Preoperative Care
A few days before surgery, the patient's overall health is assessed. Preoperative tests depend on the patient's age and health and generally include a blood test, a chest x-ray, and possibly an electrocardiogram (EKG).
Medications that "thin" the blood , including aspirin, should be discontinued several days prior to a scheduled operation to avoid abnormal bleeding during the procedure. Patients must refrain from eating or drinking at least 8 hours prior to surgery to reduce the risk of vomiting during the procedure. This may include taking oral medications and this should be discussed with the physician.
On admission to the hospital, the patient must sign an informed consent form to make sure the surgeon has explained what a mastectomy is and the risks associated with the surgery.
Next, the anesthesiologist (physician who administers the anesthesia) performs a brief physical assessment and takes a medical history. The anesthesiologist is made aware of current medications, any history of allergies, and previous adverse reactions to anesthesia to assess conditions that may determine the choice of anesthesia and any precautions that must be taken.
An intravenous line (IV) is started to administer fluids and medication during the procedure. The patient is taken to the preoperative holding area and must stay in bed from this point on, except to use the bathroom. Sedation is sometimes given in the preoperative holding area, but the anesthesia is administered in the operating room.
Postoperative Care
Immediately following surgery, the patient is taken to the postanesthesia care unit (PACU) and is closely monitored by the nursing staff until the anesthesia wears off. When the patient awakens fully from the anesthesia and the vital signs stabilize, they are taken to their room.
After the anesthesia wears off, there is pain in and around the incision and pain medication is prescribed. Most mastectomy patients have a drainage tube placed in the breast or under the arm to drain blood and fluid that accumulates during healing. The tube is usually removed within a few days, depending on recovery; however, sometimes it must remain in place for a week or two.
The IV remains until the patient can tolerate fluids taken by mouth. Clear liquids are offered the day of the surgery or the morning after. Once liquids are tolerated, the diet progresses to solid food. If medication such as antibiotics has been prescribed, the intravenous remains in longer.
The length of hospitalization depends on the type of mastectomy performed, breast reconstruction, and complications. If a simple mastectomy has been performed, the patient may be discharged the same day. Most patients remain in the hospital for 1 or 2 days, but if reconstruction is done, the stay is longer.
If discharge is the same day as surgery, the patient must be accompanied home. Patients require assistance for several hours after the anesthesia wears off.
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