Therapeutic mammoplasty

General Surgery

Name of procedure: Therapeutic Mammoplasty

It has been recommended that you have a Therapeutic Mammoplasty. This operation involves combining a wide local excision (lumpectomy) with a breast reduction technique resulting in a smaller, uplifted breast. This means cancer can be removed with a wide rim of healthy tissue. The nipple and areola are preserved with their intact blood supply and the remaining breast tissue is repositioned to allow reshaping of the breast. Your nipple is moved to a new position to suit this new breast shape and size. A cup size cannot be guaranteed as there are likely further changes to the breast after radiotherapy.

This leaflet explains some of the benefits, risks and alternatives to the operation. We want you to have an informed choice so you can make the right decision. You and your doctor will also need to record that you agree to have the procedure by signing a consent form, which your health professional will give you. Please ask your surgical team about anything you do not fully understand or want to be explained in more detail.

Benefits of the procedure

The aim of your surgery is to remove the diseased part of your breast.As long as an adequate rim of healthy tissue is achieved around the tumour, patients who undergo this type of surgery do not need to lose their breast, (mastectomy).A smaller uplifted breast can be achieved, and surgery can be performed on the other breast to match, this can be done at the same time but most commonly performed as a later procedure.

Serious or frequent risks

Everything we do in life has risks. There are some risks associated with this type of surgery. The general risks of surgery include problems with:

• the wound (for example, infection); and
  • blood clots (for example, in the legs or occasionally in the lung).

Risks associated with a Therapeutic Mammoplasty.

• Further surgery: It is important that the cancer is removed adequately with a rim of healthy tissue. You may need further surgery if the first operation has not removed all the cancer. Occasionally this may need to be a mastectomy, where the whole breast is removed.
• Pain: Breast surgery is not usually associated with severe pain, but it is advised that you take some form of pain relief after the operation. Simple painkillers such as Paracetamol and Ibuprofen are usually effective enough.
• Sensation changes: You might have tingly feelings, numbness or shooting pain in the breast.
• Infection: This is rare but can be treated with antibiotics. The risk is higher in smokers, diabetics and obese patients. If you notice a significant redness of the skin, which may feel hotter to touch, increased pain or feel unwell with a raised temperature, contact your GP or 111 if out of hours.
• Haematoma: Occasionally after an operation a haematoma (collection of blood) may develop. This may require an operation to remove it and stop any bleeding vessels.
• Seroma: Sometimes, after surgery, the wound continues to produce fluid under the scar and can cause swelling called seroma. It is quite common and is not harmful. The body will disperse the fluid but if it becomes too uncomfortable a seroma can be drained by a breast care nurse.
• Minor skin burn. Due to heat conduction used to stop bleeding during surgery.
• Wound breakdown: Up to 5% of patients can have breakdown of the wound, more commonly at the T-junction in patients with an anchor shaped scar. This leads to a delay in wound healing but usually heals on its own with the help of dressings. This is more common in smokers and those with larger breasts and thin skin. There is a small risk (less than 1%) that the skin of the nipple or areola may partially or completely ‘die off’ due to inadequate blood supply. The wound where the nipple was will heal with the help of dressings.
• Loss of nipple sensation: Numbness of the nipple and surrounding skin is common, although sensation returns in a lot of patients. Initially the nipple may have increased sensation. Covering the nipple with a gauze dressing may help to prevent rubbing of the nipple by clothing.

Most people will not experience any serious complications from their surgery. The risks increase for elderly people, those who are overweight and people who already have heart, lung or other medical conditions such as diabetes or kidney failure. As with all surgery, there is a risk that you may die. You will be cared for by a skilled team of doctors, nurses and other healthcare workers who are involved in this type of surgery every day. If problems arise, we will be able to assess them and deal with them appropriately.

Other procedures that are available

Other forms of treatment can be used in the treatment of your cancer, such as radiation therapy (using high dose x rays to kill cancer cells), chemotherapy (using drugs to kill cancer cells), antibody therapy (to stimulate your immune system to attack cells) and endocrine therapy (using tablets to stop the cells from growing). However, the present recommendation by the breast team health professionals is that in your case, surgery is the best form of treatment at this stage.

