Partial Mastectomy with Wire Localization and Sentinel Lymph Node Mapping adobe acrobat pdf of 'Partial Mastectomy with Wire Localization and Sentinel Lymph Node Mapping'

You have been found to have a small tumor or cancer in the breast that has been recommended to be removed. In addition, we will be checking some lymph nodes at the time of surgery to see if there has been any spread. We will need to inject the nuclear material before surgery to help find the specific lymph nodes. Also, since we cannot feel this area, a very thin wire will be placed to assist in locating the correct area. There will be two incisions, one in the breast and one in the axilla (arm pit) area.

Hereís 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 and given scrub pants to wear. 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. First, you will be escorted down to the Nuclear Medicine Department for the nuclear injection. From there you will be taken to the Breast Center where a mammogram or ultrasound will be done. At that time, the Radiologist will insert the wire. Once completed, you will be escorted back to the Day Surgery area.

You will see me prior to the surgery and have an opportunity to ask any additional questions that you may have. 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. After the breast tissue is removed, it is sent for x-ray to confirm the correct area was removed. Then the lymph nodes will be removed and sent to the lab while you are asleep. If there is no evidence of cancer in those lymph nodes, no additional ones will be removed. If there is evidence of cancer spread, additional nodes will be removed to assure nothing is left behind. In that case, a drain may be placed to collect any fluid the body may make in the healing process. The average duration of this procedure is 1 hour to 1 Ĺ 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.

After surgery:
Once your surgery has been completed, you will be taken to the recovery room and I will let your family know your surgery is done. I will be able to tell them the results of the lymph node evaluation. You will spend approximately one hour in the recovery room, sometimes less, sometimes a bit more, depending on how you metabolize the medications given to you.

When you are awake, the nurse will help you get dressed and transfer you to the discharge area. At that time, your family will be called to come and sit with you. You may be given some juice, soda, or crackers or assisted to the rest room if necessary. Additional discharge instructions may be given to you as well as any prescription for pain medication that I may have written.

Once you go home:
Expect to be a bit groggy for a while. I ask that you do not drive a car or operate any machinery that day. You will have no other restrictions as far as your diet or activity.

Sometimes, the anesthesia can make you a bit nauseous. Donít be alarmed, that usually resolves by the next day. It may be helpful to apply an ice-pack to the breast to help alleviate any discomfort or swelling. If you donít have an ice-pack, you can make one by taking a wash cloth and wetting it. Fold it and put it in the freezer for a while. Once cold and ďcrunchyĒ place it in plastic wrap or a zip lock bag. Instant ice-pack. You can even prepare this the day before so itís ready when you get home. You may wear a bra if you would like to for comfort, but itís not necessary.

Most of my patients experience very little pain. You may take Tylenol, Advil, Aleve, or any other over the counter pain medication if you like. The prescription you will get is for a narcotic and is stronger just in case you need it. If you do not have pain, you do not need to take any prescription medication. Very often, the axillary incision is more bothersome than the breast. Occasionally, fluid can accumulate, but that can be taken care of in the office at your follow-up visit.

The day after surgery, please remove your bandages. Under the bandage you will see small white tapes, steri-strips. Leave those alone. Once the bandages are off, you may take a shower. The steri-strips can get wet. They will start to peel off over the following 7-10 days and you can eventually peel them off without harming the incision. If they happen to come off sooner, donít worry, they are there mostly to protect the fresh incision. Your incision cannot open up accidentally. All stitches are under the skin and will dissolve.

If there is a drain, please do not remove any dressings and follow the instructions given to you about emptying and recording the drain output. Be sure to bring the record of drainage to your follow-up visit.

I will want to see you in the office after surgery to see how you are healing and to go over the pathology results. Depending on that, your next follow-up visit will be determined.

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.