Survey
* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project
Download Getting Ready for Tissue Expansion Reconstruction Surgery
Transcript
Getting Ready for Tissue Expansion Reconstruction Surgery DeeApril 2016 Royal Jubilee Hospital Victoria General Hospital Getting Ready for Tissue Expansion Breast Reconstruction Surgery About this booklet This booklet was originally developed by Cathy Parker, R.N., Breast Health Patient Navigator, Victoria Breast Health Centre, with input from nurses, physiotherapists, surgeons, community partners and people who have had surgery for breast cancer. We welcome comments about this booklet. Please contact the Victoria Breast Health Centre at 250-727-4467 or [email protected] with your comments or suggestions. Copies of this booklet can be ordered from the Vancouver Island Health Authority (VIHA) Regional Printing Services by faxing a Printing requisition to 250-519-5332, indicating the title of the booklet, number of copies required, cost centre number and shipping instructions. Getting Ready for Tissue Expansion Breast Reconstruction Surgery Table of Contents 1 Introduction ...................................................................................... 1 2 Before Surgery .................................................................................. 2 Surgery time and place .................................................................................................... 2 Pre-operative physical ...................................................................................................... 2 Taking part in research .................................................................................................... 2 Hospital pre-admission clinic appointment ............................................................. 2 Length of stay ...................................................................................................................... 3 Help at home ....................................................................................................................... 3 Results from surgery ......................................................................................................... 3 3 Getting Ready For Surgery .............................................................. 4 Preparing your skin ........................................................................................................... 4 How to use Chlorhexidine sponges ............................................................................ 4 Food and fluid restrictions .............................................................................................. 5 Medications .......................................................................................................................... 5 Smoking ................................................................................................................................. 6 Packing for the hospital ................................................................................................... 6 4 Coming to Hospital .......................................................................... 7 Surgical admission ............................................................................................................. 7 Sentinel node biopsy ........................................................................................................ 8 5 Being in Hospital .............................................................................. 9 What to expect after surgery ......................................................................................... 9 Activity .................................................................................................................................. 10 Dressings and drains....................................................................................................... 10 Getting dressed................................................................................................................. 11 Hospital discharge ........................................................................................................... 11 i Getting Ready for Tissue Expansion Breast Reconstruction Surgery 6 At Home after Surgery................................................................... 12 Effects of surgery.............................................................................................................. 12 What to do.......................................................................................................................... 13 What not to do.................................................................................................................. 13 Driving .................................................................................................................................. 14 Incision care ....................................................................................................................... 14 Bathing ................................................................................................................................. 14 About drains....................................................................................................................... 15 Drain care.............. .............................................................................................................. 16 When to call your surgeon ........................................................................................... 19 7 Follow-up after Surgery................................................................. 20 Follow-up with your surgeon(s).................................................................................. 20 Expanding the tissue ....................................................................................................... 20 Going back to work ......................................................................................................... 20 When further treatment is needed............................................................................ 21 New patient orientation sessions............................................................................... 21 8 Road to Recovery ........................................................................... 22 Physical recovery .............................................................................................................. 22 Emotional support ........................................................................................................... 24 9 Post-Reconstruction ....................................................................... 25 Breast self-examination and mammography ........................................................ 25 Removing the tissue expander.................................................................................... 25 Nipple and areola reconstruction .............................................................................. 25 Donating your prosthesis.............................................................................................. 26 Sexuality............................................................................................................................... 26 Evaluation.....................................................................................29-30 Royal Jubilee Hospital Site and Parking Map ii Getting Ready for Tissue Expansion Breast Reconstruction Surgery 1 1 2 Table of Contents Introduction Introduction ...................................................................................... 1 This booklet is designed to help you prepare for breast surgery. If you are having surgery to your Beforeaxilla Surgery .................................................................................. 2 (underarm), you will receive a breast pillow for Surgerycomfort time and place .................................................................................................... 2 after surgery. Bring this booklet and your breast pillow with you when you go to the hospital. Pre-operative physical ...................................................................................................... 2 Taking part in research .................................................................................................... 2 Breast Information Kit HospitalCancer pre-admission clinic appointment ............................................................. 2 LengthThis of stay ...................................................................................................................... booklet complements the Breast Cancer Information Kit. The kit is3 on line at www.bccancer.bc.ca/breastkit The kit will help you3 Help atavailable home ....................................................................................................................... learn more about breast cancer and the treatments available to you. The Results from surgery ......................................................................................................... 3 kits include: 3 Breast cancer Companion Guide Nutrition Guide for Women with Breast Cancer Preparing your skin ........................................................................................................... 4 Pamphlets: After breast Cancer Treatment-What Next? Getting Ready For Surgery .............................................................. 4 How to use Chlorhexidine sponges ............................................................................ 4 My Partner has Breast Cancer-How Can I Help? Food and fluid restrictions .............................................................................................. 5 Exercises After Breast Surgery, A Guide for Women Medications .......................................................................................................................... 5 The Intelligent Patient Guide to Breast Cancer, 5th Ed. Smoking ................................................................................................................................. 6 PackingHealth for the hospital 6 Breast Patient................................................................................................... Navigators 4 Breast Health Patient Navigators are registered nurses with expertise in Coming to Hospital 7 breast health and.......................................................................... breast cancer surgery. They assist patients and families ensuring they receive information and support. The navigators sent7 Surgicalbyadmission ............................................................................................................. you this booklet and breast pillow. Sentinel node biopsy ........................................................................................................ 8 5 If you are newly diagnosed with breast cancer and you have not already in contact with the Breast Health Patient Navigators you will receive Being been in Hospital .............................................................................. 9 three telephone calls: What to expect after surgery ......................................................................................... 9 The first call will be before your surgery Activity .................................................................................................................................. 10 The second call will be a few days after your surgery Dressings and drains....................................................................................................... 10 The third call will be after your post-operative visit with your Getting dressed................................................................................................................. 11 surgeon. Hospital discharge ........................................................................................................... 11 The navigators recognize that people are unique and understand that individuals vary greatly in their need for information and support. You are welcome to call a Breast Health Patient Navigator at the Victoria Breast Health Centre (250-727-4467) as little or as frequently as you wish! 1 i Getting Ready for Tissue Expansion Breast Reconstruction Surgery 2 Table of Contents 1 Before Surgery Introduction ...................................................................................... 1 Surgery time and place 2 Before Surgery .................................................................................. 2 office will phone you or SurgeryYour timesurgeon’s and place .................................................................................................... 2 Contact your surgeon’s send your surgery time and place Pre-operative physical ...................................................................................................... 2 office at once if you are information by mail. Most tissue not feeling well, or Taking expansion part in research .................................................................................................... 2 reconstructive breast surgery have a cough, cold or 2 Hospital pre-admission clinic takes between one and appointment three hours, ............................................................. fever the week before 3 on if one or both breasts are Length depending of stay ...................................................................................................................... your surgery date. Help atbeing homereconstructed. ....................................................................................................................... 3 Results from surgery ......................................................................................................... 3 Pre-operative physical 3 Getting Ready For Surgery(or .............................................................. 4 Arrange a pre-operative pre-op) physical with your family doctor as early as three months before the surgery date but no later than one 4 Preparing your skin ........................................................................................................... week before the surgery date. How to use Chlorhexidine sponges ............................................................................ 4 Food and fluid restrictions .............................................................................................. 5 Taking part in research Medications .......................................................................................................................... 5 Smoking ................................................................................................................................. If you are newly diagnosed with breast cancer, your surgeon may ask if6 to donate tissue from your surgery to the Tumour Tissue Packingyou forwish the hospital ................................................................................................... 6 4 Repository (TTR) at the Vancouver Island Cancer Centre. If you are interested, your name will be forwarded to the TTR nurse, who will Coming to Hospital contact you with .......................................................................... more information or you may contact the TTR nurse 7 Surgicaldirectly admission ............................................................................................................. 7 at 250-519-5713. Sentinel node biopsy ........................................................................................................ 8 Hospital pre-admission clinic appointment 5 Being The in Hospital .............................................................................. 9 hospital will phone you within one week of your surgery date to What toarrange expectaafter surgery ......................................................................................... 9 pre-admission clinic appointment. This appointment is usually pre-operative blood tests, etc. are done. Some people do not need Activitywhen .................................................................................................................................. 10 to come in for ....................................................................................................... a visit if all of the necessary information can be obtained Dressings and drains 10 over the phone. Getting dressed................................................................................................................. 11 Hospital discharge ........................................................................................................... 11 2 i Getting Breast yregruSReady noitcufor rtsnTissue oceR tExpansion saerB noisn apxE eReconstruction ussiT rof ydaeRSurgery gnitteG Length of stay Table stnetnof oCContents fo elbaT 11 ........Introduction 11 for .....................The ....................................................................................... .....usual ........length ..........of ....stay .......after .......tissue ............... nRemember oitcudortnto I arrange a ride to and from the expansion surgery is one to two 22 ........Before 22 ............Surgery .........nights. ....................................................................................... .....Discharge ...............time .......is ...usually ...........9...a.m. .... yreghospital! ruS erofeB 2 2 ...........Surgery .................time ..........and .........place ............................................................................................................... .......................................... ecalp dna emit yregruS Help 2 2 ..........at .Pre-operative .......home .....................physical ....................................................................................................................... .............................................. lacisyhp evitarepo-erP 2 2 ...........Taking ..............part ..........in ....You .research ........will .......need ....................................................................................................... ........help ..........with .........household ............... hcraeser ni trap gnikaT 2 to weeks 2 ...........Hospital ..................pre-admission ..........chores ..............for ......clinic .a. tfew nemappointment tnioppafter a cinil............................................................. c noissimdaIf-eitrpisladifficult tipsoH for you and 3 you 3 ...........Length ...............of .....stay ........mastectomy ....................................................................................................................... ........................and/or ..............axillary ..............dissection. .......................... yleave ats foyour htgnhome, eL do not have someone Please refer to the Breast Cancer 3 to 3 ...........Help ..........at ......home ................................................................................................................................... ................................................................................ emoh ta pleH Companion Guide, Section 3: Coping help you care for your 3 3 ...........Results ...............from ...........surgery ..with .........Cancer .............................................................................................................. ..........for ......useful .............information ....................... yregrus morf stluseR incision(s) or drain(s), about: please discuss this with 34 ........Getting 43 ..............Ready ............For .Travel .....Surgery ...and .......transportation .................................................................. ........ yregroptions uS roF ydyour aeR gnurse nittebefore G 4 ...........Preparing .....................your ..........skin ....Accommodation ................................................................................................................ ........................................................ niks rudischarge oy gnirapefrom rP the4 ............................................................................ 4 4 ...........How ..........to ......use ........Chlorhexidine ...........Financial ..................sponges ............ seg nops enidixehrolhhospital. C esu ot woH assistance. 5 5 ...........Food ...........and .........fluid ........The ..restrictions ......Breast .............Cancer .................................................................................................. ...........Companion ................... snGuide oitcirtser diulf dna dooF 5 5 ...........Medications ................................................................................................................................................... ...is ....included ..................in ....your ..........Breast ..............Cancer ..............Information ................... snKit. oitacideM 6 6 ...........Smoking ................................................................................................................................................... .................................................................................................... gnikomS 6 6 ...........Packing .................for .......the .......hospital .................................................................................................................... ........................................ latipsoh eht rof gnikcaP Results from surgery 47 ........Coming 74 ..............to .....Hospital ......................................................................................... ........................Final ........pathology latipsoHresults ot gnwill imonot C be known for 7 your 7 ...........Surgical .................admission .................................................................................................................................. .........................................ten .......to .....fourteen ....... noissidays mdaafter lacigsurgery. ruS Call 8 a post8 ...........Sentinel .................node ............biopsy ...................................................................................................................... ....................................surgeon’s .............. yspoffice oib eafter don lsurgery enitneSto book operative visit to review your pathology results. 59 ........Being 95 ...........in ....Hospital ............................................................................................. ........................................ latipsoH ni gnieB 9 9 ...........What ............to .....expect ...............after ..........surgery ......................................................................................................... .................... yregrus retfa tcepxe ot tahW 10 01 .........Activity ................................................................................................................................................. .......................................................................................................... ytivitcA 10 01 .........Dressings ....................and .........drains .................................................................................................................... ....................................................sniard dna sgnisserD 11 11 .........Getting ................dressed................................................................................................................. ........................................................................................desserd gnitteG 11 11 .........Hospital ..................discharge ............................................................................................................................... ............................................................ egrahcsid latipsoH 3 ii Getting Ready for Tissue Expansion Breast Reconstruction Surgery 3 1 Table of Contents Getting Ready For Surgery Introduction ...................................................................................... 1 Preparing your skin 2 3 Before Surgery .................................................................................. 2 notand shave under your arm for at least SurgeryDo time place .................................................................................................... 2 You can purchase two days before surgery. Pre-operative physical ...................................................................................................... 2 Chlorhexidine 4% two Chlorhexidine 4% scrub Taking Purchase part in research .................................................................................................... 2 scrub sponges at: sponges. Use the sponges as directed Wal-Mart Hospital pre-admission clinic appointment ............................................................. 2 below to bathe or shower the night Save-On Foods Length of stay ...................................................................................................................... 3 before AND on the morning of your Hospital gift shops3 Help atsurgery. home ....................................................................................................................... Some pharmacies 3 Results from surgery ......................................................................................................... This pre-surgery skin preparation (call to confirm) procedure helps to: Getting For Surgery 4 Ready Remove germs on the.............................................................. skin Preparing skininfection ........................................................................................................... 4 your Prevent How tousePromote Chlorhexidine wound sponges healing. ............................................................................ 4 Food and fluid restrictions .............................................................................................. 5 .......................................................................................................................... 5 How to useMedications Chlorhexidine sponges 4 5 Smoking ................................................................................................................................. 6 The evening before surgery: Packing for the hospital ................................................................................................... 6 Wash your entire body and hair with your usual soap and shampoo Rinse Coming Hospital .......................................................................... 7 to Open one surgical sponge and squeeze to produce lather Surgical admission ............................................................................................................. 7 Wash body from neck to feet Sentinel node biopsy ........................................................................................................ 8 Do not wash your head, hair or face with the surgical sponge Carefully clean the surgical area, navel (belly button), under arms, Being in Hospital and back .............................................................................. 9 What to expect ......................................................................................... 9 Then after clean surgery your feet and between your toes Activity.................................................................................................................................. 10 Clean your genital and anal areas last Dressings drains ....................................................................................................... 