Mastectomy Consent BEFORE SURGERY DO NOT eat or drink anything after midnight on the night before the surgery.

. Anesthetist will visit regarding anesthesia you during surgery. Please tell if have dentures or partials. May receive a sedative to help relax prior to surgery. Will be discussed by the anesthetist. DURING SURGERY Surgery takes 45 - 60 minutes. Anesthetist will give medication through IV which makes you sleep through the surgery. Will be monitored (heart monitor, blood pressure, pulse oximeter). Surgeon will make an incision on the breast and remove breast tissue. The lymph nodes on the outer edges of the breast and under the armpit may also be removed. Laboratory tests will be done on the breast tissue and lymph nodes which are removed. A drain may be placed into the surgical area to allow drainage of excess fluids. Stitches or staples will be used to close the incision. A dressing will be placed over the incision site. AFTER SURGERY After op, will be taken to ward for further monitoring. Encouraged to cough and deep breathe every hour. Use tri-ball exercise, to expand lungs. Use arm on the side of the affected breast for activities such as brushing your teeth/hair, eating, and drinking. Do not push or pull with this arm. If have a drain: Surgeon may want the drain left in place from 2 days up to 2 weeks after surgery. Leave dressing on and keep it clean and dry. If DO NOT have a drain: Keep the dressing clean and dry. The dressing will be removed after 24 48 hours. The doctor will remove the stitches or staples at follow-up visit. Pain / Medications: Aim is for the procedure as pain-free as possible. May receive pain medication through your IV by a medication pump which you control. DO NOT ask others to push the medication control button. Otherwise, may been given other pain killer; oral or injection. Diet: The first diet ordered will include clear liquids. If tolerated, diet will progress to a normal, well-balanced diet. Activity: Encouraged to be active after surgery. The night of surgery nurse will begin activity by having you sit on the side of your bed, sitting in a chair, and walking to the bathroom. Walking about in the room or down the halls also speeds the healing process as well as decreasing complications associated with surgery. Better to elevate your arm and hand, on the side of your mastectomy, on pillows to decrease the swelling. May be referred to rehab, these exercises will help to maintain movement of the arm on the surgical side. COMPLICATIONS Infection, treated by antibiotics. Lymphedema: arm on the side of the breast that was operated on swells because lymph (tissue fluid) cannot follow the main channels back into the body. Only occurs when lymph nodes have had to be removed under the arm. May be some areas of numbness at upper arm and around incision (cut by the surgeon) in the breast - because of the cutting of or damage to some of the nerves in the area. Most often unavoidable. There may be difficulty moving the arm in a full range of motion. Usually improves with time following use and exercise. Recurrence of breast cancer may happen with the very best of surgery and follow up treatment. Sometimes small cancer cells that cannot be seen with the naked eye have already spread at the time of surgery. When this happens other treatment is available. This treatment may be radiation, medications or a combination of both. AFTER DISMISSAL Incision: Keep the incision clean and dry. Can continue to shower, remembering to pat dry around the incision. Do not soak in the tub. BE SURE TO LOOK AT INCISION EVERY DAY. Notify

doctor if notice bruising, redness, drainage, or increasing pain. May want to place a light dressing or handkerchief over the incision to decrease irritation from the staples. Pain/Medications: Doctor may give prescription for pain medication to take at home. Take as directed. DO NOT take with alcohol. If an antibiotic is prescribed, continue taking until it is gone. Activity: Encouraged to move around, to speed up healing process. Do not perform any strenous activity such as lifting anything heavier than 10 lbs. You may resume normal activities when permitted by your doctor. After normal range of motion returned, some stiffness and soreness may persist for 2-3 months. This is normal and will subside. Begin sports or strenuous activities in moderation. This will give chance to rebuild endurance. Continue to be cautious of heavy lifting or carrying (no more than 0.1kg) with your affected arm. Come A.S.A.P., if having infection, featured by: Redness or swelling around the incision Yellowish, greeen or foul smelling drainage from your incision Steady bleeding from your incision Temperature above 37.5 Chills or other flu like symptoms Persistent nausea and vomiting Chest pain, trouble breathing, or difficulty urinating TERMS: Radical (extensive) mastectomy: remove entire breast, the muscles under the breast, and all of the glands ( lymph nodes) under the arm. With all of the new treatments available for cancer of the breast, this procedure has become less common. Modified radical mastectomy: muscles of the chest wall are not removed unless one of the lessor muscles is removed. One of the lessor muscles may be removed to allow better removal of the lymph nodes. The axillary lymph nodes are also removed. Rarely, during an axillary node dissection nerves to this area are damaged. Radiation therapy is then often used to the area following this surgery. Total mastectomy /complete / simple mastectomy: involves removal of only the breast. The lymph nodes and the muscles are left in place. Lumpectomy: lump is removed from breast. A sentinel lymph node biopsy may also be done. Additional treatment may be required.