What To Expect On The Day Of Surgery

How are surgeries scheduled?

Surgery and the authorizations necessary are arranged by the Surgical Boarding Office at Comprehensive Breast Care.  Our doctors have what is called ‘Block Boarding’ which means that on certain days, the doctor has their own operating room to schedule only their cases.  Many of the surgeries require coordination with other departments such as Breast Imaging and Nuclear Medicine.  Once the arrangments are made, patients are contacted with the surgery date and a tentative surgical time.  The hospital may change the order of the surgical cases for the day, depending on the necessary equipment needed.  All surgical patients will be notified the day before surgery with the exact time (estimated) and instructions.

Important Facts

1. There are certain medications that need to be stopped days before a surgery (blood thinners) and some should not be taken the morning of surgery.  You will be instructed as to these various instructions prior to the surgery date.
2. Generally speaking, there is nothing to eat or drink after midnight prior to surgery.  If medications are to be taken the morning of surgery, they should be taken with a small sip of water only – no coffee, tea, soda, etc.
3. The timing of surgery is merely an estimate.  Sometimes, for unforseen reasons, surgeries might run late.  No one wants their surgery ‘rushed’ to stay on time.  Be prepared to wait, it is all in the best interest of the patient and not to inconvenience.
4. Many surgeries require procedures in other departments on the day of surgery (e.g. a needle localization done in Breast Imaging).  There may be substantial delay between this necessary procedure and the actual operation.  These ‘delay’s cannot be avoided and are necessary for safe and effective performance of the procedure – please be patient.
5. Just in case, it is recommended that patients bring a list of current medications to the hospital.  No one wants the stress of trying to remember dosages and timing of these medications.
6. Many supplements, such as ginkgo biloba, ginseng, garlic, echinacea, fish oils, or vitamins, may be risky to take before surgery. For instance, some may raise the chance of heart problems or bleeding. Others may affect how long anesthesia lasts or mix badly with other medicines, causing unexpected side effects. Your doctor may tell you to stop taking them 1 or 2 weeks before surgery. Check with the physicians to be sure what you are taking is ok to take prior to surgery.
7. The anesthesiologist and Clinical Nurse Anesthetist (CRNA) will talk to patients prior to surgery.  The discussion involves a health history as well as, a history of prior anesthesias and issues.  There are many types of anesthesia techniques from sedation to general anesthesia.  The surgeon typically recommends the type of anesthesia in order to safely perform the procedure with minimal or no discomfort for the patient.
8. Coming to while under general anesthesia can happen, but it’s rare to become fully aware. Most people that this happens to do not feel any pain.  If you have concerns, mention to the anesthesiologist or one of the nurses in pre-op.

Terminology

• NPO – nothing after midnight.
• Needle Localization – performed either in the operating room or radiology; a wire placed through the skin so that the tip is situtated next to the area of concern.  Helps direct surgery to the site of concern.
• Mastectomy – removal of the entire breast.
• Lumpectomy – removal of the mass with a clear margin of tissue surrounding.
• Biopsy – removal of the mass without specific attention to a clear margin; used to make a diagnosis.
• Sentinle Lymph Node – the lymph node(s) most likely to receive the earliest spread of cancer, IF the cancer were to spread.
• Radiotracer – injected by the nuclear medicine physician (radiologist) typically while the patient is in the pre-op area; assists in identitying the sentinel lymph node.
• Blue Dye – injected into the breast suring surgery to assist in identifying the sentinal lymph node.
• Paravertebral Block – placement of a pain pump into the area where the nerve exits the spinal cord (the back).  The pump/catheter is placed in the pre-op area by anesthesia.  The pump/catheter typically remains in place for 3-4 days and is removed by the patient while at home.

What to expect Post Op

1. Pain control is very important.  Patients are discharged with a prescription for pain pills.  If there are pain killers that have been more successful, let your doctor know.
2. It is generally ok to shower the next day after surgery.
3. Activities should be limited until feeling comfortable.  Each procedure has specific expectations that will be reviewed with you pre-operatively.
4. If there are any questions or concerns alwasy call the office: 248-687-7300.
5. Some patients are discharged with a drainage tube.  Although these devices are rarely used today, if that is the plan, instructions as to drain care and when the drain can be removed will be discussed the the physician post-operatively.