10 and Do not rinse for 5 minutes, then rinse well. Gettingdressed................................................................................................................. 11 Do not apply deodorant, body lotion or powder afterwards. HospitalThe discharge 11 morning........................................................................................................... of surgery: Repeat the above with the second surgical sponge. 4 i Getting Breast yregruSReady noitcufor rtsnTissue oceR tExpansion saerB noisn apxE eReconstruction ussiT rof ydaeRSurgery gnitteG Table stnetnof oCContents fo elbaT Food and fluid restrictions before surgery. 11 ........Introduction 11 fluids ....NO ......SOLID ...........FOOD ....................................................................................... .........after .........midnight ...............on .....the ......evening ............ n oitcud ortnI Clear are permitted until three hours before your scheduled surgery time. 22 ........Before 22 ....Clear ........Surgery .fluids .........include: ...................................................................................... ................................................ yregruS erofeB Water Popsicle Black coffee 2 2 ...........Surgery .................time ..........and .........place ............................................................................................................... .......................................... ecalp dna emit yregruS Clear tea Jell-O Clear apple juice 2 2 ...........Pre-operative ............................physical ....................................................................................................................... .............................................. lacisyhp evitarepo-erP Carbonated drinks (pop) 2 2 ...........Taking ..............part ..........in .....research ...................................................................................................................... .......................................... hcraeser ni trap gnikaT 2 2 ...........Hospital ..................pre-admission ..............................clinic .. tnemappointment tnioppa cinil............................................................. c noissimda-erp latipsoH 3 3 ...........Length ...............of .....stay ............................................................................................................................... .............................................................................. yats fo htgneL Clear fluids DO NOT include: 3 3 ...........Help ..........at ......home ................................................................................................................................... ................................................................................ emoh ta pleH Milk, non-dairy creamer, protein beverages, or tomato juice 3 3 ...........Results ...............from ...........surgery ......................................................................................................................... .................................................... yregrus morf stluseR Alcoholic beverages. 34 ........Getting 43 ..............Ready ............For ......Surgery ............................................................................ ........ yregruS roF ydaeR gnitteG 4 4 ...........Preparing .....................your ..........skin .................................................................................................................... ........................................................ niks ruoy gniraperP Medications ............................................................................ 4 4 ...........How ..........to ......use ........Chlorhexidine .............................sponges ............ seg nops enidixehrolhC esu ot woH Take all prescribed medications as usual unless told not to by your 5 5 ...........Food ...........and .........fluid ..........restrictions ..................................................................................................................... .............................. snoitcirtser diulf dna dooF anesthesiologist, surgeon, hospital pharmacist or other specialist. 5 5 ...........Medications ................................................................................................................................................... ...................................................................................... snoitacideM 6 6 ...........Smoking ......Discuss ............................................................................................................................................. ....your ...........medications ...........................with ..........your ...........doctor ...............at ......least ...........10 ..... gdays nikobefore mS surgery. 6 6 ...........Packing ......This .........is ..for ...especially ....the .......hospital ..........important .......................................................................................................... ................if....you .........take ..........medication . latipsoh ehtfor: rof gnikcaP Diabetes e.g. Chlorpropamide, Glyburide, Metformin, Insulin 47 ........Coming 74 ..............to .....Hospital ......Blood ................................................................................... ..Thinners ..............e.g. ......Coumadin .......... latip(Warfarin), soH ot gnHeparin imoC 7 7 ...........Surgical .................admission .................Antiplatelet ................................................................................................................. ......................medications ............................e.g. .........Clopidogrel . noissimda la(Plavix), cigruS Ticlid, Acetylsalicylic Acid (ASA, Aspirin). 8 8 ...........Sentinel .................node ............biopsy ...................................................................................................................... .................................................. yspoib edon lenitneS 7 days before surgery, stop taking Vitamin E and all natural health products 59 ........Being 95 ....and .......in ....Hospital .......remedies ...................................................................................... .......e.g. ......Garlic, ...........Gingko, .............Kava, ... latiSt. pso H niWort, gnieB herbal John Ginseng, Don 9 9 ...........What ......Quai, ......to .....expect .Glucosamine, ..............after ..........surgery .....Papaya .................................................................................................... ......etc. .............. yregrus retfa tcepxe ot tahW 10 day of 01 .........Activity ......Regular ........................................................................................................................................... ........vitamins ...................and .........iron ..........supplements ............................can .........usually ...............be .......taken . ytivitcuntil A the 10 01 .........Dressings ......surgery. ..............and .........drains .................................................................................................................... ....................................................sniard dna sgnisserD 11 11 .........Getting ................dressed................................................................................................................. ........................................................................................desserd gnitteG up to and 11 11 .........Hospital ......Acetominophen ............discharge ............................................................................................................................... ...e.g. ........Tylenol .................for .......pain ..........may ...........be .... etaken grahcswhen id latinecessary psoH including the day of surgery. You may take allowed medications with 30 ml (1 oz) of water per pill up to one hour before surgery. 5 ii Getting Ready for Tissue Expansion Breast Reconstruction Surgery Smoking Table of Contents 1 Introduction ...................................................................................... 1 2 Before .................................................................................. 2 Do Surgery not smoke for twelve hours before surgery. Smoking increases your risk of serious complications. Surgery time and place .................................................................................................... 2 If your surgery is planned in advance, plan to stop smoking at least two 2 Pre-operative physical ...................................................................................................... months before your scheduled surgery date. Talk to your family doctor Taking part in research .................................................................................................... 2 for help to quit smoking. If you are in the process of quitting on your Hospital pre-admission clinic appointment ............................................................. 2 surgery date, Nicoderm patches are a better option than smoking. Length of stay ...................................................................................................................... 3 home ....................................................................................................................... 3 Packing for Help the athospital Results from surgery ......................................................................................................... 3 What to bring 3 Getting Ready For Surgery .............................................................. 4 Your B.C. care card or proof of substitute Medical Insurance Plan, or Preparing your skinof........................................................................................................... 4 some form personal identification Howto This use Chlorhexidine sponges ............................................................................ 4 booklet Food and fluid restrictions .............................................................................................. 5 Your breast pillow(s) (if you are having lymph nodes removed) Medications 5 List of.......................................................................................................................... allergies and hypersensitivities, medications and vitamins Smoking ................................................................................................................................. Eyeglasses/contacts , hearing aids and dentures with storage case 6 with your name Packinglabelled for the hospital ................................................................................................... 6 4 5 Bring your CPAP, Bi-level machines or dental device if you use one (even for day surgery) Comingfortosleep Hospital .......................................................................... 7 Aadmission small bag............................................................................................................. with personal hygiene items such as toothbrush, Surgical 7 toothpaste and comb Sentinel node biopsy ........................................................................................................ 8 Slippers A front closure top to wear home from the hospital. Being in Hospital .............................................................................. 9 What to expect after surgery ......................................................................................... 9 What not to bring or wear: Activity .................................................................................................................................. 10 or ....................................................................................................... body piercing items Dressings and drains 10 Jewellery Personal items such as money, valuables, credit cards Getting dressed................................................................................................................. 11 Make-up, perfume, deodorant or talcum powder. Hospital discharge ........................................................................................................... 11 6 i Getting Breast yregruSReady noitcufor rtsnTissue oceR tExpansion saerB noisn apxE eReconstruction ussiT rof ydaeRSurgery gnitteG 4 Table stnetnof oCContents fo elbaT Coming to Hospital 11 ........Introduction 11 ............................................................................................................ ........................................................ noitcudortnI You will be admitted to hospital on the day of your surgery. Your surgeon’s office will tell you: 22 ........Before .................................................................................. 22 ............Surgery ..............Which ..........hospital ............to ....go .....to ................. yregruS erofeB 2 2 ...........Surgery .................time ..........and ........The .place ........date ....................................................................................................... ......and .........time ..........of .....your ..........surgery .. ecalp dna emit yregruS physical 2 2 ...........Pre-operative ............................ .......The .........hospital ....................................................................................................... ...............admission .....................time .......... lacisyhp evitarepo-erP 2 2 ...........Taking ..............part ..........in .....research ......Your ...........probable ..................................................................................................... .................length ..............of .....stay. ...... hcraeser ni trap gnikaT 2 2 ...........Hospital ..................pre-admission ..............................clinic .. tnemappointment tnioppa cinil............................................................. c noissimda-erp latipsoH 3 3 ...........Length .........admission ......of .....stay ............................................................................................................................... .............................................................................. yats fo htgneL Surgical 3 3 ...........Help ..........at ......home ................................................................................................................................... ................................................................................ emoh ta pleH Check in at the front desk. You will be 3 3 ...........Results ...............from ...........surgery ......................................................................................................................... .................................................... yregrus mPre-op orf stlusSupport eR directed to the surgical admission area to: One family member or 34 ........Getting 43 ..............Ready ............For ......Surgery ......into .......a............................................................... .hospital ....... yregown gruS roF ydaefriend R gnitcan teGstay with Change you 4 to 4 ...........Preparing .....................your ..........skin ....Sign ................................................................................................................ .....your ..........Consent .................for .......Surgery ................form . niks ruountil y gniryou aperare P taken ............................................................................ 4 4 ...........How ..........to ......use ........Chlorhexidine ...........(if .....you .........have ....sponges ......not ...... salready eg nopsdone enidso) ixehrolhC the esu operating ot woH room. 5 with 5 ...........Food ...........and .........fluid ..........restrictions .....Receive ................pre-operative ................................................................................................ ..........................medications .... snoitcirtser diuProvide lf dna dothe oF nurse 5 or 5 ...........Medications ................................................................................................................................................... ..........and .........have ..........an ......intravenous ........................started. ........................... syour noitafamily cideM member number 6 6 ...........Smoking ................................................................................................................................................... ..........Before ..............going ............to ......the .......operating ....................room, ..........................friend’s ..... gnikocontact mS 6can call 6 ...........Packing .................for .......the ....you ...hospital ......will .......be ....................................................................................................... ..asked .............to: ......................... latipsoh eht so rofyour gnikcsurgeon aP them when your Empty your bladder Remove your glasses/contact lenses operation is over. 47 ........Coming 74 ..............to .....Hospital ......................................................................................... ................................ latipsoH ot gnimoC and/or dentures (these items will be 7 7 ...........Surgical .................admission .................................................................................................................................. ............................................................ noissimda lacigruS kept with your belongings). 8 8 ...........Sentinel .................node ............biopsy ...................................................................................................................... .................................................. yspoib edon lenitneS When the operating room is ready, you will be brought in on a stretcher. After surgery you will be taken to the recovery room. Recovery takes two 59 ........Being 95 there. ...........in ....Hospital ......to ....three ................................................................................... ...hours. ..........Your .......surgeon .............and ......anesthesiologist . latipsoH ni gmay nieBvisit you 9 9 ...........What ............to .....expect ...............after ..........surgery ......................................................................................................... .................... yregrus retfa tcepxe ot tahW 10 01 .........Activity ................................................................................................................................................. .......................................................................................................... ytivitcA 10 01 .........Dressings ....................and .........drains .................................................................................................................... ....................................................sniard dna sgnisserD 11 11 .........Getting ................dressed................................................................................................................. ........................................................................................desserd gnitteG 11 11 .........Hospital ..................discharge ............................................................................................................................... ............................................................ egrahcsid latipsoH 7 ii Getting Ready for Tissue Expansion Breast Reconstruction Surgery Sentinel node biopsy 1 2 Table of Contents Introduction ...................................................................................... 1 Sentinel node biopsy maps the For more detailed underarm (axillary) lymph nodes closest information, refer to 2 BeforetoSurgery .................................................................................. the cancer site. If you are booked for pages 112-114 in the 2 procedure you will be asked to go Surgerythis time and place .................................................................................................... book The Intelligent to the Nuclear department at Pre-operative physicalMedicine ...................................................................................................... 2 the hospital on the morning of surgery, Patient Guide in the Taking part in research .................................................................................................... 2 or sometimes the day before. Your Breast Cancer Information Hospital pre-admission clinic appointment ............................................................. 2 surgeon’s office will tell you the time Kit. Lengthand of stay ...................................................................................................................... 3 which hospital to go to. Help atSentinel home ....................................................................................................................... 3 node biopsy is a two-part - 3 4 5 Resultsprocedure: from surgery ......................................................................................................... 3 Possible side effects 1. Tracing Agent Getting Ready For .............................................................. A radiologist willSurgery inject a radioactive The blue dye injection 4 tracing into the breast. You may Preparing youragent skin ........................................................................................................... may cause urine and 4 feel pressure. You will be told to How to use Chlorhexidine sponges ............................................................................ stools to appear bright 4 massage the area and to pump your blue or green and your 5 Food and fluid restrictions .............................................................................................. arm up and down to help spread the skin and area around the Medications .......................................................................................................................... 5 tracing agent to the lymph nodes under incision line may appear6 Smoking ................................................................................................................................. the arm. bluish in colour. These 6 Packing2.for the hospital ................................................................................................... Dye effects are normal and Once you are in the operating room and will fade within a few youto are asleep, your surgeon may inject Coming Hospital .......................................................................... 7 days. a blue dye (Isosulfan Blue/ Surgical admission ............................................................................................................. 7 Lymphazuran) into the breast if needed Sentineltonode biopsy ........................................................................................................ 8 help visualize the lymph nodes. Being in Hospital .............................................................................. 9 What to expect after surgery ......................................................................................... 9 Activity .................................................................................................................................. 10 Dressings and drains....................................................................................................... 10 Getting dressed................................................................................................................. 11 Hospital discharge ........................................................................................................... 11 8 i Getting Breast yregruSReady noitcufor rtsnTissue oceR tExpansion saerB noisn apxE eReconstruction ussiT rof ydaeRSurgery gnitteG 5 Table stnetnof oCContents fo elbaT Being in Hospital 11 ........Introduction 11 ............................................................................................................ ........................................................ noitcudortnI What to expect after surgery 22 ........Before 22 ............Surgery ................................................................................................ ................................................ yreVisitors gruS erofeB 2 2 ...........Surgery ...........Recovery ......time ..........and .......room ..place ............................................................................................................... .......................................... ecalp dna emit yregruS Most units have flexible 2 2 ...........Pre-operative ............................physical ....................................................................................................................... .............................................. lacisyhp evitarepo-erP visiting hours. Please ask After surgery you will be moved to 2 2 ...........Taking ..............part ..........in ....the .research ......recovery ................................................................................................................ ......room. .............The ........recovery ............... hcraeser ni trap gnikaT family and friends to: 2 ...........Hospital ..................pre-admission ..........room ............nurses ........clinic .. tnwill emappointment tnioppyou a cinclosely il............................................................. c noisassimda-eKeep rp lativisits psoH short2 watch 3 3 ...........Length ...............of .....stay ........you ....................................................................................................................... .......recover ................from ..........the ........anaesthesia ........................and ............. yatLimit s fo htthe gnenumber L of give you medication for pain and Help at home ....................................................................................................................... 3 3 ....................................................................................................................... emvisitors oh ta pat leHone time nausea as needed. When you are 3 3 ...........Results ...............from ...........surgery ......................................................................................................................... .................................................... yregrus mRespect orf stluse R concerns the of stable, you will be moved to a nursing the nurses unit. asked. 34 ........Getting ..............Ready ............For ......Surgery ............................................................................ ........ yregruS roF ydaeEnd R gnvisits itteGwhen 4 3 4 4 ...........Preparing ...........Pain ..........your ..........skin .................................................................................................................... ........................................................ niks ruoy gniraperP ............................................................................ 4 4 ...........How ..........to ......use ........Chlorhexidine .............................sponges ............ seg nops enidixehrolhC esu ot woH You may experience pain and/or a sensation of tightness around the 5 your 5 ...........Food ...........and .........fluid ........mastectomy ..restrictions ..................................................................................................................... .........If...your ..........lymph ........ snonodes itcirtswere er diuremoved lf dna dofrom oF under site. 5 inner 5 ...........Medications ................................................................................................................................................... ...arm, ..........you ........may .........also .........experience ......................some ............numbness ............. snoiin tathe cideupper M and 6 6 ...........Smoking ................................................................................................................................................... ..........arm. ..........These ............sensations ......................will .......decrease ..................as ......time .........passes, ...... gnikbut omSmay linger indefinitely. 6 6 ...........Packing .................for .......the .......hospital .................................................................................................................... ........................................ latipsoh eht rof gnikcaP Some women find the surgery painful while others experience mild feelings of discomfort. You will be prescribed pain medication7based on 47 ........Coming ..............to .....Hospital ......................................................................................... ................................ latipsoH ot gnimoC 4 your individual needs. 7 7 ...........Surgical .................admission .................................................................................................................................. ............................................................ noissimda lacigruS 8 8 ...........Sentinel ...........Fluids ......node ..........and ..biopsy .........diet ............................................................................................................. .................................................. yspoib edon lenitneS Your IV will be removed as soon as you are drinking enough fluids. You 59 ........Being 95 ...........in ....Hospital ......will .....be .................................................................................. .given ........something .................to ....eat .....when ..... layou tipsare oHready. ni gnieB 9 9 ...........What ............to .....expect ...............after ..........surgery ......................................................................................................... .................... yregrus retfa tcepxe ot tahW 10 01 .........Activity ...........Constipation ...................................................................................................................................... .......................................................................................................... ytivitcA 10 01 .........Dressings ....................and ........It.drains ...is....important ............................................................................................................. ..............to ......establish ..................a...good ...........sbowel niard pattern dna sgnprior isserD to admission 11 11 .........Getting ................dressed................................................................................................................. ............because .................pain ..........medication ......................and .........limited ..............activity ....dessecan rd glead nitteto G constipation. 11 the 11 .........Hospital ..................discharge ..........The ........sooner ............................................................................................................. .............you ........resume ................your ..........regular ............. edaily grahdiet csidand latipactivity soH level, sooner this problem should dissipate. Occasionally laxatives such as Senokot or Metamucil can also help. 9 ii Getting Ready for Tissue Expansion Breast Reconstruction Surgery Activity 1 2 3 Table of Contents Introduction ...................................................................................... 1 Most people are able to resume their For 24 hours after normal activities within six to eight surgery DO NOT: Your.................................................................................. general health, the extent Beforeweeks. Surgery 2 the surgery and your commitment Make major decisions 2or Surgeryoftime and place .................................................................................................... to your exercise prescription all sign documents Pre-operative physical ...................................................................................................... 2 influence your recovery. Drive or work with Taking part in research .................................................................................................... 2 During your hospital stay, a machinery Hospital pre-admission clinic appointment ............................................................. 2 physiotherapist will assist you to get Take Aspirin – it can Length of stay ...................................................................................................................... 3 up and to do the exercises cause bleeding Help atrecommended home ....................................................................................................................... 3 for you. Take tranquilizers or Results from surgery ......................................................................................................... 3 Starting the first day post-op: sleeping pills Drink alcohol Avoid using either arm to push or Getting Ready For Surgery .............................................................. 4 pull your body Look after babies, small Preparing skin arms ........................................................................................................... children or frail elderly.4 your Use both as normally as within the limits of pain How to usepossible Chlorhexidine sponges ............................................................................ 4 and pulling on the incision Food and fluid restrictions .............................................................................................. 5 Use your arms for activities such as washing your face, combing your Medications .......................................................................................................................... 5 hair and eating meals. Smoking ................................................................................................................................. 6 Packing for the hospital ................................................................................................... 6 Dressings and drains 4 5 Your be changed as directed by your doctor. At first the Coming todressing(s) Hospital will .......................................................................... 7 breast will be smaller than your natural breast because 7the Surgicalreconstructed admission ............................................................................................................. expander is only partially filled with saline when it is placed in position. Sentinel node biopsy ........................................................................................................ 8 Your nurse will show you how to change your dressings before you are discharged. Being You in Hospital 9 may have .............................................................................. one or more drainage tubes to collect normal blood and What to expect ......................................................................................... fluids thatafter drainsurgery when tissue is cut. The drains are often left in place 9 you go home. Your nurse will show you how to measure, clean,10 Activitywhen .................................................................................................................................. and unclog your drain(s) before you are discharged. (See pages 15-1710for Dressings and drains ....................................................................................................... detailed instructions). Getting dressed................................................................................................................. 11 Hospital discharge ........................................................................................................... 11 10 i Getting Breast yregruSReady noitcufor rtsnTissue oceR tExpansion saerB noisn apxE eReconstruction ussiT rof ydaeRSurgery gnitteG Getting dressed Table stnetnof oCContents fo elbaT 11 ........Introduction 11 ....................When ........................................................................................ ........you ......get .....dressed, .............put ......the .....arm .......on ....the .. nosame itcud ortas nIthe surgery side into the shirtsleeve first. In the case of surgery to both breasts, choose what is 22 ........Before 22 ............Surgery ........most ........................................................................................ ..comfortable ...................for .....you. ...................... yregruS erofeB 2 When the 2 ...........Surgery .................time ..........and .........place ....undressing, ........................................................................................................... ................it ....will ........be ......easier ........ ecto alpremove dna em it yarm regron uSthe un-operated side first, and then remove the arm on the operated side from 2the shirt 2 ...........Pre-operative ............................physical ....................................................................................................................... .............................................. lacisyhp evitarepo-erP sleeve last..................................................................................................... 2 2 ...........Taking ..............part ..........in .....research ............................................................ hcraeser ni trap gnikaT 2 2 ...........Hospital ...........What .......pre-admission .......to .......wear ..............after ..clinic .. tnemappointment tnioppa cinil............................................................. c noissimda-erp latipsoH surgery 3 3 ...........Length ...............of .....stay ............................................................................................................................... .............................................................................. yats fo htgneL Wear a loose comfortable bra as soon as all the incisions are completely 3 3 ...........Help ..........at ......home ................................................................................................................................... ................................................................................ emoh ta pleH healed. Avoid wearing bras that are tight or have underwire. 3 3 ...........Results ...............from ...........surgery ......................................................................................................................... .................................................... yregrus morf stluseR Hospital discharge 34 ........Getting 43 ..............Ready ............For ......Surgery ............................................................................ ........ yregruS roF ydaeR gnitteG 4 told 4 ...........Preparing .....................your ......Discharge ....skin .................................................................................................................... ........is....usually ..............9....a.m. .........Your ..........family ....... nikmember s ruoy gor nirfriend aperP will be when to pick you up. Before you leave the hospital your nurse 4will: ............................................................................ 4 ...........How ..........to ......use ........Chlorhexidine .............................sponges ............ seg nops enidixehrolhC esu ot woH .....Review your care instructions with you 5 5 ...........Food ...........and .........fluid ..........restrictions ................................................................................................................ .............................. snoitcirtser diulf dna dooF Change your dressing(s) 5 5 ...........Medications ................................................................................................................................................... ...................................................................................... snoitacideM Provide you with a few dressings to take home; you may need 6 to 6 ...........Smoking ................................................................................................................................................... .................................................................................................... gnikomS purchase more 6 6 ...........Packing .................for .......the .......hospital .................................................................................................................... ........................................ latipsoh eht rof gnikcaP Provide a container for measuring the contents of your drain(s). 47 ........Coming 74 ..............to .....Hospital ......................................................................................... ................................ latipsoH ot gnimoC 7 7 ...........Surgical .................admission .................................................................................................................................. ............................................................ noissimda lacigruS 8 8 ...........Sentinel .................node ............biopsy ...................................................................................................................... .................................................. yspoib edon lenitneS 59 ........Being 95 ...........in ....Hospital ............................................................................................. ........................................ latipsoH ni gnieB 9 9 ...........What ............to .....expect ...............after ..........surgery ......................................................................................................... .................... yregrus retfa tcepxe ot tahW 10 01 .........Activity ................................................................................................................................................. .......................................................................................................... ytivitcA 10 01 .........Dressings ....................and .........drains .................................................................................................................... ....................................................sniard dna sgnisserD 11 11 .........Getting ................dressed................................................................................................................. ........................................................................................desserd gnitteG 11 11 .........Hospital ..................discharge ............................................................................................................................... ............................................................ egrahcsid latipsoH 11 ii Getting Ready for Tissue Expansion Breast Reconstruction Surgery 6 Table of Contents At Home after Surgery 1 Introduction ...................................................................................... 1 Effects of surgery 2 Before Surgery .................................................................................. 2 Most are able to resume normal activity within six to eight Surgery timewomen and place .................................................................................................... 2 weeks, depending on your general health and the extent of the surgery. Pre-operative physical ...................................................................................................... 2 Taking part research .................................................................................................... 2 Bruising andinpain Hospital pre-admission clinic appointment ............................................................. 2 around the incision is normal. Bruising usually starts to fade in3 LengthBruising of stay ...................................................................................................................... seven to ten days but can take longer. Help at home ....................................................................................................................... 3 around the......................................................................................................... incision, armpit, down ResultsPain from surgery Numbness in the arm and3 3 the arm and into the back is normal breast is common. for several weeks after surgery. If Numbness in the armpit 4 Getting Ready For lymph nodes areSurgery removed,.............................................................. pain in the and in the back of the arm underarm may........................................................................................................... increase seven to Preparing your skin 4 may linger indefinitely. days after surgery as ............................................................................ nerves How tofourteen use Chlorhexidine sponges 4 Caution: Avoid hot water heal. Some describe this as a burning Food and fluid restrictions .............................................................................................. 5 sensation or increased tenderness. bottles, hot bags or Medications .......................................................................................................................... 5 Some describe feeling “electric heating pads; desensitized Smoking ................................................................................................................................. 6 shocks”. Should this occur, it will pass or numb tissue can burn. within a week or two. Take pain Packing for the hospital ................................................................................................... 6 medication when needed. 4 5 Coming to Hospital .......................................................................... 7 Fluid build-up Surgical admission ............................................................................................................. 7 Fluid build up in........................................................................................................ the breast or in the armpit after surgery is called a 8 Sentinel node biopsy seroma. There may be a sloshing or gurgling sound in the breast, a feeling of fullness or a lump under the arm. Often the area can feel Beingwarm, in Hospital 9 firm and.............................................................................. appear reddened. What to expect after surgery ......................................................................................... 9 Seromas are not a problem unless the area becomes heavy, tight or Activitypainful. .................................................................................................................................. 10 The body will absorb small seromas. The surgeon may remove Dressings drains ....................................................................................................... largeand ones using a fine needle and syringe. This procedure is done in 10 the surgeon’s office. It may have to be repeated several times during Getting dressed................................................................................................................. 11 recovery. (See page 19, When to call your surgeon). Hospital discharge ........................................................................................................... 11 12 i Getting Breast yregruSReady noitcufor rtsnTissue oceR tExpansion saerB noisn apxE eReconstruction ussiT rof ydaeRSurgery gnitteG Table stnetnof oCContents fo elbaT What to do 11 ........Introduction 11 ............................................................................................................ ....DO .....begin .........the ......simple ..........exercises ..............in ...the ..... Canadian noitcudoCancer rtnI Society booklet Exercises After Breast Surgery: A Guide for Women included in the Information kit provided on line at www.bccancer.bc.ca/breastkit 22 ........Before 22 ............Surgery ................................................................................................ ................................................ yregruS erofeB Progress as recommended by your plastic surgeon 2 2 ...........Surgery .................time ..........and .place ............................................................................................................... .......................................... ecalp dna emit yregruS ........DO place your arm (surgical side) on a pillow if you have had lymph 2 2 ...........Pre-operative ............................physical .......nodes ................................................................................................................ ...removed. ...................Raise ...........it....above ......... lathe cisylevel hp evof itayour repoheart. -erP Do this for 45 Taking part in research .................................................................................................... 2 2 ..............................................minutes, .................two .........to .....three ...........times ............per hcrday aeser ni trap gnikaT 2 pain 2 ...........Hospital ..................pre-admission ......... ........DO .......use ......clinic ..your tnemappointment tnioas ppnormally a cinil............................................................. c no simda-erwithin p latipthe soHlimits of arm asispossible, 3 (ADL) 3 ...........Length ...............of .....stay ............................................................................................................................... ......and ........pulling ...............at .....the .......incision ................site, .........for ......the ...... yactivities ats fo htof gndaily eL living 3 3 ...........Help ..........at ......home ................................................................................................................................... .......such ..........as .....grooming, .....................washing, ..................and .........eating .......... emoh ta pleH check 3 ...........Results ...............from ...........surgery .........DO ................................................................................................................ .............with .........a...physiotherapist ........................... yror egsurgeon rus morfifstyou lusehave R any3 questions about an activity DO eat a balanced diet with generous portions of protein-rich foods 34 ........Getting ..............Ready ............For ......Surgery .as ....poultry, ....................................................................... ...meat, ..... yrfish, egru S rolegumes, F ydaeRmilk gniand tteGcheese.43Include such eggs, 4 and 4 ...........Preparing .....................your ..........skin ....high ................................................................................................................ ....fibre ..........foods .............such ..........as .....fruit, ..........vegetables, .... niks ruoywhole gnirapgrain erP bread ............................................................................ 4 daily) 4 ...........How ..........to ......use ........Chlorhexidine ...........cereal, .............and .....sponges ....drink ........ splenty eg nopof s efluids nidixe(six hroto lhCeight esu cups ot woor H two litres 5 5 ...........Food ...........and .........fluid ....... ...restrictions .....DO .......watch ......................................................................................................... ..for .......signs ...........of .....constipation ..... snoitcirtseifr you diulfare dntaking a dooFpain medications 5 fibre can 5 ...........Medications ................................................................................................................................................... ..........with .........codeine. ...................Increasing .....................fluid .........intake, ..............exercise .... snoitaand cideincreased M help. Occasionally, laxatives may be needed. 6 6 ...........Smoking ................................................................................................................................................... .................................................................................................... gnikomS 6 6 ...........Packing .................for .......the .......hospital .................................................................................................................... ........................................ latipsoh eht rof gnikcaP What not to do 47 ........Coming 74 ..............to .....Hospital .In ....the .....first ............................................................................... ..few ......weeks .........after ........surgery: ....... latipsoH ot gnimoC 7 (5-10 7 ...........Surgical .................admission .......... ........DO ................................................................................................................ ....NOT ...........lift ......or .....carry ...........anything ..................heavier ..... noissthan imda2.25-4.5 lacigruSkilograms pounds) on the affected side for four to six weeks after surgery or as 8 8 ...........Sentinel .................node ............biopsy ...................................................................................................................... .................................................. yspoib edon lenitneS directed by your surgeon DO NOT use your arm to push or pull yourself into or out of bed or a 59 ........Being 95 ...........in ....Hospital ...........chair .................................................................................. ........................................ latipsoH ni gnieB 9 9 ...........What ............to .....expect .......... .....after ...DO .......surgery ...........make .............................................................................................. .......sudden ............. yunexpected regrus retfamovements tcepxe ot tawith hW your affected NOT 10 01 .........Activity ................................................................................................................................................. ....................arm ...................................................................................... ytivitcA 10 arm until 01 .........Dressings ....................and ....... ..drains ......DO .............................................................................................................. ...........use ........deodorant, ......................talcum ...........snpowder iard dna gnisseunder rD NOT orsshave the 11 shaver 11 .........Getting ................dressed................................................................................................................. ...................the .......axillary ...............