Benign Breast Surgical Information

The aim of this booklet is to provide information about what happens before your surgery, on the day of your surgery and after your operation for breast surgery.

Before your operation
An appointment will be made for you to have a phone call or attend the Pre-assessment clinic. This is in the Horton Wing, Level 0 at St Luke’s Hospital. Depending on your past medical history and general fitness, the appointment will take between 30 minutes to 2 hours to complete. Some investigations may be performed including blood tests and MRSA (MSSA if having implants) swabs. You may need to see an anaesthetist before coming to hospital. If not the anaesthetist will see you on the day of surgery. Please bring all your regular medicines with you in their original packaging.

You will receive an admission letter either in the surgical clinic or when attending pre assessment. This will tell you the date and time for you to come into hospital. This will either be at Bradford Royal Infirmary or St Luke’s Day Case Unit. It will also tell you when to stop eating and drinking.

If you are having day surgery (going home the same day), you need to arrange for a responsible adult to stay overnight with you at home when you are first discharged.

You will need some pain relief at home ready for when you are discharged as these are not provided routinely by the ward. We suggest you take simple pain killers that can be bought over the counter such as paracetamol and/or ibuprofen. These two drugs can be taken together and may prove to be more helpful in managing any discomfort.

Make sure that you have appropriate transport arranged to and from the hospital and if necessary someone to assist you.

If you are on benefits, you may be able to claim for travel expenses. You can visit the NHS website: https//www.nhs.uk/nhs-services/help-withhealth-costs/healthcare-travel-costs-scheme-htcs which will explain who is eligible for the scheme and how to make a claim.

For information regarding your entitlement to concessionary (reduced cost) parking please ask our team for a copy of the Trust’s Concessionary Parking Arrangements for Patients and Visitors’ leaflet. If you have one, or a combination of the following medical needs, you may be entitled to hospital transport:
– Require a stretcher for the journey due to specific medical and mobility needs
– Require oxygen during transit
– Need to travel in a wheelchair and do not have a specially adapted vehicle
– Cannot walk short distances without continual physical support
– Have a medical condition that would compromise your dignity or cause concern to the public
– Have severe communication difficulties

Please make sure that you complete the checklist below before your admission to hospital:
– Pain control at home that you know works for you
– Transport to and from hospital
– Responsible adult overnight if you are having day case surgery
– Help with activities for 4–6 weeks such as heavy shopping, vacuuming, meal preparation
– Organise help for dependants/pets
– Make sure you have an understanding of what medication you are currently taking and what this is for. If needs be, ask for a medication review from your GP prior to admission
– Bring all of your medication in the original boxes

Have you been told if you need/or when to stop taking?
– Diabetic tablets or Insuline
– Blood thinning medication e.g. aspirin, warfarin, clopidogrel or rivaroxaban.
If not, contact the Pre-assessment Clinic on 01274 365758.

On the day of your surgery
– Make sure your prescribed medication is already taken as directed by the pre-assessment team.
– Arrive on the ward or Day Case Unit at the requested time.
– Ward space is limited and generally you will be escorted into a shared waiting area until the staff can allocate you a trolley. Please liaise with your Breast Care Nurse if there is a specific reason you would like someone to stay with you.
– Doctors and nursing staff will complete relevant admission records. You will be given an identification wrist band, a green surgical wrist band and a red wrist band if you have any allergies. The surgeon will examine you and place a mark on the surgical site using a pen. Checklists and consent forms will be completed.
– Patients are taken to theatre according to their clinical priorities. Theatre lists that run all day mean that some patients will wait until later in the afternoon before their surgery takes place. We will inform you on admission approximately what time you are likely to go to theatre. We will update you and let you know if this time changes.

After your operation
– When you return to the ward or discharge lounge, you will be offered something to eat and drink. Health care staff will perform wound checks and observations.
– If you are having day surgery you will be able to go home, once your blood pressure, temperature and pulse are normal for you. Then also when you are able to move around safely, your pain is controlled and there are no obvious problems with your wound. This is generally 2–4 hours after you have returned from theatre. Please arrange for someone to collect you. You can either use your mobile phone or ask a member of staff to ring for you.

