A breast surgeon discusses what patients and their caregivers should know before breast cancer surgery.
When preparing for breast cancer surgery, patients can take certain steps and engage in conversations with their care team that will make the process smoother and more bearable, explained Dr. Kristin Emilia Rojas.
“In today’s day and age, many patients end up visiting with multiple different teams getting several different opinions. What kind of questions you ask (ensures) you’re not only prepared for what’s next in your treatment, but also so that you can make sure your concerns are being heard and that you’re receiving the best possible treatment for your individual situation, your individual cancer,” she said.
Rojas is a breast surgical oncologist at the Sylvester Comprehensive Cancer Center at the University of Miami. At CURE®’s Educated Patient® Breast Cancer Summit, she discussed what patients can do before and after surgery to improve outcomes.
While Undergoing Neoadjuvant Therapy
If a patient is undergoing neoadjuvant (pre-surgery) chemotherapy or endocrine therapy, they have more time before their surgery to prepare. Rojas recommends that patients get a second opinion during this time, as well as undergo genetic testing.
Patients should also ensure that they are choosing the surgery that is best for them, as Rojas said that sometimes, individuals will have a “knee-jerk reaction” to opt for a double mastectomy – which is a major surgery – that may not be necessary.
“(Patients should) make sure that the surgery they have chosen is the right one for them,” Rojas said. “I also ask patients to consider finding a mentor. A lot of breast cancer programs have mentors, or we can link you up with another patient who was in your shoes a couple of years ago who can offer some advice.”
Try to avoid Googling, Rojas urged patients – though she admitted that this can be difficult, particularly in the age of the internet and social media.
Finally, patients should stay active before they undergo breast cancer surgery. If individuals are unsure of what to do, they should reach out to their health care team, who may be able to offer some pre- and post-surgical exercises that can help prepare patients for surgery and make the road to recovery easier and shorter.
The pre-surgical team is a multidisciplinary one, with patients seeing their medical oncologist, surgical oncologist, genetic counselor, and possibly social workers or physical therapists. Nurse navigators can also help patients navigate the process.
“All those members can be really important, especially in the beginning of organizing patient’s care and what are the next best steps,” Rojas said.
Shortly Before Surgery
For patients who are headed into surgery without doing neoadjuvant therapy first, it is key that they get written instructions from their surgeon regarding everything they need to know after their surgery, including:
If patients are undergoing a more intensive surgery like a double mastectomy and reconstruction, they may want to look into mastectomy bras, Rojas explained, emphasizing that what someone wears after surgery can help make a difference in how they feel.
“I have patients who will get these really nice kimono-style robes to wear for their recovery and I think that makes them feel good, and they’re easy to get on and off,” she said.
Patients may also want to inquire about how their post-surgical pain will be managed – if they will be prescribed opioids, or if there are over-the-counter drugs and exercises that can help mitigate pain after the procedure.
Caregivers and loved ones will be instrumental in helping patients after they undergo breast cancer surgery.
“Specifically with the drains, the caregiver can be really helpful in helping keep track of how much liquid the drain is putting out in the week after surgery,” Rojas said. “That’s how we decide when the patient can have the drains removed. So having someone as the note-taker in that specific instance is really helpful.”
Caregivers should also understand the signs and symptoms that would warrant a call to the doctor. These include:
By coming prepared and asking the right questions, both patients and their caregivers can become a part of the multidisciplinary team to ensure the best outcomes after breast cancer surgery.
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