Breast Cancer Surgery

Breast surgery is becoming more and more common. However, it's still a major procedure and can be scary for some patients. Dr. Laurel Yeager, from Benrus Surgical Associates at Barnes-Jewish St. Peters Hospital, talks about breast surgery and the treatment process involved with a surgical procedure.

How long does breast cancer surgery typically last?

Surgery is the first treatment for breast cancer and there are two main types of surgery. There is breast conserving therapy, which is usually called a lumpectomy or a partial mastectomy. This surgery must removes the cancerous tissue with a rim of normal tissue with it and this approach generally lasts about 45 minutes to an hour.

The second type of surgery is a mastectomy and this approach removes the entire breast and usually samples a lymph node. This surgery can last anywhere from an hour to an hour and a half. If reconstruction is desired, an additional one and half to two hours is usually required.

What is the recovery process like in the hospital?

The good news is that most lumpectomy patients go home the day of surgery.

The majority of patients that have a mastectomy with or without reconstruction usually spend the night in the hospital. While they are there, they are taught how to take care of a drain. Usually we make sure that their pain is controlled with pills and usually they are ready to go home the day after surgery.

When you get back home, what is the recovery process there?

Usually I recommend no strenuous activity for the upper body for about a week. Patients can’t do any lifting more than ten pounds for about a week if you have breast conserving surgery and it is usually three or four weeks if the patient has a mastectomy and reconstruction.

It is best not to drive while taking pain medication. If a drain is placed, the patient has to take care of the drain site and record the output. If patients are not comfortable with this, we can have a nurse come to the home and help them take care of their drain. I usually use dissolvable stitches and skin glue so there is no dressing changes. Most patients can shower in 24 hours and it is usually best to wear some type of support bra, similar to the one I give to my patients after surgery.

How long does it take to get back to your normal, daily routine?

Every patient is different but with breast conserving surgery, most patients can return to normal activity within a week. Mastectomy usually takes three of four weeks and if the patient has reconstruction it can be about four to six weeks.

Surgery sometimes does stress your system and sometimes the patient may experience some fatigue and the patient may not have a normal energy level for about four weeks. Patients that have lymph nodes removed are at a risk for lymphedema. Lymphedema is swelling of the arm. The risk is pretty low if you are just having a sentinel biopsy but it can be 20 to 30% with a node dissection. Lymphedema can happen any time after surgery so there are some things that you can do decrease your risk. The patient just needs to protect the arm where the lymph nodes were removed.

We usually say to try to use lotion to keep the skin from drying, treat cuts with antibacterial ointments, and wear sunscreen and gloves when gardening or cooking. The patient should just do things to protect the risk of infection. The patient should also avoid heat extremes like saunas and tight restrictive clothing. It is best to maintain a normal body weight and moderate exercise and a low fat diet are recommended for long term recovery.

How has the breast surgery process changed over the last five years?

In general we are doing much less invasive surgery and this is improving the cosmetic results without really sacrificing recurrence or survival rate. Less invasive sentinel biopsies where one or two lymph nodes are removed has replaced axillary node dissection where ten or more nodes are removed.

Another big change that has occurred is with mastectomy. Thirty to forty years ago when a patient had a mastectomy, the breast, the skin, the muscle and the lymph nodes were all removed and this was very disfiguring. Twenty to thirty years ago we stopped removing the muscle. Within the last ten years skin sparring mastectomies are done in patients that have reconstruction. A skin sparring mastectomy is a procedure that removes all the breast tissue through a single incision around the areola while preserving all of the breast skin and then a nipple can be reconstructed or tattooed later to achieve a more natural outcome.

Within the last five years, in addition to maintaining the breast some women are candidates for nipple sparring mastectomies where the women can actually keep their nipple and areola complex and it can provide a patient with a more natural looking outcome. Every patient is different so we have to develop a plan by a breast team but in general a lot of advances have been made so there is less invasive surgery and survivals are improving which is all great for women and their families.

Dr. Laurel Yeager a member of the Benrus Surgical Associates. To get more information or to schedule an appointment, call 636.916.7100