Breast Surgery
Patient Instructions Pre- and Post- Surgery
Preoperative Planning & Instructions
Scheduling
You will be contacted by a breast team surgical scheduler with the schedule for your surgery and post op visits. If you do not hear from one, please call the Smilow Breast Center at 203-200-2328 for New Haven and Guilford.
Pre-operative planning
Each patient having surgery will be given a scheduled date, either on the day of your visit with the surgeon, or by phone from your surgeon’s clinical secretary.
For surgery in New Haven/Guilford, you will also receive an automated phone call between 3-5 PM the day before surgery, telling you what time to arrive for surgery. Please call 203-200-2775 if you do not receive a call or you have further questions.
Based on your age, current medical problems, and planned surgery, your surgical team will decide what preoperative tests need to be ordered. This may include blood work, EKG and chest x-ray, which can be done here at Smilow or at your physician’s office. A preoperative telemedicine appt. will be scheduled with the anesthesia team only if indicated. If medical clearance is needed, the paperwork should be faxed, along with any lab work, to 203-737-3621.
DO NOT use any aspirin or aspirin containing products (check all cold remedies) for 7 days before your surgery. This includes Ibuprofen, Naprosyn, Aleve, Motrin and Advil. If you are on Plavix, Pradaxa or Coumadin (warfarin), or any blood thinning medication, please check with your cardiologist or primary care doctor. These will usually be discontinued 5 days preoperatively. ALSO, hold ALL vitamins and herbal supplements for 7 days before surgery.
Do NOT smoke for at least 24 hours prior to your surgery.
You will be contacted by a nurse from Pre-Admission Testing (PAT) a few days prior to your surgery with instructions regarding fasting prior to arrival and what medications you may take the morning of your surgery.
General Preoperative Instructions
• Do not eat or drink anything after midnight before surgery (including mints or candy), except clear liquids, which may be allowed up until 2 hours before your arrival time ONLY if permitted by your surgical/ anesthesia team.
• If you are diabetic, follow the recommendations from your doctor or follow the instructions given to you by your preop staff about managing your diabetes.
• Call your surgeon before your surgery if you do not feel well or develop any signs of illness, a cold, fever, sore throat, chest pain or difficulty breathing.
• Wear loose fitting clothes and consider a button-down shirt. A surgical bra will be provided.
• If you are having a Tag localizer placed, the radiology schedulers will call to arrange the date and time.
• If you are having a needle localization, you will be transported from the pre-op holding area to the mammography department on the 1st Floor approximately 90 minutes prior to your surgical time. In Guilford, you will be transported to the 2nd Floor. You will return to the holding area by wheelchair once the procedure is completed, just prior to your scheduled OR time.
• In New Haven, the operating room is on the 3rd floor. During your surgery, your family can wait in the waiting room on the 3rd floor beside the operating rooms.
• In Guilford, surgery and waiting room are on the 1st Floor. Your surgeon will speak to your family member immediately after your surgery. Please ask your nurse if visitation restrictions are in place due to COVID.
• You will stay in the PACU (recovery room) for one to two hours after your surgery. Once you are stable and your pain is controlled, you will either be discharged home or admitted to the inpatient floor as planned. If you are going home and live alone, it is best if you have someone stay with you at least for the first night after surgery. If you live alone or are unsure of availability of family and friends that can drive you home after surgery, please contact the social worker or nurse on your surgery team.
Please call 203-200-2328 if you have any questions
Pre-Operative Appointments
• Preop Labs/EKG/Other testing is done per surgery team directions
• MD/Preadmission Testing (PAT) clearance (only if requested). Results can be faxed to 203-737-3261
• TAG wireless localizer placed on _ at_____ AM/PM.
Surgery Location:
Yale New Haven Hospital ☐
20 York Street, New Haven CT 06510
Surgery Date: _______________ Arrival Time:____________ AM/PM.
Please check into the hospital in Admitting Office, 1st Floor, East Pavilion Floor at ______________ AM/PM. (same as arrival time)
Your wire localization will be at ____________________ AM/PM.
Your surgery time is __________ AM/PM.
Surgery Location:
Shoreline Medical Center ☐
111 Goose Lane, Guilford CT 06437
Surgery Date: _______________ Arrival Time:____________ AM/PM.
Please check in at the Surgery Center, 1st Floor at ______________ AM/PM. (same as arrival time)
Your wire localization will be at ____________________ AM/PM.
Your surgery time is __________ AM/PM.
Appointments:
Surgical Oncology postop appointment with Dr. is scheduled on ________ at ______ AM/PM.