(armpit) ................wound ...............is....healed. ............deOnce sserdhealed, gnitteGan electric 11 11 .........Hospital ..................discharge .................is.............................................................................................................. .preferred ...................over ..........a...razor ...........with .........a....blade ... egrahcsid latipsoH DO NOT put Vitamin E on incisions for six weeks. Some surgeons believe that Vitamin E may widen scars and irritate the incision. 13 ii Getting Ready for Tissue Expansion Breast Reconstruction Surgery Driving Table of Contents 1 Introduction 1 You may...................................................................................... drive two weeks after surgery when: 2 Before Surgery .................................................................................. 2 Your arms have near normal range of motion You are no longer taking narcotic pain medication (e.g. Tylenol 3) Surgery time .................................................................................................... 2 Youand feelplace comfortable to do so. Pre-operative physical ...................................................................................................... 2 Taking part in research .................................................................................................... 2 Incision care Hospital pre-admission clinic appointment ............................................................. 2 Most sutures are dissolvable. Your incisions will be covered with steriLength of stay ...................................................................................................................... 3 strips (small tape-like bandages) with a light (Mepore) dressing over top. Help at home ....................................................................................................................... 3 Steri-strips often peel off on their own. If they don’t, leave them until you Resultssee from surgery ......................................................................................................... 3 your surgeon. Apply a small band aid or dry gauze to any weeping 3 Bathing 4 5 areas. Dressings should be changed every one to two days or more often if there is drainage that soaks through. If you have a drain, a dressing 4 Getting Ready For Surgery .............................................................. should always be worn over the drain site. Preparing your skin ........................................................................................................... 4 How to use Chlorhexidine sponges ............................................................................ 4 Food and fluid restrictions .............................................................................................. 5 Medications .......................................................................................................................... If you are having 5 Smoking ................................................................................................................................. difficulty viewing 6 When your plastic surgeon says it is ok to your incision to the outer (Mepore) dressing Packingshower, for theremove hospital ................................................................................................... 6 first, but leave the steri-strips intact. It is okay assess healing, ask to get the incisions wet and to wash gently your surgeon before Coming to Hospital .......................................................................... 7 under your arm but avoid: showering or Surgical admission ............................................................................................................. 7 Soaking your incision(s) in a bath until bathing. Sentinel node ........................................................................................................ 8 theybiopsy are completely healed Aiming the showerhead at your incision(s). Being After in Hospital .............................................................................. 9 bathing/showering, check your incision(s) to ensure that there are What to after surgery ......................................................................................... 9 noexpect signs of infection. Gently pat the incision with a clean towel. Do not the area. Activityrub .................................................................................................................................. 10 Dressings and drains....................................................................................................... 10 Getting dressed................................................................................................................. 11 Hospital discharge ........................................................................................................... 11 14 i Getting Breast yregruSReady noitcufor rtsnTissue oceR tExpansion saerB noisn apxE eReconstruction ussiT rof ydaeRSurgery gnitteG About drains Table stnetnof oCContents fo elbaT 11 ........Introduction 11of .....................Breast ....................................................................................... ........drains ..........prevent ............fluid .......from ................... noTwo itcuto dofour rtnIinches building up around the breast incision; white drainage tubing will 22 ........Before 22 An ............Surgery .........axillary ....................................................................................... .....drains ..........prevent ............fluid .......from .............. yregbe ruSinside erofeyour B body. building up in the underarm incision. 2 2 ...........Surgery .................time ..........and .........place ............................................................................................................... .......................................... ecalp dna einch mit yor remore gruS of tubing You may have one to three drains each visible outside the physical 2 body 2 ...........Pre-operative ............................held ..........in ....place ......................................................................................................... .........by ......a...stitch. .............The ........drain ....... lais cisyhp evitarepo-erP 2 ...........Taking ..............part ..........in ....best .research ........worn .............................................................................................................. .under .............clothing. ..................This .........keeps . hcraeitser nindicates i trap gnikthat aT the2drain is coming out. Contact 2 your the 2 ...........Hospital ..................pre-admission ..........from ..........pulling ..........clinic .. tnapart. emappointment tnPin iopp a cdrain inil............................................................. c nunder oissimda-erp latipsoH surgeon. your shirt at waist level. 3 3 ...........Length ...............of .....stay ............................................................................................................................... .............................................................................. yats fo htgneL 3 3 ...........Help ..........at ......home ................................................................................................................................... ................................................................................ emoh ta pleH Removing 3 3 ...........Results ..............drain(s) .from ...........surgery ......................................................................................................................... .................................................... yregrus morf stluseR Your general surgeon will remove If you are unable to empty 34 ........Getting 4 ..............Ready .......axillary .....For .....drain(s) .Surgery ...........when ................................................................. ......drainage .. yregruisSless roF ydayour eR gdrain nitteG and do3not 4 ...........Preparing .....................your .......than ...skin .......20-30cc ............................................................................................................. ..............in .....a....24-hour ................period. ...............This .. niks ruo y gnsomeone iraperP to4help you, have is usually seven to fourteen days after ............................................................................ 4 4 ...........How ..........to ......use ........Chlorhexidine .............................sponges ............ seg nops enidixehrolhCmake esu odaily t woHappointments surgery, but can be longer. Your 5 with family doctor or 5 ...........Food ...........and .........fluid ........plastic ..restrictions ............surgeon ......................................................................................................... .....typically .................removes ........ snoitcirtser diu lf dnyour a doo F Medications .......................................................................................................................... 5 5 .......................................breast .............drain(s) ................within .............seven ............days ..........of .....the ..............your snoitnearest acideM medical clinic 6 ...........Smoking ................................................................................................................................................... ..........surgery. ...................................................................................to ......have . gnikoyour mS drain6 for 6 6 ...........Packing .................for .......the .......hospital .................................................................................................................... ........................................ latipsoh ehemptied. t rof gnikcIfaPit is difficult Drain care you to leave your home, and you do not have 47 ........Coming 74 ..............to .....Hospital ..The ......nurse ................................................................................. ..will .....show .........you ......how .......to ...empty latipsoH ot gnimoC someone to help you, drain(s) 7 7 ...........Surgical .................admission ...........your ....................................................................................................................... ................before .............you .........go ......home ............and .... noissim da lactalk igruSwith your please nurse will provide several dressings and a 8 a 8 ...........Sentinel .................node ............biopsy ...................................................................................................................... .................................................. yspoib eabout don lenarranging itneS for small container for measuring home care nurse before drainage. Detailed instructions follow. 59 ........Being 95 ...........in ....Hospital ............................................................................................. ........................................ latipsodischarge H ni gniefrom B the 9 9 ...........What ............to .....expect ...............after ..........surgery ......................................................................................................... .................... yregrus retfa tcehospital. pxe ot tahW 10 01 .........Activity ................................................................................................................................................. .......................................................................................................... ytivitcA 10 01 .........Dressings ....................and .........drains .................................................................................................................... ....................................................sniard dna sgnisserD 11 11 .........Getting ................dressed................................................................................................................. ........................................................................................desserd gnitteG 11 11 .........Hospital ..................discharge ............................................................................................................................... ............................................................ egrahcsid latipsoH 15 ii Getting Ready for for Breast Surgery G���n� Rea�� f�� Tis��� E�p�n�i�� B�eas� Rec�ns��uc�i�� S�r���� Getting Ready Breast Surgery 1.2SHQ3OXJ 2. (PSW\Measure 3. Reset 6 6 At Home after Surgery ................................................................... 14 14 At Home after Surgery ................................................................... Effects of surgery .............................................................................................................. 14 14 Effects of surgery .............................................................................................................. Incision carecare ....................................................................................................................... 14 14 Incision ....................................................................................................................... Bathing ................................................................................................................................. 15 15 Bathing ................................................................................................................................. Driving .................................................................................................................................. 15 15 Driving .................................................................................................................................. What to do 15 15 What to.......................................................................................................................... do.......................................................................................................................... What not not to do.................................................................................................................. 16 16 What to do.................................................................................................................. About drains....................................................................................................................... 16 16 About drains....................................................................................................................... When to call youryour surgeon ........................................................................................... 20 20 When to call surgeon ........................................................................................... 1: Figure 2: Figure 3: 7 7Figure Follow-up after Surgery ................................................................. 21 21 Follow-up after Surgery ................................................................. Wash your hands. Turn the bulb over. Push the plug back Follow-up withwith youryour surgeon ...................................................................................... 21 21 Follow-up surgeon ...................................................................................... Hold the drainage Empty the fluid into in while squeezing Going backback to work ......................................................................................................... 21 21 Going to work ......................................................................................................... bulb upright and a container. the bulb. When further treatment is Measure needed ............................................................................ 22 22 When further treatment is needed ............................................................................ open the plug. and record This resets the the drainage. drain’s suction action. 8 8 Road to Recovery ........................................................................... 23 23 Road to Recovery ........................................................................... Physical recovery .............................................................................................................. 23 23 Physical recovery .............................................................................................................. Emotional support ........................................................................................................... 25 25 Emotional support ........................................................................................................... Evaluation ………………………………………………… 23, 24 9DO Evaluation ………………………………………………… 23, 24 NOT rinse Sheet theSheet drainage bulb. Rinse the measuring container with water after each use. Empty the drain when the bulb is half full. Royal Jubilee Hospital SiteSite and Parking 10 10Measure Royal Hospital and Parking ...................................... theJubilee amount of drainage each time and...................................... record it in the Drain 25 25 Record table provided on page 18. Bring your Drain Record to your next surgeon’s appointment. Drainage is often pink, it often becomes yellow or clear and the amount will decrease over time. If the tubing accidently disconnects from the drainage bulb cleanse the connection site with 70% isopropyl alcohol before reconnecting it. Follow the steps to reset the drain. If the drainage plug accidently opens, follow the steps to reset the drain. Tape the drainage plug across the top of the bulb, if necessary. 9 Figures 1-3 Source: Adapted fom J. Rowlands, Multimedia Services, B.C. Cancer Agency 2007 14 ii 16 ii G���n� Rea��Getting f�� Rec�ns��uc�i�� S�r���� yreTis��� gruSReady tE�p�n�i�� saerB forroBreast f B�eas� ydaeRSurgery gnitteG How to Unclog the drain It is normal for small clots, shreds of tissue, fluid or air bubbles to sit in the drainage tubing, but drains can become clogged with clots or tissue. When this 6 41 ....happens, .At .....Home .......you ....after ..will ......notice ..Surgery ........an ....abrupt .................................................................... .........decrease .............in .yrdrainage egruS rand etfafluid emmay oH tleak A out 14 6 41 ......where .Effects ............the ...of ....tube .surgery .........enters .................................................................................................................... .......the .......body. ............To .....release ...............clots ..........or .....tissue: .......yregrus fo stceffE 14 Support the drain site with one hand and pinch the 41 .......Incision .................care ................................................................................................................................ .......................................................................tubing ..............between . erac noiyour sicnI thumb 14 and index finger close to where the drain enters your body. (Fig. 4) 51 ......With .Bathing .........the .......thumb ................................................................................................................................. ..............and ........index ............finger ............of .....the .......other ............hand ...........squeeze ................the ........tubing . gnihtaand B 15 51 ......gently .Driving ............move ..................................................................................................................................... .........your .........fingers ..............down ............the ........tubing ..............towards ................the .......bulb. ...........This ........is gncalled ivirD 15 milking 51 ......”stripping .What ............to ......do .or .............................................................................................................................. ................the .......tubing”. ................(Fig. .........5) ............................................od ot tahW 15 Repeat 2-3 times 61 .......What ............not ........to ......do.................................................................................................................. .................................................................................od ot ton tahW 16 61 ......Contact .About ..............drains....................................................................................................................... .your ..........surgeon ................or .....homecare ....................nurse, .............if...arranged, .....................if...the ......sblockage niard tuodoes bA not 16 02 ......clear. .When ..........If...you to ......call ..cannot ......your .........reach .surgeon ..........your .................................................................................................. ...surgeon .................or .....homecare ..... noegrunurse, s ruoygo llato c oatwalk-in nehW 20 medical clinic or call your family doctor. If it is after clinic hours go to a hospital emergency department. 7 12 .....Follow-up ..................after ..........Surgery .............................................................................. ...................yregruS retfa pu-wolloF 21 7 12 .......Follow-up .....Figure ................4: .with .........your ...........surgeon ....................................................................................................... .................... noeFigure grus ruo5: y htiw pu-wolloF 21 12 .......Going ..............back ..........to ......work ................................................................................................................... .......................................................... krow ot kcab gnioG 21 22 .......When .............further ...............treatment ......................is....needed ........................................................................................... dedeen si tnemtaert rehtruf nehW 22 8 32 .....Road ..........to ....Recovery ............................................................................................ ....................................... yrevoceR ot daoR 23 8 32 .......Physical .................recovery ................................................................................................................................ .................................................................... yrevocer lacisyhP 23 52 .......Emotional ......................support ........................................................................................................................... .............................................................. troppus lanoitomE 25 9 42 ,32Evaluation ……………Sheet ………………………………………………………… …………………………… teehS noitaulavE23, 24 9 ..........Jubilee ..............Hospital ......... gniSite kraPand dnaParking etiS lati...................................... psoH eelibuJ layoR 2501 1052 .....Royal Figures 4-5 Source: Adapted fom J. Rowlands, Multimedia Services, B.C. Cancer Agency 2007 17 iiii Getting Ready for Tissue Expansion Breast Reconstruction Surgery Drain Record Date Time Table of Contents Amount Amount Amount Amount Total 1 Introduction ...................................................................................... 1 2 Before Surgery .................................................................................. 2 Surgery time and place .................................................................................................... 2 Pre-operative physical ...................................................................................................... 2 Taking part in research .................................................................................................... 2 Hospital pre-admission clinic appointment ............................................................. 2 Length of stay ...................................................................................................................... 3 Help at home ....................................................................................................................... 3 Results from surgery ......................................................................................................... 3 3 Getting Ready For Surgery .............................................................. 4 Preparing your skin ........................................................................................................... 4 How to use Chlorhexidine sponges ............................................................................ 4 Food and fluid restrictions .............................................................................................. 5 Medications .......................................................................................................................... 5 Smoking ................................................................................................................................. 6 Packing for the hospital ................................................................................................... 6 4 Coming to Hospital .......................................................................... 7 Surgical admission ............................................................................................................. 7 Sentinel node biopsy ........................................................................................................ 8 5 Being in Hospital .............................................................................. 9 What to expect after surgery ......................................................................................... 9 Activity .................................................................................................................................. 10 Dressings and drains....................................................................................................... 10 Getting dressed................................................................................................................. 11 Hospital discharge ........................................................................................................... 11 18 i Getting Breast yregruSReady noitcufor rtsnTissue oceR tExpansion saerB noisn apxE eReconstruction ussiT rof ydaeRSurgery gnitteG Table stnetnof oCContents fo elbaT When to call your surgeon 11 ........Introduction 11 ...................Contact ......................................................................................... .........your ........surgeon ............if...you ......have ........a.......... Contact noitcudo rtnI surgeon your low grade fever (37.5C-37.9C or immediately if you: 22 ........Before 22 fever ............Surgery .......98.5F-101.2F) ......................................................................................... .............that .......lasts .......for .....three ................ yregrHave uS eraohigh feB grade days. or 2 2 ...........Surgery .................time ..........and .........place ............................................................................................................... .......................................... ecalp dna eof mi38.5C/101.3F t yregruS 2 2 ...........Pre-operative ..........................Contact ..physical ..............your ......................................................................................................... .......surgeon ..................if...you .........have ......... lany acisyhp evgreater itarepo-erP of the following problems with your of 2 2 ...........Taking ..............part ..........in .....research ...................................................................................................................... .......................................... hcraeserniExperience trap gnikaTshortness drain(s): breath. 2 2 ...........Hospital ..................pre-admission ..............................clinic .. tnemappointment tnioppa cinil............................................................. c noissimda-erp latipsoH The drain falls off and cannot be 3 3 ...........Length ...............of .....stay ............................................................................................................................... .............................................................................. yats fo htgneL reconnected with tape 3 3 ...........Help ..........at ......home ................................................................................................................................... ................................................................................ emoh ta pleH The drain does not remain 3 3 ...........Results ...............from ...........surgery .......compressed .................................................................................................................. .................................................... yregrus morf stluseR If you cannot reach your The directions provided do not surgeon: 34 ........Getting 43 ..............Ready ..........unclog ..For ......Surgery ...the ......drain(s) ................................................................... ........ yregruS roF yd aeCall R gyour nittefamily G doctor 4 4 ...........Preparing .....................your ..........skin ..Drainage .................................................................................................................. ............increases, ....................is ....foul .................... niks ruoGo y gn erP toiraapwalk-in medical ............................................................................ 4 inops enidixehrolhCclinic; 4 ...........How ..........to ......use ........Chlorhexidine .........smelling ..................or ..sponges ...changes ......... seg n esu otor woH consistency 5 ...........Food ...........and .........fluid ..........restrictions ..................................................................................................................... .............................. snoitcirtser diuIflf itdnisaafter dooFclinic 5hours 5 5 ...........Medications ................................................................................................................................................... ........The ........incision ................opens ..............up ........................................ sgo noito tacaidhospital eM 6 6 ...........Smoking ................................................................................................................................................... ........Contact ................your ..........surgeon ..................if...you .......................................emergency ...... gnikomS any 6 Line 6 ...........Packing .................for .......the ..experience .....hospital .................................................................................................................... ........of ......the .......following ...................skin latipsoh ehtCall rof gthe nikcB.C. aP Nurse symptoms: toll-free at 1-866-215- 4700 .....Increased swelling in the 47 ........Coming 74 ..............to .....Hospital .................................................................................... ................................ latipsoH ot gnimoC underarm or breast that causes 7 7 ...........Surgical .................admission ................tightness .................................................................................................................. ..............or .....pain ......................................... noissimda lacigruS 8 8 ...........Sentinel .................node ............biopsy ....Increased .................................................................................................................. ..........tenderness, ........................redness, ................ yorspwarmth oib edoaround n lenitnthe eS surgery site Irritation from the steri-strips or tape 59 ........Being 95 ...........in ....Hospital .........Swollen .................................................................................... .......leg(s) ........or ....achy ........and ......red ......calves. . latipsoH ni gnieB 9 9 ...........What ............to .....expect ...............after ..........surgery ......................................................................................................... .................... yregrus retfa tcepxe ot tahW 10 01 .........Activity ................................................................................................................................................. .......................................................................................................... ytivitcA 10 01 .........Dressings ....................and .........drains .................................................................................................................... ....................................................sniard dna sgnisserD 11 11 .........Getting ................dressed................................................................................................................. ........................................................................................desserd gnitteG 11 11 .........Hospital ..................discharge ............................................................................................................................... ............................................................ egrahcsid latipsoH 19 ii Getting Ready for Tissue Expansion Breast Reconstruction Surgery 7 Table of Contents 1 Follow-up after Surgery Introduction ...................................................................................... 1 Follow-up with your surgeon(s) 2 Before Surgery .................................................................................. 2 Your plastic surgeon will want to meet with you within the first ten to Surgery time and place .................................................................................................... 2 fourteen days after surgery. Ask your plastic surgeon about your post-op Pre-operative physical ...................................................................................................... 2 appointment before you are discharged from the hospital. Taking part in research .................................................................................................... 2 If you are newly diagnosed with breast cancer, your general surgeon will Hospital clinic appointment ............................................................. 2 alsopre-admission want to meet with you ten to fourteen days after your surgery to Lengthdiscuss of stayyour ...................................................................................................................... 3 pathology results. Call soon after surgery to book an appointment. You may wish to bring a tape recorder and blank tape to 3 Help at home ....................................................................................................................... your appointment to help you remember the discussion. Results from surgery ......................................................................................................... 3 Expanding the tissue 3 Getting Ready For Surgery .............................................................. 4 Youryour plastic surgeon may add saline solution to the expander during the 4 Preparing skin ........................................................................................................... first visit and subsequent visits, usually every two weeks depending on How to use Chlorhexidine sponges ............................................................................ 4 how your wounds are healing. The expansion process takes about twenty Food and fluid You restrictions .............................................................................................. 5 minutes. may experience tightness and discomfort during the expansion process and for a few days afterwards. Take pain medication 5 Medications .......................................................................................................................... as needed. If the incision has healed and your newly expanded skin Smoking ................................................................................................................................. 6 becomes dry or flaky, apply a moisturizer daily. Packing for the hospital ................................................................................................... 6 Going back to work 4 5 You can return to work or Coming to Hospital .......................................................................... do light housekeeping 7 Always check with your plastic surgeon Surgical admission ............................................................................................................. 7 activities after each before returning to work. Generally, you expansion, but avoid 8 Sentinel node biopsy ........................................................................................................ may return to work when you: lifting heavy objects for No longer have a drain (usually one to two weeks after each weeks).............................................................................. 9 Being inthree Hospital expansion. Avoid straining expect Are comfortable with......................................................................................... the basic arm What to after surgery for the duration of the 9 movements used in your job Activity .................................................................................................................................. expansion process. 10 Do do not have complications such as Dressings and drains....................................................................................................... 10 seroma or infection Remember: If you have Getting dressed................................................................................................................. 11 Have the energy and you feel ready. had axillary node Hospital discharge ........................................................................................................... 11 dissection DO NOT lift Additional information on returning to work after cancer treatment can be found on the more than 2.27 kilograms BC Cancer Agency website: (5 pounds) for four to six weeks on your surgical www.bccancer.bc.ca side. 20 i Getting Breast yregruSReady noitcufor rtsnTissue oceR tExpansion saerB noisn apxE eReconstruction ussiT rof ydaeRSurgery gnitteG Table stnetnof oCContents fo elbaT When further treatment is needed Adjuvant Therapies 11 ........Introduction 11 ....................After ........................................................................................ ......breast ..........cancer ..........surgery ............(and .................. noitcudortnI If radiation therapy is sometimes before), you will consult recommended, it can 22 ........Before 22 ............Surgery ........with ........................................................................................ .an .....oncologist ................(cancer ...........doctor) ............... yregruS erofeB begin two to three weeks to discuss the need for further 2 ...........Surgery .................time ..........and .........place ............................................................................................................... .......................................... ecalp dna after emit the yregfirst ruS visit 2and can treatment or adjuvant therapies. physical 2 2 ...........Pre-operative ............................These ............therapies ........................................................................................................... ..............can ........be ......one .........or .....a.... lacisyhp elast vitathree repo-eto rPsix weeks 2 ...........Taking ..............part ..........in ....combination .research ...................................................................................................................... ......of .....chemotherapy, ............................... hcraeser nIfi tchemotherapy rap gnikaT is2 2 2 ...........Hospital ..................pre-admission ..........radiation ..................or ..clinic .. thormone nemappointment tnioptherapy. pa cinil............................................................. c noissimdarecommended, -erp latipsoH it can 3 3 ...........Length ...............of .....stay ........Further ....................................................................................................................... ..............tests ..........are .......often ............ordered ................after ................... ybegin ats fo hone tgneto L two weeks this appointment. 3 ...........Help ..........at ......home ................................................................................................................................... ................................................................................ eafter mohthe ta pfirst leH visit 3and can six months Cancer 3 3 ...........Results ...............from ...........surgery ..The ........BC ............................................................................................................... ...............Agency’s ..................Vancouver ................... yregruslast morfour f stluto seR Island Cancer Centre (VICC) will If both are recommended, phone you with the date and time chemo is usually done 34 ........Getting Surgery .............................................................. 43 ..............Ready ......of ....your ..For ......oncology ..............appointment. ........ yregruYou S roF ydaeR gnitteG first. 4 4 ...........Preparing .....................your .......will ...skin ....be ................................................................................................................ .seen ..........four ..........to .....six ......weeks .............after ........... niks ruoy gniraperP ............................................................................ 4 date. may to 4 ...........How ..........to ......use ........Chlorhexidine ....your ..........surgery ...............sponges ...........You . seg nopsask ento idixhave ehroyour lhC eappointment su ot woH recorded help you remember the discussion. 5 5 ...........Food ...........and .........fluid ..........restrictions ..................................................................................................................... .............................. snoitcirtser diulf dna dooF 5 ...........Medications ................................................................................................................................................... ...Refer ...........to .....the ........Breast .............Cancer ..............Companion .......................Guide ......... sn(Section oitacide6) Min the 5Breast toSask about 6 6 ...........Smoking ................................................................................................................................................... ..........Cancer ..............Information ........................Kit ......provided ..................on .......line ........for ......questions ....... gnikom adjuvant treatments. 6 6 ...........Packing .................for .......the .......hospital .................................................................................................................... ........................................ latipsoh eht rof gnikcaP 47 ........Coming 74 ..............to .....Hospital ......................................................................................... ................................ latipsoH ot gnimoC New patient information 7 7 ...........Surgical .................admission .................................................................................................................................. ............................................................ noissimda lacigruS 8 8 ...........Sentinel .................node ............biopsy ...................................................................................................................... .................................................. yspoib edon lenitneS To prepare for your first visit to the BC Cancer Agency, you can view the 59 ........Being 95 ...........in ....Hospital .....DVD ........“What ................................................................................ ........to ...expect: ...........A...patient’s ............guide ... latito psthe oHBC niCancer gnieBAgency 9 9 ...........What ............to .....expect ...........Vancouver ....after ..........surgery .......Island.” .................................................................................................. ......A....copy ..........will yregbe rusmailed retfa tto ceyou pxe from ot tahthe W BC Cancer Agency once your appointment has been booked. Copies are available 10 01 .........Activity ................................................................................................................................................. .......................................................................................................... ytivitcA to borrow from the Breast Health Centre at VGH. 10 01 .........Dressings ....................and .........drains .................................................................................................................... ....................................................sniard dna sgnisserD 11 11 .........Getting ................dressed................................................................................................................. ........................................................................................desserd gnitteG 11 11 .........Hospital ..................discharge ............................................................................................................................... ............................................................ egrahcsid latipsoH 21 ii Getting for Expansion Breast yregruGetting SReady noitcuReady rtsnTissue oce R tTissue saerB Expansion noisn apxE Breast eReconstruction ussiT rReconstruction of ydaeRSurgery gnitteSurgery G for 8 Table stneTable tnof oCContents fo Contents elbaT of Road to Recovery 11 ........Introduction 11 .1...........Introduction ................................................................................................ ................................................................................................... ........................................... noitcudortnI 1 Physical recovery 22 ........Before Surgery 22 .2...........Before .............Surgery ................................................................................... ............................................................................................... ................................... yregruS erofeB 2 2 2 ...........Surgery ...........Exercises .....Surgery .time ..........and ......time .following ..place .......and ........................................................................................................ .....place .....breast .......................................................................................................... ..........surgery ................ ecalp dna emit yregruS 2 2 2 ...........Pre-operative ................Pre-operative ............physical ....................................................................................................................... ...................................................................................................................... .............................. lacisyhp evitarepo-erP physical 2 You will experience stiffness in your affected shoulder and arm after 2 Breast2 2 ...........Taking ..............part ..Taking ........in ....breast .research ..part .........in .surgery. ....research ...................................................................................................... ..........Start .......................................................................................................... ....the .......beginning ............... hcexercises raeser ni in traCSS p gnExercises ikaT after 2 ...........Hospital ................Hospital ..pre-admission ..........Surgery: ......pre-admission ..........A....clinic .. tnemappointment tnclinic iwomen oppaappointment ciisniavailable l............................................................. c noissim a-erinformation p latipsoH kit at2 guide for indthe ............................................................. 2 3 3 ...........Length ...............of .Length ....stay ........www.bccancer.bc.ca/breastkit ....................................................................................................................... ...of .....stay .............................................................................................................................. .........................................It....is....very .........important .... yats fo htotgdo neLthese exercises 3 Check with your plastic ....................................................................................................................... 3 3 ...........Help ..........at ......home ...........at .to ....home .regain .................................................................................................................................. ..full .......movement ......................and ........use ........of .....your ..........arm. .. emo h ta pleH Help 3 before you begin the more advanced exercises. 3 3 ...........Results ...............from .Results ..........surgery ......from ................................................................................................................... .surgery ........................................................................................................................ .................................... yregrus morf stluseR 3 Lymphedema awareness 34 ........Getting 43 .3...........Getting ..Ready ............For ......Surgery ......For .......Surgery ............................................................... ........ yre gruS roF ydaeR gnitteG Ready .............................................................. 4 Lymph nodes filter lymphatic fluid throughout the body. Lymphedema is 4 ...........Preparing ................Preparing .....your .......swelling ...skin ......your .............................................................................................................. ....caused ...skin .................................................................................................................... ...by .....the ........build-up .................of ......lymph . niks rfluid uo y g irappart erP of the4 body 4 innthe ............................................................................ 4 cancer,4 4 ...........How ..........to ......use ........Chlorhexidine ...to .where ....use ........the ........lymph .....sponges ........nodes .... sesponges g nhave ops been en............................................................................ idixremoved, ehrolhC e ot woH by the How Chlorhexidine orsudamaged 5 5 ...........Food ...........and .....Food ....fluid ........surgery ..restrictions .......fluid ......or ....restrictions .radiation ................................................................................................... .............therapy. ................................................................................................. .............. snoitcirtser diulf dna dooF and 5 5 ...........Medications ................Medications ................................................................................................................................... ...Lymphedema ....................................................................................................................................... ..............is....different .................from ...........the .......swelling ................in . snthe oitabreast, cideMarmpit5 and arm5 6 soon6 6 ...........Smoking ................Smoking ................................................................................................................................... ..........areas ....................................................................................................................................... .....that .........can .......happen ................just ........after ..........surgery. ................Lymphedema ............. gnikomcan S happen 6 or a 6 6 ...........Packing ................Packing .for .......the ....after ...hospital ..for .....treatment, ..the ........................................................................................................... ...........months ........................................................................................................ ..........or .....even ......... lyears atipsolater. h ehtItrcan of gbe nikacatemporary P hospital long-term condition. 47 ........Coming 74 .4...........Coming ..to .....Hospital ........to ....Hospital ............................................................................. ....................................................................................... ................... latipsoH ot gnimoC 7 7 7 ...........Surgical ................Surgical .admission .............Learn ...admission .................................................................................................................. ......about ....................................................................................................................... ....lymphedema ........................................ noissimda lacigruS 7 Sentinel node biopsy ........................................................................................................ 