Who do I contact for more information?

Call the clinical nurse coordinator for breast surgery at
Phone: 416 946 4501 extension 4302.

If you have questions about breast reconstruction, call the reconstructive nurse coordinator at
Phone: 416 340 4800 extension 5161.

Call your breast surgeon at:

• Dr. Tulin Cil
  Phone: 416 946 4501 extension 3984
• Dr. Alexandra Easson
  Phone: 416 586 4800 extension 2775
• Dr. Jaime Escallon
  Phone: 416 586 4800 extension 5163
• Dr. Wey-Liang Leong
  Phone: 416 946 4501 extension 2992
• Dr. David McCready
  Phone: 416 946 4501 extension 6510
• Dr. Michael Reedijk
  Phone: 416 946 4501 extension 4432

Call your plastic surgeon at:

• Dr. Stefan Hofer
  Phone: 416 340 4800 extension 3449
• Dr. Anne O’Neill
  Phone: 416 340 4800 extension 3143
• Dr. Toni Zhong
  Phone: 416 340 4800 extension 3858
• Dr. Siba Haykal
  Phone: 416 340 4800 extension 4327

What is a prophylactic mastectomy?

A “mastectomy” (pronounced mus-TEK-tuh-me), sometimes called “total mastectomy” or “simple mastectomy”, is surgery to remove the whole breast. This may or may not include the nipple.

A “prophylactic mastectomy” is when a mastectomy is done when a normal breast (no cancer is present) is removed to decrease the chance of the growth of cancer.

Talk to your doctor or surgeon to know if a prophylactic mastectomy is good option for you.

This image shows the part of the breast that is removed during prophylactic mastectomy.

What happens during a mastectomy?

There are 5 main steps in having a mastectomy:

1. Your doctors will give you general anesthetic (medication to help you relax, and sleep through the surgery).
2. Both breasts are removed. The surgery takes about 3–4 hours. If breast reconstruction is done at the same time, the surgery can take longer.
   The breast tissue removed during surgery is sent for a pathology test (a test of organs, body tissue and fluids to see if disease is there). This is done to be sure that no cancer is present.
3. One or two tubes per-breast called “drains” are placed under the incision (cut made during surgery). Drains help to remove fluid from the surgery area and prevent swelling.
   This image shows you where the drain will be placed.
   You may have more drains and/or have them at different places if you are having breast reconstructive surgery.
4. The incision is closed with stitches. Stitches will dissolve on their own and will be covered with a skin tape called “Steri-Strips”. A bandage will be used to cover the whole area.
   
5. If you had breast reconstruction and depending on the type of procedure, you will wake up from surgery with a partial or full breast shape.

What are the risks of a prophylactic mastectomy?

Like any surgery there are risks and side effects such as:

• Bleeding
• Infection
• Pain

You may also feel or notice:

• A change of feeling or less feeling (numbness)
• Swelling around the area where you had surgery.
• Stiffness in your arm, shoulder and chest on the side(s) of the body where you had surgery.
• Changes to your body image, or comfort with your sexuality. This may be because there will be changes to how your breast will look and feel after surgery.

How to prepare for surgery

Do this a few weeks before your surgery:

Arrange for someone to drive you home. You may bring a family member or friend with you for company and support, before and after your surgery.

Do this 5 days before your surgery:

Stop taking aspirin or any blood thinners. These medications can increase your risk of bleeding during surgery.

• If you take blood thinners (like Warfarin, also called Coumadin), talk to the doctor who prescribed the blood thinners before you stop taking them, and to know when to start taking them again.
• You can start taking aspirin again 5 days after your surgery.

Stop taking any herbal medication or remedies. This includes vitamin E, garlic pills and fish oil pills. These may affect your surgery and treatment. It is okay to eat garlic and fish.

Talk to your doctor if you have any questions or concerns. You can start taking herbal medication or remedies again 5 days after surgery.

Do this 2 days before your surgery:

Stop taking anti-inflammatories (like Ibuprofen, Advil, Motrin). You can start taking these medications again 2 days after your surgery. It is okay to take Tylenol.

Do this the day before your surgery:

Drink plenty of fluids the day before surgery. This includes juice, soup, water, and fluids in your food. This will help you feel less thirsty the morning of your surgery.

Do this the night before your surgery:

• Do not eat salty foods. This will help you feel less thirsty on the morning of your surgery.
• Do not eat any solid food after midnight. This includes candy or chewing gum.
• You can drink clear fluids up to 5 hours before your surgery. Clear fluids include: water, apple juice, ginger ale, tea and black coffee. Do not have milk or cream in any of your drinks.
• Shower with soap to clean your skin and help prevent infection.

