Your Surgical Treatment Plan

Your appointment with the surgeon you have chosen is about discussing all aspects of your surgery. The surgeon will review your mammogram and other screening tools prior to your visit, but may still want you to have additional tests so that he or she has as much information about your cancer as possible.

After examining you, the surgeon will discuss your surgical options with you. Whenever possible, surgeons recommend breast conserving surgery; what we know as a lumpectomy.

A lumpectomy is the removal of the lump and sufficient surrounding tissue to make clear margins. Follow-up treatment for lumpectomy is radiation. A lumpectomy is usually done as an outpatient.

Don't be afraid to ask questions about the differences between lumpectomy and mastectomy  (removal of one breast) and the benefits and drawbacks of both procedures if you are unsure about opting for a lumpectomy. Take into consideration the distance you live from the treatment center, and your ability to keep a Monday through Friday schedule, for several weeks, of external beam radiation.The surgeon will take into consideration your medical history, and any conditions that might not make radiation the best choice for you.

If a mastectomy or a bilateral mastectomy (both breasts removed), is necessary, the surgeon will discuss the procedure in detail. Ask as many questions as you need to understand your procedure.

Having a breast or both breasts removed is an inpatient procedure. A hospital stay may be longer than 1-2 days if reconstruction is done on the same day as the mastectomy or bilateral mastectomy.

Every woman having one or both breasts removed has the right to know her options when it comes to reconstruction of her breast(s).

The usual person to speak to a woman about this right is the surgeon.

 If the surgeon does not ask you about reconstruction, bring it up. If you do want reconstruction, the surgeon will refer you to a plastic surgeon for an in-depth discussion of your options so you can make an educated choice about reconstruction. If you have a plastic surgeon you prefer, share this with the surgeon. Most private insurance, Medicaid and Medicare cover the cost of reconstruction. Be sure to check with your insurance company as to their coverage and confirm that the plastic surgeon you choose is part of your insurance plan.

If you are having a mastectomy or bilateral mastectomy there will be surgical drains following surgery, which will need emptying. There are camisoles that you can purchase that have pockets to hold the drain(s). Find out from the surgeon's nurse or physician's assistant where you can purchase these camisoles. I would suggest buying two, so you have a change. As a rule, cancer centers have in-house boutiques that stock all the items you will need from surgery through treatment.

If you choose not to have reconstruction, the same nurse or physician's assistant will direct you to the in-house boutique, or a shop in the community, where you can be fitted with bras and prostheses after you have healed from surgery. Most insurance companies, Medicaid and Medicare cover the cost of bras and prostheses.

If you are having a mastectomy or bi-lateral mastectomy, ask the physician’s assistant or nurse if the facility where you are having surgery has a registry that can provide private duty coverage overnight, if you choose to pay for it. Having someone there, just for you, when you are on an IV, in pain, and unable to get out of bed to use the bathroom unassisted, can make all the difference in your comfort level.

Should the surgeon feel that shrinking your tumor before surgery is necessary, you may have chemotherapy before having surgery. The surgeon will refer you to a medical oncologist who will be responsible for your chemotherapy. Once the surgeon and the oncologist feel your tumor has shrunk sufficiently, the surgeon will proceed with surgery.

A  few days before your surgery, you will be scheduled for preoperative testing, including, but not limited to, lab work, and a chest X-ray.

Jean Campbell is a 2x breast cancer survivor and the former founding director of the American Cancer Society New York City Patient Navigator Program in 14 public and private hospitals.She is executive director ofa nonprofit organization providing research and resource information and support to women and men newly diagnosed with breast cancer.

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