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| Lumpectomy & Axillary Clearance |
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These notes give an overall guide to your stay in hospital. You may see some differences in the details of your treatment, since it is tailored to suit your own condition.
What is a Lumpectomy and axillary clearance?  WHAT DOES THE OPERATION CONSIST OF? Lumpectomy means removal of a lump in the breast with surrounding normal breast tissue.. The end result is smooth skin across half the chest with a barely visible scar across it. The operation means the removal of the entire lump and the lymph nodes ( glands) in the axilla (armpit). No muscles are removed. This operation is to remove cancer of the breast. The removal of the glands allows careful staging of the cancer to decide on whether further treatment after the operation is necessary or not. WHAT HAPPENS BEFORE THE OPERATION? ReceptionWhen registering at reception your medical aid details will be required. If you are not on a member of a medical aid you will be required to pay a deposit or to sign an indemnity form. As far as possible we will try to advise you about hospital costs before your admission. Welcome to the ward You will be welcomed to the ward by the nurses or the receptionist and will have your details checked. Some basic tests will be done such as pulse, temperature, blood pressure and urine examination. You will be asked to hand in any medicines or drugs you may be taking, so that your drug treatment in hospital will be correct. Please tell the nurses of any allergies to drugs or dressings. The surgeon will have explained the operation and you will be asked to sign your consent for the operation. If you are not clear about any part of the operation, then read this again and then ask for more details from the surgeon or from the nurses. Visit by the anaesthetist If you are having a general anaesthetic, the anaesthetist who will be giving your anaesthetic will interview and examine you. He will be especially interested in chest troubles, dental treatment and any previous anaesthetics you have had. Diet You will have your usual diet until 6 hours before the operation when you will be asked to take nothing by mouth. This will let your stomach empty to prevent vomiting during the operation. Shaving The operation area will be shaved to remove excess hair. Timing of the operation The timing of your operation is usually arranged the day before so that the nurses will tell you when to expect to go to the operating theatre. Do not be surprised, however, if there are changes to the exact timing. Transfer to theatre You will be taken on a trolley to the operating suite by the staff. You will be wearing a cotton gown, rings will be fastened with tape and removable dentures will be left on the ward. There will be several checks on your details on the way to the operating theatre where your anaesthetic will begin. The operation is then performed WHAT HAPPENS AFTER THE OPERATION? Coming round after the anaestheticAlthough you will be conscious a minute or two after the operation ends, you are unlikely to remember anything until you are back in your bed on the ward. Some patients feel a bit sick for up to 24 hours after operation, but this passes off. You will be given some treatment for sickness if necessary. You may be given oxygen from a face mask for a few hours if you have had chest problems in the past. You will have a drip tube in an arm vein and also two fine plastic drainage tubes in the skin near the wound. These last tubes are each connected to a plastic vacuum container. You will find these vacuum containers lying near you under the sheets. Will it hurt? There is discomfort on moving rather than severe pain. You will be given injections, suppositories or tablets to control this as required. Ask for more if the pain is still unpleasant. You will be expected to get out of bed the day after operation despite the discomfort. You will not do the wound any harm, and the exercise is very helpful for you. The second day after operation you should be able to spend most of your time out of bed and in reasonable comfort. You should be able to walk slowly along the corridor. By the end of one week the wound should be virtually painfree. Drinking and eating You will be able to eat and drink a few hours after the operation. You should be on a full diet the next day. Opening bowels It is quite normal for the bowels not to open for a day or so after operation. If you have not opened your bowels after two days and you feel uncomfortable, ask the nurses for a laxative. Passing urine It is important that you pass urine and empty your bladder within 6?12 hours of the operation. If you find using a bed pan or a bottle difficult, the nurses will assist you to commode or the toilet. If you still cannot pass urine let the nurses know and steps will be taken to correct the problem. Sleeping You will be offered painkillers rather than sleeping pills to help you to sleep. If you cannot sleep despite the painkillers please let the nurses know. Physiotherapy A physiotherapist may be asked to help with the mobilisation of your arm after the operation. Vigorous movement of the shoulder must be avoided. After the operation the entire area aches for a while and you will not feel like moving your shoulder joint. Not moving for too long, however, can make the area stiff and then it is more difficult to bring it back to normal again. This is especially so in an older person. You will be given some exercises to do. If you have chest problems the physiotherapist will check that you are clearing your lungs of phlegm by coughing and that you are helping your circulation by movement of your arms and legs. Coughing, although uncomfortable, will not harm your wound. The wound The wound has a dressing which may show some staining with old blood in the first 24 hours. The dressing may be changed for a clean one which stays until the drain tubes are removed after 4 to 5 days. The skin is closed using staples or stiches. There may be some purple bruising around the wound which spreads downwards by gravity and fades to a yellow colour after 2 to 3 days. It is not important. There may be some swelling of the surrounding skin which also improves in 2 to 3 days. The drain tubes are removed in 4 to 5 days depending on the amount of drainage. Do not be disappointed if the drainage actually increases after 3 days or so and occasionally may continue for a week or more. The wound gradually improves for one to two months after the operation. Arrangements are made for advice regarding a temporary soft sponge filling for your bra to give you some shape until a more permanent filling can be fitted when the wound has settled down. Washing You can wash the wound area as soon as the dressing has been removed. Soap and tap water are entirely adequate. Salted water is not necessary. How long in hospital? Usually you will feel fit enough to leave hospital after 4 to 7 days. You will be given an appointment for a check up about a 1 to 2 weeks after your operation. Sick notes Please ask your surgeon for any sick notes or certificates that you may require. After you leave hospital You are likely to feel a bit tired and need rests 2 or 3 times a day for two weeks or more. At the end of a month you will be back to your normal activities. Lifting At first discomfort in the wound will prevent you from harming yourself by too heavy lifting. After two months you can lift whatever you like. Driving You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about 3 weeks. You can safely wear a seat belt. What about sex? You can restart sexual activities within 3 to 4 weeks, when the wound is comfortable enough. Work You should be able to return to work within 4 to 6 weeks. Complications Complications are seldom serious and are well known. If you think that all is not well, please ask the nurses or doctors. Bruising may be troublesome. Occasionally some old blood collects under the wound, but this can easily be removed. Very rarely a second anaesthetic is required to do this. Occasionally the wound edge does not heal well in places. This always settles down but may take 2 or 3 weeks to do so. Infection is a rare problem and settles down within a week or two with appropriate treatment. Aches and twinges may be felt in the wound, shoulder and arm for up to 6 months. Occasionally there is a numb patch in the skin of the armpit and down the inside of the upper arm. This patch slowly lessens in size but may always be present. The mastectomy operation is much less of an undertaking than was the rule 10 or more years ago. Patients are usually surprised how little upset they feel and how well they manage. If you do feel depressed a few days after the operation, speak to the doctor. Depression in the immediate postoperative stage is quite common. Details of further treatment, if any, will be discussed with you by the surgeon before you leave hospital.
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