Do this the morning of your surgery:

• Do not swallow anything 5 hours before surgery. This includes both food and drinks. For example, if your surgery is scheduled for 2:00 pm, you cannot have food or drinks after 9:00 am.

• Shower with soap and do not use deodorant, perfumes or lotions on your torso (stomach, chest, breast, under-arm area, and back). This will help you prevent infection and stay safe during surgery. It is okay to use shampoo, face cream and lotions on other parts of your body.
• If you usually take blood pressure pills or heart pills, take them with a sip of water. Do not take any other medications without talking to your health care team.
• Leave your valuables at home.
• Arrive at the hospital and check-in on time.

What should I bring to the hospital the day of my surgery?

• Your health card (OHIP)
• Any medication you usually take. You may need to take them while in hospital
• Something warm to wear in the hospital (like a bath robe or sweater) if you are staying overnight
• Slippers or shoes. You need comfortable footwear to walk around the hospital in
• Toiletries that you might want to use after surgery (like toothpaste, a toothbrush or hair brush), if you are staying overnight
• A book or other entertainment
• Something loose and comfortable to wear home that opens in the front (like a sweater or jacket)

What to expect after surgery

Right after surgery, you will:

• Wake up in the recovery room. You will feel sleepy and need to rest.
• There is a waiting area nearby where your guests can wait. A member of your health care team will let your guests know when it is okay for them to see you.
• Have an intravenous (IV) in your arm. You will be getting fluids and medication through the IV.
  
• Have a sore throat. This is from a tube that was placed in your throat to help you breath during the surgery.

For a while after surgery you may:

• Feel nauseous (feeling of having to throw-up), or vomit (throw-up)
• Feel tired
• Feel some pain or discomfort. Stay active and move around after the surgery to prevent complications (problems that can arise after surgery). Take your pain medication if it is uncomfortable to move around.
• Have some bruising, swelling and tenderness where the incision (cut made during surgery) is. You may notice this a few days after your surgery. This can last for about 1 month.

When can I go home?

For implant or tissue expander reconstruction you will go home the same day as surgery unless your surgeon has told you otherwise. For a DIEP, you will go home 3 days after surgery.

Your health care team will arrange for nursing. Depending on the area that you live, a nurse will visit you at home or you will visit a nurse in a clinic.

When will I get the test results from the tissue removed during surgery?

You will get the results at your follow-up appointment. This is often about 2 to 3 weeks after your surgery.

Frequently asked questions

How will my pain be managed?

Your doctor will give you some pain medication. Most people will get Tylenol 3 (acetaminophen with codeine also called acetaminophen and codeine), Percocet (acetaminophen and oxycodone) or oxycodone.

Take your pain medication as needed.

• If you still feel pain after taking the medication, tell your doctor or nurse. They can help you manage the pain.
• For mild pain, take Tylenol (acetaminophen, 325 mg) or Tylenol Extra Strength (acetaminophen, 500 mg). Take it every 4 to 6 hours, as needed.
• As your incision starts to heal, you may feel sharp jabbing pains or a tingling feeling in that area. To help with this, your doctor may prescribe a medication called Gabapentin (pronounced GA-buh-PEN-tin).
  • Gabapentin is used to treat nerve pain. It will help to relieve or reduce your pain. Gabapentin will need to be taken the same way as the doctor prescribes (tells you to) for it to work.

What if I get constipation from my medication?

If you get constipation (not able to poop), talk to your doctor, nurse or pharmacist. They can suggest a stool softener or laxative which makes it easier for you to have a bowel movement (poop). The stronger pain medications often cause constipation.

How do I care for my incision?

This depends on if you have had reconstruction and which type in general:

• Steri-Strips (paper tapes) were used, leave them on for 14 days. They may fall off before 14 days. It is okay if this happens. After 14 days you can remove Steri-Strips by pulling them towards the incision.
• Once the Steri-Strips fall off, you can put polysporin on the incision if you wish. Do not put other lotions on until after your follow-up appointment, and your doctor says it is okay to do so.

If you have had breast reconstruction with a plastic dressing on top, leave it in place until you see your plastic surgeon.

How do I care for my drain?

Follow the instructions below until your drain is removed.

Do this:

1. Secure the drain to your clothing. This will help prevent pulling on your skin.
2. Milk the drain every 3 hours. You only need to milk the drain when you are awake. Your nurse will teach you how to do this right after surgery.

If the drainage stops, it may be blocked. Try milking the drain a few times to clear the blockage.

3. Empty the drain 2 times a day. You can empty it more often if it becomes full.

Measure the amount of fluid you remove each time and when it was emptied. Squeeze the drain while putting the cap back on to start the suction again.