Your pre-operative assessment

Before you are admitted for your operation, you may be required to attend for a pre-operative assessment, to ensure that you are fit for surgery. It is important that you attend for this appointment to avoid delaying your surgery.

Not all patients require a detailed pre-operative assessment and a health questionnaire is used to determine which patients require a full assessment. The health questionnaire may be on paper or on a tablet/computer. The information required includes all medical conditions, regular medications, allergies to medications and your previous anaesthetic history. The information you give will be reviewed by the pre-operative assessment team. If you require further assessment you will be given an appointment to attend the pre-operative assessment clinic.

At the clinic, the nursing staff will confirm the medical information you have previously given and some further tests may be required, such as a blood test, X-ray, heart or lung test. If a more detailed assessment or discussion is required you may see an anaesthetist prior to your admission for surgery. This may require an additional appointment.

If you are taking prescribed medicines please bring a copy of your repeat prescription to your appointment and a copy of the operation consent form (if you were provided with a copy at your out-patient appointment).

Following your assessment, the staff will provide you with written information regarding preparation for your surgery and a point of contact. It is important that you follow the fasting instructions given on your admission letter.

Being admitted to the ward

You will be admitted on the day of your surgery. You will be welcomed on to the ward and your details checked. We will fasten an armband containing your hospital information to your wrist.

You will usually be asked to continue with your normal medication during your stay in hospital, so please bring it with you.

Your anaesthetic

Your surgery will usually be carried out under a general anaesthetic. This means that you will be asleep during your operation and you will feel nothing.

Before you come into hospital

There are some things you can do to prepare yourself for your operation and reduce the chance of difficulties with the anaesthetic.

• If you smoke, consider giving up for several weeks before the operation.   Smoking reduces the amount of oxygen in your blood and increases the risks of breathing problems during and after an operation. Using a vaporiser instead of smoking may help the lung and breathing issues but does not significantly reduce the risk of post-operative wound problems.
• If you are overweight, many of the risks of anaesthesia are increased.  Reducing your weight will help.
• If you have loose or broken teeth or crowns that are not secure, you may want to visit your dentist for treatment.  The anaesthetist will usually want to put an airway in your mouth to help you breathe. If your teeth are not secure, they may be damaged.
• If you become unwell or develop a cough or cold the week before your surgery please contact the pre-operative assessment team on the number provided. Depending on your illness and how urgent your surgery is, we may need to delay your operation as it may be better for you to recover from this illness before your surgery.

Your pre-surgery visit by the anaesthetist

• After you come into hospital, the anaesthetist will come to see you and ask you questions about:
  • your general health and fitness;
  • any serious illnesses you have had;
  • any problems with previous anaesthetics;
  • medicines you are taking;
  • allergies you have;
  • chest pain;
  • shortness of breath;
  • heartburn;
  • problems with moving your neck or opening your mouth; and
  • any loose teeth, caps, crowns or bridges.

• Your anaesthetist will discuss with you the different methods of anaesthesia they can use. After talking about the benefits, risks and your preferences, you can then decide together what is best for you.

On the day of your operation

Nothing to eat and drink (nil by mouth)

It is important that you follow the instructions we give you about eating and drinking.  We will ask you not to eat or drink anything for six hours before your operation. This is because any food or liquid in your stomach could come up into the back of your throat and go into your lungs while you are being anaesthetised. You may take a few sips of plain water up to two hours before your operation so you can take any medication tablets. Please refrain from chewing gum.

Your normal medicines

Continue to take your normal medicines up to and including the day of your surgery.  If we do not want you to take your normal medication, your surgeon or anaesthetist will explain what you should do. It is important to let us know if you are taking anticoagulant (blood thinning) drugs.

Your anaesthetic

When it is time for your operation, a member of staff will take you from the ward to the operating theatre. They will take you into the anaesthetic room and the anaesthetist will get you ready for your anaesthetic. To monitor you during your operation, your anaesthetist will attach you to a machine to watch your heart, your blood pressure and the oxygen level in your blood. 