Dressings
Most of the dressings we use have a plastic surface and are splashproof. Keep the dressing dry by taking shallow baths, low showers or a strip wash. Beneath the dressing is a layer of steri-strips which lie on top of your wound. The wound itself will be closed using dissolving stitches.

The dressing needs to stay in place for two weeks after which you may remove the dressings and steri-strips. No further dressings are required. If your dressing leaks or becomes loose less than a week after the surgery, it will need to be changed as this increases the risk of wound infection.

If this happens please contact the Breast Care Nurses on 01274 365190 or the Practice Nurse at your GP surgery to have the dressing replaced. Otherwise you will not routinely require the attention of the District/Practice Nurse.

Wounds
– The wound area may feel ‘lumpy’ and hard for a few weeks. This is normal and part of the healing process.
– You can expect some bruising which will disappear with time.
– Numbness and ‘pins and needles’ is often experienced. This is due to tissue and nerve damage which is normal after surgery and will improve with time, although numbness is persistent in some areas.
– Some discomfort is expected and will gradually settle. Take pain relief as suggested. See your GP or pharmacist if your pain is not controlled or if you are unsure of what to take.

Causes for concern:
– New bruising and swelling which increases in colour and size in the area of surgery
– Increased levels of pain
– Any wound leakage
– Significantly limited arm movement
– Uncontrollable shivers, feeling generally unwell, or a high temperature
– Redness around the wound site/breast
All of the above can be signs of infection/bleeding and must be acted upon quickly.

If you experience any of these symptoms, you can contact:

• Breast Care Nurses: 01274 365190 Monday to Friday between 9am and 4pm. Please leave a message and someone will call you back.
• See your GP if this is easier and quicker for you.
• You can also ring 111 for support and advice.
  For out of hours, evenings, during the night and weekends please contact: Surgical Assessment Unit (SAU) – BRI: 01274 383205. This is an acute surgical ward. If at all possible, try to contact the breast
  team before a weekend if you think you may run into problems.

Returning to normal activities
This will depend on the type of surgery you have had, your usual level of activity and your personality. We recommend that you listen to your body and gradually return to your normal lifestyle at your own pace. If you are struggling with anything (physical or psychological) it is important to take a step back and try again later. There is no right answer to this; it is a case of pushing yourself a little but also resting when you need to. We are all different. In the first 24 hours following a general anaesthetic you should have a responsible adult with you. You should not take any alcohol or nonprescription drugs. You should not sign any legal documents.

– Some pain killers (particularly codeine based preparations) can cause constipation. It is sensible to drink plenty of water and follow a balanced diet following surgery.
– Walking is encouraged. Swimming needs to be avoided until the wound has healed completely. This is when the dressing has been removed and there is no leaking from the scar (approximately 4–6 weeks).
– There is no hard and fast rule about when you can resume your normal sex life. Listen to your body and when you feel comfortable to try.
– You are advised not to drive for the first 24 hours after a general anaesthetic. It is important you feel able to control a car in an emergency and feel comfortable wearing your seatbelt. Talk to your insurance company if you have any concerns about your cover.
-The amount of time you take off work will depend on your occupation and how you are feeling. Talk to your Breast Care Nurse or Breast Consultant at your clinic appointment if you have any concerns about
returning to work.
– Fit (sick) notes can be obtained whilst you are in hospital or from your GP. Please ask on the ward if you need one prior to discharge.
– If you are struggling to come to terms with your experience or any of the above side effects please contact your Breast Care Nurse, Consultant or GP.

Follow up appointments
If tissue has been sent to pathology you will have a follow up appointment. This will either be a phone call or in the Dales Suite, Area 8, in the Horton Wing at St Luke’s Hospital. The date and time of your appointment will be posted to you. It is timed so that your histology results are ready and your case has been discussed at the Multi-Disciplinary Team Meeting. At this appointment, we will ask about your wound and discuss with you your histology results and treatment/follow up care plan. We will offer you a written summary of your histology and treatment plan.

It is often advisable to take someone along with you to attend the appointment if you are attending in person.