The drain will be removed after the amount of fluid is less than 30 millilitres in 24 hours for 2 days in a row.

What if there is leaking where the drain leaves my skin?

If the fluid comes out where the drain exits your skin, pat it dry. Cover the place where your drain exits your skin with gauze padding.

What do I do if the drain falls out?

• Do not panic. This very rarely happens and is not an urgent problem. It can be fixed.
• Cover the incision where the drain left the skin with gauze. Use gauze or a bandage to soak up any drainage.

Call your surgeon to let them know what happened.

What if I have swelling in the area where I had surgery?

A little bit of swelling for up to one month after surgery is normal.

Call your surgeon or nurse coordinator if swelling becomes hard, firm or tight (see page 2for phone numbers). They may want to assess you (give you a check-up) in clinic.

What if I notice numbness where I had surgery?

The area where you had surgery may be numb. This often happens after surgery.

You may also feel numbness in your upper arm or behind your back.

As you heal, you might slowly gain more feeling again. During this time, it is normal to feel sharp, “jabbing” pains in the area. You may also feel a tingling feeling. Tapping the numb area or massaging the area may help.

What if I see signs of infection?

See page 3 to learn what to do if you see any signs of infection.

What if I am bleeding from the incision?

It is normal to have a small amount of dried blood at the incision site. This could be either:

• Under the Steri-Strips
• On the bandage covering the incision

Call your surgeon if you notice a large amount of fluid or blood coming from the incision site non-stop. A large amount of fluid or blood would be about half a cup to one cup (1/2 cup to 1 cup) every hour.

Can I take a shower after my surgery?

• For the first 2 days after surgery, have a sponge bath. Keep the area where you had the surgery dry.
• If you did not have breast reconstruction, the outer bandage can be removed 48 hours after your surgery then can then take a shower
• If you did have breast reconstruction, please follow your plastic surgeon’s instructions for showering.

Do I need to change what I eat after surgery?

No. You can eat normally. If you are taking strong pain medications you may want to have more fibre and water in your diet to prevent constipation.

What bra should I wear after surgery?

Wear a comfortable front opening shirt, a mastectomy camisole or a bra without underwire.

If you had breast reconstruction, check with your plastic surgeon about what to wear after your surgery.

You can buy camisoles at The Wig Boutique on the 3rd Floor of Princess Margaret. You can also buy camisoles and surgical bras at most medical garment stores.

Read the pamphlet called “Know where to buy bras and breast prostheses after breast surgery” for a store list.

Can I apply lotions to my surgical sites?

Do NOT apply any of these on the area where your surgery was:

• Perfumed lotions
• Talcum powder
• Underarm deodorant

These things can irritate or bother your skin. You can start using these again once your incisions have healed. Wait until your follow-up appointment with the surgeon.

When can I drive?

Do NOT drive or operate machinery if:

• The effects of the general anesthetic (medication to help you relax, and sleep through the surgery) have not worn off yet.
  The effects of general anesthetic may continue to cause drowsiness and dizziness even after you leave the hospital.
  If you have had general anesthetic, do not drink alcohol for 24 hours after your surgery. This may make your drowsiness and dizziness worse.
• You are taking narcotic pain medication. These medications include Tylenol 3 (Tylenol with Codeine also called acetaminophen and codeine) or Percocet (acetaminophen and oxycodone).
  These medications may make you drowsy or dizzy. If you do drive while taking these medications, you may have an accident and hurt yourself.
• You cannot fully move your arm(s) or leg(s) on the side where you had the surgery. This is in case you need to make any quick motions or need to respond quickly in case of an emergency situation.

What happens at my follow-up appointment?

You will have a follow-up appointment with your surgeon. It will be about 2 to 3 weeks after surgery.

Your surgeon’s assistant will give you an appointment time. They may give you a follow-up appointment when they book your surgery date, or they may give you an appointment time right before you leave the hospital.

If you had breast reconstruction, please call your surgeon’s office to book your follow up appointment.

At this appointment your surgeon will:

1. Check to make sure your incision is healing well
2. Talk to you about the test results from your surgery

Where can I find more general information about breast surgery?

If you would like more information, go to:

Patient & Family Library
Main Atrium, Princess Margaret Cancer Centre
Phone: 416 946 4501 extension 5383

The Patient & Family Library offers trusted information about:

• cancer
• cancer treatment and care
  
• support organizations and services

At the Patient & Family Library you will find computer stations, books, brochures, DVDs, audio books, electronic books and CDs. Trained staff and volunteers can help with your questions and help you to find the information and resources you need.