Before your operation for breast cancer

How long are you in hospital

Many people go home on the same day as their operation. Others are in hospital for at least a few nights, for example if you are having breast reconstruction. The length of your stay depends on the type of operation you have and your recovery.

Some hospitals have an enhanced recovery programme where they aim to have most people home quite quickly after surgery.

Tests to check you are fit for surgery

You have tests before your operation to check:

• your fitness for an ​anaesthetic​

• that you’ll make a good recovery from surgery

You might have some or all of the following tests:

• blood tests to check your general health and how well your kidneys are working

• a swab test to rule out some infections

• an ​ECG​ to check that your heart is healthy

• breathing tests (called lung function tests)

• an ​echocardiogram​ (a painless test of your heart using sound waves)

• a test to check your heart and lung function when you're resting and exercising (called a cardio pulmonary exercise test)

Pre assessment clinic

Your pre assessment clinic appointment prepares you for your operation. You have it about a week or so before surgery.

You meet members of your treatment team at this appointment. You might also sign the consent form to agree to the operation.

Your doctor or nurse might talk to you about the Enhanced Recovery Programme at your hospital. This is a programme of care that helps people recover more quickly after a big operation.

Ask lots of questions during your appointment. It helps to write down all your questions beforehand to take with you. The more you know about what is going to happen, the less frightening it will seem.

You can ask more questions when you go into hospital. So don’t worry if you forget to ask, or think of more questions when you get home.

Who you might meet before your operation

Nurse or healthcare assistant

At the pre assessment clinic a nurse or health care assistant checks your:

• general health

• weight

• blood pressure

• pulse

• temperature

The nurse asks you questions to check your fitness for the operation. They can organise any further tests you might need.

They ask about any medicines you are taking and give you information about what to expect when you come into hospital for the operation.

They will let you know if you need to stop taking certain medicines before your operation. Tell them if you usually take medicines to thin your blood or have other medical conditions, such as diabetes.

They may give you a leaflet to teach you leg and breathing exercises to do after your operation to help with recovery.

Specialist breast cancer nurse

You may also see your specialist breast nurse. They can check what help and support you have to, see what you will need when you go home. They are usually your main point of contact and care for you throughout your treatment.

Your breast care nurse or a physiotherapist will talk to you about arm exercises that you need to do after your operation. This helps with your recovery.

The breast surgeon

Your breast surgeon or a member of their team will tell you about:

• the operation you are going to have, and where the scars will be

• the benefits of having surgery

• the possible risks

• what to expect afterwards

The anaesthetist

The anaesthetist gives you the anaesthetic and they look after you during the operation. The anaesthetic is the medicine that keeps you asleep during your operation. They make sure you’re fit enough for the surgery.

Physiotherapist

The physiotherapist assesses how well you can move around. They let the doctors know if there is anything that could affect your recovery.

After breast cancer surgery you’ll start with gentle exercises and slowly build these up over a number of weeks. Depending on the type of surgery you have will depend on what exercises are right for you. You’ll have a plan to follow to help you get back to strength and full range of movement.

The physiotherapist also teaches you leg and breathing exercises to do after your operation to help with recovery. Learning how to do the exercises beforehand makes it easier afterwards.

Magnetic marker placement

You may have a magnetic marker put in a few days or weeks before your breast conserving surgery. This is to help the surgeon find a cancer they cannot feel. Magseed is the name of one of the magnetic markers in use.

The marker is about the size of a grain of rice and is 5mm in length. It's made of stainless steel. You have this put in with a mammogram or ultrasound scan with a ​local anaesthetic​ . You go to the radiology department for this.

Things you can do to help you prepare for your operation

There is a higher risk of complications if you are having breast cancer surgery and you:

• smoke

• are very overweight

• have other serious medical conditions

You might recover more quickly after surgery if you do the following things before your operation.

Stop smoking

Smoking can lower the blood supply to the bodies tissue. This can cause problems with wound healing after the operation to remove the cancer or with breast reconstruction.

It can also increase your risk of getting an infection.

If tissue is taken from your tummy (abdomen), smoking increases the risk of hernia.

Maintain a healthy weight

There is an increased risk of complications from an anaesthetic and the outcomes of the surgery if you are overweight. Ask for a referral to a dietitian if you would like to lose weight before the operation.

Keep physically active

You might have exercises to do before breast surgery to help strengthen the muscles involved. For example if tissue is going to be taken from your abdomen for breast reconstruction, it can be useful to do sit ups and gradually build these up. Talk to your doctor or specialist nurse before starting any exercise.

Learning breathing and leg exercises

Breathing exercises help to stop you from getting a chest infection after surgery. If you smoke, it helps if you can stop at least a few weeks before your operation.

Leg exercises help to stop blood clots forming in your legs. You might also have medicines to stop the blood from clotting. You have them as small injections under the skin.

You start the injections after your operation. You might also wear anti embolism stockings or have pumps on your calves to help the circulation.

Your nurse and physiotherapist will get you up out of bed quite quickly after your surgery. This is to help prevent chest infections and blood clots forming.

This 3-minute video shows you how to do the breathing and leg exercises.

What to take with you

Take in:

• nightgowns or pyjamas

• underwear

• dressing gown

• slippers

• contact lenses, solution, glasses and a case

• wash bag with soap, a flannel or sponge, toothbrush and toothpaste etc

• sanitary wear or tampons

• towel

• small amount of money

• medicines you normally take

• magazines, books, playing cards

• headphones and music to listen to

• a tablet or smartphone for web browsing, entertainment and phone calls

• chargers for electronic devices

• a copy of your last clinic letter (if you have one)

Bring a well fitting, non-wired bra for after your surgery. This will give support to your wound and make you more comfortable. You might want to take one in a darker colour and slightly larger than normal.

Family and friends

Before you go into hospital, it might be worth checking:

• whether the ward is allowing visitors

• if they have set visiting times

• the best number for friends and family to phone, to find out how you are

The letter you receive before your operation may contain this information. But if not, you can phone the ward or hospital reception to find out.

You can use your mobile phone in hospital. But there may be some time before and after your operation when you won’t have your mobile nearby. And you may not feel like talking.

Before you go into hospital

It’s worth sorting out a few things before you go into hospital. These might include:

• taking time off work

• care for children or other loved ones

• care for your pets

• care for your house

• cancelling your milk, newspapers or food deliveries

On the day of surgery