Breast Conservation Therapy

WHAT YOU SHOULD KNOW:

• Breast conservation therapy, also called BCT or lumpectomy, is a breast conserving surgery (BCS) which may be followed by radiation therapy. BCT may be done to treat breast cancer (tumor) while sparing and leaving much of the breast intact. With BCT, only the part of the breast with cancer and some area around it are removed. Radiation therapy may be given at a later date to kill cancer cells that were not removed with surgery. Sometimes, chemotherapy may be used weeks before BCS to shrink a large tumor. BCT helps you cope better with breast cancer without the loss of a breast.
  
  
• BCT is usually done in patients with early-stage breast cancer. In this stage, the tumor is still small and has not spread to other parts of the body. Women with more than one tumor present in different areas of the breast cannot have BCT. You also cannot have BCT if you had received radiation on the same breast or have certain medical conditions. These medical conditions may include poor blood flow or a big tumor in relation to the breast size. Surgery during pregnancy may be done during the later months with the radiation therapy given after delivery. You and your caregiver will decide which breast cancer treatment is right for you.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

There are always risks with having surgery. You may bleed more than usual, get an infection, have trouble breathing, or get blood clots. You may have scars, shoulder stiffness, or swelling around the area where the lump and breast tissue were removed. If a large area of the breast was cut out, you may be stressed about having unequal breasts. Radiation may affect the heart, lungs, brain, and skin, and may cause problems or lead to other cancers. Sometimes, the cancer may not have been totally removed and may come back. You may need to have more surgeries later on. Women who smoke, have another medical condition, or who have had chemotherapy are at a higher risk for problems. Call your caregiver if you are worried or have questions about your surgery, medicine, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• Monitoring:
  
  
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
    
    
  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
    
    
  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• Anesthesia: This is medicine to make you comfortable during the surgery. Caregivers work with you to decide which anesthesia is best for you.
  
  
  • General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
    
    
  • Local anesthesia: Medicine is used to numb the area of your body where the surgery or procedure will be done. It is usually injected into the skin. It also may be given as a gel or jelly applied to your gums for dental procedures or as a patch. For such areas as the genitals, medicine may be given as a cream on the skin or mucus membranes.

During your surgery:

• Caregivers will clean your chest area with soap and water. This soap may make your skin yellow, but it will be cleaned off later. Sheets are put over you to keep the surgery area clean. An incision (cut) is made in your breast, over or near the area of the tumor. The shape and length of the incision will depend on where and how big the tumor is.
  
  
• Caregivers will remove the lump together with a portion of the surrounding normal-looking breast tissue. The portion may include a small area around the lump or as much as one fourth of your breast. Your nipple and areola (dark circle around the nipple) may also be removed. X-rays may be done on the tissue removed and compared with pictures taken before surgery. Caregivers will make sure that the abnormal areas seen on the pictures have been cut out completely.
  
  
• Marker clips may be placed to outline the area where the tissue was taken. This may help during the radiation therapy and other imaging tests to be done in the future. Caregivers may also take out some of your axillary (underarm) lymph nodes to check if the cancer has spread. Thin rubber tubes may be put into your skin to drain blood from your incision. Your skin and breast tissue are closed with stitches (thread) and covered with bandages. The breast tissue and lymph nodes removed are sent to a lab for tests.

After surgery:

You are taken to a room where your heart and breathing will be monitored. Do not get out of bed until your caregiver says it is okay. A bandage may cover wounds to help prevent infection. You may be able to go home after some time passes. If you had general anesthetic, an adult will need to drive you home. Your driver or someone else should stay with you for 24 hours. If you cannot go home, you will be taken to a hospital room.

• Activity: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.
  
  
• Deep breathing and coughing: This is an exercise to help decrease your risk for a lung infection after surgery. Do the following:
  
  
  • Hold a pillow tightly against your incision (cut) when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breathes help open the airways that lead to your lungs. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour.
    
    
  • You may be given an incentive spirometer to help you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Let out your breath and cough. Repeat the steps 10 times every hour.
  
  
• Food and drink after surgery: You will able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft food easily, you may slowly begin to eat solid foods.
  
  
• Drains: These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.
  
  
• Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.
  
  
• Medicines: You may be given the following medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
  
  
• Pneumatic boots: Inflatable boots are put on your legs. The boots are connected to an air pump. The pump tightens and loosens different areas of the boots. This helps improve blood flow to prevent clots.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.