How long is the Surgery?

Hospital Stay for Surgery

After Surgery,
Will I have pain?

Here comes the most anxious part - time for admission and surgery. There are so many doubts, so many questions. A fear. What will happen? Will I have a lot of pain? WiIll I be able to walk next day? What happens to my family, how will they take care of themselves in my absence? So many questions.

No doubt, there is lot of anxiety for the patient (and family), during admission. But in two days, when she will be discharged, she will realize that, honestly, the actual pain she is having, and other apprehensions she had about surgery, are not even 10 percent of what she had imagined! Indeed. Amongst all cancer surgeries, breast cancer surgery is one of the least problematic surgeries. And more than 99 percent of patients will go home, all fit and fine, smiling and with the least discomfort! You can take my word for that!

What happens after admission to the hospital? How do things go? Lets discuss this under following headings:
Pre operative counseling - where the surgeon discusses the surgery and the consequences.
Exercises and Physiotherapy - one of the most important things during recovery.
Surgery - A brief idea of what happens.
Post operative period - Timeline of how things go.

Please remember, all centres and hospitals will have their own protocols, and there are differences from hospital to hospital. The following description is only a general overview of how we manage in our affiliated hospitals.

Pre Operative Counselling

I personally meet the patient and relatives, after admission to explain things in detail. The standard points (which I explain in detail) during my pre operative counseling are as follows:

An over view of the Surgery - (either a Breast Conserving Surgery or a Mastectomy, as would have been discussed during treatment planning.
Lymph Nodes - Will it be a complete removal of all nodes in the arm pit, or will it be Sentinel Node Biopsy.
Possible intra operative issues we can face, especially sometimes in advanced cases, where lymph nodes are stuck to the vein and are not possible to remove, issues related to anesthesia and revoery, any need of post operative ICU stay in older patients etc.
Consequences of surgery - neuropathy (pain, tingling and heaviness related to nerves, if divided during surgery), fluid collection in armpit due to removal of nodes, placement of drain, continued fluid collection for some time after surgery, occasional wound issues etc.
Necessity of Physiotherapy and Exercises - described below
A time line of dressings, removal of drain and removal of stitches
Reconstructive Surgery - If any reconstructive surgery is involved, the respective Plastic surgery team will also counsel, but I do give a brief overview to the patient, after having co ordinated with them.
And most importantly - a Hope, a Light, a Positivity - that all is soon going to be fine, that 'tomorrow, you are going to be free of cancer!'

Pre operative counselling
Physiotherapy for BC

Physiotherapy Exercises

Breast cancer surgeries involve removal of lymph nodes from the arm pit, in varying degree, depending on the stage. These nodes are 'deep' in the arm pit. So, after surgery, for a few days, if the patient doesn't lift up her arm, you can imagine that a sort of 'contracture' in the arm pit is going to develop, resulting in severe restriction in the movements at the shoulder of the operated side.

But this can easily be prevented. By starting shoulder movement exercises right from the first post operative day. The best way to learn these exercises is to learn them before surgery, so that the patient knows what is to be done after surgery. During pre operative counselling, we teach the exercise to the patient. And on the first post operative day, our Onco Physiotherapist visits the patient and helps them do the shoulder exercices, ensuring that she does it the proper way.

Apart from maintaining the shoulder movements, the exercises have an important role in reducing the pain at shoulder. The more free the movements at shoulder, the lesser the pain.

The Surgery

And finally, that time has come. The patient is wheeled in into the Operating room (OR), her husband and children holding her hand, before she enters the OR. Calmly, the anesthetist puts her to sleep (General Anesthesia). The usual time for a Breast Conservative Surgery or a Modified Radical Mastectomy is usually two to three hours, depending on various factors. If there is some reconstructive procedure in addition, the time will be more. After the surgery is over, for a standard BCS or MRM, usually, the patient is shifted back to the ward. Only in those patients, where there are additional problems, like heart issues, fluctuations in Blood pressure, or some intra operative issues, an overnight ICU stay is considered. In any case, the next day, usually they are back to ward.

To note, after surgery, all patients will have a 'suction drain' - a tube coming out from the arm pit and attached to a container, which sucks fluid collecting in the arm pit by principle of vacuum. This tube is usually kept for about 10 to 12 days and the patient goes home with it.