Location:
Yale New Haven Hospital, 20 York St, New Haven 06510 ☐
Shoreline Medical Center 111 Goose Lane, Guilford, CT 06437 ☐
Waterford Cancer Center, 230 Waterford Parkway South, Waterford, CT ☐
Reconstructive surgery postop appointment with Dr. ______is scheduled on ___________ at _____AM/PM.
Medical Oncology appointment is with Dr. ____________ at ______ AM/PM.
Location:
Yale New Haven Hospital, 20 York St, New Haven 06510 ☐
Shoreline Medical Center, 111 Goose Lane, Guilford, CT 06437 ☐
Yale Smilow North Haven, 6 Devine Street, North Haven, CT 06473 ☐
Waterford Cancer Center, 230 Waterford Parkway South, Waterford, CT ☐
Radiation Oncology appointment is with Dr. ___________ at ______ AM/PM.
Location:
SRC Radiation Oncology, 2080 Whitney Avenue, Hamden, CT 06518 ☐
Yale New Haven Hospital, 20 York St, New Haven 06510 ☐
Shoreline Medical Center, 111 Goose Lane, Guilford, CT 06437 ☐
Waterford Cancer Center, 230 Waterford Parkway South, Waterford, CT ☐
Parking
Parking in New Haven is available for all patients having surgery. The Air Rights Garage has levels 4, 6 and 8 designated for patient parking. Cost is $1.00 per hour. Valet parking is available; cost is $15.00 for up to 7 hours and $25.00 for up to 24 hours. Parking at Shoreline Medical Center is at no cost.
During your surgery, in New Haven, your family can wait in the waiting room on the 3rd floor beside the operating rooms. In Guilford, your surgeon will speak to them immediately after your surgery.
You will stay in the PACU (recovery room) for one to two hours after your surgery. Once you are stable and your pain is controlled, you will either be discharged home or admitted to the inpatient floor as planned. If you are going home and live alone, it is best if you have someone stay with you at least for the first night after surgery. If you live alone or are unsure of availability of family and friends that can drive you home after surgery, please contact the social worker or nurse on your surgery team.
Post-Surgical Instructions
• Wear the surgical bra given to you at the hospital continuously, even to bed until the post-op visit. The support of the bra will help relieve discomfort while protecting the incision. An ice pack will be given to you in the recovery room, which can be used to reduce discomfort and swelling. You may also use ice cubes in a sealed baggie covered with a washcloth.
• You will have an outer bandage. Leave the dressing(s) in place for 24 hours, then remove it. Once you have removed the outer dressing you will see skin glue. Leave glue intact.
• You may shower normally once the outer bandages are removed. Avoid a bathtub during the first week postop; check with your surgeon prior to restarting. Put the bra back on after you shower.
• You may NOT drive on the day of surgery. Discuss your return to work directly with your surgeon.
• DO NOT drive or operate machinery if taking a prescription pain medication
• DO NOT elevate your arms until after your post-op visit.
• NO swimming or hot tubs until cleared by your surgeon.
• You may be given a prescription for a pain medication. Take it as directed. Tylenol (2 tablets every 4 hours) is an alternative, but DO NOT take it in addition to pain medications since many already include Tylenol. Ibuprofen (Motrin or Advil) is another alternative pain medication you can begin to use 24-48 hours after your surgery. You may find the axillary (underarm) incision more uncomfortable than the breast incision. This is normal. Use a stool softener to avoid the constipation caused by some pain medications.
• If you have an axillary incision, no deodorant and no shaving until you are cleared by your surgeon.
• Keep the post-operative appointment already scheduled for you. Your pathology report should be available by that date.
All patients having surgery that require an inpatient hospital stay will be discharged with appropriate instructions. Details will be given and will be specific to the following areas:
Diet
You will be discharged home on the same diet as you had prior to your hospital admission.
Drain Care
You will have 1 or more drains in place when leaving the hospital. The nurses will review with you how to care for and empty the drains. You will also review how to strip (or milk) the drain 1 to 2 times a day to help keep it open. Remember to squeeze the air out of the collection bulb before you re insert the stopper. If the drain is full of air and looks like a hand grenade, it is not working. Please record how much comes out of each drain every day. We can arrange a Visiting Nurse to help you with the drain care. Please call your doctor when the drainage is less than 30cc (or 1 ounce) a day from the drain for two consecutive days. You can expect to have the drain(s) for 1 to 3 weeks.
