Modified Radical Mastectomy with Sentinel Lymph Node Mapping
(with Reconstruction)
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You have been found to have a cancer in the breast that has been recommended to be removed. Either mastectomy has been recommended or you have chosen to have that procedure along with immediate reconstruction. The breast will be removed and the lymph nodes will be evaluated for spread. Your plastic surgeon will then perform the reconstruction procedure.

Here’s what to expect:

Morning of surgery:
Please check-in at the place and time Patricia has asked on your registration sheet.

Once checked-in, you will be taken to a pre-op room and asked to change into a hospital gown. Your family can stay with you. We ask that you limit the number of family members as the rooms cannot accommodate a large crowd. Your family can keep your clothing or it can be placed in a locker for safe keeping. A nurse will check your vital signs and go over important medical history. You will be escorted to the Nuclear Medicine Department and have the tumor area injected with the radioactive material. You will then be taken back to the Day Surgery area. You will see me as well as your plastic surgeon prior to the surgery and have an opportunity to ask any additional questions that you may have. The plastic surgeon may also draw on your skin for reference

A nurse or an anesthesiologist will start an IV. In some cases, a sedative will be given to relax you prior to going to the operating room. Once you have been taken to the operating room, your family is to go to the waiting room until your surgery is completed.

In the operating room:
Once in the operating room, you will be transferred to the operating table. In the room, there are key personnel including the circulating nurse, a scrub tech, anesthesiologist, and myself. Several monitors will be connected to watch your vital signs during the procedure. Once all that is complete, you will be given anesthesia to go to sleep. The breast will be removed and the lymph nodes sent for evaluation while you are asleep. If there is no evidence of cancer spread, then no further nodes will be removed. Only if we see evidence of spread will additional lymph nodes be taken. The average duration of the mastectomy procedure is 1 ½ hours. Please allow additional time for transportation time and time to get the patient off to sleep. All tissue removed is sent to the lab for complete analysis. At this time, your plastic surgeon will proceed with the reconstructive procedure chosen.

After surgery:
Once your mastectomy has been completed, I will let your family know that portion of your surgery is done. I will be able to tell them the results of the lymph node evaluation as well. Once your plastic surgeon in done, they will also go out an notify your family. You will spend time in the recovery room, and then be transferred to a room in the hospital. The amount of time spent in recovery often depends on bed availability. Please do not be alarmed if you spend a few hours, that may occasionally happen. Once a room is available, you will be transferred and your family notified about with the room number. Your activities after surgery will be decide by your plastic surgeon. They will let you know what you can and cannot do.

Day after surgery:
I will come to visit you the day after surgery. What time I come by depends on my schedule that day. We can discuss how the surgery went. Many patients go home the next day, even with reconstruction, but that will be up to the plastic surgeon to decide. Upon discharge, the nurses will go over any drain care and give you any prescriptions that have been written. Ask your plastic surgeon when you may also resume any usual medications you take on a regular basis (including aspirin or blood thinners).

Once you go home:
Your activities will be directed by your plastic surgeon. They take a lot of pride in their skills and I allow them to make all decisions about your recovery. They will decide when your drains are removed and when you can begin certain activities.

I will want to see you in the office after surgery to see how you are healing and to go over the pathology results. I usually ask that you coordinate that visit at a time when you will be seeing your plastic surgeon to avoid multiple trips. At that visit, we will also discuss additional therapy that may be necessary at this point.

Thank you for allowing me to participate in your care. It means a great deal to me and my staff that you would trust us with such an important matter.

Should you have any questions, please do not hesitate to contact the office or staff.

Thank you,
Dr. Arlene Ricardo
Dr. Arlene E. Ricardo, M.D.