards with the other hand. Collapsed = correct Not collapsed = not correct A small amount of leakage is expected around the drain, so do not be concerned if the bandage is slightly damp. If there is a lot of leakage (bandage gauze is soaked) and there is no fluid collection in the bulb, there may be a blockage along the tubing of the drain. The blockage is most likely due to a small blood clot. Please follow directions below to unblock the drain and call the Cedars Breast Clinic or your doctor s office. 9 3. If you cannot unblock the drain, do not panic. Call your doctor s office or contact the nurses in the Breast Clinic. Be sure to call early in the morning and arrangements will be made for you to be seen. TO EMPTY THE DRAIN: Empty the drain when the bulb is about half full. 1. Check the markings on the side of the drain and note how much fluid is in the drain. Write down the amount of fluid in the table on the next page of this booklet. Bring the sheet with you to your appointment. 10

How to take care of your drain(s) How to take care of your drain(s) 2. Pop open the cap of the drain. 3. Empty the fluid into the sink or toilet, by squeezing the bulb. DATE RECORD OF FLUID FROM THE DRAIN(S) AMOUNT Drain #1 (ml) TOTAL FOR THE DAY AMOUNT Drain #2 (ml) TOTAL FOR THE DAY Ex.: July 21, 2008 10+5+10 25 5+5+20 30 4. Squeeze the bulb and keep it squeezed while putting the cap back on. REMINDER: IF YOU HAVE A DRAIN, IT IS IMPORTANT FOR YOUR RECOVERY TO DO YOUR EXERCISES. PLEASE FOLLOW THE EXERCISE PROGRAM IN THIS BOOKLET. 11 12

Exercise program: post-mastectomy and axillary lymph node dissection The following are some exercises to help you regain full movement of your arm. If you have a drain, all exercises should be done slowly and gently until pain is felt. Once the drain is removed, do the exercises until pain is felt. Hold that position. Then move the arm further each time. It is recommended that you take pain medication about 30 minutes before doing the exercises. Do each exercise 3-4 times each day. Every time you do an exercise, try and do 10 repetitions of that exercise. Rest between each exercise session Should swelling occur in your hand or arm, raise your arm and keep it raised (preferably above the level of your heart) several times during the day. When sleeping, keep your arm raised on a pillow. Hand pumping exercises are also helpful. Continue the exercises until you get full movement of your shoulder. If full movement does not come back, talk to your doctor. Avoid keeping your arm stiff or by your side. Use your arm in daily activities like swinging it when walking, washing or carrying light loads. Always keep good posture. Keep your back straight and shoulders back. Do not do heavy lifting (more than 4 kgs), or strenuous housework. Do not play sports where much arm movement is needed, like racket or contact sports for 6 8 weeks. Exercises 1. Hand pumping: Spread your fingers and then make a fist. Continue opening and closing your hand. 2. Arm elevation: Clasp both hands in front of you, keeping your elbows straight. Lift your arms as high as possible above your head and slowly lower. 3. Arm sideways: Keeping your elbow straight, lift your arm up to the side as high as possible and slowly lower. If you find it easier, you may do this with both arms. 4. Elbows apart: Clasp hand behind your neck, bring elbows together and then apart as far as possible. j k l m 13 14

Exercises When to call for help 5. Arm elevation: Keeping the elbow straight, lift your arm up as high as possible and slowly lower it. n YOU NEED TO CALL IF YOU HAVE ANY OF THE FOLLOWING SIGNS: Chills and fever higher than 38 C (or 100 F) for 24 hours. Your breast and operated area becomes swollen, hard, black and/or blue and very painful. The bandage around the drain under your arm becomes wet and no liquid is going into the bulb (the drain is blocked). You are not able to unblock the drain. 6. Reaching behind the back: a. Reach down behind your back and raise your hand as high as possible towards your mid-back. b. Reach up and over your head and try to touch your shoulder blade. o WHERE TO CALL FOR HELP MONDAY TO FRIDAY BETWEEN 08:00 AM AND 04:00 PM: Call your doctor s office or the nurses in the Cedars Breast Clinic of the MUHC. EVENINGS AND WEEKENDS: Call S9W at 514-934-1934 Ext: 34994 and ask to speak with the nurse in charge. MUHC PHONE NUMBER : 514-934-1934 7. Wall climbing: a. Standing one foot away, facing the wall, with your arm outstretched in front, walk your fingers up the wall. As you reach higher, come closer to the wall. b. Standing one foot away and sideways to the wall with the arm at your side, walk fingers up the wall and lower. p Contact Telephone Extension Breast Clinic 32829 or 35166 Dr. Fleiszer 34045 Dr. Loutfi 35611 Dr. Meguerditchian 34081 Dr. Meterissian 36631 Dr. Milne 35443 Dr. Tremblay 36313 Dr. Wexler 35178 15 16

Questions Notes DO I HAVE ANY QUESTIONS FOR MY DOCTOR? You may have other questions or concerns.. Example: When can I return to work? When can I return to my regular activities/sports? When is my next appointment with the doctor? Will I need CLSC help at home? SOME QUESTIONS I WOULD LIKE TO ASK... During your experience, your comfort & well-being is important. If you have any concerns, please let us know. Information provided in this booklet is for educational purposes. It is not intended to replace the advice or instructions of a professional healthcare practitioner, or to substitute medical care. Contact a qualified healthcare practitioner if you have any questions concerning your care. 17 18

Dr. M. Wexler Site Director, Surgical Services, RVH Associate Director of Surgery Stella Racaniello, R.N., BSc.N. Patient Flow Coordinator - Surgical Mission, RVH We would like to thank the following nurses: Bonnie Courte, Carole Magnan, Sandy Andrade, and physiotherapist Angela Yung, along with all the doctors of the Cedars Breast Clinic of the MUHC involved in producing this booklet We would like to also thank: the MUHC Patient Education Network Committee for funding, Molson Medical for the illustrations and Louise Duguay for literacy consultation www.muhc.ca 02/2010