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.

Getting Ready

The week before your surgery:

• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using any of your present medicines. These may include aspirin, ibuprofen, or blood thinners.
  
  
• Ask your caregiver before using any over-the-counter or herbal medicine or supplement. If you regularly use these medicines or supplements, tell your caregiver.
  
  
• Tell your caregiver if you know or think you might be pregnant.
  
  
• You may need a blood transfusion if you lose a large amount of blood during surgery. Some people are worried about getting AIDS, hepatitis, or the West Nile virus from a blood transfusion. The risk of this happening is very low. Blood banks test all donated blood for AIDS, hepatitis, and the West Nile virus. You may be able to donate your own blood before surgery. This is called autologous blood donation. This must be done no later than three days before surgery. You may also ask a family member or friend with the same blood type to donate blood for you. This is called directed blood donation.
  
  
• You may need to have blood and urine tests, a mammogram, chest x-ray, and other tests. A guide, such as a guidewire or marker clip, may be placed if the lump cannot be palpated (felt by hand). Areas that look different during mammography may also be marked using a needle-hookwire or blue dye injection. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your surgery:

• Remove any nail polish.
  
  
• You may be given a pill to help you sleep.
  
  
• Ask caregivers about directions for eating and drinking.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• Do not wear contact lenses on the day of your surgery. You may wear glasses.
  
  
• Caregivers will insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your surgery. Tell your caregiver if you or any member of your family has had a problem using anesthesia in the past.
  
  
• You will be asked to sign a legal piece of paper (informed consent). It gives a caregiver permission to do the procedure. If you are unable to give your consent, someone who has permission can sign this form for you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

Treatment

What will happen:

• You will be asked to change into a hospital gown. You may be given medicine to help you relax or make you drowsy. You will be taken on a cart to the operating room. Caregivers may give a general or local anesthesia to make you comfortable during surgery. Your chest and the areas surrounding the breast will be cleaned with soap and water. Sheets will be put over you to keep the surgery area clean.
  
  
• Caregivers will make an incision (cut) in your breast area. The lump together with some breast tissue will be removed. Caregivers may remove a small amount of breast tissue around the lump or as much as one fourth of your breast. Axillary (underarm) lymph nodes may be taken out to check if the cancer has spread. Thin rubber tubes will be put into your skin to drain blood from your incision. The incisions will be closed with stitches (thread) and covered with bandages.

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. An adult will need to drive you home and should stay with you for 24 hours. If you cannot go home, you will be taken to a hospital room.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your appointment on time.
  
  
• You have a fever.
  
  
• You have a skin infection or an infected wound near the area where surgery will be done.
  
  
• You have questions or concerns about your surgery.

Seek Care Immediately if

• You feel a new lump in your chest or other breast, or axilla (underarm), or see or feel other changes.
  
  
• You have discharge coming from your breast.
  
  
• You have redness, swelling, or severe pain in the breast.

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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.