Mastectomy is a surgical procedure in which the entire breast is removed. There are two types of surgical procedures: modified radical mastectomy and simple mastectomy. A modified radical mastectomy is when the entire breast and lymph nodes in the armpit (axilla) are removed. A simple mastectomy removes the entire breast but no lymph nodes. The surgeon will determine which is the correct procedure for you. Sentinel lymph node biopsy is sometimes performed with a simple mastectomy.

Complications are usually rare, but may include infection, bleeding, or hematoma (collection of blood) formation at the surgical site. Remember, some swelling and bruising are normal.

Complications involving the removal of lymph nodes include the risk of arm swelling (lymphedema), armpit numbness/soreness, decreased range of motion of that shoulder, and rarely nerve injury.

Some women may experience numbness/tingling along the incision, which is normal and may last for several months. Some numbness may be permanent.

The majority of patients who perform daily arm exercises return to their normal arm mobility within weeks after surgery. If necessary we will prescribe physical therapy to improve arm/shoulder mobility.

The surgical options and recommendations are reviewed in detail prior to your procedure. If you have any questions in regard to your alternatives and feel you do not understand fully your options and physician recommendations, please do not hesitate to meet with your physician again to review these in detail.

Please call if you develop

• A temperature greater than 101 degrees Fahrenheit
• Bleeding from the incision that with 20 minutes of pressure and ice will not stop
• Rapid or unusual swelling of the breast or under arm.
• Whitish discharge, redness or warmth along incision.

Plan for your care and recovery after the operation: Find someone to drive you to and from surgery. Allow adequate time to rest and try to find help with your day-to-day duties. * Please let us know if you live alone and need nursing assistance.

If you smoke, it is advantageous to quit at least 2 weeks prior to the procedure, preferably 8 weeks. Smokers heal more slowly and are at higher risk of wound complications.

Try to stay as healthy as possible before surgery. Eat plenty of fresh fruits and vegetables (6 servings per day) and drink > 8 glasses of water a day.

Avoid taking aspirin, Motrin/Advil (ibuprofen) or Aleve (naprosyn) at least one week before surgery. Also avoid the use of Vitamin-E supplements, a daily multi-vitamin is okay.

Please notify your surgeon if you are taking Coumadin (warfarin) or Plavix.

Eat a light meal the night before, and nothing by mouth after midnight or the morning of the surgery.

You will be given a general anesthetic and/or a paravertebral block for the procedure.

The surgeon will make an incision over the breast and remove the breast tissue, the nipple, and some skin. The underlying muscle is not removed. The remaining skin will be sutured together with absorbable sutures (do not need to be removed) and the incision will be covered with steri-strips. One or two drains will be placed under the skin to help drain natural fluids. These will be removed when you are producing less than 30ml over 24 hours. In a modified radical mastectomy, the tissue in the axilla (arm pit) contains the lymph nodes that will also be removed. This is typically done through the same incision that was made in the breast. All tissue removed will be sent to pathology for examination under the microscope.

You will be admitted to the hospital for usually 24 hours.

On the day of discharge you will be given specific discharge instructions and a prescription for pain medications. You should not drive while on prescription pain medications.

You will have a bulky dressing on. Leave this on for the first 24 hours. It will typically be removed before discharge from the hospital. If not, you may take that off after 24 hours and you will see that you have steri-strips underneath. Leave these on until they fall off or until your follow-up appointment. It is okay to shower with these on. You will be given a post-surgical support garment to wear or a prescription for one.

You may shower after 48 hours. Avoid hot tubs, pools, or the bathtub for at least 7–10 days.

Generally, we recommend a supportive bra be worn the first few days and nights after the surgery. This will minimize swelling and bleeding which will decrease pain.

Applying ice on and off for the first few days may also be helpful. Avoid the use of heat or heating pads.

We do recommend no lifting greater than 10 pounds for three weeks. However, we encourage you to use your arm and do gentle range of motion exercises.

If you had a sentinel lymph node biopsy your urine may turn blue/green in the immediate post-operative hours as the dye is being carried away. You may also notice some faint blue color to your eyes and skin of your breast.

If an axillary dissection has been performed, a drain will be placed, specific care instructions/arm exercises will be reviewed with you upon discharge.

You will need a follow-up appointment to see your surgeon 5-7 days after your procedure. Please call the office is this has not yet been scheduled. It is at this time that the pathology from the surgery will be discussed.