8 Read pages 20-22 in the CSS booklet Exercises after Breast 8 ...........................Sentinel ..................node ...........biopsy ...................................................................................................................... .................................. yspoib edon lenitneS 8 Surgery: A guide for women on line at 59 ........Being 95 .5..........in .Being ...Hospital ........in ....www.bccancer.bc.ca/breastkit ................................................................................. ........................................................................................... ........................... latipsoH ni gnieB Hospital 9 Chapter 33 in the book The Intelligent Patient Guide to 9 9 ...........What ............to ....What .expect ...........to ....after ..expect ........surgery ......after ................................................................................................... .surgery ........................................................................................................ .... yregrus retfa tcepxe ot tahW 9 Breast Cancer which can be purchased on line or borrowed Activity .................................................................................................................................. 10 01 .........................Activity ................................................................................................................................................. .......................................................................................... ytivitcA 10 from the BCCA or public libraries. Dressings and drains ....................................................................................................... 10 01 .........................Dressings ....................Attend .and .........drains .......a...free ......................................................................................................... ........information ............................session sniard dnabout a sgnisLymphedema: serD 10 11 11 .........Getting ................dressed................................................................................................................. .................dressed................................................................................................................. ...Learn .............more .............about ...............signs ............& ......symptoms, .........desserdrisk gnittfactors, eG Getting 11 Hospital discharge ........................................................................................................... 11 11 .........................Hospital ..................discharge ..prevention ............................................................................................................................. .......and ..........treatment ........................available. ... egrahcsidClass latipsheld oH the last 11 Tuesday of each month 3:30- 4:30 PM at Inspire Health, Suite 212- 2187 Oak Bay Ave. Please call 250- 595-7125 to register for the class. 22 ii Getting Breast yregruSReady noitcufor rtsnTissue oceR tExpansion saerB noisn apxE eReconstruction ussiT rof ydaeRSurgery gnitteG Table stnetnof oCContents fo elbaT Physiotherapy after breast surgery 11 ........After Introduction 11 ........surgery ...........physiotherapy ......................................................................................... ..................can ......help .......to: ......................... noitcudortnI Relieve stiffness 22 ........Before 22 .....Improve .......Surgery ......range .......................................................................................... .of ....motion ...........in ...the ......shoulder ....................... yregruS erofeB 2 any 2 .......... .Surgery .......Decrease ..........time ........swelling ..and .........place ......in ......................................................................................................... ........part .........of .....your ..........arm .......... ecalp dna emit yregruS 2 your 2 .......... .Pre-operative .......Relieve ...............tightness ......physical ............in ........................................................................................................... ..........scars. .................................... lacisyhp evitarepo-erP 2 2 ..........If .Taking ...you .........develop ..part ..........in ....problems .research ...................................................................................................................... .with .........range ............of ......motion .............. and hcrahave eser been ni trap gnikaT 2 2 ..........recommended .Hospital ..................pre-admission ...........for .......radiation ............clinic .. tntreatment, emappointment tnioppayou cinmay il............................................................. c nowish issimtodaobtain -erp laatidoctor’s psoH These Length of 3 3 ...........referral ...............for .....stay .Out-Patient .............................................................................................................................. ................Physiotherapy ............................at .....the .......Royal ............Jubilee .......... yaHospital. ts fo htgn eL physiotherapists have expertise in this area and are covered by Health 3 3 ...........Help ..........at ......home ................................................................................................................................... ................................................................................ emoh ta pleH Insurance BC (MSP). Private physiotherapy clinics also have the expertise Results 3 3 ...........to .....provide ..........from ......these .....surgery ......services ................................................................................................................... ......for .......a....fee. ................................... yregrus morf stluseR 34 ....tissue 43 Scar ....Getting .......massage .......Ready ............For ......Surgery ............................................................................ ........ yregruS roF ydaeR gnitteG Preparing 4 4 ...........Scar .........tissue ............your ..........skin ........is ............................................................................................................ ...a....popular ................self-help ..................technique ............... nikthat s rumay oy gimprove niraperP massage How ............................................................................ 4 4 ...........healing ..........to .....after .use ........Chlorhexidine .breast .............surgery. ...............sponges ..You ........can .. seg noptwo s enito dixfour ehroweeks lhC esafter u ot woH start 5 5 ..........surgery, .Food ...........and .....when ....fluid ........there ..restrictions .........is ....no ......longer .................................................................................................. ..........any .................... snoitcirtser diulf dna dooF Medications 5 5 ...........scabbing ..................on ......your ........................................................................................................................... .........incisions. ..............................................Discontinue ...........................scar .... snmassage oitacideM Smoking 6 6 ........... .......Firmly ............................................................................................................................................ ..massage ..................along ............the .......sides ............of ...........during ................radiation ....................and .. gnicheck komS with your radiation the scar in circular motions with 6 6 ...........Packing .................for .......the .......hospital .................................................................................................................... ........................................ latipsoh eht rof gnikcaP the pads of your fingers oncologist to see when it will be safe to resume. Massage for five minutes daily 47 ........Coming to Hospital .......................................................................... 74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...... latipsoH ot gnimoC Use the tips or pads of your 7 7 ...........Surgical .......fingers ..........admission ....along ............the .................................................................................................................. ...length .............of .....the ........scar .........to .....loosen ..............up ... nthe oissscar imdatissue lacigruS 8 8 .......... .Sentinel .......You ........may ..node ........find ....biopsy ....using .................................................................................................................. ..a...moisturizing ..........................lotion ............soothing. ....... yspoib edon lenitneS It is a good idea to continue scar massage for the first year or two after 59 ........surgery Being 95 ...........in ....Hospital ............tethering ................................................................................. ...........of ....the .....tissues ...........underneath ......... latipthe soH ni gnieB to prevent scar. 9 9 ..........A .What ....massage ........to .....expect .....therapist ..........after ........or ..surgery ...physiotherapist ...................................................................................................... ..................can .. yreinstruct grus retyou fa tcinepthe xe proper ot tahW 10 01 ........massage .Activity ................................................................................................................................................. ...technique ....................if....needed. ................Consult ................with .........your ..........physician ...................(family ......... ytidoctor, vitcA 10 01 ........surgeon .Dressings .................or ...and ..oncologist) .......drains .................................................................................................................... ...if...you .........feel ........a...referral ...............is ....necessary. .......sniard dna sgnisserD 11 11 .........Getting ................dressed................................................................................................................. ........................................................................................desserd gnitteG 11 11 .........Hospital ..................discharge ............................................................................................................................... ............................................................ egrahcsid latipsoH 23 ii Getting Breast yregruSReady noitcufor rtsnTissue oceR tExpansion saerB noisn apxE eReconstruction ussiT rof ydaeRSurgery gnitteG Table stnetnof oCContents fo elbaT Emotional support Besides your family, friends and health care providers, many local 11 ........Introduction 11 ....................services ........................................................................................ ..........specialize ...............in...supporting .................breast ..........cancer . noitcpatients. udortnI Vancouver Island Cancer Centre (VICC) 22 ........Before 22 ............Surgery ................................................................................................ ................................................ yregruS erofeB The is dlocated in 2 2 ...........Surgery .................time ..........and ........Vancouver .place ............................................................................................................... ..........Island .............Cancer ..............Centre ..... ecalp na emiat t y2410 regruLee S Avenue Victoria on the Royal Jubilee Hospital site. Services offered include 2 2 ...........Pre-operative ............................physical ....................................................................................................................... .............................................. lacisyhp evitarepo-erP professional counselling, relaxation group, therapeutic touch clinic and 2 ...........Taking ..............part ..........in ...nutrition ..research ................counselling ...................................................................................................... .....................all ......at .....no ......cost. .... hcFor raesmore er ni tinformation rap gnikaT or to 2make an 2 ...........Hospital ..................pre-admission .........appointment, .....................clinic .. tnplease emappointment tniocontact ppa cinPatient il............................................................. c noissand imdFamily a-erp lCounselling atipsoH at2250-5193 3 ...........Length ...............of .....stay .......5525. ........................................................................................................................ .............................................................................. yats fo htgneL 3 3 ...........Help ..........at ......home ................................................................................................................................... ................................................................................ emoh ta pleH 3 3 ...........Results ..........CancerConnection .....from ...........surgery ......................................................................................................................... .................................................... yregrus morf stluseR The Canadian Cancer Society offers a free telephone support service for match you 34 ........Getting Surgery 43 who ..............Ready ......anyone ......For ......diagnosed ............................................................................ .with .......cancer. yregruThey S rowill F yd aeR g nitwith teG a survivor has had similar surgery, treatment and similar life circumstances. 4 Please 4 ...........Preparing .....................your ..........skin .................................................................................................................... ........................................................ niks ruoy gniraperP call 1-888-939-3333. ............................................................................ 4 4 ...........How ..........to ......use ........Chlorhexidine .............................sponges ............ seg nops enidixehrolhC esu ot woH 5 5 ...........Food ..........Breast .and .........fluid ........cancer ..restrictions ...............support ...................................................................................................... .............groups ................. snoitcirtser diulf dna dooF 5 5 ...........Medications ................................................................................................................................................... ...................................................................................... snoitacideM If you have been diagnosed with breast cancer, you may benefit 6 from 6 ...........Smoking ................................................................................................................................................... .................................................................................................... gnikomS participating in a breast cancer support group. Members are able to 6 6 ...........Packing .................for .......the ...share ....hospital ........their ............................................................................................................ .experiences ........................and ........feelings ....... latipwith soh eother ht rofwomen gnikcawho P have travelled the same road. Several groups in the Victoria area meet at attend 47 ........Coming ..............to .....Hospital .various ...........locations ............................................................................. ...........and ......times. ..........You ..... are latiwelcome psoH ottogn imoCat any7time 4 in your journey. Please call the Canadian Cancer Society’s Cancer 7 7 ...........Surgical .................admission .................................................................................................................................. ............................................................ noissimda lacigruS Information Line 1-888-939-3333 to find a support group in your area. 8 8 ...........Sentinel .................node ............biopsy ...................................................................................................................... .................................................. yspoib edon lenitneS Dragon boating 59 ........Being 95 ...........in ....Hospital ............................................................................................. ........................................ latipsoH ni gnieB Breast cancer dragon boat teams participate in strenuous upper body 9 ...........What ............to .....expect ..........exercise .....after ..........surgery ..to .....demonstrate, .................................................................................................. ..................through .. yregrusdragon retfa tcboat epxecompetition, ot tahW the9 benefits 10 breast 01 .........Activity ................................................................................................................................................. ............of .....an ......active .............lifestyle ...............and .........to .....raise ..........greater ................public .............awareness .. ytivitcA about All the 01 .........Dressings ....................and .......cancer. ..drains .................................................................................................................... ......ages ..........and .........physical ................abilities ...........sniare ardwelcome. dna sgnisPlease serD call10 Canadian Cancer Society’s Cancer Information Line at 1-888-939-3333 to 11 11 .........Getting ................dressed................................................................................................................. ........................................................................................desserd gnitteG find a dragon boat team in your community. 11 11 .........Hospital ..................discharge ............................................................................................................................... ............................................................ egrahcsid latipsoH Look good feel better program (LGFB) This free 2-hour workshop provides hands on tips to enhance your appearance during cancer treatment. It can be helpful to attend before your treatment starts. All participants receive a complimentary cosmetic tool kit. In the Victoria area please call 250-592-2244 to register. 24 ii Getting Breast yregruSReady noitcufor rtsnTissue oceR tExpansion saerB noisn apxE eReconstruction ussiT rof ydaeRSurgery gnitteG 9 Table stnetnof oCContents fo elbaT Post-Reconstruction 11 ........Introduction 11 ............................................................................................................ ........................................................ noitcudortnI Breast self-examination and mammography 22 ........Before 22 ............Surgery ................................................................................................ ................................................ yregruS erofeB It is important to check both your natural breast and your reconstructed 2 2 ...........Surgery .................time ..........and .........place ............................................................................................................... .......................................... ecalp dna emit yregruS breast(s) each month. Check with your plastic surgeon about when to physical 2 2 ...........Pre-operative ............................start ..........and ............................................................................................................. ..how .........to .....do .......breast .............self-examination .......... lacisyhp evion taryour epo-ereconstructed rP 2 2 ...........Taking ..............part ..........in ....breast. .research .............If ....you ..................................................................................................... ........have ..........never ............been ...........taught . hcraeshow er nto i trexamine ap gnikayour T breasts and 2 the Breast at 2 ...........Hospital ..................pre-admission ..........would .............like .......clinic .to . tnlearn, emappointment tnicontact oppa cin il............................................................. c Victoria noissimd a-erpHealth latipsoCentre H 3 3 ...........Length ...............of .....stay ........250-727-4467. ....................................................................................................................... .............................................................................. yats fo htgneL 3 A 3 ...........Help ..........at ......home ................................................................................................................................... ....yearly .............mammogram ...........................of .....your ..........natural ...............breast ...... emis ohrecommended. ta pleH 3 3 ...........Results ...............from ...........surgery ..Mammography ....................................................................................................................... .................is ....not ........routinely ..................required ..... yregruafter s motissue rf stluexpansion seR reconstruction. 34 ........Getting 43 ..............Ready ............For ......Surgery ............................................................................ ........ yregruS roF ydaeR gnitteG 4 4 ...........Preparing .....................your ..........skin .................................................................................................................... ........................................................ niks ruoy gniraperP Removing the tissue expander ............................................................................ 4 4 ...........How ..........to ......use ........Chlorhexidine .............................sponges ............ seg nops enidixehrolhC esu ot woH 5 ...........Food ...........and .........fluid ........The ..restrictions .......expander .............................................................................................................. ...is....removed ..................and ..... snreplaced oitcirtserwith diulan f dimplant na dooFabout 5twelve 5 This 5 ...........Medications ................................................................................................................................................... ...weeks .............after ..........the ........expansion .....................process ................has .......achieved ........ snoitmaximum acideM stretch. surgery takes about one hour. You will return home the day of the 6 6 ...........Smoking ................................................................................................................................................... .................................................................................................... gnikomS surgery and be able to return to work one to two weeks after the 6 6 ...........Packing .................for .......the .......hospital .................................................................................................................... ........................................ latipsoh eht rof gnikcaP surgery. 47 ........Coming to 74 ...and ...........areola .....Hospital ..........reconstruction ............................................................................... ................................ latipsoH ot gnimoC Nipple 7 7 ...........Surgical .................admission .................................................................................................................................. ............................................................ noissimda lacigruS Nipple reconstruction is usually done a few months after the expander 8 8 ...........Sentinel .................node ............biopsy ...................................................................................................................... .................................................. yspoib edon lenitneS has been removed and replaced by the implant. This allows time for the breast mound to heal and settle into its final shape and position and 59 ........Being 95 the ...........in ....Hospital ......allows ....................................................................................... .the .....plastic ..........surgeon .............to ....align .......the latireconstructed psoH ni gninipple eB with 9 by 9 ...........What ............to .....expect ...........natural ....after ..........surgery .nipple. ..............Nipple .......................................................................................... .............reconstruction ....... yregrus retis famost tcepxcommonly e ot tahW performed minor10 day surgery 01 .........Activity ................................................................................................................................................. .............using ............tissue ............from ...........the .......breast .............mound. ................This .........is ....a....relatively ..... ytivitcA done under local anaesthetic. The reconstructed breast or nipple 10 will not 01 .........Dressings ....................and .........drains .................................................................................................................... ....................................................sniard dna sgnisserD have the same sensation as a natural breast. 11 11 .........Getting ................dressed................................................................................................................. ........................................................................................desserd gnitteG The areola is usually created using a tattoo. Give yourself a minimum of 11 11 .........Hospital ..................discharge ............................................................................................................................... ............................................................ egrahcsid latipsoH twelve weeks after nipple reconstruction before booking an appointment through your plastic surgeon’s office. The procedure is performed by trained nurses. Exact matching can be a challenge but the results are generally satisfactory. 25 ii Getting for Expansion Breast yregru SReady noitcu rtsnTissue ocfor eR tTissue saerB Expansion noisn apxE Breast eReconstruction ussiT rReconstruction of ydaeRSurgery gnitteSurgery G Getting Ready Table stneTable tnof oCContents fo Contents elbaT of Donating your prosthesis 11 ........Introduction ...........Introduction .........If........................................................................................ .you ......have ........................................................................................... ...a...gently .........used ........breast ..........prosthesis ........... nooritcmastectomy udortnI bra11that you 1 1 would like to donate to the Breast Health Centre please phone 22 ........Before 22 ............Surgery ........250-727-4467. ........................................................................................ ................................................ yregruS erofeB 2 Before Surgery .................................................................................. 