Shower
If you had breast reconstruction, please check with your plastic surgeon about when you can shower. In some cases, you will be told not to shower until the drains are removed. Most of the time, it is OK to shower after 48 hours. You may lightly shower with your back to the water and allow warm water to run over the incisions. Use a gentle soap such as Johnson and Johnsons or Dove, and do not scrub the wound. Avoid having the drain(s) pull against your skin while showering by supporting them. Pat your incisions dry after the shower. You may be asked to cover them with a fresh dressing. Depending on what type of reconstruction you have, your team may provide you with a prescription for a post-op camisole (or other garment). This can be purchased from the Boutique in the lobby of the Smilow Cancer Hospital in advance of your surgery. It will have a zip-up front and pockets for the drains. Other post op bras or garments may be recommended by your plastic surgeon.
Incision care
If you had breast reconstruction, your plastic surgeon will decide on your discharge instructions for incision care. In some cases, you will be instructed to leave the original dressing in place. If you are told to change the dressing, keep your incision covered for 48 hours after surgery. After 48 hours, you may remove the clear bandage and gauze. Do not remove the paper strips (steri-strips) directly on the skin. If allowed to shower, it is okay to get the paper strips wet in the shower and then pat them dry and leave them open to air. Leave these strips in place for at least 10 days. Sometimes the plastic surgeon will request Bacitracin, Xeroform, or Silvadene be placed on your wounds to moisturize them or prevent infection. Follow the instructions as given by your plastic surgeon. If you have flaps, monitor them for changes in color, temperature, drainage or appearance.
For a woman who does NOT have breast reconstruction after a mastectomy, you may initially have a dressing over your incision and will have at least one drain. Please refer to drain care instructions. After 48 hours, the
outer dressing on your chest incision can be removed and the area left open to air. Shower as directed above.
Pain Control
Tylenol or prescribed pain medication may be used every 4 to 6 hours as needed for pain. Do not take both Tylenol and the pain killer together. Valium 5 mg is frequently given after breast reconstructive surgery for muscle spasms and can be taken every 6 to 8 hours. Alternate the valium with the narcotic pain medication since the valium is often the more effective way to control discomfort. Ibuprofen can be used to supplement pain medications and decrease the dose of the narcotic if you tolerate it. Remember to take a stool softener such as Colace, Senokot or Milk of Magnesia to avoid constipation while taking narcotic pain medications.
Antibiotics
If you had breast reconstruction you will usually continue taking your antibiotics until the drains are removed. If you have not had a reconstruction, your antibiotics will be finished during your hospital stay.
Driving
Do not drive if you are taking a prescribed narcotic for pain, or the valium. Do not drive until your drains are removed. You may drive only when you are not experiencing pain with movement of your arms and upper body. If you had a complete lymph node removal, or a complicated flap reconstruction, this may be 2-3 weeks after surgery.
Exercise
Please do not begin any vigorous exercises until your drains are removed, since increased activity may increase the fluid drainage and delay the removal of the drains. Walking and stair climbing are fine and strongly encouraged. If you had breast reconstruction, you should not do any heavy lifting (greater than 5 pounds) or reaching over your head until your post-op appointment. Use common sense in terms of your activity level and don’t be surprised if you need to take naps during your first weeks of recovery.
Bra
You may wear a post operative camisole or a surgical bra, a camisole with an elastic shelf or nothing. Please check with your plastic surgeon. DO NOT WEAR an underwire bra or sports bra until you are told it is OK to do so. Smilow Boutique professionals can assist you. You can call for an appt 203-200-2273.
When Should I Call My Doctor?
Call the office at (203) 200-2328 any time if you have severe pain or swelling, a fever higher than 101 degrees, or redness extending more than ½ inch beyond the edges of the incision. A small amount of drainage on your bandage is normal.
You should call if the bandage becomes soaked with bright red blood or has any other persistent drainage. Call if there is a foul odor from any incision.
Your Jackson Pratt drain(s) will drain bright, red-colored fluid that resembles Hawaiian punch initially. This should change to a yellow fluid that resembles chicken broth. This is normal. If the drain fluid becomes cloudy or grey in color or creamy colored, please call your surgeon. Call immediately if your drain will not stay
compressed or if there is drainage around the drain site. Call if the drain output suddenly increases a large amount or totally stops draining.
If you are undergoing reconstructive surgery, your plastic surgeon will give you specific instructions. Any other questions regarding wounds, drains, and medications can be directed to your plastic surgeon.
Pathology
It can take 7 to 10 business days after surgery before your pathology results are ready. The results of your pathology report will be discussed with you at your post-op appointment. Call (203) 200-2328 if you have not already been given a follow-up appointment. A copy of the report will be provided to you at this appointment.