General anaesthetic

General anaesthesia usually starts with an injection of medicine into a vein.  A thin plastic tube (cannula) will be placed in a vein in your arm or hand and the medicines will be injected through the tube. Sometimes you will be asked to breathe a mixture of gases and oxygen through a mask to give the same effect.

Pain relief after surgery

Pain relief is important to aid your recovery from surgery. This may be in the form of tablets, suppositories or injections. Once you are comfortable and have recovered safely from your anaesthetic, we will take you back to the ward.  The ward staff will continue to monitor you and assess your pain relief. It is important that you report any pain you have as soon as you experience it.

What are the risks?

The risk to you as an individual will depend on whether you have any other illness, personal factors, such as smoking or being overweight and surgery that is complicated or prolonged. General anaesthesia is safer than it has ever been.  If you are normally fit and well, your risk of dying from any cause while under anaesthetic is less than one in 250,000. The side effects of having a general anaesthetic include drowsiness, nausea (feeling sick), muscle pain, sore throat and headache. There is also a small risk of dental damage. Your anaesthetist will discuss the risks with you and will be happy to answer any questions you may have.

After your surgery

• You will be taken to the recovery room to the general or day care ward. You will need to rest until the effects of the anaesthetic have worn off. You will have a drip in your arm to keep you well-hydrated. 
• You will be encouraged to get out of bed and move around as soon as possible, as this helps prevent chest infections and blood clots.
• Your surgical team will assess your progress and answer any questions you have about the operation. 

Leaving hospital

Length of stay

How long you will be in hospital varies from patient to patient and depends on how quickly you recover from the operation and the anaesthetic. Most patients having this type of breast surgery will be in hospital for 1-2 days.

Medication when you leave hospital

Before you leave hospital, the pharmacy will give you any extra medication that you need to take when you are at home. 

Recovery

How long it takes for you to fully recover from your surgery varies from person to person. It may take up to 4 to 6 weeks. You should consider who is going to look after you during the early part of this time. You may have family or close friends nearby who are able to support you or care for you in your home during the early part of your recovery period or you may consider going to stay with relatives.

Stitches

Your wound will be closed with dissolvable stitches, surgical glue and/or steristrips (paper stitches).  Please keep your wound dry for the first 48 hours.

Drain

You may have a surgical drain to help remove excess fluid from the wound. You will be shown how to manage the drain or, if required, a district nurse will be arranged by the ward to contact you once you are home. You will be given instructions as to when and where the drain is to be removed.

Personal hygiene

After 48 hours you may bathe and shower as normal, but try not to soak the dressing.

Exercise

Please read the exercise sheet in your Information Folder. These exercises can be started on the second day following your operation and will help to keep your shoulders supple. Try to go for a daily walk.

Sex

You can continue sexual activity as soon as you feel comfortable.

Driving

You should not drive until you feel confident that you could perform an emergency stop without discomfort. It is your responsibility to check with your insurance company regarding your insurance cover after an operation. You do not need to notify the DVLA of surgical recovery unless it is likely to affect driving and persist for more than 3 months.

Work

How long you will need to be away from work varies depending on:

• how quickly you recover
• how your wounds heal
• whether you need further surgery or other treatments
• whether or not your work is physical

You can usually begin gentle work within a week or two, but you might need to wait a little longer before resuming more vigorous activity. If you need a medical sick (FIT) note for work for the first two weeks after your surgery, please ask the nurses on the ward prior to being discharged.

Emotional support

It is not uncommon to feel a bit ‘down’ after any operation so do ask your doctor or breast care nurse if you feel you need more psychological support. Some find treatment for cancer a frightening experience so please tell your nurse or doctor about any concerns that you have. 

Outpatient appointment

Before you are discharged we will give you a follow-up appointment to come to the outpatient department, or we will send it to you in the post.

Contact details

If you have any specific concerns that you feel have not been answered and need explaining, please contact the following.        

Worcestershire Breast Unit

Telephone – 01905 760261

Email – [email protected]

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience

We know that being admitted to hospital can bea difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback

Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)

If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:

Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:

The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.

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