2 2 2 ...........Surgery ...............Surgery ..time ..........and .....time ....place ......and ......................................................................................................... ....place ............................................................................................................... ........................... ecalp dna emit yregruS 2 Sexuality 2 2 ...........Pre-operative ...............Pre-operative .............physical ................physical ....................................................................................................... ..................................................................................................................... ............................... lacisyhp evitarepo-erP 2 2 2 ...........Taking ..............part .Taking .........in ....Check .research .part ..........in .with ....research ...................................................................................................... ...your ..........plastic ...................................................................................................... ...........surgeon ................ h aeser about ni trapreturning gnikaT to sexual 2 orcrnurse 2 weeks2 2 ...........Hospital ...............Hospital ...pre-admission ..........activity. .....pre-admission ...........Most ....clinic .. tnwomen emappointment tnclinic iopcan paappointment csafely inil............................................................. c nresume oissim dhaving a-erp lintercourse atipsoH two ............................................................. 3 ...........Length ...............of .....stay ........after ....................................................................................................................... ..of .....stay ..surgery ............................................................................................................................ .........or ......when ...........they ..........are .......comfortable. .................... yatSome s fo htwomen gneL who3 have had Length 3 breast reconstruction surgery feel uneasy about returning to sexual Help at home ....................................................................................................................... 3 3 ..........................Help ...........at .....home .................................................................................................................................... ................................................................ emoh ta pleH 3 activity. They worry about how their changed appearance will affect their 3 3 ...........Results ...............from ...........surgery .....from .................................................................................................................... ......................................................................................................................... .................................... yregrus morf stluseR Results surgery 3 relationship with their partner. Some men worry about making the wrong moves or saying the wrong things. 34 ........Getting 43 ...........Getting ...Ready ......The .....Ready .For .nerve .....Surgery ...that ..For .....supplies ..Surgery ................................................................ ........ feeling yr.............................................................. egruto S the roFbreast ydaeR gnnipple itteGis disconnected 3 4 and 4 the 4 4 ...........Preparing ...............Preparing ......your .......during ...skin .....your ............................................................................................................... ..surgery. .....skin ................................................................................................................... ...Therefore, .....................the ........feeling ......... niof ks pleasure ruoy gnirfrom aperPtouching ............................................................................ 4 a can boost 4 ...........How ..........to .....How .use ........Chlorhexidine ..to ..breast ...use .........Chlorhexidine .and ........nipple ....sponges ..........is.. smostly esponges g noplost. s e............................................................................ nidBreast ixehroreconstruction lhC esu ot woH 4 woman’s feelings of wholeness and attractiveness and help her feel more Food and fluid restrictions .............................................................................................. 5 5 ..........................Food ............and .........fluid ..........restrictions .................................................................................................................... ............... snoitcirtser diulf dna dooF 5 comfortable with sexual intimacy. Medications .......................................................................................................................... 5 5 ..........................Medications ................................................................................................................................................... ....................................................................... snoitacideM 5 6 women 6 ...........Smoking ...............Smoking .................................................................................................................................... ..........Women ...................................................................................................................................... ...........differ ............about ............their ..........need ...........and .........readiness ...................for . gnintimacy. ikomS Some 6 feel it works best when a partner follows her lead and does not rush to Packing for the hospital ................................................................................................... 6 6 ..........................Packing .................for .......the ........hospital ................................................................................................................... ......................... latipsoh eht rof gnikcaP 6 start sexual activity. Many women have said that keeping romance in a relationship, as part of recovery, was important as it helped make the 47 ........Coming 74 to 7 ...........Coming ...to .....Hospital .relationship ......to .....Hospital ............................................................................. ....feel ......normal. ............................................................................ ..........Other .........women . latipso H osaid t gnthat imothey C needed 4 have 7 to improve 7 ...........Surgical ...............Surgical ..admission ...........openly .....admission .................................................................................................................. ....communicate ........................................................................................................................ ................their ...........feelings ................and .. noifears ssimdtoa their lacigrpartners uS 7 their partner’s understanding of the situation. Some women have found Sentinel node biopsy ........................................................................................................ 8 8 ..........................Sentinel ..................node ............biopsy ..................................................................................................................... ................................... yspoib edon lenitneS 8 that their partners go through a grieving process as well. 59 ........Being 95 ...........in ....Hospital .......in .....Hospital ................................................................................. .......................................................................................... ............................ latipsoH ni gnieB 5 Being 9 *Reference: Lamb, Sheila. Autologous Breast Reconstructive Surgery, Tissue transfer, 9 9 ...........What ............to ...What ..expect ..........to .Information ....after .expect .........surgery .....for .....Patients ............................................................................................... ........&...Family ............................................................................................. ..... y-reVancouver grus retfHospital a tcepx&eHealth ot tahServices W after surgery Centre. Feb.9 10 01 .........Activity ................................................................................................................................................. .............2000. .................................................................................................................................... ........................................................................................... ytivitcA Activity 10 Dressings and drains ....................................................................................................... 10 01 ........................Dressings .....................and .........drains ................................................................................................................... .....................................sniard dna sgnisserD 10 11 11 .........Getting ...............Getting .dressed................................................................................................................. ................dressed................................................................................................................. ........................................................................desserd gnitteG 11 11 11 .........Hospital ...............Hospital ...discharge ...............discharge ................................................................................................................ .......................................................................................................................... ............................................. egrahcsid latipsoH 11 26 ii Getting Breast yregruSReady noitcufor rtsnTissue oceR tExpansion saerB noisn apxE eReconstruction ussiT rof ydaeRSurgery gnitteG Ready aContents erB Surgery gnitteG Table sGetting tynreegtrunSof otsC ffor oroBreast ef lybdaaeRT Notes 11 ........Introduction 11 ............................................................................................................ ........................................................ noitcudortnI 22 ........Before 22 ............Surgery ................................................................................................ ................................................ yregruS erofeB 2 2 ...........Surgery .................time ..........and .........place ............................................................................................................... .......................................... ecalp dna emit yregruS 2 2 ...........Pre-operative ............................physical ....................................................................................................................... .............................................. lacisyhp evitarepo-erP 6 41 .....At .....Home ...........after ..........Surgery ................................................................................ .......................yregruS retfa emoH tA 14 6 2 2 ...........Taking ..............part ..........in .....research ...................................................................................................................... .......................................... hcraeser ni trap gnikaT 41 .......Effects ...............of .....surgery ............................................................................................................................. ....................................................................yregrus fo stceffE 14 2 2 ...........Hospital ..................pre-admission ..............................clinic .. tnemappointment tnioppa cinil............................................................. c noissimda-erp latipsoH 41 .......Incision .................care ................................................................................................................................ ...................................................................................... erac noisicnI 14 3 3 ...........Length ...............of .....stay ............................................................................................................................... .............................................................................. yats fo htgneL 51 .......Bathing ................................................................................................................................................. .......................................................................................................... gnihtaB 15 3 3 ...........Help ..........at ......home ................................................................................................................................... ................................................................................ emoh ta pleH 5Results 1 .......Driving .....from ............................................................................................................................................ .surgery ......................................................................................................................... ........................................................................................... gnivirD 15 3 3 ......................................................................................................... yregrus morf stluseR 51 .......What ............to ......do ............................................................................................................................... ............................................................................................od ot tahW 15 61 .......What ............not ........to ......do.................................................................................................................. .................................................................................od ot ton tahW 16 61 .......About ..............drains....................................................................................................................... ..................................................................................................sniard tuobA 16 4 4 ...........Preparing .....................your ..........skin .................................................................................................................... ........................................................ niks ruoy gniraperP 02 .......When .............to ......call ........your ..........surgeon ............................................................................................................ .............................. noegrus ruoy llac ot nehW 20 ............................................................................ 4 4 ...........How ..........to ......use ........Chlorhexidine .............................sponges ............ seg nops enidixehrolhC esu ot woH 5 5 ...........Food ...........and .........fluid ..........restrictions ..................................................................................................................... .............................. snoitcirtser diulf dna dooF 7 1Medications 2 .....Follow-up .................................................................................................................................... ........after ..........Surgery .............................................................................. ...................yregruS retfa pu-wollo5F 21 7 5 .......................................................................................................................... snoitacideM 12 .......Follow-up ......................with .........your ...........surgeon ....................................................................................................... .................... noegrus ruoy htiw pu-wollo6F 21 6 ...........Smoking ................................................................................................................................................... .................................................................................................... gnikomS 2 ..............for ..............back ..............hospital .............................................................................................................. ...h....e..h . ktrroowf gont ikkccaab 21 the 6 6 .........1..Packing .................Going ......to ............work .................................................................................................................. ............................................................................l.a..t..i.p...s.o P gnioG 22 .......When .............further ...............treatment ......................is....needed ........................................................................................... dedeen si tnemtaert rehtruf nehW 22 34 ........Getting 43 ..............Ready ............For ......Surgery ............................................................................ ........ yregruS roF ydaeR gnitteG 47 ........Coming 74 ..............to .....Hospital ......................................................................................... ................................ latipsoH ot gnimoC ........................................................................................................................... ..................................................................................................... ..i.s. syim redvaolcaceiR 7 23 8 7 ......8...3 ..Surgical .2 ..............Road ............admission ............to ..........Recovery .............................................................................. .n.o gro uSt daoR 2 ..............node ....................recovery .................................................................................................................................... ...o...i.b....e..d...oynrelevo P 23 8 .........3..Sentinel .................Physical ....biopsy .................................................................................................................. ................................................................................................y..s..p nictenrelSacisyh8 52 .......Emotional ......................support ........................................................................................................................... .............................................................. troppus lanoitomE 25 …sotH eenhiSgnnoieitBaulav9E23, 59 .....9..4.Being .2...,.3..2Evaluation ..… ..in ..… ..Hospital ..… ....… ...… ...Sheet .… ................................................................................ ..… ....… ..………………………………………………… .… ....… ....… ....… ...… ....… ....… ....… ....… la… tip 5 24 9 9 9 ...........What ............to .....expect ...............after ..........surgery ......................................................................................................... .................... yregrus retfa tcepxe ot tahW 10 01 .........Activity ....................................................................................................................................... .............................................................................. ytivitcA ....................Jubilee ................................Hospital ......... gniSite kraPand dnaParking etiS lati...................................... psoH eelibuJ layoR 2501 105.2..............Royal 10 01 .........Dressings ....................and .........drains .................................................................................................................... ....................................................sniard dna sgnisserD 11 11 .........Getting ................dressed................................................................................................................. ........................................................................................desserd gnitteG 11 11 .........Hospital ..................discharge ............................................................................................................................... ............................................................ egrahcsid latipsoH 27 ii Getting Ready for Tissue Expansion Breast Reconstruction Surgery Table of Contents Getting yregruSReady tsaerB forroBreast f ydaeRSurgery gnitteG Notes 1 Introduction ...................................................................................... 1 2 Before Surgery .................................................................................. 2 Surgery time and place .................................................................................................... 2 Pre-operative physical ...................................................................................................... 2 6 41 .....At ....Taking .Home .........part ..after .....in ....research .Surgery ................................................................................................................ .................................................................... .......................yregruS retfa emoH tA 14 62 41 .......Effects ...............of .....surgery ............................................................................................................................. ....................................................................yregrus fo stceffE 14 Hospital pre-admission clinic appointment ............................................................. 2 41 .......Incision ......Length ...........care ....of .....stay ....................................................................................................................... .............................................................................................................................. .............................................................................. erac noisicnI 14 3 51 .......Bathing ......Help ........................................................................................................................................... .....home ................................................................................................................................... ......................................................................................... gnihtaB 15 3 at 51 .......Driving ......Results ........................................................................................................................................... ......from ...........surgery ........................................................................................................................ ............................................................................ gnivirD 15 3 51 .......What ............to ......do ............................................................................................................................... ............................................................................................od ot tahW 15 61 .......What ............not ........to ......do.................................................................................................................. .................................................................................od ot ton tahW 16 3 Getting Ready For Surgery .............................................................. 4 61 .......About ..............drains....................................................................................................................... ..................................................................................................sniard tuobA 16 Preparing your skin ........................................................................................................... 4 02 .......When .............to ......call ........your ..........surgeon ............................................................................................................ .............................. noegrus ruoy llac ot nehW 20 How to use Chlorhexidine sponges ............................................................................ 4 Food and fluid restrictions .............................................................................................. 5 7 12 .....Follow-up ....Medications ..............after .............................................................................................................................. ......Surgery .............................................................................. ...................yregruS retfa pu-wolloF 21 75 12 .......Follow-up ......Smoking ................with .................................................................................................................................. ........your ...........surgeon ....................................................................................................... .................... noegrus ruoy htiw pu-wolloF 21 6 12 .......Going ......Packing ........back .........for .to .....the .work .......hospital ............................................................................................................ ................................................................................................................ ............................................. krow ot kcab gnioG 21 6 22 .......When .............further ...............treatment ......................is....needed ........................................................................................... dedeen si tnemtaert rehtruf nehW 22 4 Coming to Hospital .......................................................................... 7 8 32 .....Road ....Surgical ......to ....Recovery ..admission .......................................................................................... ....................................... yrevoceR ot daoR 23 87 ............................................................................................................. 32 .......Physical ......Sentinel ...........recovery ......node ...........biopsy ............................................................................................................... ..................................................................................................................... ....................................................... yrevocer lacisyhP 23 8 52 .......Emotional ......................support ........................................................................................................................... .............................................................. troppus lanoitomE 25 9 452 ,32Evaluation …Being ……… Sheet ………………………………………………………… ….............................................................................. ………………………… teehS noitaulavE23, 24 99 in…Hospital What to expect after surgery ......................................................................................... 9 Activity .................................................................................................................................. 10 ..........Jubilee ..............Hospital ......... gniSite kraPand dnaParking etiS lati...................................... psoH eelibuJ layoR 2501 1052 .....Royal Dressings and drains....................................................................................................... 