Waiting during surgery

The Post Surgery Period

After the surgery is over, the patient is monitored in the recovery room (just near the operating room), for about an hour or two, and then shifted out to ward. Following is a brief idea of what is done in the ward over next two days:

From the time of completion of surgery, the patient remains fasting for about 3 to 4 hours (sometimes 6 hours), as per the anesthetist's orders. After that fasting time, she is first started with some sips of water or Glucon D or Electral. Once she tolerates that, we wait for another half an hour to an hour, and after ensuring she is not having vomiting and is not feeling 'puky', she is started on 'soft' diet - in Indian context, something like 'khichdi' or 'dal rice' or soup with some bread or maybe some idli sambhar. She can have some tea with biscuits as well.
Once the patient tolerates oral diet, intra venous fluids are completely stopped. The only injectables going on are the antibiotic and the pain killer.
The next day morning (this is called as the 'First Post Operative Day') starts with a good breakfast. We usually visit the patient once in the morning, have a look at the 'suction drain', and also have a look at the operated site, to ensure there has been no bleeding. We take this opportunity, to teach the patient and relatives about the 'drain' as she would be going home with it, and it will remian in place from 10 to 12 days usually. After that, we encourage the patient to start with the shoulder exercises. Later, a visit by the Onco Physiotherapist happens, who re inforces the exercises.
Discharge: For routine BCS and MRM (without reconstruction), we usually discharge the patient by evening of the first post operative day or morning of the second post operative day, unless some problem has cropped up. During discharge, some oral antibiotics, pain killers, medicines to control acidity are given. Drain emptying is taught once more, and exercises by the patient are assessed. That's it! Short and sweet!

Our Approach at this Step


A patient undergoing surgery is a very tender moment for both the patient and the family. Every second of waiting outside the operating room for the relatives, praying for wellbeing of their loved one undergoing the surgery, is something which is always on my mind when I operate. Before taking up the patient in the operating room, we make it a point to meet the patient and relatives together once more, to reassure that all will be well. And of course, doing a top notch surgery, is not just a passion, but a responsibility, and we always strive to live up to it. in the post operative period, it is essential to make the patient comfortable, especially from pain, and we lay emphasis on the same. I visit the patient, once in the evening of surgery, sit with them for a while, and then visit them the next day morning as well, to carry out the agenda as mentioned in the post operative period above. During time of discharge, I have almost always seen a glint of positivity, smile, and happiness in the patient and relatives, mainly because of two reasons - one, of course, that the cancer is now out of the body, what a relief! And two, contrary to what the patient had thought of problems around surgery, hardly anything happened, and she is more than happy. So positivity is in the air! Time for an ice cream!


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TOPICS IN THIS SECTION

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Journey of BC: Diagnosis


1. I feel a lump! - The first visit to doctor
2. Is it really cancer? - Confirmatory tests
3. What is the stage? - Staging and fitness tests
4. Will it be surgery first? or chemo first? - Treatment planning and sequence

Journey of BC: Surgery


5. Should I conserve or remove breast? - Choice of Surgeries for breast cancer
6. How long will be the surgery? - Admission and Surgery - You are presently on this page
7. Care after surgery - Precautions and guidelines
8. What next? - The Pathology Report

Journey of BC: Further Treatment


9. How many chemo cycles? - Chemotherapy Consultation
10. Is a PORT necessary? - ChemoPORT insertion
11. Will I be normal during chemo? - The Chemotherapy time
12. Is Radiation painful? - Radiation Therapy
13. Yes!! I did it! - Treatment is over
14. How frequently do I meet doc? - Follow up guidelines

Other Topics


Risk Factors - The Risk Factors for Breast Cancer
Symptoms of Breast Cancer - Know the Symptoms of Breast Cancer
Early Detection of Breast Cancer - The Guidelines

Mammography, MRI, Ultrasound of the Breast
Core Biopsy - The Procedure

Neo Adjuvant Chemotherapy (NACT) - For LABC
Sentinel Node Biopsy - How is it done?
Targeted Therapy - Trastuzumab
Hormone Therapy - Who gets it?