Preparing for Your Operation

Preparing for your breast surgery will take time. Before your operation you may have:

• History and physical
• Blood work
• Mammography
• Clip placement to identify tumor site
• Urinalysis
• Electrocardiogram (ECG) if over age 50 or otherwise high-risk
• Health history, including information about sleep apnea, problems with anesthesia, and allergies as well as if you have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device

Ask which medications or supplements need to be stopped or changed before surgery. You should bring a list of all medications, including:

• Prescriptions
• Over-the-counter drugs (no prescription needed)
• Vitamins
• Herbs, minerals, or other supplements

Examples of what may need to be stopped up to 7 days before surgery include:

• NSAIDs like aspirin or Advil^®/Motrin^® (ibuprofen)
• Anticoagulants (blood thinners)
• Fish oil
• Vitamin E
• Herbs like garlic, ginseng, gingko biloba, and St. John's Wort (they can cause bleeding)

See the ACS Medication and Surgery information sheet.

There is a risk of blood clots after any surgery. The risk for a blood clot after breast surgery with general anesthesia and no reconstruction is low. Your risk will depend on how long your operation takes and your personal history.

Your team will place support stockings on your legs. You will be asked to walk soon after surgery to help prevent blood clots.

Smoking can increase your risk of problems by up to 40 percent during and after your operation. Quitting 4 to 6 weeks before your operation and staying smoke-free 4 weeks after it can decrease your rate of infection and wound complications. It will also decrease your risk of cancer coming back. Quitting permanently can add years to your life.

If you smoke, your surgeon may choose not to do a flap reconstruction procedure. In smokers, nearly half of these procedures fail because of low blood flow to the surgical site

Talk to your surgeon about your quit plan. Go to the Quit Plan. Additional resources are available at the American Lung Association website.

Talk with your surgeon about how to control your pain. Your pain plan will be based on your:

• Operation
• Pain history
• Current medications

Regional or local anesthesia may be an option. This is medication placed with a needle directly near the surgery site. It decreases pain and can last for several days. It can reduce the need for strong pain medication like opioids. Ask your surgeon if this is an option for you.

Download Safe and Effective Pain Control After Surgery to learn about your choices.

If you have had recent weight loss or are underweight, you may need to meet with a dietician. You may have to take some supplements.

Good blood glucose control before an operation reduces the risk of surgical site infections and promotes healing. If you are diabetic, your team will tell you how to adjust your medications before and after surgery. As many as one-third of patients having an operation have undiagnosed diabetes. Your blood glucose will be checked so it can be controlled before surgery.

Lymphedema after breast surgery is swelling in the arm, hand, breast, or torso caused by a buildup of lymph fluid. This can occur when lymph nodes are removed in surgery or damaged by radiation therapy. Exercise can improve your arm movement and decrease the risk of lymphedema. Learning and practicing the arm exercises before surgery helps you prepare. Download the Common Exercises after Breast Surgery and Exercise Log resources.

Skill: Arm Exercises

These exercises can increase your arm and shoulder mobility.

Prevention and Arm-Strengthening Exercises

Arm Stretch

1. Stand facing a wall with your toes about 6 inches from the wall.
2. Reach as high as you can and mark that point with a piece of tape.
3. Crawl your fingers up the wall to reach the tape. Keep your eyes straight and try not to arch your back.

Shoulder Stretch

1. Keep facing the wall with your toes about 6 inches from it.
2. Form a "W" with your arms out to the side and palms facing forward.
3. Bring your hands up so that they are even with your face or to the highest comfortable position.
4. Pinch your shoulder blades together and downward, as if you are squeezing an orange between your shoulder blades.

Wand Stretch

1. Hold the wand across your belly in both hands with your palms facing up.
2. Lift the wand up over your head as far as you can. Use your unaffected arm to help lift the wand until you feel a stretch in your affected arm.
3. Hold for 5 seconds.
4. Lower arms and repeat 5 to 7 times.

Repeat each of these exercises 10 times, 5 times per day.

Download the Common Exercises after Breast Surgery guide.

Refer to the Your Surgical Breast Cancer video for the training. Take time to practice. Go to the Exercise Logfor more instruction and begin these exercises before your operation.³³

Measuring Your Arm Before and After Surgery

Lymphedema can affect the breast, chest, and underarm areas. It is more common in the arm or hand on the same side as the breast cancer. Early swelling in the arm can be hard to notice. Measure your arms at several points. This can be done by your health care provider, physical therapist, you, or a family member.

Before your operation:

1. Use a plastic-coated or paper tape measure (like what a tailor or seamstress uses).
2. Measure your arm at the wrist, below the elbow, above the elbow, and below the underarm
3. Record the date, location, and measurements on the exercise guide.
4. Take regular measurements (every few days) after surgery.

Keeping You Informed

In 72 studies of 29,612 women, arm lymphedema occurred in 17 percent of breast cancer survivors.¹⁹

The risk for lymphedema ranges from 0 to 3 percent after lumpectomy and up to 65 to 70 percent after a modified radical mastectomy. Risks are greater with axillary lymph node dissection, removal of many lymph nodes, radiation and/or chemotherapy, higher body weight, in patients with diabetes, older age, and no reconstruction.

Risk also increases after an insect bite, infection, injury, or burn on the arm where the lymph nodes where removed or damaged.³⁵