10 Getting dressed................................................................................................................. 11 Hospital discharge ........................................................................................................... 11 28 i Getting Breast yregruSReady noitcufor rtsnTissue ocReady eR tExpansion saerTissue B noisn apxE eReconstruction ussiT rof ydaeRSurgery gnitteG Getting yfor regruS tExpansion saerB roBreast f ydaReconstruction eR gnitteG Surgery Table Table stnetnof oCContents foofeContents lbaT Getting Ready...................................................................................... For Tissue Expansion Surgery 1 1 Introduction 11 ........Introduction ...................................................................................... 11 .............................................................................. noitcudortnI _________________________________________________ 2 Before Surgery .................................................................................. 2 us what 22 ..Tell Before Surgery .................................................................................. 22 ......................Surgery ..........you ..time .......and .think! .....place ............................................................................................................ ......................... yregruS erofeB 2 41 ...................................................................yregruS retfa emoH tA 6 2 Getting 2 2 ...After ........Surgery .......reading ..........time ....Pre-operative ......and .........place ............................................................................................................... .Ready .physical ...................................................................................................................... .for .........Tissue .............. ecExpansion alp dna emit ySurgery regruS please 4 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . y r e g r u s f o s t c e f f E ...................................................................................................... 2 2 2 ...respond ........Pre-operative ..............to ......the .Taking .......physical ..following ......part .........in ....research ......statements. ............................................................................................................... ..................Your ....... lacianswers syhp evitarand epo-ecomments rP will 4 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e r a c n o i s i c n I 2 2 2 ...help ........Taking .....us .......improve ..part .......Hospital ...in .....research .....the .....pre-admission .....information. ....................................................................................................... .....................clinic ..........appointment ........... hcraese............................................................. r ni trap gnikaT 51 .....pre-admission ..................of ............clinic ...........appointment ........................................................................................ ........................................................ gn2ihtaB 3 2 ...Circle ........Hospital .......one .........number .....Length ..............for ......stay ..each ............................................................................................................................ . tnstatement: emtnioppa cinistrongly lc noissimddisagree a-erp latipsoH strongly agree 5 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................................... gn3ivirD 3 3 ..._______________________________________________________________ ........Length ...............of .....stay .Help .............................................................................................................................. ...at .....home .................................................................................................................................. ........................................................... yats fo htgneL 51 ...home ................................................................................................................................... ...................surgery ........................................................................................od ot t3ahW 3 3 ...........Help ..........at ............Results ..............from ................................................................................................................................... .............................................. emoh ta pleH I read all of the information 6 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..provided. ..........................................1...........2 .........o3d ot t4 on t3ah5W 3 ...Comments ........Results ...............from ...........surgery ......................................................................................................................... .................................................... yregrus morf stluseR ..................Ready ...............For .........Surgery ................................................................................ ..................................................sniard tuobA 4 361 .........Getting _______________________________________________________________ 02 ........................................................................................... noegrus ruoy llac ot nehW 4 34 ........Getting ...........Ready ..Preparing ..........For .is ....your .Surgery ......skin ..to ............................................................................................................... .read. ............................................................... ........ yregruS roF yd1aeR 2gnitt3eG 4 43 5 The...information easy How skin to use Chlorhexidine sponges ............................................................................ 4 4 4 ...Comments ........Preparing .....................your .............................................................................................................................. ........................................................ niks ruoy gniraperP 12 .use .....Food ........and ......fluid ........restrictions .......................................................................................... ............................................................................................... ......................yregruS retfa pu-wo4lloF 5 7 4 ..._______________________________________________________________ ........How ..........to ..............Chlorhexidine .............................sponges ............ segnops enidixehrolhC esu ot woH 12 .......fluid ..Medications .................................................................................................................................................. ..................................................... noegrus ruoy htiw pu-w5olloF 5 5 ...........Food ...........and ...................restrictions ..................................................................................................................... .............................. snoitcirtser diulf dna dooF The information 12 .........Smoking ............................................................................................................................. ...........is .................................................................................................................................... ...easy .............to ......understand. ..............................................1 ...........2 krow 3 ot kca4b g5ni5 oG 6 Medications 5 ...Comments ....................................................................................................................... snoitacideM 22 .........Packing ................for .......the .......hospital ................................................................................................................... .....................dedeen si tnemtaert rehtruf n6ehW 6 6 ...........Smoking ................................................................................................................................................... .................................................................................................... gnikomS _______________________________________________________________ 6 6 ...........Packing .................for .......the .......hospital .................................................................................................................... ........................................ latipsoh eht rof gnikcaP 432 .this Coming to Hospital .......................................................................... Reading information helped me 1 2 3 4 .......................................................................... yrevoceR ot da5 oR 7 8 prepare 32 .for ........Surgical .and ...........recover ....admission ................................................................................... .......from ................................................................................................................. ..........my .........surgery. .............................................. yrevocer lac7isyhP 7 47 ........Coming ..............to ..Sentinel ...Hospital .........node ........biopsy .................................................................................................................. .................... latipsoH ot gnimoC 4 8 Comments 5 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t r o p p u s l a n o i t 7omE 7 ...........Surgical .................admission .................................................................................................................................. ............................................................ noissimda lacigruS _______________________________________________________________ 42 ,32 …… ……........................................................................................................ ……………………………………… teehS noitau8lavE 9 8 ...........Sentinel .......5 ..........node ....Being ........biopsy .......in .....Hospital .................................................................................................. ................................ yspoib edon lenitneS 9 The information answered my questions. 1 2 3 4 5 What to expect after surgery ......................................................................................... 9 Comments 59 ........Being in Hospital .............................................................................. 9 ......5..2........Activity ............................................................................................................................................ .......................g..n ..i.k ...r.a..P...d ...n..a.. elatitSiplsaotiHpsnoiHgneieelB ibuJ la5 yoR 10 01 _______________________________________________________________ 9 9 ...........What ............to .....expect ....Dressings ...........after .........and .surgery ........drains ................................................................................................. ........................................................................................................... ................ yregrus retfa tcepxe ot tahW 10 I would recommend this information to 1 2 3 4 5 10 11 01 .........Activity ................................................................................................................................................. ......Getting ................dressed................................................................................................................. .................................................................................... ytivitcA other patients. 10 11 01 .........Dressings ....................and .Hospital ........drains ..........discharge .......................................................................................................... ........................................................................................................................... ....................................sniard dna sgnisserD Comments 11 11 .........Getting ................dressed................................................................................................................. ........................................................................................desserd gnitteG 11 11 .........Hospital ..................discharge ............................................................................................................................... ............................................................ egrahcsid latipsoH ________________________________________________________________ 29 ii i regruSReady Getting Breast Reconstruction y noGetting itcufor rtReady snTissue ocefor R tExpansion saerB noisn apxE eReconstruction ussiT rof ydaeRSurgery gnitteG yregTissue ruS tExpansion saerB roBreast f ydaeR gnitteG Surgery Table Contents stneTable tnof oCof fContents o elbaT 1 Introduction ...................................................................................... 1 Getting Ready For Tissue Expansion Surgery Getting Ready For Breast Surgery 11 ........Introduction 11 ............................................................................................................ ........................................................ noitcudortnI _________________________________________________ 2 Before Surgery .................................................................................. 2 and place .................................................................................................... 2 22 ........Before ..............Surgery ......Surgery ................time .............................................................................................. ..........................................................y..r.e..g. y ofoeH B tA 22 6 4.1 .Pre-operative ....physical ............................................................................................................................. rure SgrreutfSaeerm 2 3 ....................................................................................................................... emoh ta pleH I3 would surgery ..Getting ....from .............liked ..MORE ..For ..about: .r..u...s...m ....o ..srn .........3.6.Results .1.........have ...Ready ........................................................................................................................ ........Surgery ................information .................................................................. ...............................y..r..e..g f isȱatrld usteuRobA 43 02 .........Preparing ....................your ..........skin ................................................................................................................... ............................................ noegrus ruoy llac ot nehW 4 __________________________________________________________ 34 ........Getting 43 .........How .....Ready ..to ...use ......Chlorhexidine .For ......Surgery .............sponges ............................................................... ........ y............................................................................ regruS roF ydaeR gnitteG __________________________________________________________ .restrictions ...................................................y..r..e piura-pweorPlloF 54 7 4 ..........1.Preparing ..2................Food ................your ..and ..............fluid ..skin .......................................................................................................................... ................................................................................................................................. ...gnriu ksS rrueotyfagn _________________________________________________ ȱ5 .......................................................................................................................... ....Medications ........use .................Chlorhexidine ..........................s..e..g ...n ...o...p...s...e. n hstiuwoptuw -w ............................................................................ 4 ..........1.How .2................to ...........................................................sponges no ideig xeruhsrorulhoCy e oo HlloF 4 6 ..and ..Smoking .................fluid ...................................................................................................................................... ................................................................................................................... ...............information I5 would ..........1.Food .2................have ...........liked ....restrictions ..........................LESS ...............................................s..n...o...i.t.c...i.r.about: t..s..e..rkrdoiw ulfodtȱ nkacadbogonFioG 5 Packing for the hospital ................................................................................................... 6 22 ................................................................................................................................................ ......................................................dedeen si tnemtaert rehtruf nehW 5 5 ...........Medications ............................................................................................................... snoitacideM __________________________________________________________________ 6 6 ...........Smoking ................................................................................................................................................... .................................................................................................... gnikomS __________________________________________________________________ 432 ......Coming to Hospital .......................................................................... 7 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . y r e v o c e R o t d a o R 6 6 ...........Packing .................for .......the .......hospital .................................................................................................................... ........................................ latipsoh eht rof gnikcaP _________________________________________________________ ȱ Surgical admission ............................................................................................................. 7 32 .............................................................................................................. yrevocer lacisyhP Sentinel node biopsyyou ........................................................................................................ 8 What52changes ..........................would ...................................make ...................in ........this .............book ...... troppto us lamake noitomEit better or 47 ........Coming 74 ..............to .....Hospital ......................................................................................... ................................ latipsoH ot gnimoC 4 2 , 3 2 … … … … … … … … … … … … … … … … … … … t e e h S n o i t a u l a v E 9 please add other comments: ȱ 7 .........5..Surgical ............Being .....admission ........in ......Hospital .................................................................................................................... ......................................................................................... ................................................. noissimda lacigruS 97 __________________________________________________________ 8 ...........Sentinel ............What .....node ......to .....expect .biopsy ............after .......................................................................................................... ........surgery ....................................................................................................... ............................ yspoib edon lenitneS 98 52 ......Activity ............................................................................................................................................ ...................... gnikraP dna etiS latipsoH eelibuJ layoR 10 01 __________________________________________________________ 10 59 ........Being 95 .........Dressings ..in ....Hospital ........and ......drains ............................................................................... .............................................................................................................. ................................. latipsoH ni gnieB _________________________________________________ ȱ Getting dressed................................................................................................................. 119 9 ...........What ............to .....expect ...............after ..........surgery ......................................................................................................... .................... yregrus retfa tcepxe ot tahW Hospital discharge ........................................................................................................... 11 I01am: 10 .........Activity ................................................................................................................................................. .......................................................................................................... ytivitcA ȱȏȏȱȱȱ 10 01 .........Dressings ....................and .........drains .................................................................................................................... ....................................................sniard dna sgnisserD 11 11 .........Getting ................dressed................................................................................................................. ........................................................................................desserd gnitteG ȱȏȏȱȱ¢ȱȱȱ 11 11 .........Hospital ..................discharge ............................................................................................................................... ............................................................ egrahcsid latipsoH dŚĂŶŬLJŽƵ͊ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱDZȱȱ Breast Health Centre, CFAU Victoria General Hospital 1 Hospital Way Victoria B.C. i V8Z 6R5 ii 2830 28 i i 2 ..........4.Surgery .1........to .............have .........time ..this ..and ..................place .information ...................................................................................................................... ........................................e..c..a...l.p....d...n...a.yeremgirtuysrfeogsru I2prefer .................part ..................................................................................................................... ...............................in: tcSeffE 2 Taking in...research .1.....................................................physical ........................................................................................................................................ ...................................................l..a..c..i.s...y..h...p....e..v..i..t.a. ererapcon-eorisPicnI 2 .......................clinic .....................appointment ȱ2 ..........4.Pre-operative Hospital pre-admission ............................................................. 2 Taking part in research .................................................................................................... 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . h 5 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...c..r..a..e...s..e..r...n ...i..t..r..a..p ....g ...n . giknaihTtaB 32 ______ A book like this one ȱ Lengthjust of stay ...................................................................................................................... 2 ..........5.Hospital .1...........Help .....home ................................................................................................................................... .. .t.n c..n sonH ......pre-admission ......at .............clinic ...e...m .appointment ...t.n ...i.o ...p ...p...a...c...i.n..i..l............................................................. ...o ...i.s..s..i.m ..d ...a...-..e..r..p....l.a..t..i.p .. g ivirD 32 ______Separate handouts on each topic..that I..need 3 ..........5.Length .1...........Results ......from ......................................................................................................................... .......surgery ..................................................................y...a..t..s...f..o.ohdtg ...of ........stay .......................................................................................................................... on te taLhW 33 ȱ 6Help 1 .......at ......home .................................................................................................................................... ........................................................................................od ot ton tahW 3 *HWWLQJ5HDG\IRU%UHDVW6XUJHU\ *HWWLQJ5HDG\IRU%UHDVW6XUJHU\ 5R\DO-XELOHH+RVSLWDO6LWHDQG3DUNLQJ 5R\DO-XELOHH+RVSLWDO6LWHDQG3DUNLQJ 11 Le e A ve nu ! e Le e A ve nu ! e C B Can ce r BC an gen CA " ce cy r gen A cy " ic Er Mar tin Pa vi lio ic Er n Mar tin Pa vi lio n D & T Ce n tr e D & T Ce n tr e e R n a l Re n ln U a it n U it n t e tre tre "S y a B lio "S y a B t e M vi a n lio vilP a a ri lP ia o o rem M m e a P ti an Ad ac ion an Ad Pa vil ac Pavil ion P r o it is V r rk a o e P d it a Vis e d a rk a P P a P tie n tC a re en C tC e a n tre re C e n tre D & T Centre D & T Centre Link to BC Cancer Agency, Level 0 Link to BC Cancer Agency, Level 0 Emergency, Level 1 Emergency, Level 1 Medical Imaging, Level 1 Medical Imaging, Level 1 Clinics, Level 1, 2 Clinics, Level 1, 2 Surgical Day Care, Level 3 Surgical Day Care, Level 3 Cardiac Short Stay, Level 3 Cardiac Short Stay, Level 3 Coronary Care Unit (CCU), Level 3 Coronary Care Unit (CCU), Level 3 Cardiovascular Unit (CVU), Level 3 Cardiovascular Unit (CVU), Level 3 Intensive Care Unit (ICU), Level 5 Intensive Care Unit (ICU), Level 5 Patient Care Centre Patient Care Centre Adult / Senior Mental Health 1, 2 Adult / Senior Mental Health 1, 2 Heart Health / Clinical Teaching, Level 3 Heart Health / Clinical Teaching, Level 3 General Medicine, Level 4, 8 General Medicine, Level 4, 8 Rehabilitation / Bone Health, Level 6 Rehabilitation / Bone Health, Level 6 General Surgery, Level 6, 7 General Surgery, Level 6, 7 e W st e W lo B st ck B lo ck ic R o C h ro n m at io o n n d R ic Co h ro m n P P av av il ili at o io n n o io n d n av P av P il ili o io n n R ic h m o n d R ic R h o a m d o n d R o a d o R y "a lB lo ck o R y "a lB lo ck Richmond Pavilion Richmond Pavilion Victoria Hospice, Level 3, 4 Victoria Hospice, Level 3, 4 West Block West Block Nuclear Medicine, Level 1 Nuclear Medicine, Level 1 Outpatient Laboratory, Level 1 Outpatient Laboratory, Level 1 29 25 29 25 The Victoria Breast Health Centre color scheme and logo are inspired by Ted Harrison’s print “The Poet Who Greets the Sun”. The print was a gift from the Victoria Breast Cancer Support Group to mark the inception of the Victoria Breast Health Centre in 2001. Booklet created by Cathy Parker, R.N., B.Sc.N.; Revisions by Dorothy Yada, R.N. Shawna Bond, R.N. Breast Health Patient Navigators Victoria Breast Health Centre [email protected] www.viha.ca/breast_health_services/ Victoria General Hospital 1 Hospital Way, Victoria, B.C. V8Z 6R5 250-727-4467
